Primary Care Commissioning Committee ‘Committee in Common’ Part 1 Date: 8 June 2016 Time: 1.00 – 2.15pm Venue: Maritime House, Ground Floor, 1 Linton Road, Barking, Essex, IG11 8HG Item Time Lead Attached or verbal For Noting or Approval 1. Welcome and apologies 1.00 Chair – Richard Coleman 2. Declarations of interest 1.05 Chair Attached 3. 3.1 Minutes of last meeting 3.2 Actions log 1.10 Chair Attached For approval For approval 4. Budget Update 1.20 Tom Travers Verbal For noting 5. CQC action plan 1.25 Sarah See To follow For approval 6. Estates and Technology Transformation Fund 1.35 Sarah See Attached For noting 7. NHS England – CQC requires improvements SOP 1.45 Alison Goodlad Attached For noting 8. Contract Variations and discretionary payments (locum reimbursements) 2.00 Alison Goodlad To follow For approval 9. Risk register 2.05 Sarah See Attached For approval 10. Questions from public 2.10 Chair 11. Any other business 2.15 Chair Date of next meeting: 6 July 2016
8. Contract Variations and discretionary payments (locum reimbursements)
2.00 Alison Goodlad
To follow For approval
9. Risk register 2.05 Sarah See Attached For approval
10. Questions from public 2.10 Chair
11. Any other business 2.15 Chair
Date of next meeting:
6 July 2016
1
Register of interests 2015/16
Declaration of Primary Care Commissioning Committee members
Last updated: May 2016
Name Role Organisation Nature of interest
Amendment and date
Richard Coleman
Chair, Lay member Havering CCG
Richard Coleman Associates Ltd NIHR healthcare technology co-operative for GI disease, Enteric (hosted by Barts Health NHS Trust) 1-2-1 Social Enterprise PriceWaterhouseCoopers
Director/co-owner. Spouse also a director/co-owner. Chair of Steering committee Associate on pro bono basis providing mentoring to the NHS Nephew is a partner
Khalil Ali
Lay member, Redbridge CCG
St Francis Hospice, Havering Dr Joseph’s GP practice, Collier Row, Romford
Spouse is donor/contributor Family GP
2
Name Role Organisation Nature of interest
Amendment and date
Sahdia Warraich
Lay member The Forum for Health and Wellbeing The Forum for Health and Wellbeing Trading Ltd Healthwatch Waltham Forest Healthwatch Redbridge London Borough of Redbridge
Director Company Director Company Director (from 8/2/13) Member (from 1/4/13) Spouse is a Councillor
Member of Healthwatch Newham – removed 20/4/16
Kash Pandya
Lay member - Governance
Hillcroft College for women, Surbiton Essex Ministry of Justice Advisory Committee Health & Safety Executive Her Majesty’s Inspector of Constabulary Brentwood Citizen’s Advice
Council Member and Honorary Treasurer Lay Member for appointment magistrates Independent Audit Committee Member Associate Inspector Generalist advisor
Hillcroft College Audit Chair removed and Honorary Treasurer added – 19/4/16 NCL CCGs removed 17/5/16
3
Name Role Organisation Nature of interest
Amendment and date
Bureau Havering CCG Redbridge CCG PricewaterhouseCoopers Berwin Leighton Paisner (BLP) University of Essex
Lay Member Lay Member Kiren Pandya (son) Management consultant Anand Pandya (son) trainee solicitor Independent Audit Committee member
BLP added 19/4/16
Ah-Fee Chan
Secondary care consultant
North Middlesex University Hospital NHS Trust Nadia Medical Services Ltd (March 2015)
Consultant in Anaesthetics and Intensive Care Medicine Director of the company providing consultant services at a range of private facilities in London where practice privileges are given
Steve Ryan
Secondary Care Consultant
Steve Ryan Healthcare UCL Partners CAMHS Transformation
Sole Trader Honorary contract Strategic Lead
4
Name Role Organisation Nature of interest
Amendment and date
Healthy London Partnership London Clinical Senate Council
Member
Conor Burke
Accountable officer
Your business works (not trading) Redbridge college
Director Former Audit committee member
Tom Travers
Chief financial Officer Royal Free Foundation Trust Wife works in finance department
Sarah See Director, Primary Care Transformation
North East London Foundation Trust (NELFT)
Spouse is a NELFT employee working in Redbridge CAMHS
Jacqui Himbury
Nurse director Nursing, Midwifery Council Nurse member – Fitness to Practice panels
Dr Waseem Mohi
Chair, B&D CCG Markyate Surgery Together First Limited (from May 2014) London Wellbeing Care Ltd
GP Partner (April 2013) Director and shareholder in onsite pharmacy (April 2013) Sister is NHS dentist within Havering Part owner Father is a trustee Shareholder Partner at Maylands Surgery – (Dr Kendall) is a director (Nov 2014) Director (Jan 2011) Co-opted member
6
Name Role Organisation Nature of interest
Amendment and date
Dr Alex Tran
Clinical director
Hornchurch Healthcare, The Medical Centre Hornchurch Healthcare Limited NHSE & the Cancer Commissioning Board Havering Health Limited
Principle GP Director GP Advisor Shareholder
Dr David Derby
GP Partner, Havering CCG
Rosewood Medical Centre (negotiations are underway concerning a merger with another practice) PELC Havering Health Limited Barking, Dagenham and Havering LMC
GP Director/Council Member Shareholder, Director and Company Secretary Member
Dr Gurkirit Kalkat
Clinical Director, B&D CCG
Thames View Health Centre Primary Clinical Partnership
GP Principal Director/owner or part owner/
7
Name Role Organisation Nature of interest
Amendment and date
Ltd Apex Healthcare Ltd Queen Mary Medical School, London Together First Limited (from May 2014) BHR CCGs
Share holder Director/owner or part owner/ Share holder Honorary Lecturer Shareholder Area Prescribing Chair
Dr Adedayo Adedeji
GP Partner, B&D CCG
PELC (Dec 2013) Together First Ltd (April 2014) Primary Care Clinical Partnership Ltd
Council member Board member & shareholder Shareholder
Dr Anil Mehta
Chair, Redbridge CCG
Fullwell Cross Medical Centre Metropolitan Police The cleaning company NHS England (Feb 2015)
GP Partner Forensic Medical Examiner Owner - Sister in law GP Appraiser
8
Name Role Organisation Nature of interest
Amendment and date
Healthbridge Direct (from September 2014) Fouress Enterprises Ltd
Shareholder Director
Dr Shabana Ali
Clinical director
Southdene Surgery North East London Foundation Trust Avicenna Ltd Healthbridge Direct (from September 2014) BMA RCGP CVGP NHSE
GP Partner/Principal. Daughter is receptionist/admin GP with special interest in cardiology Director. Husband is also a director Shareholder Member Member (applying to become a member) GP appraiser (B&D CCG, Havering CCG)
9
Name Role Organisation Nature of interest
Amendment and date
Frances Carroll B&D Healthwatch
B&D Healthwatch Motor Neurone Disease Association – North London St Joseph Hospice
Chair Chair Volunteer Therapist
Anne Marie Dean
Havering Healthwatch Havering Healthwatch One in Four Kent & Medway NHS Partnership Trust St John’s Ambulance
Chair and Executive Director Trustee Non-executive Director Volunteer
Ian Buckmaster Havering Healthwatch
Havering Healthwatch Limited St John’s Ambulance Kings Park GP Surgery, Havering
Director (13/3/2013) Volunteer Patient
Matthew Cole Director, Public Health LB of Barking & Dagenham
BHRUT Redbridge CCG
Spouse is a midwife at BHRUT Family GP is Chair of
10
Name Role Organisation Nature of interest
Amendment and date
Redbridge CCG
Vicky Hobart Director, Public Health LB of Redbridge
None
None
Cllr Wendy Brice-Chambers
LB of Havering Tapestry - Prevention, Care & Support (Havering)
Board Member
Dr Shabnam Ali
GP Partner, Redbridge CCG
Oakhurst Developers Ltd Director
Cathy Turland Healthwatch Redbridge (HWR)
Health Education – North Central & East London Redbridge CCG London Borough of Redbridge Greenfields Community Housing (Braintree)
HWR – receives grant funding for projects HWR – commissioned by the CCG to support research and hold funds for projects working with other healthwatch groups in local boroughs. Commissioned to provide consultations Board Member (Non-Executive Director)
11
Name Role Organisation Nature of interest
Amendment and date
Terilla Bernard Primary Care Director
- Barking, Dagenham and Havering LMC
Lambeth CCG MD Sengat Services
Interim Assistant Director, Primary & Community Care Commissioning Management Consultancy (NHS &LA)
Dr Ambrish Shah
Redbridge LMC
1 Draft PCC Minutes 11 May 2016 v1.1
Draft Minutes of the Primary Care Commissioning Committee (Committee in Common) held on 11
May 2016 at Becketts House 1.00pm
Present – Members
Richard Coleman (RC) Chair Lay Member, Havering CCG Khalil Ali (KA) Lay Member, Redbridge CCG Kash Pandya (KP) Lay Member, BHR Audit & Governance Dr Shabnam Ali (SHA) GP, Redbridge CCG Dr Shabana Ali (SA) Clinical Director, Redbridge CCG Dr David Derby (DD) GP, Havering CCG Steve Ryan (SR) Secondary care consultant Sarah See (SS) Director of Primary Care Transformation, BHR CCGs Sahdia Warraich (SW) Lay Member, Barking & Dagenham CCG Conor Burke (CB) Chief Officer, BHR CCGs Jacqui Himbury (JH) Nurse Director, BHR CCGs Dr Alex Tran (AT) Clinical Director, Havering CCG In attendance Alison Goodlad Head of Primary Care, NHS England Anne-Marie Keliris (AMK) Company Secretary, BHR Lorna Hutchinson (LH) Assistant Head of Primary Care Commissioning, NHSE Dr Anil Mehta (AM) Chair, Redbridge CCG Dr Heath Springer (HS) GP, Redbridge LMC Glynis Xavier Deputy Director of Public Health, London Borough of Redbridge Cathy Turland (CT) Chief Executive Healthwatch Redbridge Terilla Bernard (TB) Barking, Dagenham and Havering LMC Natalie Keefe (NK) Head of Primary Care Transformation, BHR CCGs Matthew Cole (MC) Director of Public Health, LBBD Apologies Dr Adedayo Adedeji (AAd) GP, Barking & Dagenham CCG Dr Gurkirit Kalkat (GK) Clinical Director, Barking & Dagenham CCG Dr Waseem Mohi (WM) Chair, Barking & Dagenham CCG Anne-Marie Dean (AMD) Chair, Healthwatch Havering Frances Carroll Chair, Healthwatch Barking & Dagenham Dr Atul Aggarwal (AAg) Chair, Havering CCG Ian Buckmaster (IB) Director Healthwatch Havering Vicky Hobart (VH) Director ,Public Health, Redbridge Tom Travers (TT) Chief Finance Officer, BHR CCGs
2 Draft PCC Minutes 11 May 2016 v1.1
Action 1.
Welcome and Apologies for absence
The Chair welcomed those present and apologies were noted. It was noted that B&D Primary Care Commissioning Committee were not quorate, as a GP needed to be present.
2. Declaration of Interests Members noted the Committee’s Declaration of Interest.
Dr David Derby advised of one further declaration of interest, he is supporting Havering CCG with developing a locality operating model over the next two months. His Declaration of Interests form will be updated accordingly. No further interests were declared relating to agenda items.
DD
3. 3.1 Minutes of meeting held on 13 April 2015 The minutes of the previous meeting were agreed.
3.2 Actions log/matters arising Committee members noted the actions that had been taken and the following updates were noted: ACT27 – NHS London operating model – It was noted that the operating model will be reviewed as part of the continuing organisational review of NHS England’s primary care commissioning resource (which will enter into phase 2 within the next month).
4. Budget update SS presented the month 12 primary care commissioning budget update. The
Month 12 reported position for all three of the CCGs is year to date breakeven and also a predicted year end variance of breakeven. The 2016/17 high-level budget has been received but the CCG are awaiting further detail on the bottom-up detailed budget. KP questioned when the CCG will be clear on its QIPP requirements for 16/17. SS confirmed that the QIPP requirement is 1% but NHSE have agreed across London that only 0.5% should be reflected in the delegated budget – and will be linked to ongoing list maintenance and rates reimbursement project; the other 0.5% will need to be incorporated with the CCG’s overall QIPP requirements. KA referred to significant over-spend on specific lines and suggested closer review of these. SS agreed that once detailed budget lined information is received this line of enquiry will be explored. The Chair agreed that it was important to understand QIPP requirements for 16/17. The committee noted the report.
TT
5. CQC analysis AG presented a report which reported on the key themes that are emerging from
CQC reports carried out under the new inspection criteria. The Chair questioned what the timescale is for the improvement plan. SS confirmed this would be presented to the next meeting.
3 Draft PCC Minutes 11 May 2016 v1.1
HS questioned what criteria CQC used to select which practices are visited. LH confirmed that the CQC had asked for a list of practices where there had been quality concerns in the past and any practices which may benefit from a visit. HS commented that the LMC would like assurance that a fair and transparent process was followed. KA commented that more emphasis should be placed on clinical governance in practices to support all practices not just those being inspected. KP welcomed the report and highlighted that the next steps were important and how the CCG supports practices who have been visited and also those who are still to be visited. HS commented that practices feel they are already under pressure with time and resource and the challenge of the committee will be to look at the general lessons learnt from the CQC reports and how practices can be supported. SS suggested that the themes could be used to develop the PLE programme. The committee noted the themes identified by the analysis of available CQC reports and requested an improvement action plan is developed for roll out across BHR.
SS
6. All PCC Committees – Q4 2015/16 delegated self-certificates SS presented the CCG Assurance Framework Q4 2015/16 delegated functions
self-certification. The audit and governance committee had agreed the drafts presented to the committees today. KP reported that the audit and governance committee were not confident about the value of the quality internal audit review and from our lobbying; it would appear that there has been a review of the entire process. That is, the self-certification process in its current form will not roll into 2016/17; CCGs are likely to be assured via the structured assurance process already in place – there may be some other form of assurance, further detail is expected. SS reported that proposed changes to the statutory conflict of interest policy may require further changes to the committee’s terms of reference. The Havering PCC approved the quarter 3 delegated self-certificate. The Redbridge PCC approved the quarter 3 delegated self-certificate. The Barking & Dagenham PCC quarter 4 delegated self-certificate would be sent for virtual approval to members.
SS SS
7. Contract variation and discretionary payments (locum reimbursements) AG presented a report which detailed contract variations and discretionary
payments which included cost of funding. The committee noted the report.
8. Risk Register SS presented the risk register.
The committee approved the risk register.
9. Questions from Public There were no questions from the public.
4 Draft PCC Minutes 11 May 2016 v1.1
10. Any Other Business 10.1
The committee thanked Lorna Hutchinson who was moving to a new role, for the support she has given to the committee and wished her well. 10.2 SS reported that the PMS review has been effectively paused in London following a letter from London wide LMCs to NHS England concerning 17 issues which are still outstanding from their perspective; Liz Wise is keeping the CCG updated on progress from these discussions with the LMC. However, 1:1 meetings with Havering practices had taken place to discuss the new contract and financial mode in relation to their respective practice; workshops had been held across all 3 CCGs to advise on the high-level contract and financial model. Barking and Dagenham LMC have now requested that individual practice meetings take place with the B&D PMS providers; these meetings will start in June. It was noted that equality impact assessments had been updated and further finance information has been requested.
11. Date of next meeting The next meeting was confirmed as 8 June 2016.
Signed………………………………………………..Date………………………….
Actions Log
Log owner: Sarah See, Director of Primary Care Transformation
Log manager: Natalie Keefe, Primary Care Team
Last Update:
URN Action Part Raised Owner Deadline Completed Status Resolution / Comments / Document Ref
ACT 35 Operating model
Page 27, section 2.4 on delegated responsibilities that were not in
the delegated agreement to be updated with stronger wording
around resources and budget associated to offer protection to the
CCG
1 07/10/2015 Alison
Goodlad
30-Nov-15 on-going Open MOU being discussed as part of NHSE/CCG review
of resources for primary care commissioning.
Second phase of review, including resource
operating model and staff consultation to commence
by end of May.
ACT 49 Approval of additional premises space
Set of principals to be included in the SEP around agreeing
additional space in health centres
1 13/01/2016 Tom
Travers
30-Jun-16 Open To be developed by Asst Director of Estates once in
post.
ACT 50 Transformation fund
Update wording as discussed in committee and share for
agreement with LMC. Updated paper to be reviewed by the
Committee once finalised.
1 13/01/2016 Natalie
Keefe
31-Mar-16 Open Document updated and shared with LMC's
18.04.16.
CCGs will need to submit bids for 2016/17 by the
end of June 2016, via portal arrangements (along
with any IT/Digital roadmap bids).
ACT 55 Quality Report
Small group to be convened to review the information and the key
lines of enquiry. Revised report to come back to committee for
review.
1 10/02/2016 Alison
Goodlad/Liz
Wise
30-Apr-16 Open
Follow up meeting took place with NHSE 03.05.16.
Agreed that there needs to be a NE London approach.
NHSE setting up NE London workshop to progress.
ACT 58 Building Resilience (formerly Vulnerable practices)
Committee suggested that the funds for support should be held
with the CCG as the commissioner. LW agreed this could be
reviewed.
1 10/02/2016 Liz Wise 31-Mar-16 OpenNHSE have arranged a workshop 13.05.16 to review how
phase 2 of the scheme will work. Update to be provided
at June committee.
ACT 59 Sustainability and Transformation Plan (STP)
Sarah See to request a copy of STP engagement plan from Tara-
Lee Baohm to be shared with PCCC to ensure members are kept
up to date and engaged.
1 09/03/2016 Sarah See 31-May-16 OpenSecond draft being developed in partnership with WEL
collegues - to be shared for comment to PCC Committee
members.
ACT 60 Locality Plan
Following an application from Berwick Surgery to close the practice
list and the application from Spring Farm to close branch surgery
the committee agreed that a locality plan should be agreed
between the practices in North Rainham to ensure access to
services and overall capacity is managed.
1 09/03/2016 Sarah See 31-May-16 Open
Meeting being arranged.
ACT 63 Budget update
Month 12 data showed significant over-spend on specific lines,
agreed that once detailed budget line information is received from
NHSE this line of enquiry will be explored..
1 11/05/2016 Tom
Travers
31-May-16 Open
ACT 64 CQC Improvement plan
Analysis of available CQC reports and themes shared with
members, agreed an improvement action plan needs to be
developed for roll out across BHR
1 11/05/2016 Sarah See 30-Jun-16 Open
31-May-16
To: Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committees
From: Sarah See, Director, Primary Care Transformation
Date: 8 June 2016
Subject: Draft Local Action Plan to support practices to achieve CQC compliance
1.0 Purpose of the report 1.1 This report appends a draft local action plan that has been developed to support
practices across Barking & Dagenham, Havering and Redbridge (BHR) to achieve CQC compliance or address any gaps resulting from CQC inspections which have already taken place; and in doing so assure the committee of progress being made to improve safety and quality of services to patients whilst ensuring that contractual and legal requirements are met. The action plan has been developed taken into account common themes identified from the published reports of inspections to date from across BHR.
2.0 Recommendations
The committee is asked to:
Note and feedback on the content of the draft action plan.
3.0 Background 3.1 A paper was presented to the May 2016 Primary Care Commissioning Committee
outlining the themes that were arising from CQC practice visits that had taken place to date.
3.2 The analysis was based on 15 CQC inspection reports relating BHR practices that
had at the time been published. It identified 9 common themes and recommended the development of a local action plan that could be rolled out across BHR to address issues relating to:
Safeguarding
Chaperones
Policies
Pre-employment checks including DBS and references
Health & Safety
Risk Management
Infection Control
Medicines Management
Mandatory Training 4.0 Next steps 4.1 Action plan to be updated with comments from the committee and shared with the
LMC’s for feedback and discussion regarding areas where work can be developed jointly.
Draft Local Action Plan to support practices to achieve CQC Compliance
The CQC follow key lines of enquiry to assess 5 areas; is the practice: Safe, Effective, Responsive, Caring and Well Led; focussed on 6 population groups (Older People; People with LTCs; Families, Children & Young People; Working Age people; People whose circumstances may make them vulnerable; People experiencing poor mental health including Dementia)
The 9 common themes NHS England identified from the published CQC reports as requiring a local action plan were: Safeguarding, Chaperones, Policies, Pre-employment checks (including DBS and references), Health & Safety, Risk Management, Infection Control, Medicines Management and Mandatory Training. Accordingly, the local action plan is based around these 9 areas.
Area/theme and associated issues identified
Delivery mode(s) Owner
Safeguarding Required training had expired or not carried out.
Training session(s) in association with BHR’s Safeguarding Leads to be set up. Associated communications to highlight the importance of the training as well as keeping up to date. Template policy to be provided to practices that they can adapt in line with individual practice needs and circumstance.
PCC team and BHR Safeguarding lead
Chaperones Staff with chaperone duties had not had a DBS [Disclosure & Barring, previously known as CRB – Criminal Record Bureau] check and/or undergone the necessary training
Arrange access to training either via a training session(s) or on-line resource. Written guidance/resource for practices to include an outline role of chaperone, DBS checks and other employment check required. NB useful resource: https://www.gov.uk/disclosure-barring-service-check/overview Also see below (Pre-Employment checks)
PCC team with support from CSU HR.
Policies Various clinical & administrative policies out of date/not reviewed within timescales/in place at all
A range of policies and procedures to be sourced that (i.e. share good policies locally from practices rated good/outstanding) practices can adapt to individual practice needs, policies include:
Infection control policy and details of infection control team
Complaints
Pre-employment checks protocol
Recruitment and selection policy that meets the equality agenda
Medicines Management policies
Equality & Diversity Policy
Records management policy
Business continuity plan
Consent policy
Information governance policy
Locum policy.
This is a non-exhaustive list and will need to be developed further in collaboration will the LMCs and practices. General guidance will also need to be developed regarding policies and procedures, including systems for updating policies, ensuring a practice staff lead for each policy and details of when it was updated and version control etc.
HR, CCG corporate team, CCG quality team, Medicines Management team.
Pre-Employment checks (incl DBS & references)
See above (Chaperones). Also failures to carry out DBS checks on new/temp staff (clinical & administrative)
Written resources to be developed to including a list of pre-employment checks that should be undertaken. Written information about what should be included in staff HR files including copy of induction programme and appraisal information.
PCC team with support from CSU HR.
Health & Safety
Variable - range cited: not having an adequate policy, environmental issues that were a risk to staff & patients, failure to have carried out
See above (policies). Arrange access to training either via a training session(s) or on-line resource to include risk assessments.
PCC team with support from CSU and CCG corporate team
suitable risk assessments in areas that cannot be addressed such as structural inadequacies
Presentations at practice managers forum / PLE & PTIs as appropriate
Risk Management
Lack of robust risk management policies & procedures in place, failure to manage Serious Incidents appropriately ensuring ‘root cause analysis’ and sharing ‘learned outcomes’ to all staff
See above (Policies). Arrange access to training either via a training session(s) or on-line resource to include risk assessments. Session would also cover requires of PAT tests etc The training could incorporate the development of robust Risk Management policies & procedures and the management of SI to incl root cause analysis and shared learning across practice staff.
PCC team with support from CSU and CCG corporate team
Infection Control
Lack of legionella risk assessments or failure to address issues that had been highlighted by Infection Control audits, Not having adequate policies in place demonstrating compliance & safe practice
See above (Policies). Arrange access to training either via a training session(s) or on-line resource. Training could incorporate Infection Control, highlighting legionella and ensuring policies are adequate ie demonstrate compliance and safe practice CCG and NHSE area team to liaise with Infection Control Team to agree programme of visits.
PCC with support from Infection control team
Medicines Management
Various including: failure to keep adequate records e.g. controlled drugs and appropriate recording of prescribing, inadequate repeat prescribing policies to assist safe practice
See above (Policies). Work with Medicines Management team to establish what resources are currently available and what can be developed to support practices. Including a good practice guide.
CCG medicines Management team.
Mandatory Training
Required mandatory training had not been attended/maintained – including CPR and Health & Safety
Arrange access to training either via a training session(s) or on-line resource. Training to include:
Managing risk and learning from mistakes
Health and Safety
PCC team with support from CSU and CCG corporate team
CPR
Equality and Diversity
Informed consent
Informed decision making
Whistleblowing
Chaperone training
Safeguarding for children and adults
Fire safety
Governance
PREVENT
This is a non-exhaustive list and will need to be developed further in collaboration will the LMCs and practices.
Guide to practices on how to prepare for a CQC visit
A written guide to be produced as practical guide for practices on how to prepare for a CQC inspection, including what information they should have ready, what to expect during the visit and what resources there is available to help practices. On-going communication to practices reminding them of what resources are available to assist them1
PCC team and LMC
1 There is a wealth of information at the disposal of practices to assist with preparing for CQC inspections; these were highlighted during the CQC workshop sessions that the CCG provided in each
Borough in December 2015/January 2016.
GPC guidance on CQC inspections: http://bma.org.uk/practical-support-at-work/gp-practices/service-provision/care-quality-commission/cqc-inspection
Londonwide LMCs’ guidance on CQC inspections: http://www.lmc.org.uk/visageimages/guidance/2015/Londonwide%20LMCs%20CQC%20Guidance.pdf
How CQC Regulates: NHS GP practices and GP out-of-hour services; provider handbook (updated 27 March 2015) http://www.cqc.org.uk/sites/default/files/20150327_gp_practices_provider_handbook_march_15_update_01.pdf
Infection control: The Health and Social Care Act 2008, Code of Practice on the prevention and control of infections and related guidance
Londonwide LMCs’ detailed guidance on CQC’s safeguarding requirements mapped against each key domain http://www.lmc.org.uk/visageimages/guidance/2015/GP%20support/CQC%20safeguarding%20themes_amalgamated%20table2.pdf
New CQC inspection guidance for general practice published Nov 15: www.cqc.org.uk/gpintroguide
Examples of inadequate care in general practice: http://www.cqc.org.uk/content/what-does-inadequate-practice-look-examples-our-gp-inspections
Examples of outstanding practice: http://www.cqc.org.uk/content/examples- outstanding-practice-gps
To: BHR Primary Care Commissioning Committees (Committee in Common) From: Sarah See, Director of Primary Care Transformation Date: 8 June 2016 Subject: Estates and Technology Transformation Fund (formally Primary Care Transformation Fund) Executive summary The purpose of this paper is to brief the Primary Care Commissioning (PCC) Committees on recent guidance from NHS England (NHSE) regarding the new process for submitting proposals for capital funding via the Estates and Technology Transformation Fund (previously known as the Primary Care Transformation Fund). The paper advises the Committees of the process set out by NHSE. It also sets out proposed governance arrangements for reviewing and approving the submission. Recommendations The committee is asked to:
• Note the content of this report; • Review and agree the proposed governance process; and • Note next steps, and advise of any other actions that should be undertaken.
1.0 Purpose of the Report 1.1 The purpose of this paper is to brief the PCC Committees on NHSE’s approach to the second
year of what is now known as Estates and Technology Transformation funding. It also outlines a suggested governance process that could be used locally to approve the submissions.
2.0 Introduction 2.1 In 2015/16, NHSE began a £1 billion investment programme to support primary care and
general practice to make improvements across a range of areas, including premises and technology.
2.2 During 2015 GP practices were invited twice (in January and July) to submit bids directly to
NHSE to access the funding; subsequently a number of practice applications across BHR were approved by NHSE.
2.4 However, it was acknowledged that the process for 2015/16 was not ideal for all involved;
therefore to ensure subsequent applications/business cases are progressed in a more manageable way NHSE have put new arrangements in place for 2016/17.
2.3 NHS England wrote to CCGs in October 2015 outlining the process for accessing this funding
from 2016/17. Historically practices submitted individual bids to NHSE that had to be accompanied by a letter of support from the CCG. From 2016 NHSE confirmed that applications going forward will only be received from CCGs rather than directly from practices.
2
2.4 Between 1 June 2016 and 29 June 2016, CCGs will need to submit a single electronic
submission that outlines all of the CCG’s priorities for primary care premises and technology for the coming 3 years via an on-line portal.
2.5 CCGs are expected to submit priorities which are in line with their Local Strategic Estate Plan
(SEP) and Local Digital Road Maps (LDRs). Priorities should also demonstrate that they will contribute to improving extended access to effective care across local services and help practices establish infrastructure which enables sufficient routine appointments at evenings and weekends to meet local demand.
2.6 Recommendations, whether premises or technology related will also need to meet NHSE Core Criteria:
• Improved access to effective care • Increased capacity for primary care services out of hospital • Commitment to a wider range of services as set out in the CCG’s commissioning
intentions to reduce unplanned admissions to hospital • Increased training capacity
3.0 Process and Milestones 3.1 Back in December 2015 the CCG wrote to all practices asking whether in the next 2 – 3
years they were: • planning to expand the practice premises; • looking to undertake any redevelopment work; or • looking to move premises.
3.2 The resulting information has been collated and will be reviewed along with the deferred bids from 2015/2016 to determine whether schemes align with the SEP, LDRs and meet the criteria set out by NHSE.
3.3 CCGs will need to support the revenue consequences of recommended schemes. The
applications submitted by CCGs will provide NHSE with assurance in principle that the CCG will support any associated revenue costs. The due diligence stage will then allow CCGs to define those costs and reconfirm their commitment to schemes.
3.4 Following receipt of CCG submissions, NHS England will carry out an initial review of all
schemes against the criteria and undertake an assessment of deliverability. It is anticipated that this will be completed and initial feedback provided to CCGs by the end of August 2016.
3.5 CCGs will then be expected to work with GP practices and NHS England to confirm the
purpose and benefits of each scheme, work up detailed descriptions and plans for the development and test options for funding in order to provide NHS England with assurance that the scheme delivers value for money.
4.0 Governance Process 4.1 BHR Finance and Estates group are responsible for working up proposals for each of the CCG’s.
These proposals will then be presented to each Borough’s Primary Care Commissioning Committee for approval.
4.2 The Estates and Finance Group are due to meet on 14 June 2016. Proposals will be discussed and recommendations made to the PCCC at this meeting. Due to the submission timeframe a decision cannot be delayed until the July PCCC. It is therefore recommended that the Committee delegates decision-making to the Chair, Chief Financial Officer and Director of Transformation.
To: Barking & Dagenham, Havering, Redbridge Primary Care Commissioning Committees From: Jill Web Head of Primary Care NHS England (London) Date: 8 June 2016 Subject: Proposed Standard Operating Procedure (SOP): A Consistent Approach to Issuing Breach &
Remedial Notices in Response to Care Quality Commission (CQC) ‘Requires Improvement’ Reports
Executive Summary The aim of this SOP is to Support primary care commissioners to place due consideration on the issues that have led to GP practices receiving overall ‘Requires Improvement’ ratings following CQC inspections, and ensure that appropriate actions are taken to remedy contractual quality and safety concerns. The SOP will provide consistent guidance to CCGs across London on issues to take into account when considering CQC reports with an overall status of ‘Requires Improvement’. Recommendations The BHR PCCC is asked to consider the attached proposed Requires Improvement SOP and confirm whether they are in agreement, in principle, with the proposed approach and considerations, subject to any material changes that may occur following other CCG or London LMCs inputs. 1.0 Purpose of the Report
The purpose of this ‘Requires Improvement’ SOP is to:
1.1 Support primary care commissioners to place due consideration on the issues that have led to GP practices receiving overall ‘Requires Improvement’ ratings following CQC inspections, and ensure that appropriate actions are taken to remedy contractual quality and safety concerns
1.2 Provide level 1, 2 and 3 Primary Care Commissioners across London with consistent guidance on issues to take into account when considering CQC reports with an overall status of ‘Requires Improvement’ that may require the issue of a contractual breach and remedial notice and/or alternative support
1.3 CCGs are being asked to confirm whether they are in agreement, in principle, with the proposed approach and considerations, subject to any material changes that may occur following other CCG inputs.
1.4 London LMCs have been consulted on the attached version and most of their comments have been incorporated in this version. Any material changes that may be made following CCG inputs across London will also need to be shared with London LMCs for their final comments.
2.0 Key Issues 2.1 The current outcome of CQC inspections of general practices across England shows London region is
a significant outlier compared to other regions relating to practices that are given an overall ‘Requires Improvement’ status (17.6% as a proportion of inspected practices in England – as at 11th April 2016, compared to the10% average for England)
2.2 This, coupled with the fact that London currently has a greater percentage of overall ‘Inadequate’ status GP practices, compared to the rest of England is a cause for concern, which London needs to both understand better and ensure that it is putting in place appropriate actions to address, beyond the requirements identified in the Framework for responding to CQC inspections of GP practices published on 20 October 2014.
2.3 In recognition that there is no framework that guides NHS England in whether or not it is appropriate to consider issuing remedial breach notices based on CQC findings, although technically, when a practice is in receipt of a CQC report indicating that they require improvement, they have immediately breached their contract ‘The Contractor shall comply with all relevant legislation and have regard to all relevant guidance issued by the Board or the Secretary of State or Local Authorities in respect of the exercise of their functions under the 2006 Act.’
2.4 NHS England (London) and the Strategic Planning Group (SPG) CCG leads support the principle that London should have a consistent, reasonable and proportionate approach to considering whether contractual action is appropriate, and/or whether alternative support should be considered when an overall ‘Requires Improvement’ status is given to a GP practice.
2.5 In keeping with the previous governance which under pinned the agreement of CCGs to the NHS England (London) Operating Model, SPG leads asked for each CCG to be sent the proposed London region Requires Improvement SOP for in principle agreement. Feedback was requested by the end of April 16
2.6 London LMCs have also been consulted about the proposed SOP and most of their comments have been incorporated.
2.7 Adoption of this SOP would require future decisions on the appropriate response to be made by joint or delegated primary care commissioning committees on a case by case basis.
Appendix A. CQC ’Requires Improvement’ London SOP
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NHS England (London): Standard Operating Procedure for Primary Medical contracts:
A consistent approach to responding to Care Quality Commission ‘Requires Improvement’ notifcations
1.0 Purpose
The purpose of this Standard Operating Procedure (SOP) is to:
• Support primary care commissioners to place due consideration on the issues that have led to GP practices receiving overall ‘Requires Improvement’ ratings following CQC inspections, and ensure that appropriate actions are taken to remedy contractual quality and safety concerns
• Provide level 1, 2 and 3 Primary Care Commissioners across London with consistent guidance on issues to take into account when considering CQC reports with an overall status of ‘Requires improvement’ that may require the issue of a contractual breach and remedial notice and/or alternative support
2.0 Interface with NHS England Standard Operating Procedures and the Care Quality Commission (CQC) inspection framework
This SOP draws on the Primary Medical Services SOP published 12 January 2016 which replaced individual policies that have been available on the NHS England website and Framework for responding to CQC inspections of GP practices published 20 October 2014.
3.0 Background and context
In most cases, the issuing of a breach notice or application of a sanction should be considered as the final stage in a process where NHS England and the contractor have endeavoured to resolve matters satisfactorily through local resolution.
From October 2014, the Care Quality Commission (CQC) initiated a new inspection regime to inspect and rate every GP practice in England by April 2016. Practices are inspected across five key questions, considering the extent to which they are safe, effective, responsive, caring and well-led. They are then rated in one of four categories; outstanding; good; requires improvement; or inadequate.
The framework is designed to support regional teams to work with the minority of practices that are rated inadequate so that there is a consistent approach to mitigating risk to patients and ensure continued patient confidence in the local NHS and primary care services.
However, when reviewing CQC quality reports there is also recognition in London that where a practice has been identified as Requires improvement, there is a lack of consistency in identifying contractual responses between commissioners including cases where breach notices may be required. It is evident from the table on page 2 that based on CQC results from inspections to date, that London is an outlier compared to the rest of England, in respect of the percentage of inspected practices that have received ‘Requires improvement’ status.
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This proposed SOP seeks to provide the considerations that should be taken into account as part of the determination as to what formal contractual actions, if any, may should be recommended to a Primary Care Commissioning Committee (PCCC) at level 2 or 3, when a practice has received a Requires improvement notice.
The table below provide a high level summary of current CQC ratings across England and London - as a proportion of inspected practices in England – as at 3rd Mayl 2016
AS A PROPORTION OF INSPECTED PRACTICES
Geography Outstanding Good
Requires improvement Inadequate
North Region 4.3% 85.9% 7.9% 1.9% Midlands and East Region 4.8% 80.1% 10.6% 4.5% London Region 2.0% 75.7% 17.6% 4.8% South Region 4.1% 85.2% 8.0% 2.6% ODS Code Not Found 3.3% 85.2% 8.2% 3.3% England 4.1% 82.7% 10.0% 3.2%
4. Suggested considerations
1. Should contractual action be considered?
In accordance with NHS England’s statutory contractual responsibilities, contractual actions should always be considered.
Technically, when a practice is in receipt of a CQC report indicating that they require improvement, they have immediately breached their contract ‘The Contractor shall comply with all relevant legislation and have regard to all relevant guidance issued by the Board or the Secretary of State or Local Authorities in respect of the exercise of their functions under the 2006 Act.’
2. Issuing breach/remedial notices based on CQC visit report evidence
The Primary Medical Services Standard Operating Procedure published in January 2016 does not provide specific advice in respect of Requires improvement notices (it is designed to support teams to work with practices that are rated inadequate). However, legal advice taken by NHS England, has confirmed that the guidance does have read-across value and para 90 identified below is helpful.
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90. Where, following risk assessment and any necessary contractual practice visit and further investigation, an area team considers that the concern/inadequate rating also constitutes a contractual failure which is capable of remedy, the area team should issue the contractor with a remedial notice under the terms of the contract/agreement.
It follows that NHS England may be justified in issuing a breach and remedial notice without conducting a practice visit Where a CQC report identifies and evidences matters which are contract breaches.
Alternatively, the report may contain evidence that suggests a possible breach, but it is not clear whether there has been an actual breach. If this is the case, then NHS England shouldspeak to or visit the practice in order to decide/confirm whether or not it is and/or in order to obtain the evidence.
A decision as to whether to issue a breach and remedial notice should therefore be made on a case by case basis.
3. Proportionality
This SOP has been informed by reviewing information at CCG and practice level across London based on the first 58 published CQC ‘Requires improvement’ reports, which enabled NHS England to retrospectively identify potential and actual breaches and identify the following contractual breach themes, all of which are capable of being remediated:
1. No Safeguarding training 2. No Chaperone training 3. Policies are not up to date and relevant. 4. Lack of disclosure and barring checks (DBS). 5. Health and safety issues 6. Lack of employment references 7. Lack of Infection Control training 8. Medicines Management issues
Whilst some of the above findings that have been shared with NHS England following a CQC inspection, may arguably be prevalent in practices that have not yet received an inspection, primary care commissioners need to be mindful of their duties which include assuring that GP contractors are meeting contractual requirements, supporting improvements in quality and consideration of grounds for contractual action.
Subject to the depth and breadth of CQC findings, their relevance to GP contractual requirements and a practice’s willingness to work with commissioners to address these findings (e.g. a contractor’s preparedness to share its CQC action plan and status of completion with commissioners), it may be more appropriate:
• To write to the contractor to set out what has occurred, and confirm that formal contractual action will not be pursued on this occasion, based on the contractor’s response to the outcome of their inspection and/or
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• For the CCG to arrange to offer advice and support, which may be relevant if the issues that need resolving are not matters of patient safety and there is no history of wider contractual concerns
4. Practice track record/contractual history
Viewed in isolation, a PCCC may not consider it proportionate to issue a breach and remedial notice to a practice on the basis of a CQC ‘Requires Improvement’ report. However, when provided with a full contractual history of the practice, contractual sanctions may be deemed reasonable. E.g. where there is documentary evidence of a number of items of concern which have resulted in warnings or contractual breach/remedial notices over a period of time; and/or where there is documentary evidence that concerns identified in a CQC report have been raised before.
5. Proposed start date for issuing Breach Notices
The CQC initiated their new inspection regime in October 2014. A Requires improvement report issued twelve months ago should have therefore been remediated. It is recommended that a retrospective review is undertaken on a contractor by contractor basis to ensure that actions have been taken to remedy potential breaches.
As GP contractors with Requires improvement notices have a 12-month window to remedy any areas of concern and CQC should re-inspect at the 12-month point, NHS England shall review the re-inspection report and if there is no evidence that necessary actions have been taken to address the concerns identified, and/or a GP contractor cannot provide demonstrable mitigations as to why their action plan is outstanding, a retrospective breach notice may will be considered.
This SOP – – will be communicated to contractors and implemented with immediate effect, following input from London LMCs and agreement by level 2 and 3 commissioners.
6. Conclusion
This SOP is designed to provide a framework for decision making, enabling a PCCC to take consistent, reasonable and proportionate decisions based on the considerations included within this paper.
Updated 28th April 2016
To: The Redbridge Primary Care Commissioning Committee The B&D Primary Care Commissioning Committee Havering Primary Care Commissioning Committee Item: Discretionary Payments & Contract Variations processed
Author: Mark Lockwood, Primary Care Contract Manager
Date: 8/06/16
Executive Summary:
All practices are entitled to reimbursement of the cost of GP cover for parental leave (maternity/paternity/adoption leave), sickness and suspension. Costs incurred for locum cover are reimbursement at £1,131.74 for the first two weeks, and £1,734.18 for the period of the 3rd through week 26 or the actual invoiced costs whichever is lower during the period. The practice is eligible for reimbursement where the cover is provided by external
locums. Payment is made equally where there is flexibility/capacity within the
practice for the duties of the GP on leave to be performed by GPs within the practice
who are not full time, in order to maintain the delivery of services.
Purpose of the report:
The respective committees are asked to note:
1) locum reimbursements processed in May 2016
2) the recent contract variations processed in May 2016
Reimbursement for Claims for Locum Cover
CCG Type of Cover
Start Date of Claim
End Date of Claim Comment Cost
Havering Suspension 04/04/16 30/06/16
Payment for April 2016 £2880.00
The above claim covers the cost of locum cover for a fixed term period due to the removal of lead GP from performers list at Dr Gillett-Wallers practice. Practice is due to close on 30 June 2016.
CCG Type of Cover
Start Date of Claim
End Date of Claim Comment Cost
Havering Sickness 30/03/16 11/05/16
Payment for April 2016 £3143.74
The above claim is to cover sickness of doctor at Western Road Medical Centre after
Lead GP recovering after surgery.
Contract Variations
CCG Name Practice
Code
Contract
type i.e.
GMS/PMS
Contract holder
i.e. practice
name
Contract Variation i.e. new partner/ removal
Details of change i.e.
new/removed partner name
Effective date of change
Barking & Dagenham
Y00918 GMS Granville Medical Centre
Removal of Partner
Removal of Dr S Ahmed
30th March 2016
(Agreed Retrospecti
vely)
Barking & Dagenham
Y00918 GMS Granville Medical Centre
Addition of Partner
Addition of Dr Baloch
1st April 2016
Commentary: Removal and addition of a partner leaving 4 partners remaining on the contract.
Risk Log
Last updated:
URN Impact on Risk and impact Date Opened Part Owner Mitigating Action Prob Imp Severity Category Status Next review Next action / comments
RSK3 BHR CCGs NHS England RT support
Inadequate support from the NHS London
Commissioning Team (e.g. due to resourcing
issues) results in inadequate fulfilment of
delegated functions and BHR having to
dedicate additional resources to management.
16-Mar-15 1 Sarah
See
NHSE commissioning a review of all
PCC resources both at NHSE and CCG's
3 3 9 Operational Open 01-Mar-16 Second phase of review,
including resource operating
model and staff consultation
to commence by end of May.
RSK5 All PMS contract review
Relationship between practices / members and
the Committee may be challenged if difficult
decisions have to be made, leading to
resistance and poor relationships with practices.
24-Mar-15 1 Sarah
See
Local working group estbalished
Project plan and Comms plan developed.
Members drop in sessions carried out in
each borough in January and April 2016,
regular updates in GP newsletter.
Attendance at local LMC meetings
3 4 12 Reputational Open On-going Drop in sessions taken place
in B&D and Redbridge.
Individual practice visits
have taken place in April in
Havering.
Awaiting formal update from
NHSE regarding LMC letter
and extension to timeframe.
RSK14 B & D PCCC Lawns Medical Centre / North Street Medical
Centre merger
The merger has created a void space at the
Lawns which is still under lease and will need to
be paid. This will impact the delegated budget.
03-Jun-15 1 Sarah
See / Tom
Travers
This is a legacy issue which needs to be
referred to NHS England in terms of
finance.
2 2 4 Financial Open On-going The resolution of this issue
