PRIMARY CARE COMMISSIONING COMMITTEE · 2019-07-11 · 1 | Page . PRIMARY CARE COMMISSIONING...

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PRIMARY CARE COMMISSIONING COMMITTEE

HELD IN PUBLIC SESSION ON FRIDAY 21 OCTOBER 2016 1:00pm – 3:00pm THE BOARD ROOM, 3RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE,

VENTURE WAY, BRIERLEY HILL, DY5 1RU QUORACY A meeting of the Committee will be quorate provided that at least 4 members are present of which: • one must be either the Chair or Vice-Chair of the Committee • one must be the Chief Finance Officer/Deputy Chief Finance Officer or Chief Nursing Officer

AGENDA

Item Presented by

1 Apologies Mr S Wellings

2

Declarations of Interest To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest will not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. This meeting is being held in public and is being recorded purely to assist in the accurate production of minutes, decisions and actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded.

Mr S Wellings

3 Questions from the Public Mr S Wellings

4 Minutes of last meeting held on Friday 19 August 2016 Enclosed Mr S Wellings

5 Matters Arising/Action Log Enclosed Mr S Wellings

6

Contractual 6.1 Report from the Primary Care Operational Group 6.2 Report on the Closure of Market Street Surgery 6.3 Report on the Closure of Masefield Road Surgery 6.4 Dudley Quality Outcomes for Health - Phase two pilot update 6.5 Primary Care Extended Access - Winter Scheme 2016-17

Enclosed Enclosed Enclosed Enclosed Enclosed

Mrs J Robinson Mr R Franklin Mr R Franklin Mrs J Taylor Mrs J Taylor

7 Quality 7.1 Report from the Quality and Safety Team

Enclosed

Mr C Brunt

8

Finance 8.1 Finance Report

Enclosed

Mr P Cowley

9

Performance 9.1 Performance Report

Enclosed

Mr A Nicholls

10 National flu immunisation programme 2016/17 Enclosed Mrs J Robinson

11 Primary Care Commissioning Committee – Revised Terms of Reference Enclosed Mr D King

12 Risk Register Enclosed Mr D King

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Item Presented by

13 Any Other Business

14

Date and Time of Next Meeting Friday 18 November 2016 1pm – 3pm The Board Room, Third Floor, Brierley Hill Health and Social Care Centre

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MINUTES OF THE MEETING HELD IN PUBLIC ON FRIDAY 30 SEPTEMBER 2016 OWEN HOUSE ROOM 1, (down the service road to the back block), ZION CHRISTIAN

CENTRE, LITTLE CORNBOW, HALESOWEN, B63 3AJ

Quorum: A meeting of the Committee will be quorate provided that at least four members are present of which one must be either the Chair or Vice Chair of the Committee and one must be the Chief Finance Officer/Deputy Chief Finance or Chief Nursing Officer. ATTENDEES: Members Mr S Wellings Non-Executive Director for Governance, Dudley CCG (Chair) Mrs C Brunt Chief Nurse, Dudley CCG Mrs S Johnson Deputy Chief Finance Officer, Dudley CCG Dr D Pitches Consultant in Public Health, Dudley MBC In Attendance Dr V K Mittal GP Representative Mr T Thomik Dudley LPC Representative Mrs A Nicholls Senior Contract Manager, NHS England (West Midlands) Dr T Horsburgh Clinical Lead for Primary Care, Dudley CCG Mrs J Robinson Primary Care Contracts Manager, Dudley CCG Mr P Cowley Senior Finance Manager, Dudley CCG Mrs L Harding Communications Specialist, Dudley CCG Ms J Emery Chief Executive, Healthwatch Dudley Dr C Handy Non-Executive Director for Quality & Safety Mr D King Director of Membership Development and Primary Care, Dudley CCG Mrs J Jasper Lay Member for Patient and Public Involvement, Dudley CCG Mrs H Codd Community Engagement Manager, Dudley CCG Mr B Dhami Contracts Manager, NHS England (West Midlands) Miss E Williams Graduate Placement, Dudley CCG Minute Taker: Mrs R Gretton Personal Assistant, Dudley CCG Mr Wellings welcomed members of the public for attending the Committee. He explained how the meeting would be run and advised that item 6.1 would be discussed first. Members of the Committee were asked to introduce themselves and say what their role is on the Committee. Item 8.1 and 9.0 were discussed following item 6.2 before returning to the set agenda. 1. APOLOGIES FOR ABSENCE Apologies were received from: Mrs L Broster, Head of Communications and Public Insight, Dudley CCG Dr A Catto, Secondary Care Clinician, Dudley CCG Mr M Hartland, Chief Operating and Finance Officer, Dudley CCG Mrs J Taylor, Commissioning Manager for Primary Care, Dudley CCG Mrs E Smith, Governance Support Manager, Dudley CCG Mr D Stenson, Patient Opportunity Panel Representative

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2. DECLARATIONS OF INTEREST To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item: GP members and Practice Managers declared a standing interest, particularly with regards to the contractual items, although they do not have a voting position on the Committee. 3. QUESTIONS FROM THE PUBLIC Mr Wellings had received questions from the public in advance of the Committee which would be answered as part of the discussion under agenda item 6.1. 4. MINUTES FROM THE PREVIOUS MEETING HELD ON 19 AUGUST 2016 The minutes of the Committee held on 19 August were accepted as a true and accurate record. 5. MATTERS ARISING/ACTION LOG MATTER ARISING The action log was discussed and updated accordingly with the following points noted: PCCC/JAN/2016/6.2 This action was noted to be deferred to October PCCC/FEB/2016/6.1 This action was noted to be deferred to October PCCC/APR/2016/9.1 The Committee was informed that the IT team are still awaiting final roll out

schedules from Dudley Group IT Services. Finalisation of the procurement process was awaited before Wi-Fi would be rolled out to practices

PCCC/AUG/2016/6.1 This action was noted to be complete PCCC/AUG/2016/12 This action was noted to be complete PCCC/AUG/2016/13 The Committee was informed that there would need to be an addendum to

the Terms of Reference and that Ms Johnson was formally noted within the minutes to ensure quoracy

6. CONTRACTUAL 6.1 PROVISION OF SERVICES FROM PRACTICE PREMESIS AT 146-148 COOMBS ROAD This item was discussed first on the agenda OUTCOMES FOR HEALTH UPDAT Mr Wellings spoke to this item to inform the Committee that there had been significant developments in the last 24 hours subsequent to the published report. It was noted that the situation had been remarkably complex and an apology was given to both the Committee and public on behalf of Dudley CCG. It was reported that during the August meeting the Committee was informed that the CCG was unaware of any withheld rent payments by the practice. Subsequent to the meeting on 19 August, it had been discovered that this was not correct and some members of the CCG had knowledge of this. Those individuals aware of the withheld rent acted on very clear legal and regulatory advice, that the dispute was a private matter and that the CCG could not intervene. Although the CCG acted in accordance with advice, in hindsight a review and learning would be taken from the processes undertaken.

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The Committee was informed that legal documents had today been signed, which will allow for access to the Coombs Wood branch surgery and written confirmation had been received that once this was available, the surgery would re-open following cleaning processes etc. It was noted that due to the recent developments, some questions received from the public in advance of the Committee meeting are now not relevant. A proposal to summarise questions with replies was put forward. The first question was reported to relate to the re-opening of the branch surgery, which had been addressed and a further statement would be given later in the meeting. Further to a question which assumed the lease dispute was a financial matter, it was made clear that this was not the case. The Committee was informed of an action that could be taken by the CCG, which required agreement of both landlord and tenant, for future rent payments to be made direct to the landlord on behalf of the tenant. Both parties had agreed that this action be taken and following signature of the lease, understanding was that there are no outstanding rent payments. It was reported with regard to a question which assumed the branch surgery would be closing, that the CCG has a clearly defined policy agreed by the Primary Care Commissioning Committee, along with a set of procedures that are to be followed in the event of any request for a branch surgery closure. No application or intention to close the branch surgery had been received or was known. The policy was explained to require a request made to the CCG for consideration, which includes an appropriate business case from the practice, followed by a twelve week public consultation period before the final application, if still deemed appropriate, is decided by Committee. In response to a question asking if many people had left the practice as a result of the Coombs Wood closure, it was reported that 86 of the 6,000+ patients of Stourside had chosen to leave the practice. The reasons for this were unknown and it was explained that it was normal for there to be turnover on GP’s lists. A further question asked how well the practice is performing overall. The Committee was informed that the Care Quality Commission (CQC) regularly inspects practices and Stourside Surgery had recently undergone inspection by the CQC with many examples of good practice published within the report. Dudley CCG continues to work with Stourside, as indeed all member practices, to continue to improve primary care. It was noted that all CQC reports are available to the public and are published on the CQC website. The reasons for the meeting time were explained to the Committee in response to a question from the public. It was stated that this was a normal meeting of the Committee held at this time due to commitments of members in attendance, for example, GP members who attend between clinics. The Committee was informed that the CCG will undertake work with the practice and Patient Participation Group around how the trust and confidence of those patients affected by the closure of the Coombs Wood branch surgery is re-gained. A further comment received from a member of the public stated that it was unfortunate that the CCG had been blamed for the situation. Mr King reported that he was delighted that the situation had been resolved and advised what action the Committee would now need to take. The Committee was informed that the original report asked for consideration of a contractual breach. The Committee noted that the contractual breach no longer existed following resolution of the dispute. The Committee formally received a petition, presented to Dudley CCG, that had been signed by 301 patients who wished to see the surgery up and running again efficiently. A provisional opening date of 17 October was reported to the Committee and confirmation was awaited for this date. Mrs Brunt invited members of the public to speak to herself outside of the meeting in relation to the quality and safety of the service provided.

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Ms Emery also invited members of the public to speak to herself outside of the meeting in relation to patient experience.

Mrs Brunt, Ms Emery and Mrs Jasper left the meeting

Resolved: 1) The Committee noted the recent developments and resolution of the situation 2) The Committee noted that the contractual breach no longer exists in relation to the

closure of the branch surgery 3) The Committee formally received a petition presented to Dudley CCG, signed by 301

patients 6.2 REPORT FROM THE PRIMARY CARE OPERATIONAL GROUP Mrs Robinson spoke to this item to update the Committee on the issues discussed at the Primary Care Operational Group (PCOG) held on 3 August 2016. The Committee was informed that there were no updates from the Primary Care Operational Group and only contractual changes were considered. Six contractual changes were noted by PCOG; AW Surgeries for the addition of a new partner, Thorns Road Medical Practice for the addition of a new partner and four changes in relation to Quarry Bank Medical Centre. Changes at Quarry Bank Medical Centre noted a 24 hour retirement of one partner, the addition of a new partner and then the removal of one of the existing partners in February 2017 followed by the removal of a second existing partner at the same time. This would result in a single handed practice with a salaried GP and the salaried GP would be one of the ex-partners. Resolved:

1) The Committee noted the actions of the Primary Care Operational Group for assurance 2) The Committee approved the contractual changes recommended by the group

7. QUALITY 7.1 QUALITY AND SAFETY REPORT This item was discussed following item 8.1 and 9.0 Mrs Brunt spoke to this item and highlighted key points within the report. The Committee was informed of the current position of CQC, which reported that re-inspections for those practices requiring improvement are being undertaken and practice were appreciative of support being provided by the CCG. It was noted that the matrix shows several outstanding ratings and reported that the rating of ‘outstanding overall’ was difficult to achieve. It was reported that a Member Event is due to be held in November when outstanding work would be showcased, with invites to CQC, all practices and presentations from the Quality & Safety Team on learning gained from inspections. Datix The Committee was informed that this work is progressing and now had GP clinical input around incident management. Datix was described to members of the public in attendance as an IT system that records, in particular, serious incidents from which a process follows with regard to how they are reported nationally, how they are dealt with and the learning from those incidents.

Mrs Jasper and Ms Emery re-entered the meeting

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Following discussion on the CQC process, it was reported that subsequent to a CQC inspection, if the CCG are aware of issues raised by CQC, support is offered to that practice. This is done in two ways; nationally via the Royal College of General Practitioners (RCGP), or via the support package offered by the CCG which includes mentorship for various clinical members and Practice Managers. Serious Incidents (SIs) The Committee was informed that there were no new reported SIs since the last meeting. Infection Prevention & Control (IPC) It was noted that completed IPC audits had been rated green overall. Resolved: 1) The Committee received the report for assurance 8. FINANCE 8.1 FINANCE REPORT This item was discussed following item 6.2 Mr Cowley spoke to this item. The Committee was informed that there had been no changes to the budget delegated to the Committee at this stage and remains at £40,719,000. The delegated co-commissioning budget is expected to achieve a break-even position across the remainder of this financial year. Two changes had taken place this month and both were reported to Committee last month in advance with regard to changes in premises costs and in payments for the Long Term Conditions (LTC) Framework. It was reported that there had been a small underspend forecast against the core CCG budgets for the development of primary care. Resolved:

1) The Committee received the report for assurance

9. GP RESILIENCE PROGRAMME IN THE WEST MIDLANDS Mr King spoke to this item to inform the Primary Care Commissioning Committee of the draft proposal produced by NHS England for a GP Resilience Programme in the West Midlands. The Committee was informed that NHS England had committed, through the GP Forward View, to invest in primary care. This year there is £1.2m available across the West Midlands to specifically support GP resilience. It was noted that a CCG response had been made, which states that the CCG fully support and welcome the investment that is going to be made available through NHS England. The response also noted that as Dudley CCG are a fully delegated commissioning organisation that there should be some flexibility and autonomy about where that money is spent.

Mrs Brunt re-entered the meeting Resolved:

1) The Committee noted the draft proposals for the GP Resilience Programme in the West Midlands

2) The Committee noted the response provided to NHS England on behalf of the Committee

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10. RISK REGISTER This item was discussed following item 7.1 Mr King spoke to this item. Each risk was discussed and members were asked to consider whether the residual score should change since the last Committee and if any additional risks should be added. Risk 34: The impact of significant individual performance issues in relation to primary medical services that could result in removal of GP member from the Performer’s List. No change. Risk 50: Failure of member practices to meet the standards of the Care Quality Commission risks continuity of service provision in member practices. No change. Risk 59: The ability of member practices to fulfill their contractual obligations and provide primary medical services as a result of difficulties recruiting substantive GPs No change. Risk 69: Loss of Primary Care Medical Services as a result of increasing overheads and financial pressure on member practices beyond their control i.e. increasing cost of medical indemnity insurance, rent increases and financial sustainability of operating branch surgery sites. No change.

Dr Mittal left the meeting

It was reported that there is a strong sense from the members of the public who spoke to Committee members outside of the meeting of a perceived inequity in services between a branch surgery and a main surgery. It was agreed that clarity be gained from Stourside practice in regard to what sessions are being held across the three sites and how they are delivering the core contract which will be reported to the Committee. Risk 76: Member GP practices being significantly underpaid as a result of processing errors by Primary Care Support England (PCSE). Destabilises GP practices and is a reputational risk to the CCG A recommendation was made to close this risk Risk 81: The reputational risk to the CCG through branch closures No change. Risk 96: That increases in the cost of facilities management and service charges of buildings owned by NHS Property Services (NHSPS) may destabilize the finances of General Practices, leading to loss of services. No change. The Committee agreed that the Accountability Sponsor & Owner be changed from Dr Horsburgh to Mr Wellings and this also be the case for the remaining new risks. Risk 100: Unexpected branch closure due to dispute between landlord and tenant. The committee agreed that this risk duplicated risk 81 and was removed from the register and the wording of Risk 81 be amended for the removal of the word “Reputational”. Risk 105: Lack of resilience within primary care workforce and the fragmented nature of current GP provision results in a failure to meet patient demand. The Committee agreed that this risk be removed from the register following duplication of Risk 59 Risk 106: Any adverse impact upon NHS England delegated primary care commissioning funding and/or political interference results impacts upon the CCGs ability to deliver the required changes to primary medical services The Committee agreed that this risk be removed from the register. It was agreed that those risks removed be referred back to the CCG Board.

ACTION: MR KING

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Dr Horsburgh, Mrs Nicholls and Mr Dhami left the meeting Risk 117: Failure to provide sufficient differential benefit from the MCP to adequately engage primary care and get buy in The Committee accepted the risk and recommended that a check to see if there is a risk register of the Partnership Board and Project Board be made. ACTION: MR KING Risk 118: Lack of clinical and managerial capacity and capability for primary care to deliver the required transformation and operate primary care at scale The Committee agreed the addition of this risk. Risk 119: Poor quality GP estate that compromises the ability of practices to deliver General Medical Service contracts The Committee agreed the addition of this risk following the re-wording to note that the CCG Estates Strategy had been ‘agreed’ removing the word “published”. Resolved:

1) The Committee accepted the updated Risk Register with the aforementioned comments 2) The Committee recommended the closure of Risk 76 from the register 3) The Committee agreed the removal of Risk 100 from the register and the amendment of

wording of Risk 81 4) The Committee agreed that the Accountability Sponsor and Owner for Risks 96, 118 and 119

be changed to Mr Wellings 5) The Committee agreed that Risk 105 be removed from the register following its duplication of

Risk 59 6) The Committee agreed that Risk 106 be removed from the register 7) The Committee agreed that the new risks that have been agreed to remove are referred back

to the CCG Board 8) The Committee accepted the addition of Risk 117, but seek to check where this risk should

be placed 9) The Committee accepted the addition of Risk 119 following re-wording

11. ANY OTHER BUSINESS No items of other business were raised. 14. DATE AND TIME OF NEXT MEETING Friday 21 October 2016 1pm – 3pm The Board Room, Third Floor, Brierley Hill Health & Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Name Title

Signed Date

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OUTSTANDING ACTION LIST – 21 October 2016

MEETING

REFERENCE ACTION LEAD STATUS DATE COMPLETED

PCCC/JAN/2016/6.2

Report on the Closure of Market Street Surgery Monitoring Exercise to be presented to Committee in six months’ time (June 2016) to take the learning from this process moving forward

Mr King In progress To be reported in October 2016

PCCC/FEB/2016/6.1 Report on the Closure of Masefield Road Surgery Monitoring Exercise to be presented to Committee in six months’ time (July 2016)

Mr King In progress To be reported in October 2016

PCCC/APR/2016/9.1 Finance Report – Practice Wi-Fi Members requested presentation of on-going situation reports for assurance as available

Mr Cowley In Progress

PCCC/AUG/2016/6.1

Report from the Primary Care Operational Group (PCOG) It was agreed that a new statement in regard to the current position in relation to Coombswood branch closure would be issued

Mrs Robinson Complete 30 September 2016

PCCC/AUG/2016/12 Risk Register Following earlier discussion it was felt that a new risk be added to the register in relation to Coombswood Surgery


PCCC/AUG/2016/13 Any Other Business Terms of Reference – The ToR were agreed to be changed to reflect Mr Hartland’s removal and Ms Johnson’s addition


PCCC/SEPT/2016/10 Risk Register The Committee agreed that the newly added risks noted by the Committee for removal are referred back to the CCG Board

Mr D King In Progress

PCCC/SEPT/2016/10 Risk Register The Committee accepted Risk 117, but seek to check if there is a risk register for the Partnership Board and Project Board

Mr D King In Progress

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Date of Committee: 21 October 2016 Report: Update from the Primary Care Operational Group

Agenda Item: 6.1

TITLE OF REPORT: Update from the Primary Care Operational Group

PURPOSE OF REPORT: To update the Committee following the Primary Care Operational Group meeting held on 5 October 2016

AUTHOR OF REPORT: Mrs J Robinson, Primary Care Contracts Manager

MANAGEMENT LEAD: Mr D King, Director of Membership Development and Primary Care CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

• The group provides assurance that there are no contractual

breaches to be issued for any Dudley practice • Request to vary a GMS contract held in partnership to a sole

contractor deferred pending a full business case • The group considered the quality and safety issues that are set

out in the quality and safety report • The group received details of a counter fraud report and agreed

next steps • Update received in respect of the closure of Coombswood

surgery

RECOMMENDATION:

The Committee is asked to:

• Note the actions of the primary care operational group for assurance

FINANCIAL IMPLICATIONS: Not applicable

WHAT ENGAGEMENT HAS TAKEN PLACE: Not applicable

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP – PRIMARY CARE COMMISSIONING COMMITTEE UPDATE FROM THE PRIMARY CARE OPERATIONAL GROUP – 21 October 2016 1.0 INTRODUCTION

1.1 This report provides an update from the Primary Care Operational Group (PCOG) following its

meeting held on 5 October 2016.

2.0 CONTRACTING ISSUES

2.1 PRIMARY CARE CONTRACTUAL CHANGES The group considered a request to vary a GMS contract held in partnership to a sole contractor. The group deferred the decision pending a full business case.

2.2 STOURSIDE MEDICAL PRACTICE – Branch Surgery, Coombs Wood Road, Halesowen

2.3 The group received an update in respect of the closure of Coombswood Surgery, a branch surgery of Stourside Medical Practice.

2.4 A new lease has been signed by the landlord and tenant. The remedial breach notice issued on 7

June 2016 will be fully satisfied when medical services at Coombswood Surgery are resumed. The CCG will then write to the contractor in accordance with NHS England policy to confirm that no further action will be taken in this matter. However, should the breach be repeated or otherwise breach of the Contract resulting in a further Remedial Notice or Breach Notice, the CCG may take steps to issue a notice to terminate the Contract or consider the imposition of a Contract Sanction.

2.5 The Coombswood Surgery will be re-opening on 17 October 2016. 2.6 The group were advised that as members of the public had expressed concerns about the quality of

medical services provided an evening listening event had been organised in Halesowen for 13 October 2016.

2.7 The Director of Membership and Primary Care has commissioned a lessons learned review, timescales will be determined after the exercise has been fully scoped.

2.8 COUNTER FRAUD REPORT

2.9 The group received details of a counter fraud report commissioned by NHS England following an accusation that patients had been inappropriately added to QOF registers.

2.10 There was no evidence to support the allegation of fraud.

2.11 The recommendations of the report included:

• Data cleanse of the practice system • QOF review of the registers

2.12 The group agreed that the practice will be required to cleanse their disease registers by 31 March

2017. The CCG and NHS England will then jointly conduct a QOF review. 3.0 QUALITY & SAFETY ISSUES

3.1 The group considered the quality and safety issues that are set out in detail in the Quality and

Safety report to the Primary Care Commissioning Committee. 3.2 There are no issues in the quality and safety report that require contractual actions to be taken

against any practice.

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4.0 PRIMARY CARE SUPPORT ENGLAND

4.1 PCOG received an update in respect of primary care support services, a service now provided by

Capita on behalf of NHS England. The NHS England representative confirmed that 2 senior leaders have stepped down and a team of its own employees has now been “embedded” in Capita’s primary care support services team – including Jill Matthews, who ran PCS at NHS England before Capita took the service over. Capita are being challenged with increasing levels of scrutiny across all of the service lines and are now having daily performance meetings. The medical records service is to be substantially sorted by the end of October. The CCG continue to log issues on behalf of member practices and forward these to NHS England on a weekly basis.

5.0 RECOMMENDATION

The Committee is asked to: • Note the actions of the Primary Care Operational Group for assurance

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Date of Committee: 21 October 2016 Report: Market Street Practice Closure

Agenda Item: 6.2

TITLE OF REPORT: Market Street Practice Closure

PURPOSE OF REPORT: To update committee on the outcomes of the branch practice closure

AUTHOR OF REPORT: Robert Franklin, Patient Insight Specialist.

MANAGEMENT LEAD: Laura Broster, Head of Communications & Public Insight

CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

- Since the closure of the branch practice there has been 229 new patients join the practice, 33 leave.

- The practice has received no complaints around the branch closure.

- The main concerns raised from the practice patient survey relate to car parking, online access and the phone systems in place.

- 10% of staff felt their travelling time had increased. - 5% felt their workload had increased to an unmanageable

level due to the closure.

RECOMMENDATION: • Committee to read and note contents of the report. • Committee are assured closure has had limited impact on

patients and staff.


WHAT ENGAGEMENT HAS TAKEN PLACE: Wordsley Green Patients

ACTION REQUIRED: Decision Approval √ Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP – PRIMARY CARE COMMISSIONING COMMITTEE REPORT TITLE – MARKET STREET PRACTICE CLOSURE 1.0 INTRODUCTION

Market Street is a branch surgery of Wordsley Green in the Kingswinford, Amblecote and Brierley Hill (KAB) locality, the branch surgery closed on the 15th March 2016. As part of the closure the Primary Care Commissioning Committee made the recommendation that a review should take place 6 months from closure on how or if the closure has impacted both Patients & Staff

2.0 PATIENT/STAFF SURVEY (PRACTICE PROVIDED)

At the time of the practice closure the number of patients registered was 9617, on the 5.9.16 there was 9846 (Figures provided by practice Appendix 1). During this period 229 new patients had joined the practice with 33 who left; the number of complaints during the period was 15, with none of the complaints relating to the closure of Market Street.

There were 127 completed surveys asking a range of questions;

Question Ranked Excellent, Very Good

or Good Our Opening Hours are suitable to you 89% Pleasant environment 90% Adequate parking 68% Signage around the surgery is easy to follow 94% Your ability to gain access to our patient online access 68% Information displayed in the surgery helpful and informative 89% Taking time to explain medical findings 88% Explaining follow up care 88% Amount of time spent with you 88% Use empathy and understanding 89% Instructions regarding medication 86% Advise and support on healthy living 79% The thoroughness of the examination 87% The caring concern of our nurses/HCAs 86% The friendliness and courtesy of the receptionist 90% Getting advice or help when needed during office hours 81% Our ability to return your calls in a timely manner 68% Your phone calls answered promptly 66%

*Full results in Appendix 2

Of those staff who completed a survey;

- 100% stated their working pattern had not altered - 85% felt it was a pleasant working environment - 95% felt there was adequate parking - 10% felt their travelling time had increased - 5% felt their workload had increased to an unmanageable level due to the closure.

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Appendix 1

NHS

Patient Survey following the closure of Markets Street Surgery

cflavell

Practice Manager

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Patient Survey Results August 2016

Market Street closed for practice on the 15th March 2016.

Number of registered patients up to 15th March 2016 = 9617

Number of patients currently registered on 5.9.16

= 9846

Number of new patients from 15.03.16 to 05.09.16

= 229

Number of Market Street patients who left the practice after 15.03.16

= 33

Number of complaints from 15.09.2015 to 14.03.16

= 21

Number relating to closure of Market Street

= 0

Number of complaints from 15.03.16 to 05.09.2106 =15

Number of complaints relating to closure of Market Street= 0

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Questions YES NO N/A Not answeredHas your working pattern altered 100%If yes are you happy with the changes

Pleasant Working enviroment 85% 15%

Adequate Parking 95.00% 5%

Has your travelling time increased 10% 80% 10%

Has your worklaod increased to an unmanageable level due to the closure 5% 75% 15% 5%

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Appendix 2

Excellent– Very

Good– Good– Fair– Poor– Not Applicable– Total–

–

30.71% 25.20% 33.07% 9.45% 1.57% 0.00%

Our Opening Hours are suitable to you

39 32 42 12 2 0 127

– 32.80% 25.60% 32.00% 6.40% 2.40% 0.80%

Pleasant environment 41 32 40 8 3 1 125

– 18.33% 17.50% 32.50% 20.83% 8.33% 2.50%

Adequate parking 22 21 39 25 10 3 120

– 27.73% 26.89% 39.50% 4.20% 0.84% 0.84%

Signage around the surgery is easy to follow

33 32 47 5 1 1 119

– 19.83% 16.38% 31.90% 6.03% 3.45% 22.41%

Your ability to gain access to our patient online access

23 19 37 7 4 26 116

– 24.37% 26.89% 37.82% 9.24% 0.84% 0.84%

Information displayed in the surgery helpful and informative

29 32 45 11 1 1 119

Taking time to explain medical findings

28.57% 23.81% 35.71% 7.14% 2.38% 2.38%

36 30 45 9 3 3 126

– 26.27% 23.73% 38.14% 6.78% 1.69% 3.39%

Explaining follow up care 31 28 45 8 2 4 118

– 24.79% 23.97% 38.84% 9.92% 1.65% 0.83%

Amount of time spent with you

30 29 47 12 2 1 121

– 26.89% 21.85% 40.34% 6.72% 2.52% 1.68%

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Use empathy and understanding

32 26 48 8 3 2 119

– 26.45% 28.10% 31.40% 9.92% 1.65% 2.48%

Instructions regarding medication

32 34 38 12 2 3 121

– 23.08% 27.35% 28.21% 8.55% 2.56% 10.26%

Advise and support on healthy living

27 32 33 10 3 12 117

– 25.42% 27.12% 34.75% 8.47% 0.85% 3.39%

The thoroughness of the examination

30 32 41 10 1 4 118

– 31.62% 23.08% 31.62% 5.13% 1.71% 6.84%

The caring concern of our nurses/HCAs

37 27 37 6 2 8 117

36.00% 27.20% 27.20% 8.00% 1.60% 0.00%

The friendliness and courtesy of the receptionist

45 34 34 10 2 0 125

– 23.93% 26.50% 30.77% 5.13% 5.13% 8.55%

Getting advice or help when needed during office hours

28 31 36 6 6 10 117

– 16.38% 25.86% 25.86% 13.79% 2.59% 15.52%

Our ability to return your calls in a timely manner

19 30 30 16 3 18 116

– 13.33% 23.33% 29.17% 23.33% 8.33% 2.50%

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Your phone calls answered promptly

16 28 35 28 10 3 120

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Date of Committee: 21 October 2016 Report: Masefield Road Practice Closure

Agenda Item: 6.3

TITLE OF REPORT: Masefield Road Practice Closure

PURPOSE OF REPORT: To update committee on the outcomes of the branch practice closure.

AUTHOR OF REPORT: Robert Franklin, Patient Insight Specialist.

MANAGEMENT LEAD: Laura Broster, Head of Communications & Public Insight


KEY POINTS:

• From the 01.04.16 to the 05.09.16, 24 Patients have left the practice.

• There has been no additional request for home visits since the practice closure

• The main concerns raised by patients relate to Parking, Online access and the practice returning telephone calls.

• Most staff felt the branch closure has had minimal impact however some raised issues around room availability, increase in home visits but reported a more manageable workload

RECOMMENDATION: • Committee to read and note contents of the report. • Committee are assured closure has had limited impact on

patients and staff.


WHAT ENGAGEMENT HAS TAKEN PLACE: Lower Gornal Medical Practice patients

ACTION REQUIRED: Decision Approval √Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP – PRIMARY CARE COMMISSIONING COMMITTEE REPORT TITLE – MASEFIELD ROAD PRACTICE CLOSURE

1.0 INTRODUCTION

Masefield Road is a branch surgery of Lower Gornal Medical Practice in the Sedgley, Coseley and Gornal (SCG) locality, the branch surgery closed on the 1st May 2016. As part of the closure, Primary Care Commissioning Committee made the recommendation that a review should take place 6 months from closure on how or if the closure has impacted both Patients & Staff

2.0 PATIENT/STAFF SURVEY (PRACTICE PROVIDED)

From the 01.04.16 to the 05.09.16, 24 Patients have left the practice, however it is difficult to know if these patients were Masefield Road Patients or Patients whose records were kept at Masefield Road.

There have been 3 complaints at the practice in the last 6 months and all related to clinical aspects of care, this number is consistent with previous years. The only feedback the practice received through a comment box has been around the lack of parking facilities at the practice.

There has been no additional request for home visits since the practice closure.

There were 65 completed surveys asking a range of questions;

Question Ranked Excellent, Very Good

or Good Our Opening Hours are suitable to you 95.38% Pleasant environment 87.10% Adequate parking 12.50% Signage around the surgery is easy to follow 92.19% Your ability to gain access to our patient online access 57.81% Information displayed in the surgery helpful and informative 90.48% Taking time to explain medical findings 98.44% Explaining follow up care 90.48% Amount of time spent with you 92.31% Use empathy and understanding 96.83% Instructions regarding medication 95.38% Advise and support on healthy living 89.23% The thoroughness of the examination 95.38% The caring concern of our nurses/HCAs 89.23% The friendliness and courtesy of the receptionist 98.46% Getting advice or help when needed during office hours 85.94% Our ability to return your calls in a timely manner 76.56% Your phone calls answered promptly 85.94%

*Full results in Appendix 1

As part of the staff review practice staff where asked how they feel the closure of Masefield road has impacted them. Most felt that the impact had been minimal, the key points that come out from staff relate to room availability and an increased perception in home visits but more manageable workload. The comments from staff can be seen below;

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Comments

The closure of Masefield Road Surgery has impacted on me as there is often a shortage of clinical rooms which has meant I have had to do more home visits. Although this has worked out so far there will come a time when we run of home visits. IT has already been mentioned to myself about changing my working day to allow for room shortages but this is not something I am happy doing as it has an impact with my childcare arrangements, I also feel that when changes are necessary it tends to be myself that is often affected the most. The only problem has been room availability

I have found that a small number of my patients have tended to ask for home visits where previously they had come to surgery. I would estimate this as fewer than 5 in total. On a personal level I found the day at Masefield less stressful in general however it is definitely more convenient for communication and workload sharing for all the doctors to be in one building

It has saved me time in only having the one site to manage with regard to IT. Also having more staff in the office again has been good as we were short staffed when staff had to work at Masefield Road. Diabetic Clinics are easier to manage now as I only have to book them in at one site.

I have seen a subjective increase in the number of requests for Home visits for Patients that I would have seen at the Surgery; I do not feel that there has been an increase in the Total workload since the closure. I sometimes have the feeling that some patients are not seen as frequently as they would have been there I'm not sure if that may be because they have a greater range of doctors to see down her when the appointments are all filled. I have enjoyed the loss of the feeling of working in Isolation which sometimes present in MR.

The only real impact on me has been with finding records as they are now all stored here and I don’t have to ring and ask for them from Masefield. The only other benefit has been to be able to speak to the GP face to face with queries as sometimes it easier to be able to show them paperwork. Generally it seems better in the office now that the receptionist from Masefield is working here as there is a bit more flexibility.

No impact on patient care, now we can provide same services for all patients, there has been an increase in visit rate that is expected. The impact on the practice, the room availability, selling building still not sorted. Easier way of communication with colleagues From a working point, the surgery is working much better, access to Drs and Colleagues easier, brings the team together. Personally not had any bad feedback from patients as to the move, the MF patients ask for appointments around bus timetable and we try to accommodate them by changing slot types round if needed. No difference at all Less hassle

The only thing that I have noticed has been the complaints from patients. There have been some but not many, this of course has been from patients who found is easier to access Masefield road. The amount of nursing hours dropped initially when jay lost an hour when she moved to a Wednesday only at bull street but it has been difficult to notice the full impact of this, and then Jay leaving, which i presume will be noticed from September onwards.

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The positives are we are able to provide all services to patients on one site, where as previously had to rapidly refer patients from one site to another meaning wasted multiple appointments. Attendance of patients has improved; previously patients booked to be seen at Surgery A would arrive at Surgery B and then be told they were at the wrong surgery then be late for their appointment at the correct surgery causing delayed consultations for everyone and wasted duplicate appointments. Having all Drs and Clinicians on same site allows for better staffing. All facilities on same site mean if necessary referrals for 2nd opinions from Drs/Clinicians who have areas of special interest can be made immediately this improving patient care. On a negative side the number of home visits has increased slightly.

Appendix 1

Excellent– Very Good–

Good– Fair– Poor– Not Applicable–

Total–

–

– 18.46% 53.85% 23.08% 3.08% 0.00% 1.54%

Our Opening Hours are suitable to you

12 35 15 2 0 1 65 95.38%

– 20.97% 38.71% 27.42% 12.90% 0.00% 0.00%

Pleasant environment

13 24 17 8 0 0 62 87.10%

– 3.13% 3.13% 6.25% 17.19% 65.63% 4.69%

Adequate parking

2 2 4 11 42 3 64 12.50%

– 12.50% 42.19% 37.50% 6.25% 0.00% 1.56%

Signage around the surgery is easy to follow

8 27 24 4 0 1 64 92.19%

– 9.38% 32.81% 15.63% 4.69% 1.56% 35.94%

Your ability to gain access to our patient online access

6 21 10 3 1 23 64 57.81%

– 17.46% 49.21% 23.81% 6.35% 0.00% 3.17%

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Information displayed in the surgery helpful and informative

11 31 15 4 0 2 63 90.48%

Taking time to explain medical findings

31.25% 50.00% 17.19% 1.56% 0.00% 0.00%

20 32 11 1 0 0 64 98.44%

– 26.98% 47.62% 15.87% 3.17% 0.00% 6.35%

Explaining follow up care

17 30 10 2 0 4 63 90.48%

– 23.08% 50.77% 18.46% 6.15% 1.54% 0.00%

Amount of time spent with you

15 33 12 4 1 0 65 92.31%

– 26.98% 49.21% 20.63% 3.17% 0.00% 0.00%

Use empathy and understanding

17 31 13 2 0 0 63 96.83%

– 24.62% 50.77% 20.00% 4.62% 0.00% 0.00%

Instructions regarding medication

16 33 13 3 0 0 65 95.38%

– 18.46% 44.62% 26.15% 4.62% 1.54% 4.62%

Advise and support on healthy living

12 29 17 3 1 3 65 89.23%

– 26.15% 47.69% 21.54% 3.08% 0.00% 1.54%

The thoroughness of the examination

17 31 14 2 0 1 65 95.38%

– 20.00% 46.15% 23.08% 3.08% 0.00% 7.69%

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The caring concern of our nurses/HCAs

13 30 15 2 0 5 65 89.23%

The friendliness and courtesy of the receptionist

44.62% 41.54% 12.31% 0.00% 0.00% 1.54%

29 27 8 0 0 1 65 98.46%

– 25.00% 43.75% 17.19% 3.13% 0.00% 10.94%

Getting advice or help when needed during office hours

16 28 11 2 0 7 64 85.94%

– 21.88% 35.94% 18.75% 3.13% 1.56% 18.75%

Our ability to return your calls in a timely manner

14 23 12 2 1 12 64 76.56%

– 21.88% 40.63% 23.44% 9.38% 1.56% 3.13%

Your phone calls answered promptly

14 26 15 6 1 2 64 85.94%

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Date of Report: 12th October 2016 Report: Primary Medical Services Report

Agenda item: 6.4

TITLE OF REPORT: Primary Medical Services Report – ‘Dudley Quality Outcomes for Health’ Phase two pilot update

PURPOSE OF REPORT: To present to the Committee an update report on the ‘Dudley Quality Outcomes for Health’ Phase two pilot

AUTHOR OF REPORT: Mrs. J Taylor, Primary Care Commissioning Manager

MANAGEMENT LEAD: Mr. D King, Director of Membership Development and Primary Care CLINICAL LEAD: Dr. T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

• The phase two pilot is being undertaken in 40 of our 46 membership practices

• EMIS supporting alert system has been piloted and is now fully deployed

• The phase two evaluation framework has commenced and due to be completed by November 2016

• Template utilisation rates are being actively monitored and further support packages put in place to address any further training requirements

• The preliminary indicator findings are presented to committee for assurance

• The process for re-base lining of thresholds and financial weighting is outlined

• Highlights the external factors and risks to developing a local contractual offer for 2017/18 and states the reasons for recommending that the DQOFH framework is offered as a pilot in 2017/18

RECOMMENDATION:

The Committee is asked to note for assurance

• The ‘Dudley Quality Outcomes for Health’ Phase two pilot update report

The Committee is asked to note and Approve

• The process for determining the thresholds and financial weighting for a substantive contractual offer in 2017/18 to be made

• The Committee is asked to Approve

• The Committee is asked to approve that the DQOFH framework is offered as a pilot for 2017-18

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FINANCIAL IMPLICATIONS: The cost of this proposal will be contained within the existing financial envelope for the commissioning of primary medical services

WHAT ENGAGEMENT HAS TAKEN PLACE:

• Initial engagement has taken place with patients and the public • Members Meetings • Locality meetings • Dudley Local Medical Committee (LMC) • CCG Clinical Executive Team • Practice Managers Steering group • CCG Clinical Leads


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DUDLEY CLINCAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE – 12th October 2016 PRIMARY MEDICAL SERVICES REPORT – ‘DUDLEY QUALITY OUTCOMES FOR HEALTH’ 1.0 PURPOSE OF REPORT 1.1 To present to the Committee an update report on the ‘Dudley Quality Outcomes for Health’

(DQOFH) phase two pilot, for assurance purposes. 2.0 BACKGROUND 2.1 The phase two pilot has been in operation in 39 or our 46 membership practices since April 2016;

2.2 In July 2016 we had a further practice sign up to pilot the DQOFH framework taking the total to 40 of the 46 practices;

2.2 At the committee meeting in July 2016, the phase two evaluation plan was approved for implementation.

3.0 UPDATE

3.1 The CCG continues to receive feedback on the template and indicators from Membership practices which is regularly discussed and debated at the steering group;

3.2 The EMIS supporting alert system (to replace the QoF version) has been developed and piloted in ten practices. Following feedback from the pilot sites this has under gone a process of redevelopment and has now been fully deployed to all 40 membership practices;

3.3 The phase two evaluation framework has commenced implementation. The timescales to undertake this detailed evaluation will occur between September and November 2016 with the expectation that the final evaluation report will be ready to present to committee in December 2016;

3.4 All practices participating in the phase two pilot have received a short survey monkey questionnaire to be completed by the 4th November 2016;

3.5 The 8 practices which have been identified as the case study practices to undertake the in depth evaluation have been contacted and confirmed, and the evaluation is due to be completed by mid-November 2016. Practices have been selected based on demographics, list size, previous QoF achievement and participation in the phase one pilot. The participating practices are:

Locality Chosen practice 1 Chosen practice 2 Dudley and Netherton Keelinge House

Links Medical Practice

Sedgley, Coseley and Gornal The Green’s Health Centre

N/A

Halesowen Feldon Lane Practice

Lapal Medical Practice

Stourbridge, Wollescote & Lye

Pedmore Medical Practice

N/A

Kingswinford, Amblecote and Brierley Hill

AW Surgeries High Oak Surgery

3.6 The first training and education event to support delivery of the DQOFH framework (which has been developed through the Primary Care Development Steering Group) took place in September 2016 and was well attended by 54 of our nursing workforce. We received excellent feedback (appendix 1) from the event; the second day in the series of three will take place the middle of October with the final day planned for November. An on-going educational and training programme will be developed to run in parallel with the GP education programme to commence from January 2017;

3.7 Although 2016/17 is a pilot year the practices signed an agreement to actively participate in the new contractual framework therefore the CCG has been actively monitoring utilisation of the supporting template;

3.8 We have identified a wide variation in utilisation rates between the practices (13 – 47%). All practices with utilisation rates under 20% have been contacted and if necessary visited by the primary care team to understand the reasons for low rates of utilisation and identify any potential barriers. Currently the majority of practices are identifying a lack in confidence in using the template and additional training requirements have been implemented at these practices.

4.0 PRELIMINARY INDICATOR FINDINGS

4.1 The CCG has commenced to extract the data from the DQOFH framework. Although many of the indicators are new (and therefore will be lower in achievement) some of the preliminary findings are:

• The new LTC template has been utilised on 23,132 patients which is 28% of the LTC population

• 25,000 patients have received a holistic comprehensive assessment including a medication review which is 30% of our LTC population

• 18,500 patients have received a person centred care plan with individualised goals which is 23% of the LTC population

• Of the total LTC population 25% have had a physical activity assessment, 24% have had a screen for depression and 80% have had their BP recorded in the last 12 months

• 88% of patients with atrial fibrillation with a CHADSVASC score of 2 or more have been prescribed anticoagulation medication

• 51% of patients with Diabetes have had an additional 6 month review • 65% of patients with Diabetes have their BP treated to evidence based target of

≤140/80mmHg (≤130/80mmHg with retinopathy, CKD or CVD complications) • 62% of patients with Hypertension have their BP treated to evidence based target of

≤140/90mmHg • 48% of patients have been offered an Advance Care Planning within 2 months of admission

to nursing / residential care • 73% of patients with a vascular condition have their BP treated to evidence based target of

≤140/80mmHg

4.2 The CCG Business Intelligence (BI) team is currently working on a solution to incorporate all of the indicators into the Primary Care Analysis Tool (PCAT) which will be reported to committee on a regular basis in the future.

5.0 PROCESS FOR THRESHOLD SETTING

5.1 Although thresholds were previously set against the indicators, for the new indicators these were based on an arbitrary 5 – 95% achievement;

5.2 A process of re-base lining will need to take place based on the first six months achievement (projected to end of year position) and will take the form of:

• Data extracted from EMIS for the 39 practices (1 practice commenced July 2016 and therefore will be excluded for the purpose of threshold setting)

• BI team will undertake a statistical process in establishing the confidence intervals for all indicators

• Clinical leads will input into their relevant areas • Thresholds will be recommended by steering group • Final approval by committee

6.0 PROCESS FOR FINANCIAL WEIGHTING

6.1 As previously agreed the principles for financial weighting will be based on:

• Workload • Disease prevalence • Local priorities

6.2 Due to conflicts of interest there will be no clinical input into the process of financial weighting which will take the form of:

• Primary care finance manager to undertake a preliminary exercise based on the principles outlined above

• Financial weighting exercise with representation from primary care finance, primary care commissioning, public health and non-executive directors of the CCG

• Final weighting based on outcomes of phase two pilot • Final approval by committee

7.0 EXTERNAL FACTORS AND RISKS

7.1 Uncertainly of National contractual offer:

7.1.1 In December NHS Employers and the British Medical Association’s General Practitioners Committee (GPC) will agree a number of changes to Quality and Outcomes Framework (QOF) effective from 1 April 2017;

7.1.2 The practices will therefore need to make a choice between the National contractual offer and the local contractual offer by Dudley CCG. The Committee needs to be aware that in order to give practices a choice, a fully costed and revised proposal needs to be agreed at the December meeting of the Committee;

7.1.2 The Committee has previously agreed and committed to the DQOFH Framework being fully evaluated, indicators amended, financial weightings agreed and applied, and formal contract offer being made to substantively contract a replacement to the National offer that will effectively move practices from a ‘block’ contractual arrangement as was applied in the pilot year, to a Dudley version of the QoF that will provide income on the delivery of the local outcomes.

7.2 Financial certainty:

7.2.1 The main advantage to practices in signing up to the DQOFH Framework in 2015/16 was that the scheme gave practices certainty and stability over the income during the pilot year. This enabled them the necessary time to focus on re-organising the way in which they delivered the framework. Practices have required changing the skill mix of staff and undertaking additional training and education of their staff to deliver the framework;

7.2.2 When the National contractual offer is made in December 2016 practices will need to make a reasonable judgement with regard to the potential workload, income and improvement in outcomes based a system that they are familiar with and our local framework ;

7.2.3 The DQOFH framework will have only been subject to six months of piloting at the point by which the Committee needs to take a decision to formally move from a pilot to model whereby each indicator is weighted and costed;

7.2.4 The view of the steering group is that this timetable will not give enable practices to effectively compare the Dudley offer to the National offer, as the financial weightings for the DQOFH framework will only be available to practices for the first time in December 2016.

7.3 Evaluation timetable and feedback:

7.3.1 Preliminary feedback from the evaluation team is that it is too early to really determine the impact on outcomes and to undertake the detailed financial weighting analysis to assign to each of the

indicators;

7.3.2 In addition the practices are reporting that the indicators will need further refining based on the outcomes of the evaluation. Hence without certainty on the financial weightings and the ability to have rigorously tested the impact of delivering the DQOFH framework on practice income, the National offer becomes the more rationale to protect practices financial stability.

7.4 MCP Alignment

7.4.1 The intention is that the indicators within the in the DQOFH framework will form the basis of the outcomes measures to be commissioned from the Multispecialty Community Provider (MCP) contract , with the intention that the MCP will be fully mobilised by 1st April 2018.

7.5 Risk

7.5.1 The cumulative risk of the above factors makes it unlikely that the practices would commit to participating in the DQOFH framework outside of an additional pilot i.e. accepting a contract that is based on income per indicator from 1st April 2017, when the financial weightings will only be available to Committee and practices from 1st December 2016;

7.5.2 There is a significant risk that the timescale and inability for practices to predict their income will present a risk for practices willingness to participate in the DQOFH framework from 1st April 2017 if it commissioned as based on payment by performance.

7.6 Mitigation

7.6.1 The view of those evaluating the framework, Steering Group and practice feedback to date is that the Committee considers and supports the following:

7.6.2 That the DQOFH framework is offered as a pilot for 2017-18 on the under the same terms as 2015-16, specifically:

• A participation agreement is offered that enables the practice to opt out of the National QoF offer

• The financial terms of the agreement are amended and developed by a sub-group • A block payment and uplift for PMS premium is agreed • The access pre requirements are amended to reflect the additional requirements set out in

the NHS Operating Plan (i.e. same day access for over 75s)

7.6.3 In supporting this recommendation the Committee is also enabling practices the opportunity to mobilise and prepare for the full the commissioning of the DQOFH framework as part of a mobilised MCP from 1st April 2018.

NEXT STEPS

7.1 Evaluation of phase two pilot to be completed with a report to be presented to committee in December 2016;

7.2 Review of current indicators and access requirements to develop contractual offer for 2017/18;

7.3 Presentation of evaluation report and revised contractual offer for 2017/18 at Membership event in December 2016.

8.0 RECOMMENDATION 8.1 The Committee is asked to note for assurance the ‘Dudley Quality Outcomes for Health’ phase

two pilot update report; 8.2 The Committee is asked to note and approve the process for determining the thresholds and

financial weighting for a substantive contractual offer in 2017/18 to be made;

8.3 The Committee is asked to approve that the DQOFH framework is offered as a pilot for 2017-18.

Appendix 1

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Date of Report: 12th October 2016 Report: Primary Care Weekend

Extended Access during Winter Scheme 2016-17

Agenda item 6.5

TITLE OF REPORT: Primary Care Extended Access during Winter Scheme 2016-17

PURPOSE OF REPORT: To present to the Committee a proposal to commission a Primary Care extended weekend access during Winter Local Incentive Scheme (LIS)

AUTHOR OF REPORT: Mrs. J Taylor, Primary Care Commissioning Manager

MANAGEMENT LEAD: Mr. D King, Director of Membership Development and Primary Care CLINICAL LEAD: Dr. T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

• The CCG is under obligation from NHS England (NHSE) to commit financial resources towards improving patient access during the winter period

• The CCG has previously offered an Extended Access LIS to practices over the past two years and proposes to offer a similar scheme in 2016/17 to be in operation from 1st November 2016 – 31st March 2017

• The scheme for 2016/17 will be offered to membership practices in two components:

o Component One: Data sharing agreement for EMIS remote consultation

o Component Two: Extended Weekend Access Option A - Extended weekend access to the

practices own registered population Option B - Extended weekend access to their

own and other practices registered population • CCG has received feedback from the September locality rounds • Risks and mitigations are outlined

RECOMMENDATION: The Committee is asked to Approve

• The proposal for commissioning a Primary Care extended weekend access during winter LIS

FINANCIAL IMPLICATIONS: The total cost of this proposal will be fully developed and presented to committee once applications from practices have been received. For committee purposes an indicative budget which will not exceed £700K


• Clinical Executive for Primary care • GP Engagement Lead

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• CCG Clinical Executive Team • September locality meetings


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DUDLEY CLINCAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE – 12th October 2016 PRIMARY CARE EXTENDED ACCESSDURING WINTER SCHEME 1.0 PURPOSE OF REPORT 1.1 To present to committee a proposal to commission a Primary Care extended weekend access

during Winter Local Improvement Scheme (LIS). 2.1 BACKGROUND 2.1 Dudley CCG is under obligation from NHS England (NHSE) to commit financial resources towards

improving patient access during the winter period;

2.2 In addition moving towards improving and extending access is a key direction of travel which is set out in the GP Five Year Forward View (April 2016);

2.3 Dudley CCG has previously offered an Extended Access LIS to practices over the past two years (in

2015-16 as part of a wider winter pressure scheme);

2.4 Uptake of the scheme has previously been low with only 13 practices which signed up to participate in the scheme in 2015-16;

2.5 Overall there was a 77% utilisation rate of these additional appointments, with a did not attend

(DNA) rate of 11%;

2.6 Feedback from participating practices indicated that extended access did have some impact on reducing the pressure on routine weekday demand, but had no significant impact on urgent/same day demand for appointments;

2.7 Dudley CCG as a Vanguard transformation site is under significant pressure from NHSE to move towards a solution for providing seven day access to primary care medical services.

3.0 PROPOSAL FOR WINTER PERIOD 2016/17

3.1 The scheme for 2016/17 will be offered to membership practices in two components;

3.2.1 Component One: Data sharing agreement for EMIS remote consultation

Practices will be required to sign and return a Data sharing agreement (DSA) to allow the facility of EMIS remote consultation (which will be provided by the CCG) to be activated. This facility will allow patient’s clinical records to be shared between practices for the purpose of delivering direct patient care. This is in line Primary Care Development Group key area of collaborative working, and will support improving access via practice collaboration;

3.2.2 Component Two: Extended Weekend Access

A Local Incentive Scheme (LIS) enabling practices to improve patient access during the winter season by offering additional routine weekend general practice appointments which will be offered with two options:

Option A: Extended weekend access to the practices own registered population

This is in line with the weekend access component which was offered to practices in 2015/16 with the exception of the introduction of a capitated rate for the maximum number of hours provision a practice can provide;

Option B: Extended weekend access to their own and other practices registered population

This option will utilise the EMIS remote consultation facility to offer weekend consultations in addition to the above to other practices within the health economy. Practices must allocate at minimum of 25% of the total appointments to be available to other practices that have the signed and returned the Data sharing agreement for EMIS Remote Consultation, which should be visible (for the purpose of booking the appointment) no less than 72 hours prior to the appointment. The appointments should not be utilised for a routine long term condition reviews and any practice abusing the extended appointment facility will be reported to the CCG;

3.3 Before commencing the practices will need to submit all proposals for providing extended weekend access for agreement by the CCG.

4.0 FEEDBACK FROM LOCALITIES

4.1 The proposed extended weekend access during winter scheme was presented at the September 2016 locality meetings;

4.2 The following key feedback themes were received:

4.2.1 Concerns were raised around the increase in potential indemnity costs, which may prohibitive practices offering access to patients who are not currently their registered population;

4.2.2 The CCG has confirmed with the Medical Defense Union (MDU) and the Medical Protection Society (MPS) that there will be no additional cost to a practice that provides option B compared to option A of the scheme;

4.2.3 Members raised concerns providing option B with handling appointment booking, cancellations and DNA’s;

4.2.4 All necessary processes required for option B will be fully covered during the implementation training;

4.2.5 Members felt that the scheme would be better to be implemented between the beginning of November and end of February;

4.2.6 The CCG will consider this option dependent on the uptake for this scheme;

4.2.7 Members felt that the scheme should be for acute patients only and not for those to manage their long-term conditions;

4.2.8 The CCG has incorporated this recommendation into the specification for the scheme.

5.0 FINANCE

5.1 The finance that will be assigned to each component of the scheme is proposed:

5.1.1 Component One: Data sharing agreement for EMIS remote consultation

The practice will be paid £100 for the signed returned copy.

5.1.2 Component Two: Extended Weekend Access

Option A : Extended weekend access to your own registered population

1st GP £105.00

Concurrent GP £85.00

Concurrent ANP/Nurse/PA £17.00

Concurrent HCA £8.50

Option B: Extended weekend access to your own and other practices registered population

1st GP £131.25

Concurrent GP £106.25

Concurrent ANP/Nurse/PA £21.25

Concurrent HCA £10.63

*All rates are based on a 30 minute session

6.0 RISKS AND MITIGATIONS

6.2 If all 46 practices opted to provide extended weekend access under option B, this would create a significant cost pressure for the CCG with a potential budgetary requirement of £1.7 million for this scheme. However this is potentially low risk due to the previous poor uptake in previous years;

6.3 The CCG will have the option to mitigate the financial risk by either reducing the capitation rate for maximum number of hours for practice provision or agree that the scheme will finish at the end of February 2016;

6.4 The CCG have allocated an arbitrary budget of £700k, however this will be confirmed once all applications have been received and confirmed.

7.0 RECOMMENDATION 6.1 The Committee is asked to approve the proposal for commissioning a Primary Care extended

weekend access during winter LIS.

1

Dudley CCG Primary Care Extended Access During Winter Scheme

2016-17

Sign Up Sheet This document constitutes an agreement between the NHS Dudley Clinical Commissioning Group (the commissioner) and a GMS or APMS contractor (the contractor) in respect of participating in the CCG Primary Care Extended Access During Winter Scheme. The details and requirements of the scheme are set out in Appendix 1. The scheme is commissioned in two components. Component 1: Data Sharing Agreement for EMIS Remote Consultation Description Practice Opt In

Data Sharing Agreement for EMIS remote consultation Yes/No Component 2: Extended Weekend Access Option Description Practice Opt In

Option A Extended weekend access to your own registered population Yes/No

Option B Extended weekend access to your own and other practices registered population Yes/No

By entering into this agreement the contractor enters into an arrangement to deliver the requirements of specification that they are opting into provide, as set out in Appendix 1 for the period Duration of agreement: From 1 November 2016 to 31 March 2017 The commissioner reserves the right to terminate this agreement should the contractors GMS contract be terminated or be subject to such conditions that in the reasonable opinion of the commissioner warrant early termination. Signed on behalf of the commissioner: Date: …………………………………………………………………… ……………………………………… Signed on behalf of the contractor: Date: …………………………………………………………………… ………………………………………

Please note for GMS practices, one partner may sign, for APMS contractors, all signatories to the APMS agreement must sign

2

Practice stamp: Please return this page signed to: [email protected]

mailto:[email protected]

3

APPENDIX 1: SCHEME DETAILS

Introduction 1. The scheme recognises that there will be increased demand across the whole health economy this

winter.

2. The CCG has been required by NHSE to invest additional resources during winter across the system and this scheme recognises and provides a resource for primary care to contribute to the CCG winter plan.

3. The scheme recognises the significant contribution of General Practice in managing demand over the

winter and provides the practice with the option of providing additional capacity.

4. The requirements of this scheme have been developed by the Primary Care Commissioning Committee on delegated approval of the CCG Board.

Component One: Data sharing agreement for EMIS remote consultation 5. The practice is asked to sign and return a Data sharing agreement (DSA) for the facility of EMIS remote

consultation (which will be provided by the CCG). This facility will allow Patient’s clinical records to be shared between practices, is in line Primary Care Development Group Key Area of collaborative working, and in addition improving access via collaborative working is a key component of NHS England General Practice Forward View.

Component Two: Extended Weekend Access 6. A Local Incentive Scheme (LIS) Specification enabling providers to improve patient access during the

winter season by offering additional routine weekend general practice appointments is attached in Appendix 1 for the practice to consider.

Monitoring 7. All participating practices will be able to demonstrate achievement as per the monitoring requirements

set out in the LIS document in Appendix 1.

Payment Component One: Data sharing agreement for EMIS remote consultation 8. The practice will be paid £100 for the signed returned copy. Component Two: Extended Weekend Access 9. The practice will be paid as per service specification in Appendix 1 as set out in the tables below:

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Option A : Extended weekend access to your own registered population 1st GP £105.00 Concurrent GP £85.00 Concurrent ANP/Nurse/PA £17.00 Concurrent HCA £8.50

Option B: Extended weekend access to your own and other practices registered population 1st GP £131.25 Concurrent GP £106.25 Concurrent ANP/Nurse/PA £21.25 Concurrent HCA £10.63

*All rates are based on a 30 minute session 20. The CCG reserves the right to retrieve payments for non-achievement and under achievement of the

requirements defined within the scheme.

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APPENDIX 2: EXTENDED ACCESS SPECIFICATION Service Extended Weekend Access 2016 (V2.0) Commissioner Lead Daniel King Clinical Lead Tim Horsburgh Period 1st November 2016 – 31st March 2017 Date of Review April 2017 Key Service Outcomes A Local Improvement Scheme (LIS) Specification between Dudley GP Practices (the Provider) and Dudley Clinical Commissioning Group (the Commissioner), enabling providers to improve patient access during the winter season by offering additional routine weekend general practice appointments. 1. Purpose 1.1 Aims and Objectives The aim of this LIS is for practices to provide additional routine weekend appointments at times outside of core contracted hours and NHS England commissioned Extended Hours (if currently provided). This LIS facilitates practices to respond to patient demand and capacity pressures during the winter period, and also allow patients to attend the practice at a time when it is more convenient for them. It is designed to be flexible so that providers can respond to their practice population requirements and offer variable hours. Seven day access to GP services is currently high on the political agenda. This scheme will therefore also provide a local evidence base as to whether there is a need of the population for seven day General Practice services, and the capabilities of practices to provide such services; thus helping to inform local primary care commissioning intentions for the future. 1.2 National/Local Context and Evidence Base Patient access to GP appointments continues to be a challenge nationally and locally. Several factors have increased demand including an ageing population, more complex patients, and increasing numbers of patients being managed in the community rather than in secondary care services. Demand for appointments invariably rises during the winter period, adding further strain to the primary care system. The NHS England GP Patient Survey (June 2016) reports that in the Dudley CCG locality 69% of patients were able to get an appointment at their practice when they required one. 48% of patients were able to get an appointment within 48 hours of contacting their surgery, with 10% having to wait a week or longer to be seen. In relation to practice opening times within Dudley CCG, 76% of patients reported overall satisfaction with their practice opening times. However 73% stated a desire to have access to GP appointments on a Saturday. 2. Scope 2.1 Service Description and Definitions The scope of this LIS is to enable providers to offer additional general practice appointments commencing from 1st November 2016 until 31st March 2017. Providers must offer routine appointments on weekends at times outside of Core Hours and NHS England contracted Extended Hours (if currently provided).

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(a) Definition of Core Hours Core Hours are defined under the nGMS Contract Regulations 2004 as Monday to Friday 08.00 - 18.30. Core hours cannot be substituted for extended hours and current contracted core hours must be maintained. (b) Definition of NHS England Extended Hours (NHSE EH) NHSE EH is defined as any additional hours that Providers have contractually agreed with NHS England under the national Enhanced Service Extended Hours Scheme. (c) Definition of Weekend General Practice Hours For the purpose of this agreement Weekend GP Hours are defined as any weekend hours that fall outside core hours and NHSE Extended Hours that practices currently provide. 2.2 Eligibility Criteria

• To be eligible for this enhanced service providers must be a Dudley CCG member practice; • Practices must currently provide a minimum of 47.5 core opening hours; • Current provision of NHS England Extended Hours is not necessary to be eligible; • This enhanced service is only operational from 1st November 2016 to 31st March 2017 and does not set

a precedent for any future extended hours scheme that may be commissioned by Dudley CCG. Contractors must submit a proposed plan for Weekend GP Hours. Dudley CCG will then review all proposals in view of agreeing arrangements within one week of receiving a plan. Dudley CCG is not required to enter into arrangements under this agreement after 1st December 2016 unless there are exceptional circumstances. Practices must ensure that all elements of the service specification are being met. Failure to do so could result in non-payment. 3. Service Delivery 3.1 Service Requirements Option A : Extended weekend access to your own registered population The following service requirements must be adhered to: a) The minimum session time is 60 minutes. Sessions should be rounded to be nearest 30 minute period

thereafter as payments will be per 30 minutes of activity. b) The Commissioner has defined a maximum session time threshold per weekend which is based on 30

minutes per 500 patients on their registered list size (list sizes will be rounded to the nearest 500 for the purpose of this calculation). However, all reasonable requests will be considered and agreed between the Commissioner and Provider on an individual case basis.

c) It is expected that the majority of appointments offered should be with a GP. However requests to offer additional appointments with Advanced Nurse Practitioners, Physician Assistants, nurses and Health Care Assistants (HCAs) will be considered. These will be paid at a different rate to GP appointments.

d) Appointments must be face to face consultations only. e) Core hour consultation times and the number of core GP appointments available must not reduce in

light of extended weekend opening. f) Providers are not permitted to reduce current NHS England contracted Extended Hours in order to

accommodate this scheme.

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g) Providers cannot schedule Weekend GP Hours sessions to run concurrently with existing NHSE Extended Hours sessions. For example if a practice already provides an NHSE EH session on Saturday morning, it cannot provide an additional session at the same times as the NHSE EH session and claim for this under this scheme. Sessions must be offered at times outside of existing contracted hours.

h) It is expected that a minimum of 5 GP appointments should be available in a 60 minute session. i) All appointments available for Weekend GP Hours must be routine (i.e. pre-bookable). Any unfilled

appointments may then be offered on the day for urgent cases. j) Practices will be responsible for ensuring patients who contact the surgery requiring urgent care and

who cannot be seen by the practice, are signposted to the out of hours service. k) Practices are also expected to manage any urgent telephone contact from the Community Rapid

Response Team/assertive case managers/ community nursing teams, and support discharges from hospital to care homes e.g. medication queries.

l) Non NHS work must not be carried out in weekend GP sessions. m) Appointments should be available for the practice registered population and not restricted to any

particular target group, for example, commuters. n) Where a practice provides out of hours (OOH) services, it must not limit access to any of these clinical

sessions to those patients it would have been obliged to see anyway under the OOH arrangements. o) Practices will not be expected, as part of this agreement, to undertake home visits during weekend

sessions. Patients requiring this service should be referred to the out of hours service. p) Practices are required to promote and publicise availability of the additional extended access

appointments. Option B: Extended weekend access to your own and other practices registered population In addition to the service requirements in Option A the following must be adhered to: a) Practices must allocate at least 25% of the total appointments to be available to other practices that

have the signed and returned the Data sharing agreement for EMIS Remote Consultation. b) These slots will be visible to other practices (for the purpose of booking the appointment) no less than

72 hours prior to the appointment. c) Any appointments which are still unfilled 24 hours prior may then be offered as additional appointments

to their own registered population. d) Any consultations undertaken under this scheme will be fully documented in the patient’s own health

record to the minimum data quality standard outlined in the data sharing agreement. Practices will not have access to any spine functionality during the remote consultation and therefore prescribing should be undertaken via an FP10. Follow-up requirements will need to be communicated to and actioned by the patients registered practice through the EMIS task function.

e) The appointment should not be booked for a routine long term condition review and any practice identified as abusing the extended appointment facility should be reported to the Commissioner.

f) The commissioner will facilitate practices in publicising their details throughout localities to promote this extended service provision.

3.2 Location(s) of service delivery

a) Weekend sessions must be delivered from the contractors premises on a regular basis each week.

Practices that own a branch surgery will be viewed as one surgery and can operate from either location as long as all patients from both the main and branch surgery can access the service and the practice can demonstrate that patient’s needs are being satisfied. It must be made clear to patients and Dudley CCG, which location the weekend hour’s surgery will operate from. If arrangements alternate between the main surgery and the branch surgery then again this must be clearly publicised.

b) Providers signed up to this agreement may offer concurrent appointments during Weekend hours. If contractors are proposing concurrent working then this must be clearly specified in their access

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proposal. Practice proposals will be reviewed on an individual basis and will still need to meet the evidenced needs of the registered population. Concurrent working appointments are paid at a different rate.

For example if a practice has decided to offer GP appointments on a Saturday and they are offering an additional 12 appointments, this can be done by a single GP or by two GPs (or one GP and one nurse/ANP etc.) concurrently offering 6 appointments each.

3.3 Days/hours of operation

a) Practices will be required to define their suggested extended opening hours to Dudley CCG in their access proposal. A template has been provided to assist practices in formulating and drafting proposals and can be found in Appendix A. Once the proposal is agreed by Dudley CCG, practices are committed to providing the stated hours on a weekly basis from the 1st November 2016 to 31st March 2017 inclusive.

b) Practices may wish to provide the same amount of weekend hours each week at fixed times, or they may wish to be flexible and provide varying number of hours on a week to week basis according to need and resources available. If Providers opt for the latter, then they must declare the minimum and maximum amount of hours they are willing to provide in a week when the proposal is submitted. Practices will then be paid based on the actual amount of hours completed at the end of each month. Payment for any hours provided above the declared maximum set by a practice will only be done by prior approval by Dudley CCG.

c) Weekend opening should be offered at those times that best meet the needs of the registered

population. To ensure opening times are in line with patient expressed preferences, the following should be reviewed:

• National GP Patient Survey Results, in particular the latest results • Preferences expressed through the Patient Participation Group • The “friends and family” test (FFT) • Other feedback e.g. In-house Patient Survey Results (IPQ / GPAQ)

d) Once weekend opening hours have been agreed with Dudley CCG any future changes with regard

to these extended hours must be discussed with and agreed by Dudley CCG. It is recognised that a practice may wish to change its extended access arrangement in light of patient demand. Any changes must be agreed with Dudley CCG in advance and may include an agreed notice period.

e) It is the responsibility of the provider to make arrangements for alternative staff cover in the event of sickness and/or annual leave to ensure the extended access services are maintained.

f) In the event a session has to be cancelled the practice must ensure that all patients are notified and offered an alternative appointment. The practice is also required to notify Dudley CCG in writing within 48 hours of the session being cancelled, providing reasons for the cancellation. If the session is not re-scheduled within the same week, a payment amendment will be made.

g) Where scheduled extended opening sessions fall on Christmas Day, Boxing Day and New Year’s

Day practices are not required to re-provide extended hour services but must ensure patients are aware of the closure.

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4. Termination and Variation 4.1 Termination of Agreement Both the practice and Dudley CCG may terminate this agreement by giving not less than one months’ notice in writing to the other party. 4.2 Variation of Agreement Dudley CCG may vary this agreement by giving not less than one month’s notice in writing to the provider, unless required to do otherwise under national policy. 5. Quality and Performance Requirements Providers are expected to maintain quality and performance requirements as detailed in their main medical services contract. 6. Monitoring and Activity 6.1 Activity Plan Practices signed up to this LIS will ensure that appropriate information, records and documentation of this service level agreement are maintained at all times, to effectively monitor performance. This information will include: • A written practice plan of how the practice proposes to deliver extended access sessions in view of the

days and times. Appendix A provides a practice plan template to be completed, submitted, and approved by Dudley CCG

• Extended hours offered. The practice will also provide feedback on: • Number of face to face appointments available in extended hours. • Number of DNA’s and/or cancellations. • Date of sessions cancelled and reasons. • Feedback on utilisation of EH Plus appointments by patients. • Any problems experienced in extended opening. 6.2 Monitoring A monthly report will be required from practices in order to monitor performance under this agreement. A pro-forma will be supplied (Appendix B) and practices must ensure that the data is completed and retained should we require them at any time. Where there is evidence that appointments are consistently underutilised, Dudley CCG may decide to decommission the service with that practice / group of practices. Where this decision has been taken, Dudley CCG will communicate this, in writing to the practice(s), giving the agreed notice period. 7. Payments Option A : Extended weekend access to your own registered population 1st GP £105.00 Concurrent GP £85.00 Concurrent ANP/Nurse/PA £17.00 Concurrent HCA £8.50

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Option B: Extended weekend access to your own and other practices registered population 1st GP £131.25 Concurrent GP £106.25 Concurrent ANP/Nurse/PA £21.25 Concurrent HCA £10.63

*All rates are based on a 30 minute session Payments will be made monthly in arrears on completion of the Submission Sheet (Appendix B). It is important to note that incomplete claims will not be processed, so practices are advised to complete all sections of the submission sheet. Payments are only payable in respect of periods during which the service is provided. Remuneration will not be made to any practices offering weekend hours unless they have an agreed plan with Dudley CCG. Providers are advised that all activity, records and claims related to this service may be validated through external audit and Dudley CCG retains the right to claim any over payments made under this agreement. Payment may be with-held if practices breach the conditions outlined in this service specification.

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Appendix A: To be completed and returned to [email protected] Extended Weekend Access Practice Proposal 2016/2017 Practice Name:

Practice M/Y Code:

Names:

Branch Surgery:

No. of current core hours:

No. of current extended hours:

Section 1 – Proposed House Please indicate whether proposing fixed weekly hours or variable:

Fixed Variable

If fixed, please indicate total number of hours per week proposed (nearest 30 mins) = If variable, please indicate minimum and maximum number of hours per week (nearest 30 mins) Minimum = Maximum =

Section 2 – Session Times and Healthcare Professional Please complete the table below indicating proposed session times and the nominated Healthcare Professional(s) who will deliver the session(s) and whether this is a concurrent appointment proposal. If you are proposing variable weekly hours, please indicate the potential session times showing the maximum session time and mark these sessions as variable.

Day of week A.M Sessions (please state

times)

P.M Sessions (please state

times)

Healthcare Professional(s)

providing session e.g. GP/ANP

Face to face appts being

offered

Fixed (F) or

Variable (V)

Concurrent working

(Y/N)

Main (M) or branch surgery (state

branch name)

Saturday

Sunday

For Dudley CCG use only Total Hours proposed

Total number of appointments


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Section 3 – Evidence to Support Proposal Please state below how registered patient needs and demands in respect to extended opening are being met in view of your access proposal. Please also indicate how the practice aims to advertise the additional opening times.

Section 4 – Practice Declaration and Obligation to Delivering Extended Weekend Hours Plus Scheme and Dudley CCG Approval I can confirm that the terms of this Extended Weekend Access LIS have been read and understood, and that on the agreement of Dudley CCG the Practice will deliver extended hours opening as detailed in this proposal, from the 1st November 2016 to 31st March 2017 inclusive. I can also confirm that core consultation times and number of GP and other Health Care Professional appointments will not reduce in light of Weekend GP Hours provision. Name: Signature: Position: Date: I can confirm on behalf of Dudley CCG that this plan for extended opening has been reviewed against the required criteria and agreed: Name: Signature: Date:

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Appendix B: Extended Weekend Access Claim Submission Form 2016-17

Practice Name: Practice Code: Claim Month:

In the table below please specify session times and the category of health care professional e.g. GP, ANP, nurse etc. For concurrent sessions details each session separately. Total monthly hours claimed:

Weekend GP ANP/Nurse/PA HCA Primary Session Concurrent Session I hereby confirm the above to be an accurate representation of activity undertaken and understand that any claim may be subject to audit as detailed in the Extended Weekend Hours Plus Service Specification 2016-17. Signed (Practice Manager): Name: Date: To be completed and returned to: [email protected]

Week commencing

…………………………….

Week commencing

…………………………….

Week commencing

…………………………….

Week commencing

…………………………….

Week commencing

…………………………….

Saturday

Sunday

For Dudley CCG use only: Approved and checked by: Date:


Page 1 of 3

DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE

Date of Meeting: 21 October 2016 Report: Quality & Safety Report

Agenda Item No: 7.1

TITLE OF REPORT: Quality and Safety Report

PURPOSE OF REPORT: To provide on-going assurance to the Primary Care Commissioning Committee (PCCC) regarding quality and safety in accordance with the CCG’s statutory duties

AUTHOR(s) OF REPORT: Jim Young, Quality and Patient Safety Manager

MANAGEMENT LEAD: Caroline Brunt, Chief Nurse

CLINICAL LEAD: Dr Ruth Edwards, Clinical Lead, Quality & Safety

KEY POINTS: • One new CQC inspection has been completed

• Two CQC reports have been published

RECOMMENDATION:

The Primary Care Commissioning Committee is asked to:

• Note this report for assurance

FINANCIAL IMPLICATIONS:

None to report

WHAT ENGAGEMENT HAS TAKEN PLACE: N/A

ACTION REQUIRED: Assurance

Page 2 of 3

DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE – 21 OCTOBER 2016 QUALITY & SAFETY REPORT

1 Introduction

1.1 A primary care quality and safety report is provided to the CCG Quality and Safety Committee (QSC) and CCG Primary Care Operational Group (PCOG) monthly. This report is a material summation of the report submitted to the QSC in September plus any additional information identified after the QSC report was finalised. There was no PCOG meeting in September.

1.2 The PCCC will be briefed on any contemporaneous matters of consequence arising after submission of this report.

2 CQC Inspections

2.1 Appendix A shows the latest status of CQC inspections across Dudley.

2.2 There have been two CQC reports published since the last meeting. • Wychbury Medical Group have been rated as good overall and for all domains.

• Norton Medical Practice has been rated good for the Safe domain following a previous requires improvement rating (only this domain was inspected).

2.3 Coseley Medical Centre has been inspected for the first time.

2.4 A CCG ‘mock inspection’ has been carried out at Quincy Rise following their overall inadequate rating.

3 Serious Incidents (SIs)

3.1 No new SIs have been reported since the last meeting. Currently, there are three open SIs.

4 Infection Prevention & Control (IPC)

4.1 Seven IPC audits scheduled for 2016/17 have been carried out so far. All seven practices have been rated as green overall.

5 Service Developments

5.1 Datix – progress has been delayed due to issues mapping data for NRLS reporting. These have now been addressed and work continues to finalise the configuration work during October for testing within the CCG Q&S team. This will then be developed further for use within primary care.

Page 3 of 3

APPENDIX A: Overview of CQC Inspections (as of 11/10/16)

Practice Name Visit Date Report Published

Overall rating

Safe

Effective

Caring

Responsive

Well Led

Pedmore Road Surgery 22/10/2015 14/01/2016 RI Inad Good

Good

Good

Good

Steppingstones Surgery 28/10/2015 17/12/2015 Good Good

Good

Good

Good

Good

Rangeways Road Surgery 12/11/2015 07/01/2015 Good Good

Good

Good

Good

Good

Bath Street Surgery 24/11/2015 28/01/2016 Inad Inad Inad

Good

RI Inad

Woodsetton Medical Practice 08/12/2015 04/02/2016 Good RI Good

Good

Good

Good

Bilston Street Surgery – follow up 09/12/2015 14/03/2016 Good RI Good

Good

Good

Good

Lapal Medical Centre 15/12/2015 11/02/2016 Good Good

Good

Good

Good

Good

The Waterfront Surgery 17/12/2015 03/03/2016 Inad Inad RI Inad

RI Inad

The Limes Medical Centre 13/01/2016 11/02/2016 Good RI Good

Good

Good

Good

Moss Grove Surgery 19/01/2016 10/03/2016 Central Clinic - follow up 02/02/2016 03/03/2016 Good Goo

d Good

Good

Good

Good

Dudley Partnerships for Health 10/02/2016 14/04/2016 Inad Inad RI RI RI Inad

Stourside Medical Practice 16/02/2016 04/04/2016 RI RI Good

RI Good

Good

Lower Gornal Medical Practice 01/03/2016 06/04/2016 Good RI Good

Good

Good

Good

Quincy Rise Surgery 09/03/2016 02/06/2016

AW Surgeries 14/03/2016 11/05/2016 Eve Hill Medical Practice 15/03/2016 17/05/2016 Northway Medical Centre 14/04/2016 09/06/2016 Cross Street Health Centre 25/05/2016 24/06/2016 Feldon Lane Surgery 04/05/2016 30/06/2016

Ridgeway Surgery 17/05/2016 06/06/2016

Quincy Rise – follow up 1 18/07/2016 02/09/2016 No change to ratings from this inspection

Bath Street – follow up 26/07/2016 22/09/2016

St. James Medical Practice (Porter) 02/08/2016 13/09/2016

Bilston Street - follow up (2) 10/08/2016 No report No change to ratings from this inspection

Wychbury Medical Group 16/08/2016 03/10/2016

Clement Road Surgery 25/08/2016

Norton Medical Practice – follow up 01/09/2016 03/10/2016

Bilston Street – follow up (3) 06/09/2016

The Waterfront Surgery – follow up 06/09/2016

High Oak Surgery – follow up 14/09/2016

Links Medical Practice (Netherton) 20/09/2016

Coseley Medical Centre 06/10/2016

Dudley P’ships for Health – follow up 12/10/2016

Key:

Good Inadequate Requires Improvement Outstanding

1 | P a g e

DUDLEY CLINICAL COMMISSIONING GROUP


Date of Report: 21 October 2016 Report: Finance Report

Agenda item No: 8.1

TITLE OF REPORT: Primary Care Commissioning Finance Report

PURPOSE OF REPORT: The report provides an overview of financial performance against budgets delegated to Committee.

AUTHOR OF REPORT: Mr P Cowley, Senior Finance Manager

MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD: Dr T Horsburgh, Clinical Lead Primary Care Co Commissioning

KEY POINTS:

• There have been no changes to the budget allocated to Committee since the previous report

• A break-even position is expected to be achieved against co-commissioning budgets.

• A proposal has been made to amalgamate the Minor Surgery LIS with the national Minor Surgery DES, with a resulting transfer of expenditure into the delegated allocation.

• A small underspend is forecast against core CCG budgets for membership development

RECOMMENDATION:

Committee is requested to • Note the reported financial position for assurance. • To approve in principle the commissioning in 2017/18 of a

single scheme to replace the current Minor Surgery LIS and DES.

• To approve the interim proposal to report Minor Surgery LIS expenditure against the delegated allocation

FINANCIAL IMPLICATIONS: As above.

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ACTION REQUIRED: Decision Approval √ Assurance √

Finance Report (September 2016) This report submitted to Dudley CCG Primary Care Commissioning Committee provides a breakdown of financial performance for Co-commissioned Primary Care and other budgets within the remit of the committee during the month of September.

Contents Financial Overview p2 Financial Detail p3

Appendices Appendix 1 Revenue and Resource Limit Appendix 2 Service Level Financial Summary Report

Financial Overview

Budgets reported to the committee have an annual value at September 2016 of £40,719,000, including both the delegated co-commissioning allocation and core CCG budgets. There have as yet been no in-year allocation adjustments.

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Budget Allocations

Performance against Budget

Primary Care Co-

Commissioning

£39,863k

CCG Core Commission

ing £856k

Delegated Co-Commissioning is forecast to break even at the end of the financial year. CCG Core Commissioning budgets are expected to underspend by £30,100, mainly as a result of expected underspends against the Practice Engagement LIS.

Allocation Breakdown

Delegated Co-Commissioning

The forecast expenditure level against delegated budgets continues to reflect a break-even position, with the quarterly nature of list size adjustments meaning that there has been no material change in September. A proposal to amalgamate the Minor Surgery LIS (which had previously been recorded against core CCG budgets) with the Minor Surgery DES is made in the following section of this report. The impact of the proposal upon the level of reserves is shown overleaf, but it should be noted that the acceptance of this proposal would not affect the reported forecast variance.

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Summary Position

It has recently been brought to the attention of the CCG that NHS England have changed their policy on practices which house community services in their buildings. Previously, the spaces occupied by these services would be included within rent reviews and reimbursed within notional or actual rent payments, but NHS England have begun to apply the Premises Cost Directions strictly and are now excluding these spaces from the review, leading to a loss of income for practices. This policy makes sense for NHS England as a commissioner, as it reduces primary care premises costs, but for a delegated CCG which also funds community services there would be no net financial change, as practice’s would simply invoice community service providers for the space, with those providers then increasing their charges to the CCG to include these new costs. It would however impose a significant administrative burden on practices and community service providers and work against the CCG’s model of care. The CCG has therefore agreed a process with NHS England to ensure that payment for these spaces continues to be made to practices. Although any space occupied by community services will be excluded from rent reviews in line with the Premises Costs Directions, NHS England have agreed to process separate payments to practices for any excluded space, meaning that no practice will see their rent reimbursement reduced due to the presence of NHS community services in their building.

Rent Review Impact of Practices Housing Community Services

AreaBudget (WTE)

Annual Budget(£'000)

Forecast Variance(£'000)

GP Contract 25,881 - QOF and Enhanced Services 6,909 (4)Premises Costs 4,774 (3)Dispensing/Prescribing Drs 255 - Other GP Services 635 7Reserves 1,409 -

Total - 39,863 0

Proposal to amalgamate Minor Surgery DES and LIS schemes

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Introduction and Background Prior to the NHS reforms in 2012, Dudley PCT commissioned a Minor Surgery Directed Enhanced Service (DES) that was wider than the scope of the national scheme, including a wider range of procedures and also allowing referrals between practices to enable patients of surgeries that did not offer the full range of surgery to access these services. The scheme also paid a higher rate for minor surgery than the national scheme. With the new commissioning landscape created the 2012 reforms this service, along with the full budget, transferred to NHS England. Shortly afterwards, NHS England reverted to the national specification, reducing the range of procedures offered and ceasing inter-practice referrals and reducing the rate paid to practices.

At this point Dudley CCG introduced a parallel Minor Surgery Local Improvement Scheme (LIS) in order to retain the benefits that the local scheme had brought to patients. However, the provision of and payment for these services under two distinct schemes has always been anomalous . It is unnecessarily bureaucratic for practices, with differing requirements and data submission processes causing confusion and increasing the administrative burden on practices. The advent of co-commissioning and ability of CCGs to commission replacements for DES schemes has now removed the organisational barrier to re-introducing a single local scheme, and it is believed that re-combining these schemes will offer a significant administrative benefit to practices.

Current Funding Breakdown Item DES LIS TotalDES procedures for own patients £514,391 £113,819 £628,210DES procedures for other practices' patients £0 £42,388 £42,388Non-DES Procedures £0 £0 £0Total £514,391 £156,207 £670,598

Payment SourceAn analysis of costs in 2015/16, shown opposite, has shown that despite the intention behind the scheme, the LIS is only currently used to fund procedures approved under the DES, with practices undertaking no non-DES procedures.

Of the expenditure on procedures covered by the Minor Surgery DES, 94% of the total cost is associated with practices undertaking DES procedures for their own patients, with 6% of costs being incurred on the performance of minor surgery DES procedures that have been referred on by another practice.

Proposal to amalgamate Minor Surgery DES and LIS schemes (cont’d)

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Impact upon co-commissioning budget

In light of the history of the DES and LIS schemes, and the financial information shown on the previous page, it is proposed that the Minor Surgery DES and LIS schemes be re-combined and the situation that existed prior to 2012 be restored. This combined scheme would make a single payment to practices based upon the combined payment rates of the current DES and LIS, utilising EMIS extractions and removing the need for practices to submit the quarterly claim forms that are required under the DES. The contractual changes that are required mean that the amalgamation into one contract will not be able to take effect until new contracts are issued in 2017/18, so the proposed changes will take full effect from next financial year. However, it is proposed as an interim measure to begin reporting all Minor Surgery expenditure against the co-commissioning allocation from this point forward.

Proposal

Forecast expenditure against the Minor Surgery LIS in 2016/17 is £183,000, and the impact of reporting this expenditure against the co-commissioning forecast outturn has been modelled. The table opposite shows that making the transfer would reduce the level of uncommitted reserves from £886,000 to £703,000. This would leave sufficient uncommitted reserves to fund the maximum £700,000 value of the proposed ‘Extended Weekend Access During Winter’ Scheme, while also retaining the reserves required to fund remaining commitments against the delegated allocation.

Reserve Uncommitted Potential Committment

Definite Committment Total

1% Non Recurrent Fund £68 £331 £3990.5% Contingency £199 £1994 x GPwSI @ £95k per post £380 £380GPIT Transitional Costs £150 £150List Size Growth @ 0.27% £6 £6DES Performance Reserve £177 £177NHSPS Market Rent Impact £40 £40Rent Reviews Reserve £37 £37Unallocated Reserve £22 £22Total £886 £193 £331 £1,409

Impact of Minor Surgery Transfer -£183 £0 £0 -£183

Revised Total £703 £193 £331 £1,226

CCG Core Commissioning

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Summary Position • The Nurse Mentors and EVTS report is showing an underspend by

£6,000. The cause of this underspend is the under-establishment of the Nurse Mentoring Team.

• The Practice Engagement LIS is currently forecast to underspend by

£30,000, as the maximum cost of the published scheme is lower than the available budget.

• The Primary Care Investments report shows a forecast overspend of £6,000, which represents payments to a practice under the Syrian Refugees scheme. Although these costs can be reclaimed from the Home Office and the process to do so is underway, the CCG understands that this is a difficult process and to be prudent has assumed at this stage that costs will not be recovered.

Recommendation: • Committee is asked to note the reported financial position for assurance. • Committee is asked to approve in principle the commissioning of a single Minor Surgery LIS in

2017/18, with a further paper being presented to committee prior to final approval. • Committee is asked to approve the proposal to report Minor Surgery LIS expenditure against the

delegated allocation, alongside the Minor Surgery DES.

AreaBudget (WTE)

Annual Budget(£'000)

Forecast Variance(£'000)

Primary Care Training 70 - Nurse Mentors and EVTS 0.84 196 (6)Practice Engagement LIS 591 (30)Primary Care Investments - 6

Total 0.84 856 (30)

PRIMARY CARE CO-COMMISSIONING

Recurring

(£000's)

Non Recurring

(£000's)

Total

(£000's)

TOTAL 16/17 NOTIFIED RESOURCE ALLOCATION 39,863 0 39,863

Notified Resource Adjustments

0

0

0

0

0

0

Total Notified Resource Allocation 0 0 0

Anticipated Resource Adjustments

Total Potential Resource Allocation 0 0 0

0 39,863

Appendix 1: Revenue Resource Limit

Period : September 2016

CCG RESOURCE LIMIT 2016/17 : CO-COMMISSIONING 39,863

Appendix 2: Primary Care Service Level Financial Summary Report 2016/17

Period : September 2016

Dudley Clinical Commissioning Group

Primary Care Co-Commissioning WTE

Budget

WTE

Actuals

Annual Budget

£000's

Year to date

Budget £000's

Year to date

Actual £000's

YTD

Variance

£000's

General Practice - GMS 25,413 12,696 12,697 0

General Practice - APMS 468 234 233 (1)

QOF 2,155 772 772 0

Enhanced Services 4,754 2,647 2,645 (2)

Premises Cost Reimbursement 4,765 2,764 2,763 (1)

Other Premises Costs 9 4 4 0

Dispensing/Prescribing Drs 255 127 127 -

Other GP Services 2,044 685 693 8

Primary Care Co-Commissioning Total 39,863 19,931 19,934 2

Primary Care Development WTE

Budget

WTE

Actuals

Annual Budget

£000's

Year to date

Budget

£000's

Year to date

Actual

£000's

YTD

Variance

£000's

Primary Care Training - - 70 35 35 (0)Nurse Mentors and EVTS 0.84 0.80 196 98 94 (4)Practice Engagement LIS - - 591 295 280 (15)Primary Care Investments - - - - 6 6

Primary Care Development Total 0.84 0.80 856 428 415 (13)

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DUDLEY CLINICAL COMMISSIONING GROUP Primary Care Commissioning Committee

Date of Report: October 2016 Report: Primary Care Analysis Tool

Agenda item No:9.1

TITLE OF REPORT: Primary Care Analysis Tool (PCAT) Report and Update

PURPOSE OF REPORT: Update the Primary Care Development Committee on the PCAT and analysis of high and low performer practices.

AUTHOR OF REPORT: Anthony Nicholls (Head of Intelligence)

MANAGEMENT LEAD: Matt Hartland (Chief Operating & Finance Officer)

CLINICAL LEAD: Jonathan Darby

KEY POINTS:

• The PCAT continues to develop. • Information on the Dudley GP Outcomes Framework is now

being extracted via EMIS Search & Report and loaded into PCAT. These data will be reported within PCAT from 20th October 2016.

• Updated NHS Choices section - This section now includes a rate per 1000 for Positive & Negative Comments at a practice level, it also includes categorisation of comments at a practice level.

• Work on standardisation by deprivation for Dudley Practices has commenced. This is available for Emergency Admissions data and other data at more granular levels are being assessed for deprivation adjustments.

• Reporting to GP Practices remains problematic. A technical solution for Practice access that doesn’t involve the Citrix environment has not progressed. An alternative solution which takes the Qlik reporting environment out of the current IT Server provision and stand both Qlik and data in the Cloud environment is being explored. This alternative solution is being assessed for cost and fit with the IT Strategy.

• In the interim PDF Practice reports are being developed and will be available by the end of October 2016.

RECOMMENDATION: The PCAT was designed to be a flexible and responsive analysis tool. Therefore development will in a sense be on-going through the request for change process.

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FINANCIAL IMPLICATIONS: None


Extensive clinical and management engagement has previously taken place on the development of the PCAT metrics in various forums both formal and informal.


Care Quality Commission

Friends & Family

GP Patient Survey

NHS Choices

Infection Control

Secondary Care

Prescribing

Urgent Care Centre

July 2016

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Care Quality Commission Average CQC rating across all GP Practices (overall rating)

Friends and Family Average % for patients recommending the GP Practice.

GP Patient Survey Average % "Good" response for overall experience of the practice - across all practices.

NHS Choices Average rating across all GP Practices

Infection Control Achievement % overall compliance

Secondary Care Emergency Admissions. Standardised Admission Ratio (SAR) West Midlands. Prescribing % achievement across 3 Domains and 24 indicators

Urgent Care Centre Not yet available by Practice

There are 8 Domains within the Primary Care Analysis Tool. Each Domain has further subsections which can be explored and analysed. This high level dashboard shows current performance and change from the previous quarter. As more serial data is entered into PCAT tracker graphs will be included.

2

+0.01

-0.69%

+0.13

+0.00

+0.76

+0.00

+3.56

Performance Change

Emergency Admissions and the influence of Deprivation

Like age and gender, deprivation is an important factor in accounting for the variance of Emergency Admissions by GP Practices. The scatterplot below shows the correlation between the emergency admissions rate by practice and the Index of Multiple Deprivation by practice. There is a strong correlation even though there is clear outlier that does not fit the model (Summerhill). When the Summerhill Practice is removed the correlation is stronger.

3

Rho = 0.496, P=0.019

Two work packages are currently under way that will advance the analysis of emergency admissions by practice: • The ‘Summerhill Factor’. For Summerhill, traditional standardisation adjustments don’t

appear to fit. Age standardisation only partly addresses this issue since the high number of elderly living in care homes have a different case mix to the same age group living in their own homes. This is being explored further.

• Standardising for age, gender and deprivation becomes problematic with low activity numbers. The viability of standardisation across emergency admissions by condition and condition grouping (ambulatory care sensitive , Long Term Conditions, alcohol related).

4

Emergency Admissions and the influence of Deprivation

The bar chart below shows the age, gender and deprivation standardised emergency admissions rate by GP Practice. The red bars show practices significantly above the indirectly standardised rate for Dudley (SAR).

If all the practices significantly above the Dudley SAR reduced admissions to the expected rate there would be a reduction of 2,323 admissions per year. However, if Dudley were to achieve the expected rate for the West Midlands there would need to be a reduction of 7,886 emergency admissions. All practices have a different profile of emergency admissions. The following page compares two practices to illustrate these differences.

Comparison of Emergency Admissions Profiles – 2 Practices

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Top 3 reasons 1. Unspecified Acute Lower Respiratory

Infection 2. Viral Infections 3. Pain Localised to Upper Abdomen

Top 3 reasons 1. Unspecified Acute Lower Respiratory

Infection 2. Urinary Tract Infection 3. Viral Infections

Bean Medical Keelinge House

Readmissions Percentage Readmissions Percentage

Admission Percentage by Day

Admission Length of Stay Proportions

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DUDLEY CLINICAL COMMISSIONING GROUP


Date of Report: 21 October 2016 Report: Influenza Immunisation Programme Update

Agenda item No: 10.0

TITLE OF REPORT: National flu immunisation programme 2016/17

PURPOSE OF REPORT: To update the Committee on the Influenza Immunisation Programme 2016/17

AUTHOR OF REPORT: Ms T Jeavons, Primary Care Contracts Support Officer

MANAGEMENT LEAD: Mr D King, Head of Membership Development & Primary Care


KEY POINTS:

• CCG fully engaged with Dudley Public Health and NHS England Screening and Immunisation teams

• Responsibilities of each organisation for 2016/17 flu programme determined

• Flu lead nominated to provide clinical leadership and support • Key priorities include increasing uptake in the children’s

programme and those most at risk

RECOMMENDATION: The Committee to note the report for assurance



• NHS England • Public Health England • Dudley Public Health Immunisation Team

ACTION REQUIRED:

Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE – 21 October 2016 INFLUENZA IMMUNISATION PROGRAMME 2016/17 UPDATE 1.0 INTRODUCTION

1.2 NHS England - Public Health England commission the annual Influenza immunisation programme through general practice and community pharmacies.

1.3 The aim is to build further on last winter to increase vaccine uptake rates, particularly among

those who are most vulnerable to the effects of flu. 2015/16 uptake and 2016/17 targets are attached at Appendix 1.

2.0 TARGET GROUPS 2.1 In 2016/17, flu vaccinations will be offered as an NHS service to the following groups:

• people aged 65 years or over (including those becoming age 65 years by 31 March 2017) • people aged from 6 months to less than 65 years of age with a serious medical condition such as: − chronic (long-term) respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis − chronic heart disease, such as heart failure − chronic kidney disease at stage three, four or five − chronic liver disease − chronic neurological disease, such as Parkinson’s disease or motor neurone disease, or learning disability − diabetes − splenic dysfunction − a weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment) • all pregnant women (including those women who become pregnant during the flu season) • all those aged two, three, and four years (but not five years or older) on 31 August 2016 (ie date of birth on or after 1 September 2011 and on or before 31 August 2014) through general practice29 • all children of school years 1, 2 and 3 age through locally commissioned arrangements30 • primary school-aged children in areas that have been participating in primary school pilots since 2014/15 • people living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality. This does not include, for instance, prisons, young offender institutions, or university halls of residence • people who are in receipt of a carer’s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill • consideration should also be given to the vaccination of household contacts of immunocompromised individuals, specifically individuals who expect to share living accommodation on most days over the winter and therefore for whom continuing close contact is unavoidable.

3.0 RESPONSIBILITIES

3.1 Members of the CCG Primary care team held a Flu Steering Group meeting on 23rd August 2016 with Hayley Farrell, Screening & Immunisation Coordinator, Public Health England, Barry

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Jones, Interim Nurse Consultant Communicable Disease, Office of Public Health Dudley and Lesley Cliff, Clinical Nurse Advisor, Immunisation Office of Public Health, Dudley. The responsibilities of each organisation were determined.

3.2 CCG responsibilities include:

• General Practice promotion via weekly communications and locality meetings • CCG to monitor practice uptake and act accordingly • CCG communications team to liaise with and support NHS England communications team • Promote and make flu vaccination available to all CCG staff

3.3 NHS England will be using the advertising methods below supported by the CCG:

• Adverts in local magazines, newspapers and twitter • Advertising on Free radio during Oct and Nov • Periodical press releases • Advertising on West Midlands buses • Leaflet and poster distribution to pharmacies, libraries, children’s centres, Dudley Group

maternity unit and care homes

3.4 Dudley CCG will promote through “Stay Well This Winter”

3.5 Dr Horsburgh is nominated as CCG Flu lead to provide clinical leadership and support 4.0 MONITORING 4.1 NHSE will supply monthly information to the CCG and Office of Public Health local team. The

CCG will share and discuss this information through practice performance visits and locality meetings.

4.2 Poorly performing practices will be contacted by NHSE to gather information around problems

being experienced. 4.3 Those practices underachieving will be targeted directly by the CCG, support will be provided

by the members of the primary care team to include the GP Engagement Lead and Practice Nurse mentors.

5.0 EDUCATION 5.1 3 sessions to support the Influenza immunisation programme were provided by NHS England

local team in August/September

o 2 commissioned by Future Proof Health o 1 commissioned by the Dudley Practice Managers Association

6.0 RECOMMNDATION

The Committee is asked to note the report for assurance

Table 2: 2015/16 % Flu immunisation uptake

Table 3: National targets for flu immunisation 2016/17

Group 2016/17 Target Target Narrative DCO 2015/16 performance

Aged 65 + 75% Based on WHO recommendation

• 4.7% improvement needed in 2015/16 • 70.3% in 2015/16 • No CCG met 75% target in 2015/16

< 65 at risk 55%

55% target at clinical-risk group level with improvement where 55% was met last year

• 8.8% improvement needed in 2016/17 • 46.2% in 2015/16 • No CCG met 55% in 2015/16

Children 40-65% Expect target to be met across localities and across age groups

• 40.2% overall uptake in 2015/16 (GP31.4%, SAIS 54.4%)

• Need to improve GP uptake by 8.6% and maintain/improve SAIS uptake in 2016/17

HCW 75% Trust level objective supported by a national CQUIN

• 24.4% improvement needed in 2016/17 • 50.6% achieved in 2015/16

Area % uptake

GP/Pharmacy delivery School delivery 65+ <65 Preg 2 yrs 3 yrs 4yrs 5yrs 6yrs

WM DCO 70.3 46.2 43.6 32.3 34.9 27.1 54.7 54.2 ENGLAND 71.0 45.1 42.3 35.4 37.7 30.0 54.4 52.9

NHS BIRMINGHAM CROSSCITY CCG 68.4 42.0 38.6 25.1 27.4 21.1 Bham 42.8

Bham 42.4 NHS BIRMINGHAM SOUTH AND CENTRAL CCG 71.1 48.8 45.7 27.4 31.9 22.3

NHS SANDWELL AND WEST BIRMINGHAM CCG 67.7 44.5 40.2 30.5 32.5 24.0 Sand 53.0

Sand 54.3

NHS WOLVERHMAPTON CCG 68.4 44.8 45.3 30.7 35.2 26.1 58.2 56.4 NHS DUDLEY CCG 70.4 47.3 46.3 38.1 40.0 30.6 53.0 54.3

NHS WALSALL CCG 69.8 47.8 47.3 30.2 34.3 26.7 47.7 48.4 NHS SOLIHUL CCG 70.7 42.7 42.3 32.2 33.2 27.0 58.4 57.0

NHS WARWICKSHIRE NORTH CCG 69.2 44.9 44.8 33.9 35.4 28.5 64.0 64.3

NHS SOUTH WORCESTERSHIRE CCG 72.5 50.4 44.1 45.1 45.0 36.1 NHS COVENTRY AND RUGBY CCG 69.5 47.1 47.9 28.8 33.8 26.6 67.3 66.2

NHS HEREFORDSHIRE CCG 69.3 48.5 40.9 36.3 40.9 32.0 64.7 67.0 NHS WYRE FOREST CCG 74.0 51.5 51.5 38.8 40.6 33.6

65.2 65.9 NHS REDDITCH AND BROMSGROVE CCG 71.8 46.4 44.4 38.4 38.3 30.0 NHS SOUTH WARWARKSHIRE CCG 74.2 50.6 48.4 49.0 47.9 41.8

Performance in the 25% of lowest performing CCGs in ENGLAND (LAs for school programme) Performance in the 25% of highest performing CCGs in ENGLAND (LAs for school programme)

APPENDIX 1

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Date of Committee: 21 October 2016 Report: Primary Care Commissioning Committee – Revised Terms of Reference

Agenda Item: 11.0

TITLE OF REPORT: Primary Care Commissioning Committee – Revised Terms of Reference

PURPOSE OF REPORT: To present to the Committee a revised draft of the Terms of Reference (TOR) for comment and approval.

AUTHOR OF REPORT: Mr D King, Director of Membership Development and Primary Care

MANAGEMENT LEAD: Mr D King, Director of Membership Development and Primary Care


KEY POINTS:

• General amendments have been made to incorporate the standard CCG format for TOR

• Additional information included with regards secretarial support (Section 3)

• Additional information included with regards the management of Conflicts of Interest process (section 8)

• Updates have been made to the Schedules (page 8) • Recommendation to review the membership to ensure this is fully

reflected now the Committee has progressed and in light of new appointments

• Recommended to include the wording suggested in Section 2.6 • Recommendation to indicate who is the Vice Chair in the TOR

RECOMMENDATION: The Committee is asked to discuss the recommendations and approve in principle TOR version 2.


WHAT ENGAGEMENT HAS TAKEN PLACE: • Governance Team


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Governing Body’s

Primary Care Commissioning Committee

Terms of Reference – Version 2.0

AMENDMENT HISTORY VERSION DATE AMENDMENT HISTORY V1.0 December 2014 First Draft of PCC TOR V1.0 May 2015 Presented to Board for approval V1.0 October 2016 Governance Team reviewed with PC Team REVIEWERS This document has been reviewed by: NAME DATE TITLE/RESPONSIBILITY VERSION Paul Lewis-Grundy May 2015 Governance Manager V1.0 Emma Smith October 2016 Governance Support Manager V2.0 Julie Robinson October 2016 Primary Care Contracts Manager V2.0 APPROVALS This document has been approved by: VERSION BOARD/COMMITTEE DATE V1.0 Dudley CCG Board May 2015

NB: The version of this policy posted on the intranet must be a PDF copy of the approved version. Please note that any changes to these Terms of Reference must be done in line with the Terms of Reference Development Guidance. Changes must be agreed at Committee and ratified through the Governing Body. The Governance Team must be included in any revision to ensure that the statutory duties are unaffected and in line with the CCGs Constitution.

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Primary Care Commissioning Committee – Terms of Reference 1. Introduction & Purpose 1.1. The Primary Care Commissioning Committee (the ‘Committee’) is established in

accordance with paragraph 6.9.3(h) of NHS Dudley Clinical Commissioning Group’s (CCG) constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and will have effect as if incorporated into the constitution. The Committee terms of reference will be reviewed annually. Any changes to the terms of reference will be approved by the Governing Body.

1.2. The Chief Executive of NHS England, announced on 1 May 2014 that NHS England

was inviting CCGs to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG’s preference for how it would like to exercise expanded primary medical care commissioning functions. One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to a CCG.

1.3. In accordance with its statutory powers under section 13Z of the National Health Service

Act 2006 (as amended). NHS England has delegated the exercise of the functions specified in Schedule 2 to these terms of reference to NHS Dudley CCG. The delegation is set out in Schedule 1.

1.4. The CCG has established the NHS Dudley CCG Primary Care

Commissioning Committee (“Committee”). The Committee will function as a corporate decision- making body for the management of the delegated functions and the exercise of the delegated powers.

1.5. It is a committee comprising representatives of the following organisations:

• NHS Dudley CCG; and • The Office of Public Health, Dudley Metropolitan Borough Council • A representative from NHS England will also be in attendance

2. Membership

2.1 Each member of the Committee as defined in Schedule 3 shall have one vote. The

Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary.

2.2 All independent members of the governing body except the Chair of the Audit Committee

will be eligible for membership. That is:

• Lay member for Governance (Chair) • Lay member for Quality & Safety • Secondary Care Specialist Doctor • Chief Operating & Finance Officer • Chief Quality & Nursing Officer • Public Health representative

2.3 The Chair of the Committee will be appointed by the Governing Body. Unless there are

any material reasons for not doing so this person will be the Governing Body lay member responsible for governance matters. Where the latter is not the case the material reasons must be documented.

2.4 The Vice Chair of the Committee will be appointed by the Committee members.

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2.5 Other people that will normally be in attendance (members but non-voting) will include a:

• HealthWatch representative • Health and Wellbeing Board representative • Patient Opportunity Panel representative • LMC representative • GP Lay Member

2.6 Governing Body elected GPs, Clinical Executives, other GP members or employees of the

CCG (not already listed in the membership) will be in attendance for those agenda items that the Committee membership has deemed appropriate for their input. This will be in an advisory and non-voting capacity. The CCG’s “Registering Interests and Managing Conflicts of Interest Policy” will be observed and complied with at all times.

3. Secretary 3.1 A named individual will be responsible for supporting the Chair in the management of the

Committee’s business and for drawing members’ attention to best practice, national guidance and other relevant documents as appropriate.

4. Quorum 4.1 A meeting of the Committee will be quorate provided that at least 4 members are present

of which:

• One must be either the Chair or Vice-Chair of the Committee • One must be the Chief Operating & Finance Officer or Chief Quality & Nursing Officer

5. Frequency of meetings 5.1 The Committee will formally meet on a monthly basis. There may be a need for the

Committee to meet informally from time to time. Any informal meetings will support the work of the Committee and will have no delegated decision-making authority.

5.2 Meetings of the Committee shall:

a. Be held in public, subject to the application of 27 b. the Committee may resolve to exclude the public from a meeting that is open to the public

(whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest be reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

6. Authority & Statutory Framework 6.1 The Committee will be directly accountable for the commitment of the resources /

budget delegated to the CCG by NHS England for the purpose of commissioning primary care medical services. This includes accountability for determining appropriate arrangements for the assessment and procurement of primary care medical services, and ensuring that the CCG’s responsibilities for consulting with its GP members and the public are properly accounted for as part of the established commissioning arrangements.

6.2 For the avoidance of doubt, the CCG’s Scheme of Reservation & Delegation, Standing

Orders and Prime Financial Policies will prevail in the event of any conflict between these

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terms of reference and the aforementioned documents.

Statutory Framework 6.3 NHS England has delegated to the CCG authority to exercise the primary care

commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act.

6.4 Arrangements made under section 13Z may be on such terms and conditions (including

terms as to payment) as may be agreed between NHS England and the CCG. 6.5 Arrangements made under section 13Z do not affect the liability of NHS England for the

exercise of a ny of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act, including:

a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2).

6.6 The CCG will also need to specifically, in respect of the delegated functions from NHS

England, exercise those functions set out below:

• Duty to have regard to impact on services in certain areas (section 13O); • Duty as respects variation in provision of health services (section 13P).

6.7 The Committee is established as a committee of the Governing Body of NHS Dudley CCG in

accordance with Schedule 1A of the “NHS Act”. 6.8 The CCG (and Committee) is subject to directions made by NHS England or by the

Secretary of State for Health. 7. Remit Duties and Responsibilities Operation of the Committee 7.1 The Committee will operate in accordance with the CCG’s Standing Orders and “Registering

Interests and Managing Conflicts of Interest Policy”. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than 5 working days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify. The reasons for calling a meeting at short notice will be recorded in the minutes of the meeting.

7.2 GPs and patients are represented in the committee through the inclusion of non-voting

members from the LMC; Healthwatch and the Patient Opportunity Panel. 7.3 Members of the Committee have a collective responsibility for the operation of the Committee. 7.4 The Committee may delegate tasks to such people, sub-committees or individual members

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as it shall see fit, provided that any such delegations are consistent with the CCG’s relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

7.5 The Committee may call experts, as required, to attend meetings and inform discussions. 7.6 Members of the Committee shall respect confidentiality requirements as set out in the CCG’s

Constitution, and comply with Section 8 of the Constitution: Standards of Business Conduct and Managing Conflicts of Interest.

7.7 Following each meeting, the Committee will present its minutes to NHS England and

report to the governing body of the CCG (including the minutes of any sub- committees to which tasks have been delegated under paragraph 32 above).

7.8 The Committee will also comply with any reporting requirements set out in the

CCG Constitution. Procurement of Agreed Services 7.9 The procurement arrangements will be set out in the delegation agreement (Schedule 1 and

Schedule 2 to this Terms of Reference) between NHS Dudley CCG and NHS England. Decisions 7.10 The Committee will make decisions within the bounds of its terms of reference. 7.11 The decisions of the Committee shall be binding on NHS England and NHS Dudley CCG

where they are within the bounds of the terms of reference. Role of the Committee 7.12 The Committee has been established in accordance with the above statutory provisions

to enable decisions on the review, planning and procurement of primary care services in Dudley, under delegated authority from NHS England.

7.13 In performing its role the Committee will exercise its management of the functions

in accordance with the agreement between NHS England and NHS Dudley CCG. 7.14 The functions of the Committee are undertaken in the context of continually improving

the quality of care provided to patients within the resources available. This is underpinned by equality of access to services, increased efficiency, productivity, value for money and to minimise bureaucracy.

7.15 The Committee will have at its heart three key principles, of shared ownership,

shared responsibility and shared benefits to create jointly the best healthcare for the registered patients of Dudley.

7.16 The role of the Committee shall be to carry out the functions relating to the commissioning

of primary medical services under section 83 of the NHS Act. 7.17 This includes the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

• Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”);

• Design of local incentive schemes as an alternative to the Quality Outcomes

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Framework (QOF); • Decision making on whether to establish new GP practices in an area; • Approving practice mergers; and • Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

7.18 The CCG will also carry out the following activities:

a) To plan for sustainable primary medical care services in Dudley; b) To review primary medical care services in Dudley with the aim of further improving the

care provided to patients c) To co-ordinate the approach to the commissioning of primary care services generally; d) To manage the budget for commissioning of primary medical care services in Dudley.

Geographical Coverage 7.19 The Committee will be responsible for commissioning primary care medical

services coterminous with the geographical boundaries of NHS Dudley CCG. Partnership 7.20 The Committee will be responsible for working with other statutory and voluntary agencies

to maximise the benefits from investment in primary care services for the people served by the CCG.

8. Managing Conflicts of Interest 8.1 Conflicts of interest are a common and sometimes unavoidable part of the delivery of

healthcare. The CCG is required to manage any conflicts of interest through a transparent and robust system. Members of the Committee are encouraged to be open and honest in identifying any potential conflicts during the meeting. The Chair of the Committee will be provided with the latest Declaration of Interest register at each meeting and will be required to recognise any potential conflicts that may arise from themselves or a member of the meeting.

8.2 It is imperative that CCGs ensures complete transparency in any decision-making processes

through robust record-keeping. If any conflicts of interest are declared or otherwise arise in a meeting, the chair must ensure the following information is recorded in the minutes; who has the interest, the nature of the interest and why it give rise to a conflict; the items on the agenda to which the interest relates; how the conflict was agreed to be managed and evidence that the conflict was managed as intended.

9. Relationship with the Governing Body

9.1 The Committee is accountable to the governing body to ensure that it is effectively

discharging its functions.

9.2 For the next meeting of the governing body following each meeting of the Committee, the Chair of the Committee will provide a written summary of the key matters covered by the meeting, including any action or decisions reserved for the governing body.

9.3 A report from of each meeting of the Committee will be presented to the next meeting of the

governing body for information by the Chair of the Committee. 10. Review of Committee Effectiveness 10.1 The Committee will annually self-assess and report to the governing body and NHS England

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on its performance in the delivery of its objectives. 10.2 The Committee’s terms of reference will be reviewed annually. 10.3 Any changes to the terms of reference will be approved by the governing body.

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Schedule 1 – Scheme of Delegation Available on request Schedule 2 – Delegated Commissioning Functions The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act. This includes the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

• Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”);

• Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

• Decision making on whether to establish new GP practices in an area; • Approving practice mergers; and • Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

Delegated commissioning arrangements exclude individual GP performance management (medical performers’ list for GPs, appraisal and revalidation). NHS England will retain responsibility for the administration of payments and list management. Schedule 3 - Membership Voting Members Lay member for Governance (Chair) Lay member for Quality & Safety Secondary Care Specialist Doctor Chief Operating & Finance Officer Chief Quality & Nursing Officer Public Health representative Non-Voting Members HealthWatch representative Health and Wellbeing Board representative Patient Opportunity Panel representative LMC representative GP Lay Member In Attendance Director of Primary Care and Membership Development Primary Care Contracts Manager Primary Care Commissioning Manager NHS England Manager

Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2015/16

07-Oct-16

1A Primary care and Multi Speciality Community Provider (MCP) development

NOTE: TREND IN RESIDUAL RISK AGAINST PREVIOUS MONTH IS SHOWN //=

ID Original Date Last Review

(Committee

Date)

Last Update

(Risk

Amended)

LIN

K T

O

CO

RP

OR

AT

E

OB

JE

CT

IVE

(S

EE

KE

Y A

BO

VE

)

Risk Description Accountable

Committee

Accountability

Sponsor & Owner

Management Lead

P I

Initial Risk

Score (PxI)

Score

before any

controls are

in place.

Key Controls

What controls/systems are in

place to assist in securing

delivery of our

objective. Such as strategies,

policies and procedures

Gaps in Control

Where are we failing to put

controls/ systems in place. /

Where are we failing in

making them effective. For

example lack of training or no

regular review of performance

Gaps in Assurance

Where are we failing to gain

evidence that our controls/

systems, on which we place

reliance, are effective. Such as

no assurance a strategy or

policy is effective

(R) P (R) I

Residual

Risk Score

(PxI)

Score

following

controls put

in place

Risk Trend Internal Assurances

Board Reports, Minutes

of meetings

External Assurances

Internal and External

Audit Reports, CQC

Reports

Actions

To improve control, ensure delivery of

principal objectives, gain assurance

Timescales

Date action will be

completed

COMMENTS

34 22/04/2013 30/09/2016 07/03/2016 2

The impact of significant individual

performance issues in relation to

primary medical services that could

result in removal of GP member from

the Performers' List

PCC Steve Wellings Dan King 4 4 16

GP Contracts / Appraisals

Peer Review Audit

Training and Education

GMC Registration

GP under performance referred to

the NHS England Professional &

Practice Information Gathering

Group (PIGG)

None identified. None identified 2 1 2 =

Primary Care

Operational Group

reporting into Primary

Care Commissioning

Committee and Quality

and Safety Committee

GMC Registration

Two way communication

between the CCG PCOG

and the PIGG at NHS

England

GP / Nurse Mentoring

Commissioning of Services for Primary

Care

GP Education, training and Development

On-going

50 04/08/2014 30/09/2016 15/07/2016 2

Failure of member practices to meet

the standards of the Care Quality

Commission risks continuity of

service provision in member

practices.


Relationship with the Link

Inspector at the CQC who is

invited to attend the Primary Care

Operational Group (PCOG).

Training and Development with

Practices to help them manage

inspections.

Blue Stream online academy.

Quality Assurance Manager for

Primary Care appointed and in

post. PCOG and PCC following

NHS England "Framework for

responding to CQC inspections of

GP practices". CCG has support

process and package in place for

all practices.

Further develop the working

arrangements with NHS

England Professional & Practice

Information Gathering Group.

None identified 4 3 12 =

All CQC inspection

reports considered in the

Primary Care

Operational Group and

coordinated actions in

place between CCG,

NHS England and CQC.

CQC Reports and

associated action plans

from GP Practices.

Develop a quality framework and Care

Quality Review Meeting (CQRM) for

Primary Care

On-Going

Residual risk score increased from

9 to 12 as a result of CQC

inspection and statutory

enforcement notices issued to

Quincy Rise

59 29/10/2014 30/09/2016 27/05/2016 3

The ability of member practices to

fulfil their contractual obligations and

provide primary medical services as a

result of difficulties recruiting

substantive GPs


Developing and implementing the

new model of care - Dudley

Multispecialty Community Provider

(MCP). As part of the new model,

developing and investing in the

clinical and non clinical

infrastructure and estate to deliver

the model.

N/A 3 3 9 =

Engagement visits with

all GP practices.

Workforce data

collection. Developing

and investing in the


infrastructure and

professional

development to

implement the new

model of care.

NHS England and Health

Education England

commitment to training

and professional

development. New

models of care team

supporting the Dudley

Vanguard MCP model of

care and development.

Successful bids to the new models of

care team for additional investment and

support to enable the implementation of

the new model of care.

On-GoingResidual Risk score to be

considered by the Committee

69 22/05/2015 30/09/2016 15/07/2016 2

Loss of Primary Care Medical

Services as a result of increasing

overheads and financial pressure on

member practices beyond their

control i.e. increasing cost of medical

indemnity insurance, rent increases

and financial sustainability of

operating branch surgery sites.





(MCP). As part of the new model,

developing and investing in the


infrastructure and estate to deliver

the model.

None identified. N/A 1 3 3 =

Engagement visits with

all GP practices.

Workforce data

collection. Developing

and investing in the


infrastructure and

professional

development to

implement the new

model of care.

Successful bids to the

new models of care team

for additional investment

and support to enable

the implementation of the

new model of care.

New models of care team

supporting the Dudley

Vanguard MCP model of

care and development.

Education, training and support.

Providing access to specialist advice and

support. Coordinating and supporting

practices liaising with NHS property

services regarding rent increases.

Investing in systems and creating

processes that enable improvements in

practise efficiency i.e. practice

development programmes.

Implementation of the new model of care

including successful bid to the new model

of care team for additional investment,

and the development and implementation

of the estates strategy.

Publication of the GP Forward View

Mar-17

81 05/10/2015 30/09/2016 30/09/2016 1

The reputational risk to the CCG

through branch closures

The risk to provision of primary

medical services arising from brand

surgery closures.


GP Practices need to undertake

statutory Consultation and apply to

CCG, which has full authority to

decide on an application

None None 3 3 9 =Application considered

by PCOG decision by

PCCC

NHS England Policy

which CCG adopted

under delegated primary

care commissioning

Support GP Practices in the consultation

process.

Primary Care contracts manager meeting

practices to take through contractual

process in terms on branch closures.

Finance & IT provide advice on financial

advice and IT infrastructure advice.

Oct-16Changes made to Risk

Description for clarity of purpose

96 17/06/2016 30/09/2016 17/06/2016 4

That increases in the cost of facilities

management and service charges of

buildings owned by NHS Property

Services (NHSPS) may destabilise

the finances of General Practices,

leading to loss of services.

PCC Steve Wellings Daniel King 2 3 6

The CCG has set up a working

group of affected practices to

ensure visibility of issues and co-

ordinate practice responses, and

has offered to act on practices’

behalf in dealing with NHSPS to

resolve existing disputes.

Further development of CCG

and practice relationships with

NHS Property Services is

required.

2 3 6 =

Liaise with NHS Property Services on

behalf of General Practices and use

tenants’ forum to identify common issues

and approaches to resolution

Sep-16

100 31/05/2016 30/09/2016 19/08/2016 1Unexpected branch closure due to

dispute between landlord and tenantPCC Steve Wellings Daniel King 4 4 16

General Medical Services

Contract.None

General Medical Services limited

when matter relates to private

legal dispute disrupting the

provision of General Medical

Services.

3 3 12 =Regular reports to

PCOG and PCCC

Press statements, briefing

to MP, Health Overview

and Scrutiny Committee

Direct rental payments arranged with

landlord, legal advice sought to facilitate

dispute, public communication on the

dispute and actions taken to resolve.

Sep-16

Risk created from Committee in

August 2016 Julie Robinson to

complete a New Risk Form. Time

Limited Risk - which has now been

resolved and the practice is due to

open 17 Oct 2016

RECOMMENDATION TO AUDIT

COMMITTEE TO CLOSE THE

RISK AS THIS HAS NOW BEEN

RESOLVED.

3. Improving quality and safety 3A Ensure on-going safety and performance of the system

4. System effectiveness

4B Primary Care contract

STRATEGIC AIMS

1. Reducing health inequalities

2. Delivering best possible outcomes

4A Procure the MCP

4C Actively participate in the Black Country Sustainability Transformation Plan (STP)

OBJECTIVES 2016/17

2A Ensure appropriate procurement of secondary care services

2B Public engagement on model and procurement

2C Develop the CCG: Fit for purpose for the future2D Performance management of the system and Value Propisition (VP) implementation

ID Original Date Last Review

(Committee

Date)

Last Update

(Risk

Amended)

LIN

K T

O

CO

RP

OR

AT

E

OB

JE

CT

IVE

(S

EE

KE

Y A

BO

VE

)

Risk Description Accountable

Committee

Accountability

Sponsor & Owner

Management Lead

P I

Initial Risk

Score (PxI)

Score

before any

controls are

in place.

Key Controls

What controls/systems are in

place to assist in securing

delivery of our

objective. Such as strategies,

policies and procedures

Gaps in Control

Where are we failing to put

controls/ systems in place. /

Where are we failing in

making them effective. For

example lack of training or no

regular review of performance

Gaps in Assurance

Where are we failing to gain

evidence that our controls/

systems, on which we place

reliance, are effective. Such as

no assurance a strategy or

policy is effective

(R) P (R) I

Residual

Risk Score

(PxI)

Score

following

controls put

in place

Risk Trend Internal Assurances

Board Reports, Minutes

of meetings

External Assurances

Internal and External

Audit Reports, CQC

Reports

Actions

To improve control, ensure delivery of

principal objectives, gain assurance

Timescales

Date action will be

completed

COMMENTS

105 08/06/2016 30/09/2016 30/09/2016 4B

Lack of resilience within the primary

care workforce and the fragmented

nature of current GP provision results

in a failure to meet patient demandPCC Steve Wellings Daniel King 3 3 9




(MCP). NHSE GP Resilience

Programme. Dudley Primary Care

Development Group & investment.

None None 2 2 4 =

Primary Care

Development Steering

Group reports to Primary

Care Commissioning

Committee.

Implementation updates

provided to NHS England

and New Care Models

Team.

None identified Mar-17

RECOMMENDATION TO AUDIT

COMMITTEE TO CLOSE THE

RISK AS THIS IS COVERED

UNDER RISK 59

118 08/06/2016 30/09/2016 30/09/2016 1A

Lack of clinical and managerial

capacity and capability for primary

care to deliver the required

transformation and operate primary

care at scale


Primary Care Development

Steering Group established and co-

ordinating and developing plans to

enable practices to improve and

change.


Primary Care

Development Steering

Group reports to the

Primary Care

Commissioning

Committee

Primary Care

Commissioning

Committee reports to

NHS England

None identified Mar-17

This Risk was approved by the

Committee subject th sponsor

being changed to Steve

Wellings

119 08/06/2016 30/09/2016 30/09/2016 4B

Where there is poor quality GP estate

that compromises the ability of

practices to deliver General Medical

Service contracts


Primary Care Estates Strategy and

participation and support of CCG to

enable access to National funding

streams.


The CCG agreed its

Estates Strategy.

Practical support

available to practices to

prepare and access

National funding

streams.

None identified None identified On-goingThis Risk was approved by the

Committee with the

alterationsas outlined.

120 08/06/2016 30/09/2016 3A

Quality and safety compromised by

the use of online consultations

(reduction in face to face

consultations)

PCC 0 0 NEW

This has been dsicussed at

Q&S and it was proposed that

this should be considered at

PCCC

1

GLOSSARY

ABBREVIATIONS

Abbreviation Meaning

#NOF Fractured Neck of Femur

£K £1,000 equivalent

A&E Accident and Emergency

ABC / ABCD Above and Beyond the Call of Duty (Local surveys which include praise for

nominated staff members as well as assessment of services)

ACS Acute Coronary Syndrome

AD Assistant Director

AfC Agenda for Change

AGM Annual General Meeting

AHSN Academic Health Science Networks

ALE Auditors Local Evaluation

ALOS Average Length of Stay (in hospital)

AMI Acute Myocardial Infarction

AMMC Area Medicines Management Committee

Anti-D An antibody occurring in pregnancy

Anti-TNF Drugs used in the treatment of rheumatoid arthritis and Crohn’s disease

AQP Any Qualified Provider

ARIF Aggressive Research Intelligence Facility

ASAP As soon as possible

AVE Advertising Value equivalent

BACs Bank Automated Credit

BAF Board Assurance Framework

BCC Black Country Cluster

BCF Better Care Fund

BCPFT Black Country Partnership NHS Foundation Trust

BFT Behavioural Family Therapy

BMA British Medical Association

BME Black Minority Ethnic

BMJ British Medical Journal

BPAS British Pregnancy Advisory Board

BSCCP British Society of Colposcopy and Cervical Pathology

2

CAB Citizens Advise Bureau

CAO Chief Accountable Officer

CAMHS Children and Adolescent Mental Health Service

CASH Contraception and Sexual Health

CCBT (CBT) Computerised Cognitive Behavioural Therapy

CCG Clinical Commissioning Group

CCRN Comprehensive Clinical Research Networks

CDC Commissioning Development Committee

CDiff Clostridium difficile

CEO Chief Executive Officer

CFO Chief Finance Officer

CHADD The Churches Housing Association of Dudley & District Ltd

CHC Continuing Healthcare

CHD Coronary Heart Disease

CLT Collaborative Leadership Team

CMO Chief Medical Officer

CNST Clinical Negligence Scheme for Trusts

CNT Community Nursing Team

COSHH Control of Substances Hazardous to Health Regulations 2002

CPA Care Programme Approach

CPN Community Psychiatric Nurse

CRL Capital Resource Limit

CRRT Community Rapid Response Team

CSU Commissioning Support Unit

CT scan Computer Topography

CQC Care Quality Commission

CQNO Chief Quality and Nursing Officer

CQUIN Commissioning for Quality and Innovation

CQRM Clinical Quality Review Meeting

CSG Clinical Strategic Group

CVD Cardio Vascular Disease

D&N Dudley and Netherton (Locality)

DACHS Directorate of Adult Children and Housing Services

DCS Dudley Community Services

DCVS Dudley Community Voluntary Service

DES Directed Enhanced Service

DfES Department for Education and Skills

DGFT Dudley Group Foundation Trust

DMO Designated Medical Officer

DNA Did not attend

3

DoH Department of Health

DoLS Deprivation of Liberty Safeguards

DoS Directory of Service

DPMA Dudley Practice Managers Alliance

DSCB Dudley Safeguarding Children’s Board

DTC Diagnostic and Treatment Centre

DToC Delayed Transfer of Care

DWMHPT Dudley and Walsall Mental Health Partnership Trust

DXA Dual X-ray Absorptiometry (measures bone density).

E&D Equality and Diversity

EAU Emergency Assessment Unit

ECA Extra Care Area

ECM Every Child Matters

ECT Electroconvulsive Therapy

ED Emergency Department

EI Early Implementer

EI Early Intervention

EMI Elderly Mentally Ill

EMIS Education Management Information System

EoL End of Life

EPP Expert Patients Programme

EPR Electronic Patient Record

EPRR Emergency, Preparedness, Resilence, Response

ERT Enzyme Replacement Therapy

ESR Electronic Staff Record

FCEs Finished Consultant Episodes

FED Forum for Education and Development

FFT Friends and Family Test

FHS Family Health Services

FMC Facility Management Centre

FOI Freedom of Information

FYE Full Year Effect

FYFV Five Year Forward View

GGI Good Governance Institute

GMS General Medical Services

GOWM Government Office for the West Midlands

GP General Practitioner

GPAQ General Practice Assessment of Quality

GPwSI GP with Special Interest

GU Genito-urinary

4

GUM Genito-urinary Medicine

H&QB Halesowen and Quarry Bank (Locality)

HCAI Healthcare Associated Infections

HCF Healthcare Forum

HEE Health Education England

HENIG Health Economy NICE Implementation Group

HF Heart Failure

HIC Health Improvement Centre

HIV Human Immunodeficiency Virus

HPA Health Protection Agency

HPS/S Health Promoting Schools / Service

HPU Health Protection Unit

HR Human Resources

HSC Health and Safety Commission

HSCQC Health and Social Care Quality Centre

HSE Health and Safety Executive

HSMC Health Services Management Centre

HT Home Treatment

HV Health Visitor

HWBB Health and Well-being Board

IAPT Improved Access to Psychological Therapies

IC Infection Control

ICAS Independent Complaints Advocacy Service

ICE Integrated Commissioning Executive

ICNA Infection Control Nurses Association

ICP Integrated Care Pathway

IFR Individual Funding Request

IG Information Governance

IOSH Institute of Occupational Safety and Health

IT Information Technology

IUCD Intrauterine Contraceptive Device

JCAB Joint Clinical Advisory Board

JCC Joint Consultative Committee

JD Job Description

JSA Joint Strategic Assessment

KAB Kingswinford, Amblecote and Brierley Hill (Locality)

KLOE Key Lines of Enquiry

KPI Key Performance Indicators

LAA Local Area Agreement

LAC Looked After Children

5

LAT Local Area Team

LD Learning Disability

LDP Local Delivery Plan

LEA Local Education Authority

LIFT Local Improvement Finance Trust

LIG Local Implementation Group

LIT Local Implementation Team

LMC Local Medical Committee

LNG Local Negotiating Committee

LPS Local Pharmaceutical Scheme

LRF Local Resilience Forum

LTC Long Term Conditions

LVD Left Ventricular Dysfunction

LVSD Left Ventricular Systolic Dysfunction

MAPA Management of Actual and Potential Aggression

MAU Medical Assessment Unit

MBC Metropolitan Borough Council

MCP Multi-speciality Community Provider

MDT Multi Disciplinary Team

MIMT Major Incident Management Team

MIRE Major Incident Response Executive

MLSOs Medical Laboratory Scientific Officers

MRSA Methicillin Resistant Staphylococcus Aureus

MSS Medium Secure Service

NCA Non contract activity

NCB National Commissioning Board

NCM New Care Model

NCRS National Care Record System

NELHI National Electronic Library for Health Information

NFI National Fraud Initiative

NICE National Institute for Clinical Excellence

NGMS New General Medical Services

NHS National Health Service

NHSCPT NHS Community Practice Teacher

NHSCSP NHS Cancer Screening Programme

NHSE NHS England

NHSLA NHS Litigation Authority

NHSP National Healthy Schools Programme

NICE National Institute for Clinical Excellence

NMC New Model of Care/Nursing and Midwifery Council

6

NOF New Opportunities Fund

NPfIT National Programme for IT

NPSA National Patient Safety Agency

NRF Neighbourhood Renewal Fund

NRLS National Reporting and Learning System

NSF National Service Framework

OAT Out of Area Treatment

OBD Occupied Bed Day

OD Organisational Development

ODM Oesophageal Doppler Monitoring

OOH Out of Hours

OPH Office of Public Health

OSC Overview and Scrutiny Committee

OT Occupational Therapist

PACS Primary and Acute Care Systems

PALS Patient Advice and Liaison Service

PAF Positive Assurance Framework

PAS Patient Administration System

PAU Paediatric Assessment Unit

PbR Payment by Results

PC Personal Computer

PCCC Primary Care Commissioning Committee

PCDSG Primary Care Development Steering Group

PCOG Primary Care Operational Group

PDF Portable Document Format

PDR Personal Development Review

PDS Personal Dental Services

PDSA Plan, Do, Study, Act

PDU Professional Development Unit

PE Pulmonary Embolism

PEAK Database holding the main registered details of patients and associated referral,

contact, caseload, outpatient, inpatient, MH Act and clinic information.

PEAT Patient Environment Action Team

PEPP Pooled Budget External Placement Panel

PFI Private Finance Initiative

PGD Patient Group Directives

PHE Public Health England

PICU Psychiatric Intensive Care Unit

PID Project Initiation Document

PIN Personal Identification Number

7

PMLD Profound and Multiple Learning Difficulties

PMS Primary Medical Services

PNA Pharmaceutical Needs Assessment

POPs Patient Opportunity Panels

PPA Prescription Pricing Authority

PPG Patient Participation Group

PSA Public Service Agreement

PSHE Personal and Social Health Education

PSIAMS Personal Social Impact Action Measurement System

PTCA Percutaneous Transluminary Coronary Angioplasty

Q&A Questions and Answers

Q&S Quality & Safety

QA Quality Assurance

QIB Quality Improvement Board

QIPP Quality, Innovation, Productivity and Prevention

QMAS Quality Management and Analysis System

QOF Quality and Outcome Framework

QPDT Quality and Practice Development Teams

RACPC Rapid Access Chest Pain Clinic

RAS Respiratory Assessment Service

RCA Root Cause Analysis

RCGP Royal College of General Practitioners

RES Race Equality Scheme

RHH Russells Hall Hospital

RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

RMO Responsible Medical Officer

RRL Revenue Resource Limit

RTT Referral to Treatment

SAP Single Assessment Process

SCG Sedgley, Coseley and Gornal (Locality)

SCIE Social Care Institute for Excellence

SCR Serious Case Review

SEPIA Mental health computer system

SFBH Standards for Better Health

SFI Standing Financial Instructions

SI Serious Incident

SIC Statement of Internal Control

SLA Service Level Agreement

SPA Single Point of Access

SRE Sex and Relationship Education

8

SRG System Resilience Group

SSD Social Services Department

SSDP Strategic Services Development Plan

STI Sexually Transmitted Disease

STP Sustainability and Transformation Plan

STRW Support, Time & Recovery Worker

SWL Stourbridge, Wollescote and Lye (Locality)

SWOT Strength, Weakness, Opportunity and Threat

TB Tuberculosis

TIA Transient Ischaemic Attack

TP Teenage Pregnancy

TPT Teenage Pregnancy Team

TTO To Take Out

UCC Urgent Care Centre

UHBT University Hospital Birmingham Trust

Vaccs & Imms Vaccinations and Immunisations

WAN Wide Area Network

WCC World Class Commissioning

WIC Walk in Centre

WMAS West Midlands Ambulance Service

WMHTAC West Midlands Health Technology Advisory Committee

WMSCG West Midlands Strategic Commissioning Group

WMSSA West Midlands Specialised Services Agency

WTE Whole Time Equivalent

YHC Young Health Champion

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