meeting of the primary care commissioning committee monday

Meeting of the Primary Care Commissioning Committee

Monday 4 February 2019 – 2:30pm to 4:15pm

The Pavilion, Branston Golf and Country Club, Burton, DE14 3DP

AGENDA

No. Item Decision/

Discussion/ Information

Enc. Lead Time

1. Welcome, Introductions and Apologies Verbal Chair 2.30

2.

Quoracy and Declarations of Interest: If any member has any interest in any contract, proposed contract or other matter under consideration at this meeting, he/she shall disclose the fact to the Chair and shall not take part in the consideration or discussion of the matter or vote on any question with respect to it.

Verbal Chair

3. Minutes of the Meeting held on 5 November 2018 Approval Enc. 1 Chair

4. Actions from previous meetings Assurance Enc. 2 Chair

Strategic Planning

5.

Stapenhill Medical Centre Application to close their branch surgery in Rosliston - Rosliston Medical Centre, Main Street, DE12 8JW

Approval Enc 3 EW/TCh 2.40

6. PMS Reinvestment Approval Enc. 4 EW 3.00

7. GP Forward View – 10 High Impact Actions Plan Assurance Enc. 5 EW 3.15

8. Workforce Report Assurance Enc. 6 RW 3.30

9. Workflow Optimisation Evaluation Report Information Enc. 7 EW 3.40

Governance

10. Risk Register Assurance Enc. 8 LM 3.50

11. Finance Report Assurance Enc. 9 MR 4.00

12. Any items for Escalation Discussion Verbal Chair 4.10

13.

Date and time of next meeting: Monday 4 March 2019, The Pavilion, Branston Golf and Country Club, Burton On Trent, DE14 3DP

4.15

EAST STAFFORDSHIRE CLINICAL COMMISSIONING GROUP

Minutes of the Primary Care Commissioning Committee Held on Monday 5 November 2018 at 2:00pm

The Pavilion, Branston Golf and Country Club, Burton On Trent, DE14 3DP

Members:

Quo

racy

07/0

3/18

02/0

5/18

31/0

7/18

05/0

9/18

05/1

1/18

04/0

2/19

04/0

3/19

Voting Members Lynne Smith, Chair and Lay Member for Quality ESCCG A A √ √ √

Chris Ragg, Lay Member for PPI, ESCCG √ √ √ √ A David Harding, Lay Member for Governance A √ A A √ Dr John Tansey, Retired GP Representative √ Lynn Millar, Director of Primary Care, 6 CCGs √ A A √ Alistair Mulvey, Director of Finance A A A Heather Johnstone, Director of Nursing and Quality A A

Wendy Kerr, Chief Finance Officer, ES CCG √ Non Voting Members Terry Chikurunhe, Primary Care Lead, NHSE √ √ √ √ √ Rebecca Woods Head of Primary Care, NHSE √ √ A √ √ Kirsten Owen, Interim Programme Manager for PC, ES CCG √

Eleanor Wood, Senior Primary Care Development Manager – South East √ √ √

Manir Hussain Deputy Director of Primary Care and Medicines Optimisation √ √ A

Sarah Jeffery, Head of Primary Care Development √ √ A

Emily Ross, Analyst √ A Tracey Cox, Primary Care Development Lead √ A Cllr Gill Burnett √ A A √ Carol Goodwin, Interim Project Manager, ES CCG √ √ A

Nicky Harkness, Managing Director (East) A √ Theresa McGougan, Strategic Improvement Lead √

Laura Bird, Primary Care Development Manager √ Kimberli McKinlay, Head of Commissioning, Finance √ A

Emma Keeling, Corporate Services Manager (minutes) √ √ √

Vanessa Ridout, Executive Assistant (minutes) √ A Elizabeth King, Administrator (minutes) √ A

Enc. 1

2

MINUTES OF THE MEETING OF THE PRIMARY CARE COMMISSIONING COMMITTEE ACTION

PCCC(11)01 WELCOME AND INTRODUCTION • Lynne Smith welcomed all present to the meeting of the East Staffordshire

Primary Care Commissioning Committee (PCCC). • Introductions were made.

APOLOGIES • Alan White, Alistair Mulvey, Chris Ragg

PCCC(11)02 QUORACY AND DECLARATIONS OF INTEREST • It was agreed that the meeting was quorate.

• Declarations of interest for all Committee members and including NHSE are publicly available and can be accessed via the ESCCG website.

• Dr John Tansey informed he is the landlord of Stretton Medical Centre. • There were no further declarations of interest.

PCCC(11)03 MINUTES OF THE MEETING HELD 5 SEPTEMBER 2018 • The minutes were agreed as a true and accurate record.

PCCC(11)04 ACTION LOG • All actions are updated in the action log.

• Eleanor Wood will forward the outcomes of the boundary workshop to Lynne Smith.

Eleanor Wood

STRATEGIC PLANNING PCCC(11)05 NHSE PRIMARY CARE UPDATE The paper was taken as read. Rebecca Woods provided a verbal update

• The paper was for information.

Key Areas Discussed:

• No questions were raised.

In relation to the paper the PCCC: • Received the report and noted the contents.

PCCC(11)06 360° ACTION PLAN The paper was taken as read. Eleanor Wood provided a verbal update:

• NHS England commissions Ipsos Mori to undertake an annual 360o survey for each CCG nationally on an annual basis. The nationally set questions and sample size provides CCGs with a comparable indication over time of how partners and GP member practices feel about their working relationships with each CCG.

• It provides data for CCGs to help with their ongoing organisational development, supporting them to build strong and productive relationships with stakeholders. The findings can provide a tool for all CCGs to evaluate their progress, and inform the way that they work and make decisions.

• It helps NHS England to assess CCGs’ stakeholder relationships and leadership within their local health and care systems, and how effectively they commission services to improve service quality and health outcomes.

• The purpose of this report is to develop an action plan to close the gaps and improve communications and engagement with GP members’ Practices and their staff.


• Lynne Smith reflected on the outcome report for East Staffordshire and highlighted that it reported good representation from practices but poor representation from stakeholders. Other CCGs appear to have had better stakeholder responses therefore it would be useful to know how to improve

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them. Secondly 21% of GP’s reported poor working relationship with the CCG, again it would be useful to have a better understanding of why. This will enable the CCG to show practices there has been a direct correlation between what they reported and the response of the CCG to mitigate the issues.

• Lynn Millar felt it is was disappointing to have received some of the comments and that some of the figures were due to the ongoing changes to the 6 CCGs. The primary care team will be working on improving the working relationships between GPs and the CCG.

• Dr John Tansey reported from a personal perspective, GP’s haven’t liked the 6 CCGs combining under one management team and the feeling that they have no influence or clear steer of future planning for primary care. He reported that colleagues felt like they were even more removed from the leadership than before.

• Nicola Harkness highlighted that there needs to be recognition around what is within the gift of the CCG to commission and what sits with local authority or neighbouring CCGs. Communication is key to ensuring that GPs understand what they can influence locally and that expectations are managed in accordance with the future direction of the Staffordshire CCGs.


QUALITY PCCC(11)07 QUALITY REPORT The paper was taken as read. Eleanor Wood provided a verbal update:

Admin. • The paper offers assurance to the East Staffordshire Primary Care

Commissioning Committee through a quarterly report in regards to primary care quality for East Staffordshire CCG.

• Gordon Street Surgery has moved to requires improvement as an overall rating.

• 1 practice has been de-escalated following the Primary Care quality quarterly review meeting outcome.


• Eleanor Wood will look at future dates for the workshops on Sepsis and John Tansey confirmed that there is a sepsis tool in use on the EMIS system for GPs to use following a question raised by Theresa McGougan.

• Lynne Smith queried the 2 way conversations with practices on interventions that can reduce long term care conditions admissions to hospital and whether there had been any recommendations that could be used to improve it. Eleanor Wood informed that they have visited a number of practices and a report will be brought back to the PCCC to share where areas of good practice have been identified.

• Lynn Millar informed the meeting that discussions are taking place with Cheryl Hardisty on the identified gap around management and clinical leadership of LTC’s. There will be a focus on how primary care can manage conditions better in the community.

• Mel Mahon is leading on the anticoagulation and Spirometry as part of the enhanced services and investment review and will be presented to the East GP Steering group in November.

• John Tansey raised concerns with anti-coagulation and the number of practices that have withdrawn from prescribing amber 2 drugs in East Staffordshire. There is a real disparity and dis-functional expectation from secondary care of the GP to still prescribe the drugs following a hospital assessment and blood monitoring process. This is a real safety issue and contradictory to other processes in place.

Eleanor Wood

4

• Lynn Millar agrees this is a high risk area especially where a patient is discharged into the community with no adequate arrangements in place. It has been included on the risk register. Every area has a different approach therefore alternative models are being looked at but ultimately it will be for the practices to decide how this is managed.

In relation to the paper the PCCC: • Received the report and are assured that general practice quality is being

monitored and managed.

PERFORMANCE PCCC(11)08 RISK REGISTER The paper was taken as read.


• David Harding highlighted his concern around workforce and the rating still being indicated as high although mitigating actions have been put into place.

• Lynn Millar informed that although there is work around new models of care and recruitment campaigns are underway, it doesn’t appear to have improved enough yet to reduce the risk. There needs to be a strategic plan for primary care that involves engagement with practices and that is overseen by the PCCC. The GP Forward view is nationally driven that will bring together primary care into one programme of work to ensure sustainability.

• John Tansey raised an issue around his practice having workflow programme training cancelled earlier in the year that has yet to be reorganised. Eleanor Wood informed this is already being rescheduled.

• Nicola Harkness suggested that the wording on the register may need changing to reflect the work that is ongoing, actions being taken and the anticipated date for completion to offer better assurance.

• It was suggested that on the risk register the overarching VAF needs to be included and the following suggested additional risks need to be included for East Staffs:

o proposed housing developments; o proposed boundary changes to practices. It would also be easier to see

this in terms of figures. • Rebecca Woods informed the meeting that there is a piece of work underway

that can be submitted to the PCCC along with a report that went to the CQC that includes the figures relating to workforce and the activities being undertaken to support practices.

• John Tansey suggested that when he made it known he was retiring, NHSE could have had discussions with him around potentially not finishing and looking at ways for him to remain in general practice, but this had not happened. This may be the case for many retiring GP’s and Nurses and could offer an option for them to undertake an exit interview to understand better the reason for them leaving the NHS.

• Rebecca Woods informed the meeting that there is a piece of work to understand why female GPs are leaving the profession and to engage and understand what the challenges are to help retain clinicians in general practice. As a system NHSE are having conversations with general practice as part of the appraisal process that involves the 24 hours retirement process.

• It was suggested that to help the workforce recruitment, East Staffs need to make it more attractive for GP’s to work in the area and this could include work relocation packages and portfolio opportunities.

• Lynne Smith asked for East Staffs to be included in the stakeholders section on the risk register and consideration needs to be given on the level of risk applicable to different areas; for example, GP recruitment and retention concerns may differ from area to area and the risk treatment should reflect

Lynn Millar

Lynn Millar

Rebecca Woods

Lynn Millar

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this. In relation to the paper the PCCC:

• Reviewed the report and are assured the Primary Care risks on the RiskRegister are being appropriately managed.

PCCC(11)09 FINANCE UPDATE The paper was taken as read.

Key Areas Discussed: • No member of the finance team was available for the meeting. Lynn Millar will

liaise with Anne Perry to include the primary care commissioning budget in future reports. Lynne Smith also noted that the general Primary Care budget was not included, unlike the other CCGs. Lynn Millar gave assurances that it would be included in future.

• Lynn Millar informed that there are reserves within the delegatedcommissioning budget that could be used to manage the risks. Better planningis in place to mitigate the financial risks and a more visible process aroundmanaging the business. The financial planning and forecasting has yet to befinalised and is a piece of work that will commence in the new year. A paperwill be circulated to the committee previously written on delegated budgetand the discretionary spends.

• Rebecca Woods highlighted that some of the delay is due some unanticipatedchanges to the contacts in primary care that have led to the delay in the CCGsfinancial and forecasting planning.

• Ideas for how to spend any reserve funds has been scoped with practices atthe East GP Steering group should there be any schemes to invest in. NicolaHarkness will circulate a list of potential schemes for consideration by thePCCC.

Lynn Millar

Lynn Millar

Nicola Harkness


PCCC(11)10 ANY ITEMS FOR ESCALATION

• No items were noted for escalationPCCC(11)11 DATE AND TIME OF NEXT MEETING

Monday 4 February 2019, 3:00pm, The Pavilion, Branston Golf and Country Club, Branston, DE14 3DP

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ACTION LIST PRIMARY CARE COMMISSIONING COMMITTEE OPEN ACTIONS

Meeting Date

Agenda Item Agenda Number

Subject and Action

Lead

Status

05/11/18 PCCC(11)04 4 Boundary Workshop: Eleanor Wood will forward the outcomes of the boundary workshop to Lynne Smith.

Eleanor Wood

05/11/18 PCCC(11)07 7 LTC admissions to hospital: Eleanor Wood informed the meeting that they have visited a number of practices and a report will be brought back to the PCCC to share where areas of good practice have been identified that may help to reduce the long term conditions admissions to hospital.

Eleanor Wood

05/11/18 PCCC(11)08 8 Risk Register: Lynne Millar is to ensure that wording on the risk register be amended to reflect the following:

• The work that is ongoing, actions being taken and the anticipated date for completion to offer better assurance.

• East Staffs to be included in the stakeholders section on the risk register and consideration needs to be given on the level of risk applicable to different areas; for example, GP recruitment and retention concerns may differ from area to area and the risk treatment should reflect this.

• The overarching VAF needs to be included and the following suggested additional risks need to be included for East Staffs:

o proposed housing developments; o proposed boundary changes to practices. It would also be easier to see this in

terms of figures.

Lynne Millar

05/11/18 PCCC(11)08 8 Workforce: Rebecca Woods will circulate information on a piece of work underway along with a report that went to the CQC that includes the figures relating to workforce and the activities being undertaken to support practices.

Rebecca Woods

05/11/18 PCCC(11)09 9 Primary Care Budget: Lynn Millar will liaise with Anne Perry to ensure that the primary care commissioning budget and the general primary care budget are included in future reports. Lynne Millar informed that there are reserves within the delegated commissioning budget that

Lynne Millar

Enc. 2

2

could be used to manage the risks, a paper will be circulated to the committee previously written on delegated budget and the discretionary spends.

05/11/18 PCCC(11)09 9 Reserve Funds: Ideas for how to spend any reserve funds has been scoped with practices at the East GP Steering group should there be any schemes to invest in. Nicola Harkness will circulate a list of potential schemes for consideration by the PCCC.

Nicola

Harkness

CLOSED ACTIONS Meeting

Date Agenda Item Agenda

Number

Subject and Action

Lead

Status 31/07/18 PCCC(07)05 5 Terry Chikurunhe to feedback on the impact the Derby/Burton merger may have on

specialist services once identified. Update 05/09/18: Not aware of any issues at this time. This action is closed.

Terry Chikurunhe

Closed

31/07/18 PCCC(07)08 8 Tracey Cox agreed to look at a more pragmatic view to take forward in respect of friends and family. Update 05/11/18: There is a primary care quality dashboard meeting to look at patient feedback in general. The escalation process around non-compliance with family and friends now includes the opportunity for the CCG to engage with practices and offer a supportive approach. This action is closed.

Tracey Cox Closed

31/07/18 PCCC(07)06 6 Lynne Smith to ask Dr Charles Pidsley whether he would be a voting member on the East Staffordshire Primary Care Committee. Update 23/08/18: As Charles has retired from medicine, I have emailed Lynn Millar asking her advice about this as well as whether she knows of any other out of area clinicians who might be suitable. Update 05/09/18 LS to contact Lynn Millar Update: 05/11/18: Dr John Tansey is now a voting member of the PCCC. Dr John Tansey invited the committee to make an informed decision in the future as to when he has been out of general practice for a long enough period for him not to be able to comment in a clinical role or there is another colleague willing to step into the role. This action is closed.

Lynne Smith Closed

02/05/18

PCCC(05)06 5 Primary Care Development: Lynne Millar informed that in the STP there is a strategic plan that needs to be shared and therefore to ensure that engagement and communication has been fully undertaken a mini workshop will be organised to look at future development of Primary Care locally and Staffordshire wide and will include Lay Members and key clinicians. Update: 31/07/18: Eleanor Wood to pick this up and canvas for dates. Update 05/11/18: A date has been set for 28 November with clinical leads having been advised of the date. This action is closed.

Lynne Millar

Eleanor Wood

Closed

Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

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REPORT TO:

East Staffordshire Clinical Commissioning Group

Enclosure: 3

Report to: Primary Care Commissioning Committee

Title: Stapenhill Medical Centre Application to close their branch surgery in Rosliston - Rosliston Medical Centre, Main Street, DE12 8JW

Meeting Date: 4 February 2019

Executive Lead(s): Exec Sign-Off Y/N Author(s):

Lynn Millar Y Terrance Chikurunhe (NHSE) Eleanor Wood (CCG)

Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme):

Action Required (select): Decision X Discussion For Assurance / For Information

Purpose of the Paper (Key Points + Executive Summary): An application has been submitted by Stapenhill Medical Centre requesting closure of Rosliston Branch Surgery. The practice has provided a business case, attached as Appendix 2 of this report, outlining the issues that have led to this application. Patient engagement has been undertaken and is detailed within the business case. The practices main reasons identified for wanting to close the branch include the following key points:

i. The branch site is only open in the mornings and has occasionally had to close due to staffingproblems. The branch is currently temporarily closed due to a water leak in September 2018which caused significant damage to the property and made it unsafe for patients to be seen atthe surgery;

ii. Lone working is a big issue for staff at the branch;iii. There is an issue with continuity of care at the branch as there is a different doctor rota’d every

day. Most patients are reported to be attending the main branch;iv. The building was previously starting to show signs of wear and tear and following the water

leak will require significant investment to bring it up to expected standard. The floors arecarpeted and these can’t be changed due to how the flooring and ducting was done in thebuilding. In addition there are issues with the boiler and water supplies;

v. IT is a major standing issue which is impeding the efficiency in working from the branchincluding the slow speed of Wi-Fi. This has had an impact on for example printing ofprescriptions or opening of patient letters which can take up to 8 minutes to load a document;

vi. More patients are reported to be utilising the main site (approx. 80%);vii. Privacy of patient consultations is an issue. It is noted that conversations being held in the

consulting room can be heard in the main waiting room.

The committee is being asked to consider the application and make a decision on the application.


2

Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register): 1. Patients may not have access to GP services. This is mitigated by patients having

access to the main site surgery.

Implications:

Legal and/or Risk Patients may not have access to GP services. This is mitigated by patients having access to the main site surgery.

CQC The practice feels that if the CQC visited the Rosliston Branch Surgery then there would be concerns raised around privacy, confidentiality and also infection control.

Patient Safety The practice feel that should the Rosliston Surgery remain open this would impact on patient safety.

Patient Engagement An engagement exercise has been conducted as detailed in the report.

Financial There are potential savings to both the CCG and to the practice should the branch surgery be closed. These are detailed in the report

Sustainability The practice feel that should the Rosliston surgery be retained this would impact negatively on the sustainability of the Stapenhill main surgery.

Workforce / Training The practice have struggled with recruitment and the practice feel that the Rosliston branch surgery is impacting negatively on the recruitment of clinicians.

Key Requirements: Yes No

1. Has a Quality Impact Assessment been completed?

Please provide detail within the body of the report Yes

2. Has an Equality Impact Assessment been completed?

Please provide detail within the body of the report as to these considerations:

• Can you confirm an Equality Impact & Risk Assessment (EIRA: stage 1 & 2) has been completed; if not, what is the rationale for non-completion?

• Which if any of the nine Protected Groups were targeted for engagement and feedback to CCGs, and why those?

• Summarise any disaggregated feedback from local Protected Group reps about any negative impacts arising / recommendations (e.g. service improvements)

• What mitigation / re-shaping of services resulted for people from local Protected Groups (along the lines of ‘You Said: We Listened, We Did’?)

• Explain any ‘objective justification’ considerations, if applicable

Yes


3. Has Engagement activity taken place with Stakeholders / Practices / Communities / Public and Patients

Please provide detail within the body of the report

Yes

Recommendations / Action Required:

The Primary Care Commissioning Committee is asked to: • Discuss the contents of this report and accept or decline the application


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1. Background

Stapenhill Medical Centre is a GMS contract with a list size of 9241 patients. The practice operates across two sites, Stapenhill is the main site and Rosliston Medical Centre is the branch surgery. The practice area is as shown in Appendix 1 of this report. Patients are split as follows: about 2000 branch and 7241 main surgery.

Practice Total List Size: 9241

Total 4682 Male / 4559 Female patients

Carr Hill Weighted List Size: 10568.9772377358 Number of Patients in a Nursing Home: 33

As set out in the Business Case, Appendix 2, Rosliston Medical Centre has been operational for some 35 years, operating originally, according to the partners, as what can only be classed as a garden shed. In 1992 the Partners took the decision to build a purpose built, at the time, state of the art medical centre with a dispensary for the local and surrounding community. This branch surgery was initially operational almost


4

throughout the core hours of the week with both a doctor and nurse facilities. The practice now needs significant investment to update the building.

The practice considers that the changes and requirements expected on GP practices have left the practice with no alternative but to propose closure of the branch surgery.

The other practices close to the Branch site according to NHS choices are:

Practice Distance from DE12 8JW

CCG locality

Stapenhill main site 2.7 miles (DE15 9QD) ESCCG

Gresleydale Healthcare Centre (11266 pts)

2.8 miles (DE11 9JT) Derbyshire

Trent Meadows (11865 pts) 3.1 miles (DE14 3EY) ESCCG

All Saints Surgery (8533) 3.3 miles (DE14 3LS) ESCCG

Dr GD Butchart (13916) 3.3 miles (DE14 3AG)

Dr Vishnu Parmar (1945) 3.4 miles (DE12 6JF)

2. Workforce

One of the GP Partners retired in January 2018 and a second Partner elected to leave in July 2018. Neither of these posts have been filled to date despite efforts to recruit. A further salaried GP left at the end of 2018 for a position in Australia. This post has since been filled. The practice has been advertising for an additional ANP for over 8 months with very little interest. The practice has identified staff shortage as an issue that has contributed to the request for closing the branch so that they can concentrate on developing their main branch.

3. Branch Clinical system connectivity

As identified in the Practice Business case (Appendix 2), there have been excessive IT issues which the practice has experienced in Rosliston for many years. The practice has identified having endless issues with IT which previously the PCT, and subsequently the CCG (CSU) have been working to resolve. These issues include taking up to 5 mins to open a letter if possible at all, no EPS, slow operating system, printing problems, one script will print correctly the next will not, unexpected logging off. The practice has identified that previous updates and changes by CSU have made the situation worse. IT colleagues were due to re-visit the site in September but this had to be cancelled due to the flooding of the site.

4. Premises Issues

Rosliston Medical Centre although purpose built is now twenty six years old and while the practice (Appendix 2) have over the years continued with general maintenance it is now at the state where it needs some considerable investment to bring it up to the standard required to be compliant with the new legal requirements. In addition there is the need to replace the hot water system that has underground ducted piping that has leaked several times over recent years and caused additional damage. This system has now caused two further episodes of flooding within short proximity of each other and has caused significant internal damage. The practice remains closed at this time.


5

5. Patient Consultation

i. Initial advice to Practice

Primary care officers from both the CCG and NHS England primary care team met with the practice to discuss various issues about the branch surgery with a options discussed. The practice acknowledged that engagement with patients in Rosliston would be required in order to submit an application. The practice was advised and accepted that no patients would be deregistered if there was a decision to close the branch.

ii. Engagement with Patients

The practice is required to consult and inform patients of any changes to service provision in accordance with section 13Q of the NHS Act 2006. This states that “NHS England must make arrangements to secure that individuals to whom the services are being or may be provided are involved, whether by being consulted or provided with information or in other ways.” The duty applies to all levels of decision making by the Board of NHS England including where decision making has been formally delegated in both policy and commissioning.

iii. Engagement with Patients

Section 6 of the business case attached as Appendix 2 confirms that the practice has undertaken patient consultation over two open evenings which were well attended including the MP for South Derbyshire.

It should be noted that the initial events were held at relatively short notice and no notes were taken. However, it appears that the outcome of those events has been well documented by the practice and the comments from the practice reflect the views raised by patients directly to NHS England and the CCG.

From the information included in the business case, it is difficult to assess which points attracted the most attention but it is fair to conclude that patients wanted the practice to remain with some programme to improve the issues that the practice had identified as of concern. Of note is the issue of transport for the elderly and concerns over getting appointments at Stapenhill.

The practice has considered all the feedback from the engagement events and taken on board the anonymously shared feedback provided from patients to the CCG and NHS England.

iv. Letters from Patients

Both the CCG and NHS England have received a number of letters from Rosliston residents/patients regarding the potential closure of the service. The key themes from those letters are:

• Stapenhill surgery is felt to be at full capacity therefore there is concern about patients being able to obtain appointments

• The bus service between Rosliston and Stapenhill is irregular (approximately every 2 hours) therefore patients may find it difficult to reach the surgery in Stapenhill.

• There is concern that the IT system should be fully functional and that the NHS should fund this accordingly

• It was felt that the recruitment of doctors could be resolved by better advertisement and would resolve in three to four years’ time therefore the practice should consider to keep the branch open in the interim

• The building has been mismanaged and shouldn’t be in a state of disrepair. • Mismanagement at the practice has created this situation


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6. Financial Implications

There are possible cost savings to the CCG in rent reimbursement of £16,848.84 for the branch to the CCG.

Stapenhill Surgery have also identified within their Business Case that they would see financial savings within the practice and that this could subsequently be re-invested in to the Stapenhill site to provide an improved provision to all of their registered patients.

7. Registered List size and patient demographics

According to the practice profile on primary care web tool, there are 33 patients in nursing home, a total of 4682 are Male and 4559 are female patients; 2000 patients access GP services from the branch surgery. The age profile of patients registered at Roslistion is higher than that at the main surgery site.

8. Equality Impact Assessment and Quality Impact Assessment

Both an Equality Impact Assessment and a Quality Impact Assessment have been completed. The Quality Impact Assessment has been reviewed. The panel raised concerns about travel implications specifically for those temporarily housebound and wished for this to be considered further. The practice has since confirmed that housebound patients, inclusive of those that are temporarily housebound, would continue to be visited as happens currently. A stage 2 Equality Impact Assessment has now been submitted and is due for final review.

9. Recommendation

With all of the information detailed within the business case and provided above the Committee are asked to review the case and to accept or decline the application.


7

Appendix 1

Source: Primary Care Web Tool 13th April 2018

Appendix 2. Practice Business Case Report

• dispensing services (if applicable). WELL ft-1All/11AC"I orJ STTE: /'cT &APfl'-lH I LL

7) From which date do you wish the branch closure to take effect?

Note: Where an application to close premises is granted by the CCG on behalf of NHS England, the contractor shall remain fully responsible for cessation or assignment of the lease for any rented premises and any disposal of owner-occupied premises. In both cases, payments under the premises directions will cease from the day of closure.

Please note that this application does not concert any obligation on NHS England to

agree to this request.

NHS England Branch Closure for primary medical services Document Number: OPS_ 1023 Issue

Date: July 2014 Version Number: 01.04 Status: Approved Next Review Date: July 2016

To be signed by all parties to the contract

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Page I 2


1

REPORT TO: South East Staffordshire & Seisdon Peninsula CCGs

Enclosure: 04


Title: PMS Re-investment


Executive Lead(s): Exec Sign-Off Y/N Author(s): Lynn Millar Eleanor Wood

Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): Dr Rachel Gallyot N

Action Required (select): Decision Discussion For Assurance / For Information

Purpose of the Paper (Key Points + Executive Summary):

The re-investment monies for each CCG have increased in 2018/19 following the increase in global sum and for East Staffordshire CCG the re-investment funds are as outlined below:

A group met to discuss the funding. It was agreed that for 2018/19 an additional service should be added to the bundle of care for the increase in payment and the bundle of care should include:

• Ear Irrigation

The proposal has been shared with the East Staffordshire GP Steering Group who have also agreed the approach. The bundle would be paid accordingly at £1.66 per head of population.

Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register): No risks identified

YearTotal Re-investment per year

Re-investment per head of population

2016/17 35,766.00£ 0.25£ 2017/18 149,970.00£ 1.06£ 2018/19 236,001.00£ 1.66£ 2019/20 302,792.00£ 2.13£ 2020/21 360,482.00£ 2.54£


2

Implications: Legal and/or Risk N/a CQC N/a Patient Safety N/a Patient Engagement N/a

Financial Funding is available for this through the delegated budget and is assigned specifically for the re-investment

Sustainability Will support the sustainability of General Practice through ensuring funds are provided for service provision.

Workforce / Training N/a





Please provide detail within the body of the report as to these considerations: • Can you confirm an Equality Impact & Risk Assessment (EIRA: stage 1 & 2) has been

completed; if not, what is the rationale for non-completion?

• Which if any of the nine Protected Groups were targeted for engagement andfeedback to CCGs, and why those?

• Summarise any disaggregated feedback from local Protected Group reps about anynegative impacts arising / recommendations (e.g. service improvements)

• What mitigation / re-shaping of services resulted for people from local ProtectedGroups (along the lines of ‘You Said: We Listened, We Did’?)






The Primary Care Commissioning Committee is asked to:

Approve the proposal

Page | 1

1. Introduction PMS re-investment funds for East Staffordshire CCG have previously been re-invested at a rate of £0.84 per head of population. This funded a bundle of care which included the following services:

• Spirometry • ECG • 24 BP monitoring

The invested funds covered years 16/17 and 17/18 therefore there is a requirement for plans from 18/19 onwards. These monies are not ‘new’ monies into General Practice it is rather a re-distribution of funds to ensure that all PMS and GMS practices have equitable funding within a CCG area. Therefore PMS practices will see a reduction in funding with GMS practices seeing a slight increase in funding in order to pay for services that many practices have provided over and above GMS without funding. The funds are required to be re-invested to ensure that a level of services remain to be provided in PMS practices and GMS practices are funded to also provide the same services. Some PMS practices may need to discontinue services if not included within the bundle. Practices will be required to inform the CCG if looking to discontinue a service in order for the CCG to assess the impact. A group met in November to consider proposals for the re-investment. This paper provides a proposal on PMS re-investment for this financial year. 2. PMS re-investment fund The re-investment monies for each CCG have increased in 2018/19 following the increase in global sum and for East Staffordshire CCG the re-investment funds are as outlined below:

The principle of the funds is that these will be re-invested to ensure that a level of services remain to be provided in PMS practices and GMS practices are funded to also provide the same services. The group reviewed the current services provided under PMS, Local Enhanced services, and also services currently provided by GMS practices over and above core contract.

YearTotal Re-investment per year

Re-investment per head of population

2016/17 35,766.00£ 0.25£ 2017/18 149,970.00£ 1.06£ 2018/19 236,001.00£ 1.66£ 2019/20 302,792.00£ 2.13£ 2020/21 360,482.00£ 2.54£

Page | 2

3. Proposal It was recommended that for 18/19 an additional service should be added to the bundle of care for the increase in payment and the bundle of care would include:

• Ear Irrigation The bundle would be paid accordingly at £1.66 per head of population. The CCG are in the process of confirming the level of inflation to be paid to practices. It is expected that this will be approximately 30p per head of population and will be paid to all practices. The group will continue to meet to review proposals for future years. The East Staffordshire GP Steering Group have had the opportunity to comment on the recommendation and the Group were in agreement with the proposal. 4. Recommendation It is recommended that the Primary Care Committee approves the proposal.


1

REPORT TO: East Staffordshire Clinical Commissioning Group

Enclosure: 5


Title: GP Forward View – 10 High Impact Actions Plan



Lynn Millar Y Sarah Turner Laura Bird

Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): Y – Enhancing Primary and Community Care

Action Required (select): Decision Discussion For Assurance / For Information

Purpose of the Paper (Key Points + Executive Summary):

1. Introduction This paper provides an update on the current status, funding and future plans for delivery of General Practice Forward View (GPFV) specifically related to the 10 High Impact Actions for East Staffordshire CCG.

2. Active Signposting and Document Management (Workflow) Funding from NHS (NHSE) England was allocated to CCGs for the purpose of supporting the training of reception and clerical staff in GP practices to undertake active signposting and document management (workflow optimisation). 132 staff have been trained in active signposting to date, further training sessions have arranged with the trainer going into practices and working with them direct. These sessions are being rolled out throughout January and February 2019. Appendix 1 provides a detailed summary for each these specific elements. An evaluation of workflow is currently underway through an online survey with a report expected back at membership boards and Primary Care Commissioning Committee in February 2019. Plans are in place to roll out and embed these programmes. The CCGs have invested this funding into primary care training and are on plan to spend the allocated funds in the following ways:

(i) ongoing staff training events (ii) provider licences (iii) backfill for focused support (iv) access to online training resources (v) advertising and communication materials to support patients understand of signposting


2

3. Delivery Plan (Appendix 2) provides an update on current status of the 10 High Impact Actions and future delivery plans/timescales. A number of these work streams have been undertaken without investment however, it is recognised that opportunities for practices to work collaboratively within their locality and/or with other localities may lead to greater economies of scale, shared use of resources, common learning and approaches. This is at the discretion of individual practices. The CCGs are awaiting final confirmation of exact funding for 2019/20 from NHSE. However, the CCGs have partial plans as outlined in the attached delivery plan and are committed to spending the funding. The primary care team are working closely with practices and localities to finalise 2019/20 plans.

Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register): N/A

Implications:

• Legal and/or Risk Approved providers used for basis of delivery of training • CQC Not applicable • Patient Safety Processes in line with delivery of high quality and safe patient care • Patient

Engagement Signposting patients to appropriate and available services

• Financial Information has been collated and is in line with NHSE monthly returns. Funding is received from NHS England as part of GP Forward View.

• Sustainability Supports the GP Forward View of sustainable General Practice • Workforce /

Training Staff are receiving the appropriate ongoing training and support to deliver these initiatives

• Key Requirements: Yes No



N/A










3



• Recommendations / Action Required:

• The Primary Care Committee is asked to:

Review the paper for information and be provided with assurance on how funding has been invested.

East

Practice Code & NameRegistered population

1. Does the practice have any staff trained/recruited as care navigators/ signposters or to

manage (code and action) incoming clinical correspondence?

3. Headcount of staff trained to code and action

incoming clinical correspondence without reference to a GP where

appropriate?

4. Headcount of staff trained/recruited as a combination of both roles? (This is

separate to the headcount of staff from questions 2 and 3, refer to the guidance if

unsure.)C81018 DOVE RIVER 8,607 Yes 3 0M83010 GORDON STREET SURGERY 10,411 Yes 2 0M83013 YOXALL 4,849 Yes 0 0M83026 CARLTON STREET SURGERY 14,265 Yes 0 0M83027 TRENT MEADOWS 11,873 Yes 2 0M83035 ALREWAS 5,842 Yes 1 0M83037 TUTBURY HEALTH CENTRE 7,547 Yes 0 0M83042 BRIDGE SURGERY 9,826 Yes 3 0M83051 WETMORE ROAD SURGERY 11,020 Yes 3 0M83059 ABBOTS BROMLEY SURGERY 4,042 Yes 1 0M83065 BARTON 7,150 Yes 1 0M83073 STAPENHILL MEDICAL CENTRE 9,605 Yes 0 0M83074 BALANCE STREET 13,779 Yes 0 0M83641 MILL VIEW SURGERY 2,051 Yes 0 0M83680 NORTHGATE SURGERY 5,912 Yes 0 0M83681 ALL SAINTS SURGERY 8,661 Yes 2 0M83718 PEEL CROFT 3,527 Yes 1 0Y00078 WINSHILL 4,219 Yes 0 0

Practices expected to receive training this year

2016/17 2017/18* 2018/19 2019/20Funding available £20,410 £65,040 £25,515 £25,515

Funding spent/planned £20,410 £65,040 £25,515 £0

* Please note 17/18 funding includes one-off funding for workflow optimisation training

7

2. Headcount of staff trained in active signposting, to ascertain the patient’s need and signpost them to the most

appropriate person or service, referring to a local directory of

services?121444

15119

1180

D. Practices have been contacted and those wishing to extend their access to the Workflow e-learning after the 31st October is being arranged with the provider. It has been identified that some practices would prefer face to face workflow training. EPI can provide this training and this is being explored. Sessions to be arranged for Jan-March 2019

10314766

Additional InformationA. Active signposting events took place between April and June 2018. Rollout now ongoing.B. Due to some signpost training sessions being cancelled last minute options are being explored to arrange another two signpost session to ensure all staff are trained. EPI have been identified as the provider and sessions are currently being arranged for Jan-March 2019.

C. Online workflow optimisation training has been offered to all practices (minimum of one place per practice, with an additional place offered to those practices that have not yet received training to date).

Number of staff expected to attend the training Who is expected to provide training? Cost of training

£1,500 for a development sessions allowing Practice Managers and receptionist to share learning and implementation plans across all

practices.

Maximise practice uptakeTwo schemes are discussed regularly at locality and practice manager

meetingsEvaluation and learning will be shared across the localities and schemes

develop. Feedback shared from those practices trailblazing the approach to

encourage other practices.Ongoing evaluation on workflow to inform the developments & get the most out of the available funding and that it is being rolled out to the

maximim levels.Comms engagement - e.g. Youtube, PPGs. There will be a comms

approach for raising awarenes of the schemes with the public as they're ready.

Prepared guidance for localities so clarity on the packages available and framework given to assist them in picking their provider so that it will

work best for the locality.Regular feedback to those practices currently not in a position to

partiicpate so they can participate at a later date.

Locality approach - encourages working at scale - therefore working together as primary care networks.

Consistent approach schemes as same local staff support extended access services.

Online directory available for use by all practices e.g. MiDOS or locally developed.

Supporting work with local partners in the community to support working at scale & utilising services in the comunity setting.

WorkflowOn going access to practices, unlimited access for new users allowing access to the online modules and the

help desk.

WorkflowPractice Unbound

Workflow £14,174.90 which will provide a full year access to online training

modules, help desk and data.

Details of other expenditure e.g. backfill costs. How is the CCG maximising value?Connection with other GPFV initiatives e.g. Primary Care Networks,

Extended Access

6 Practices have yet to trained in active signposting due to cancelled training

sessions earlier this year.

Practices received a 4 day workflow training session 10/18 practices attended along with a year access to online training modules and access to the practice unbound helpdesk. On discussions with practices they wish to train

further staff within their practices on workflow. The remaining practices that have not received any form of workflow training will require an group session and access to the online modules and helpdesk to fully

implement within their practice. Therefore we are going to look at extending the

practice unbound access for another year to allow time for staff to be fully trained.

SignpostSignpost sessions will train 20-30 members of staff

depending on training provider chosen.

SignpostThe three below providers have been shared with practices. Practices are encouraged to source alternative

training providers. West Wakefield Health and WellbeingEffective Professional Interactions (EPI)

Thornfields

17/18 BudgetThe budget of £65,040 was invested in redirecting worfklow active

signpost training between December 17 - June 18. NHS England provided additonal funding towards workflow training for 17/18.

18/19 BudgetSignpost

West Wakefield - £10,000 for a 2 day face to face session EPI charges £10,000 for 2 half day sessions

Thornfields price range from £2,000 - £5,000 per training session£1,000 set aside for venue and refreshment costs for the signpost session.

EAST STAFFORDSHIRE CCG Delivery of the 10 High Impact Actions – Status and next steps Introduction: The General Practice Forward View represents a step change in the level of investment and support for general practice. The 10 high Impact Actions are a collection of ways to improve workload and improve care through working smarter, not harder. 10 High Impact Changes

Current Status Intended Action / Next Steps Anticipated Implementation date

Care Navigation 132 staff trained in active signposting Comprehensive report on current status and funding spend / planned to be submitted to PCC.

Rollout ongoing

Care Navigation Signpost Training sessions took place between April and June 2018 which 13 practices booked onto. Further training sessions arranged with EPI which took place on 17th January 2019 this provides another 20 trained members of staff across 6 practices.

Comprehensive report on current status and funding spend / planned to be submitted to PCC. EPI will be providing further face to face workflow training sessions to practices. These training sessions have been arranged with the trainer going into practices and working with them direct. These sessions are being rolled out throughout January and February 2019.

January / February 2019

Care Navigation Signposting Dashboard to be developed to measure the impact of the scheme

Working on a signposting dashboard with the Data Quality Specialists (DQS) to cover East practices reporting on signpost activity. Once in place DQS will download monthly data and share quarterly performance reports with practices and monthly with the CCG. This will continue on a quarterly basis.

Ongoing

Care Navigation Super User Event to be arranged

Further practices are yet to be trained. Once all training is complete the Primary Care Team will contact practices to discuss holding a super user event.

Ongoing

Care Navigation Dashboard developed to measure the impact of the scheme.

DQS downloads monthly data and shares quarterly performance reports with practices and monthly with CCG. This will continue on a quarterly basis.

Ongoing

New consultation types

Dr Ruth Chambers, in her role as Clinical Chair & Staffordshire STP’s clinical lead for technology enabled care services, is involved in various work around this subject. Paper submitted last year on different models of consultation to the STP who recommended it be endorsed by the Staffordshire Digital Design Authority (SDDA) Technology Enabled Care Services (TECS) plan in place - action learning sets for nurses have taken place to utilise TECS to support LTC pathways.

Individual TECS reports have been sent to practices c/o Dr Ruth Chambers, which highlight long term condition rates at the practice and provide technology solutions / apps that may be beneficial for patients with these conditions. Practices can promote these to patients. These have also been incorporated into action learning sets for practice nurses to utilise through long term condition clinics. Improving practice delivery of care for long term conditions with technology enabled care event took place on 9th January 2019 which a number of East Staffs practices attended. The event demonstrated to practices new ways of working with technology.

Reports issued October 2018 January 2019


Skype consultations / E-consultations between Care Homes / Practices Digital conference held in November 2018 in Birmingham to share learning.

Programme lead continues to review other suppliers who have emerged onto the market to ensure area is piloting products that suit the objectives of the programme. Follow up meeting with NHSE Primary Care Digital Transformation Lead for Staffordshire to confirm how CCG will support the new 111 app to understand how both primary care and UEC systems can integrate. Staffordshire looking to have four pilot practices in early phases of development.

2019/20


Staffordshire currently procuring an Integrated Care Record (ICR) which will work across Staffordshire and neighbouring areas (following successful EFFT bid for funds).

Procurement currently underway Procurement expected to be completed by July / August 2019


Online consultations – Single Staffordshire approach. 20% practices have either had EMIS Online Triage or eConsult deployed to date.

Online consultations – More practices are due on board to pilot a solution up to January 2019

Online consultations – First phase due to be complete January 2019.

Reduce DNAs The CCG funds all practices to send text messaging reminders for appointment as a minimum through EMIS. Some practices fund other suppliers e.g. MJOG which provides additional benefits such as can accept replies from patients regarding health

Details for the PM’s IT workshop finalised with agenda prepared.

Date to be confirmed

promotion, 9 practices currently use this in East Staffordshire

Develop the team

Practice Manager Development Fund. Comprehensive programme shared with GP Fed in the north and locality bids submitted in South (See list).

This year’s funds are currently in development. Working group being set up.

February 2019

Develop the team

The General Practice Nurse (GPN) 10 Point plan developed and submitted to NHSE in March 2018. Deep dive undertaken and shared with NHSE Umbrella group in November 2018.

• NHSE led regional workshops continue to drive the GPN 10 point plan agenda and working group set up to monitor and drive implementation of plan

• Nurse facilitators gathering info on LTC and HCA training needs • 10 point implementation plan for Staffordshire is in the process of

being updated

Ongoing

Develop the team

Staffordshire Training Hub established to support procurement of training at scale. Funding opportunities created.

• Practice Manager Training – November 2018 and additional session being planned for February/March 2019.

• Practice Nurse Development through the GPN 10 Point Plan. • Practice Nurse Facilitator in post to support Practice Nursing. • PLT programme in place – including in-house and external training • Wider workforce roles – e.g. Clinical Pharmacists

Feb / March 2019

Develop the team

Other workforce e.g. Physician Associates, Clinical Pharmacists, Pharmacy Ambassador in post.

The newly qualified nurse incentive has gained some interest with 4 recruited in practice and now on fundamental programme.

Ongoing

Develop the team

Nurse facilitator roles across the CCGs in place to support practice nursing, develop learning and education programmes, delivery of the 10 point plan.

Working group is being set up to monitor and drive implementation of actions within the Staffs Implementation and Delivery Plan.

Ongoing

Develop the team

Locality Development Programme (LDP) – first “diagnostic” phase completed to understand the readiness of practices to work at scale and to identify programme of support tailored to the needs of each geographical area. (Commissioned by CSU Strategy Unit). Results presented to STP and membership/locality boards.

LDP – report and development plan to be produced taking into account the recommendations in the report and following engagement with localities. Also see Developing QI expertise section.

From September 2019

Develop the team

PLT programme in place pan Staffordshire

PLT dates are agreed across East Staffordshire practices for 2019. Dr Catherine Faarup leads the PLT training sessions and organises the speakers.

Productive Work flows

Online survey issued by CCG to all pan Staffordshire practices.

Survey results evaluated by CCG and report being presented to Primary Care Committees and Membership Boards.

Feb / March 2019


Online workflow optimisation training has been offered to all practices (minimum of one place per practice, with an additional place offered to those practices that have not yet received training to date). 18 staff trained in workflow Practices have been contacted, access to Workflow e-learning is being arranged with the provider. It has been identified that some practices would prefer face to face workflow training. EPI can provide this training and this is being explored. Sessions to be arranged for January - March 2019

6 practices in East Staffs have agreed to extend their access to the Practice Unbound so that they can access the e-learning models. Need to increase the number of trained staff and engage with those practices that have previously declined. Trainer provider EPI have been organised to provide further face to face workflow training within practices across East Staffs. Some practices are attending the face to face sessions.

These training sessions are taking place during January and February 2019.


Local dashboard to be developed to measure the impact of the scheme

Working with DQS to develop, they will then download monthly data and share quarterly performance reports with practices.

Ongoing

Personal Productivity

GP Resilience funds supporting Personal Productivity

Back fill funding for each of the practices to be supported by the workforce project manager to work with the practices to understand each of their workforce challenges, discuss potential workforce solutions and to develop a practice and network / locality workforce plan.

Ongoing

Partnership working

Extended Access: All locations now live and in place from 1st September. (5 bases)

Extended access is now live across East Staffordshire and delivered at scale.

Live

Social Prescribing

Elements of social prescribing will be incorporated into the active signpost training.

Some practices across East Staffs are already delivering social prescribing. These models will be looked at and discussions with practices on the best approach going forward.

2019/20

Support Self care

Supported by Care navigation and TECS around prevention and social prescribing.

Communication and Engagement team have supported this national campaign week. This year’s theme is health literacy and the strapline is Understanding Self Care for Life.

14-20th November 2018

Support Self care

Pharmacy first promoted / reducing prescribing over the counter Medicines (OTC)

In line with NHS-E guidance on reducing prescribing of Over-the-counter medicines the Medicine Optimisation Team will be implementing the locally agreed policy on OTC medicines. The policy and link to NHS-E documents can be found here: http://www.southstaffordshirejointformulary.nhs.uk/docs/pc/Over-the-Counter%20Prescribing%20Policy/. It is identified that the Pharmacy First minor ailment service may contradict this local policy and therefore although the service continues across Staffordshire at present there will be a review prior to April 2019.

Ongoing

Support Self care

“Help us Help” you campaign supported by Communication and Engagement team as part of winter and flu campaign. Resource packs issued to practices for winter 2018.

Messages will be shared which explain what Self Care means, on top of the self-care messages the CCG will be sharing throughout the Winter e.g. in social media packs sent to partner organisations and sent out with web and TV banners.

Ongoing throughout Winter 2018/19

Develop QI Expertise

Quality Improvement Facilitator working with CCG and LMC to be appointed.

Role will support the co-ordination of the learning from the resilience training programmes and QI pack/ Repository of resources to be developed to maintain practices and support other practices. Recruitment process underway.

Interviews being held February 2019


Resilience funding panel took place in June 2018. 18/19 funding is targeted towards workforce to support practices and localities to develop a plan.

Staffordshire wide offer issued to localities to develop workforce plan. Deep dive on previous resilience funding to be completed by NHSE. Case studies produced on the use and impact of resilience funding for 17/18 and 18/19.

Workshops will take place next financial year to showcase new workforce roles/models.

http://www.southstaffordshirejointformulary.nhs.uk/docs/pc/Over-the-Counter%20Prescribing%20Policy/

http://www.southstaffordshirejointformulary.nhs.uk/docs/pc/Over-the-Counter%20Prescribing%20Policy/


Productive General Practice Quick start programme has been offered to all South Staffordshire practices

Three practices within East Staffs have opted to take part in the quick start programme

December 2018 – March 2019

Other notes: • The CCG is in close links with RCGP GPFV ambassador in terms of any GPFV presentations and papers • Monthly data and update reports on GPFV progress are submitted to NHSE. • CCG attend monthly “checkpoint” meeting with NHSE. • NHSE Regional GPFV newsletter is shared with practices via CCG practice newsletter. • The CCG will share learning and case studies from practices via the CCG practice newsletter and practice manager/locality meetings Further information available from:- 10 high impact actions to release time for care https://www.england.nhs.uk/gp/gpfv/redesign/gpdp/

1. Active signposting: Provides patients with a first point of contact which directs them to the most appropriate source of help. Web and app-based portals can provide self-help and self-management resources as well as signposting to the most appropriate professional.

2. New consultation types: Introduce new communication methods for some consultations, such as phone and email, improving continuity and convenience for the patient, and reducing clinical contact time

3. Reduce Did Not Attend (DNAs): Maximise the use of appointment slots and improve continuity by reducing DNAs. Changes may include redesigning the appointment system, encouraging patients to write appointment cards themselves, issuing appointment reminders by text message, and making it quick for patients to cancel or rearrange an appointment.

4. Develop the team: Broaden the workforce in order to reduce demand for GP time and connect the patient directly with the most appropriate professional. 5. Productive work flows: Introduce new ways of working which enable staff to work smarter, not harder. 6. Personal productivity: Support staff to develop their personal resilience and learn specific skills that enable them to work in the most efficient way possible. 7. Partnership working: Create partnerships and collaborations with other practices and providers in the local health and social care system. 8. Social prescribing: Use referral and signposting to non-medical services in the community that increase wellbeing and independence. 9. Support self care: Take every opportunity to support people to play a greater role in their own health and care with methods of signposting patients to sources of information, advice

and support in the community. 10. Develop QI expertise: Develop a specialist team of facilitators to support service redesign and continuous quality improvement.

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/1-active-signposting

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/2-new-consultation-types

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/3-reduce-dnas

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/4-develop-the-team

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/5-productive-work-flows

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/6-personal-productivity

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/7-partnership-working

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/8-use-social-prescribing

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/9-support-self-care-and-management

https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/10-build-qi-expertise


1

REPORT TO: East Staffordshire Clinical Commissioning Group

Enclosure: 6


Title: Primary Care Workforce


Executive Lead(s): Exec Sign-Off Y/N Author(s): Lynn Millar N Rebecca Woods

Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): Y Workforce and EPCC

Action Required (select): Decision Discussion For Assurance / For Information X

Purpose of the Paper (Key Points + Executive Summary): To present to committee information on:

• workforce challenges facing primary care • local actions being taken to help address these challenges • governance processes to oversee delivery • risks associated with delivery

Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register):

Implications: Legal and/or Risk N/A CQC N/A Patient Safety N/A Patient Engagement Practice level engagement when introducing new workforce models Financial Funding provided through GPFV, HEE, NHS England Sustainability To support sustainability of general practice

Workforce / Training Outlines approaches being undertaken locally to address workforce challenges


2



Please provide detail within the body of the report N/A








N/A




N/A

Recommendations / Action Required: The Primary Care Committee is asked to NOTE this presentation

www.england.nhs.uk

• Presented by: Rebecca Woods

1

Staffordshire Workforce

www.england.nhs.uk 2

Pressures on general practice

www.england.nhs.uk

• Significant numbers of local GP vacancies • Recruitment challenges to GP vacancies, many practices have had

vacancies that have remained unfilled for numerous years • Challenges to recruiting to nursing vacancies • Limited investment in nurse development to take on extended roles • Traditional ‘GP-centric’ model of general practice delivery • Patients expect to be seen by a GP, rather than a range of health

care professionals within a general practice setting • Lack of a culture within general practice to introduce and empower

new workforce models • Underutilisation of skill mix within general practice • Leadership capacity and capability across the GP and practice

manager workforce • Lack of networking to share and implement best practice.

3

Local Workforce Challenges

www.england.nhs.uk 4

Workforce Trajectories

NB: submitted balanced trajectories PA numbers not included as employed by MPFT

Staffordshire

Indicator Sep-15 Mar-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Dec-17 Mar-18 Jun-18 Sep-18 Dec-18 Mar-19 Jun-19 Sep-19 Dec-19 Mar-20 Jun-20 Sep-20

FTE number of GPs excluding registrars 594 592 581 576 579 577 563 553 556 551 540 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/AGPs excluding registrars FTE trajectory #N/A #N/A #N/A #N/A #N/A 573 559 559 558 558 569 574 596 599 644 653 676

676 676 676 676 676 676 676 676 676 676 676 676 676 676 676 676 676 676 676Performance against GPs excluding registrars FTE trajectory n/a n/a n/a n/a n/a -3.4% -0.4% -1.4% -3.1%

StaffordshireIndicator Sep-15 Mar-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Dec-17 Mar-18 Jun-18 Sep-18 Dec-18 Mar-19 Jun-19 Sep-19 Dec-19 Mar-20 Jun-20 Sep-20

FTE number of wider workforce (clinical and non-clinical)

1,823 1,853 1,850 #N/A 1,867 #N/A 1,873 1,845 1,856 1,873 1,877 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A

Wider workforce (clinical and non-clinical) FTE trajectory

#N/A #N/A #N/A #N/A #N/A 1,872 1,856 1,870 1,888 1,893 1,898 1,900 1,902 1,900 1,899 1,900 1,903

1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896 1,896Performance against Wider workforce (clinical and non-clinical) FTE trajectory n/a n/a n/a n/a n/a -1.4% 0.0% 0.2% -0.6%

www.england.nhs.uk

GP Retention

5

• £162,000 has been allocated to Staffordshire which has been prioritised to support: • Exploring why female GPs are leaving the profession

early • Newly qualified GP and host practice support scheme • Place based plans for a programme of organisational

development to support 5 Localities to develop workforce plans, develop a vision for the locality linking with integrated care teams and premises developments.

• Trajectory to retain 58 GPs by 20/21. Potentially challenging to deliver

www.england.nhs.uk

GP Retention

6

• Career Plus Pilot – 1 of 11 national schemes (£100,000) • Trajectory of 1 by 20/21. Achieved • 2 GPs retained, 12 expressed an interest, developed to

support locums (60 locums registered) • GP locum mobile app launched in June 2018, to roll out to

nurses • Tier 2 retention – 60 trainees across North Midlands –

analysis for Staffordshire awaited. Funding made available by NHS England to support Tier 2

• Trajectory of 5 by 20/21. On track to deliver

www.england.nhs.uk

GP Retention

7

• CCT GP Fellowships – slow recruitment to date to HEE scheme due to strict criteria, now is being relaxed

• Local CCT Fellowships – £38,500 NHS England local funding has retained 9 GPs post qualification to date across Staffordshire

• Trajectory of 8.16 by 20/21. On track to deliver • Additional £60,000 from HEE – progressing well. North

Staffordshire ST3 event has been held – outcomes awaited. • 2019/20 will have potentially 24 GPs qualifying who could be

retained in the local area and no funding for 2019/20 Fellowships has yet been secured. Bid for £60,000 submitted to NHS England GP retention funding. Could be mitigation for retention and GPIR schemes

www.england.nhs.uk

GP Supply

8

• GPIR – bid for 100 submitted, reduced to 45 • Slow progress to date. Scheme being refreshed. • Training places over filled on the GP VTS to enable

future workforce supply. Anticipated increase of an additional 30 GPs in September 2021

• 11 additional TERS offered for Staffordshire announced 22.01.19

www.england.nhs.uk

Wider workforce – clinical pharmacists

9

• 7 bids have been submitted and approved across the STP within the National Scheme.

• 27.8 wte pharmacists have been approved. 13 wte appointed 14.8wte yet to be recruited

• Locally North Midlands funded CP Ambassador role

appointed 7 to advocate CP in general practice and to provide Senior Clinical Pharmacist supervision.

www.england.nhs.uk

Wider workforce – clinical pharmacists

10

• 9 practices in total have self-funded Clinical Pharmacists these consist of the following:

4 in Stafford and Surrounds 2 in South East Staffs and Seisdon 3 in East Staffs • A total of 5.2 whole time equivalent in post to date.

• Trajectory of 40 wte by 20/21. On track to deliver

www.england.nhs.uk

Wider workforce – Physicians Associate

11

• New role in general practice • North Staffordshire Federation (Dr Sharon Turner, supported by Lucy Minshull) has led the development of a PA one

year preceptorship programme. Collaborative model – Split placements 2 days a week Trust based, 3 days a week GP, HEE funded education programme, practice and NHS England locally co-fund (50:50) salary for time in general practice.

• 17 in post by end November 2018; a further 5 to be recruited in February 2019 intake.

• 6 graduates of the PA programme have secured full time roles in general practice locally. • Trajectory of 24 PAs by September 2018. Slippage on programme however are delivering against wider

workforce trajectory

• Funding available to support delivery of 24 PAs. • Preceptorship programme has just been endorsed by the RCGPs and Region are looking to roll out a similar

programme

• Seeking to expand the programme beyond 24. In discussions with Regional team to develop a CP funding approach to PAs.

www.england.nhs.uk

Wider workforce – Nursing

12

• National GPN 10 point nursing plan developed and CCGs submitted their local plan. • Point 1: Recognise the existing GPN workforce and their contributions as well as raising the profile

of General Practice Nursing and Health Care Support Workers, and promote general practice as a first destination career.

• National Communication Strategy in place to raise the profile of GPN. The Midlands & East (M&E) Communications strategy has been shared at the (M&E) Regional GPN Delivery Board on 21 June for review and discussion. Once the regional strategy has been agreed the rollout can commence. The Regional plan aims to engage with the GPN and Health Care support Worker workforce, stakeholders and the public to promote the GPN 10 point plan.

• Nursing presence on the GP reference group reviewing the contract and looking at the nursing element of the contract.

• Point 7 Support Access to Educational Programme • Review being undertaken of the fundamentals programme.

• Point 10 Improve Retention

• Scoping the possibility of a National GPN Bank. Other areas in M&E are also scoping out the idea of a GPN bank associated with the training hubs.

• Locally we have shared the RCN information regarding nurse retirement so that we can utilise the experience of retired nurses in a mentor role.

‘Make a real difference’ as a digital nurse champion conference was held in Birmingham on 20 November. Showcased the digital achievements of GPN’s in Staffordshire. The digital agenda will help to meet a number of actions on the GPN 10 point plan including Action 2 Extend Leadership and Educator Roles, Action 6 Embed and Deliver a Radical Upgrade in Prevention, Action 10 Improve Retention and the digital agenda was championed at the GPN Regional Board on the 13 December.

www.england.nhs.uk

Wider workforce – Nursing

13

• SSOTP nurse redeployment opportunity • SSOTP / NHS England co-fund six month salary

contribution, whilst nurses undergo Nurse Fundamentals Course training

• 4 nurses have been redeployed from an available 8 (additional 2 in Telford) • Trajectory of 15.6 wte by September 2018

Slippage, however delivering wider workforce trajectory

• Developing programme to bring school children into nursing.

www.england.nhs.uk

Workforce data quality

14

• Practices submit data via the NHS Digital workforce tool • Data quality is increasingly robust • Working with practices to improve data quality • New reporting tool being piloted in a South Staffordshire

practice, with the aim of improving data accuracy • Offer to practices

www.england.nhs.uk

Workforce offer to practices

15

• £1,020 backfill funding is being made available to each of the practices for the following:

• Review the latest NHS Digital workforce return, to validate the accuracy and update the return.

• Practice Manager and GP to attend workforce workshop to be held in May 2019 (one planned to be held in Southern Staffordshire – attendance not funded)

• 2 hour meeting between a practice GP, nurse and practice manager and the workforce

project manager to explore practice workforce challenges and potential solutions and to also consider future potential retirements.

• Practice (s) to develop a practice and network workforce plan by June 2019.

• In addition to the above to engage with a group of practices to understand their

challenges, support the co-production an overarching vision and a plan for general practice across a number of locality footprints across the Southern Staffordshire area, to include workforce, integrated care teams and premises as part of an organisational development programme.

www.england.nhs.uk

Enablers

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• Care navigation • Redirecting workflow

• Practice manager training

www.england.nhs.uk

Governance

17

• CCG primary care committees

• GPFV PMO STP checkpoint meetings

• Shropshire and Staffordshire Primary Care Workforce Meeting

• Staffordshire STP workforce meeting

• NHS England Umbrella Group GPFV

www.england.nhs.uk

Summary

18

• Good progress is being made against GP and non GP clinical trajectories

• Many innovative collaborative schemes have been developed in Staffordshire (Recognised Regionally)

• Further work is being undertaken on Nurse development

• GPIR mitigation through retention schemes • Increased practice engagement and improved data

quality planned through offer • Key risks – future funding for Fellowship and PA

programmes, GP recruitment

Cannock Chase Clinical Commissioning Group East Staffordshire Clinical Commissioning Group North Staffordshire Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

1

REPORT TO:

East Staffordshire Primary Care Commissioning Meeting Enclosure: 7

Report to: Primary Care Commissioning Meeting

Title: Workflow Optimisation Evaluation


Executive Lead(s): Exec Sign-Off Y/N Author(s): Lynn Millar Director of Primary Care and Medicines Optimisation

Y Laura Bird, Tracy Spooner & Kath Frain Primary Care Development Managers

Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme):

None Y – Enhanced Primary Care and Community Care (as part of the GP Forward View)

Action Required (select): Decision Discussion For Assurance / For Information X

Purpose of the Paper (Key Points + Executive Summary): This report gives an overview of the Workflow Optimisation roll out across Staffordshire’s GP Practices and shares feedback from practice representatives on the impact it has had to date, challenges faced and opportunities for the future. Prioritised next steps are suggested and a further review is scheduled for one year’s time to continue to monitor progress. Workflow optimisation is the effective management of clinical correspondence in GP Practices and is included in the GP Forward View as a 10 High Impact Action to promote resilience and manage workload. This way of working includes administrative staff members coding incoming clinical correspondence and taking action where appropriate, and only forwarding letters to the GP which require clinical overview. Through training and putting in place appropriate processes, governance and audits this way of working can substantially reduce the amount of time GPs spend reading and actioning clinical correspondence. The findings of a survey across Staffordshire GP Practices has found that up to 90% of clinical correspondence can be managed through workflow optimisation, thereby freeing up to 10 hours of GP time per week. Overall practice feedback on workflow optimisation has been extremely positive with GP Champions, Practice Managers and Administrators all confirmed that the implementation of workflow within their practices has had a positive impact. The majority of GP Champions and Practice Managers stated they would recommend workflow to other GP practices. Workflow optimisation training has been funded by NHSE (both through a one-off funding to kick-start this new way of working and through annual funding as part of the GP Forward view). This includes the opportunity for practices to have face-to-face training (or e-learning) from Practice Unbound


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(previously known as ‘Brighton & Hove’). To date 109 practices have at least one trained member of staff and practices are encouraged to cascade the learning to other staff members to ensure sustainability of the workflow optimisation process. Implementing workflow optimisation has saved between 1 to 10 hours of GP time per week, however adoption of the process will lead to an increase in administration time, workload and responsibility as the work is transferred away from the GP. A number of challenges have been raised by practices implementing workflow optimisation, most crucially:

- Process will be hindered if no adoption and leadership by GP practice champion - Need to recognise culture change and full completion of the training of staff can take time - Initially creates more work for GPs to write and test practice specific protocols and

implementation of audit process but in the medium to long term it’s been demonstrated to significantly reduce GP workload

- Increase in administration time and level of responsibility which may be outside of the scope of their existing role.

In order to support the continued roll out and embedding of workflow optimisation, the following next steps will be implemented:

• Re-offer of training to practices, such as continuing with the Practice Unbound’s training & resources through e-learning and for those practices that would prefer face to face training sessions this will be explored with a number of training providers and offered to practices. (NHSE funding is available to support additional training).

• Recommendation to localities to consider communication or peer support group opportunities to further enable staff the opportunity to share their own learning, good practice, challenges or issues they have faced and overcome.

• Recommendation to all Practices to ensure they have governance, contingency plans and indemnity cover in place for workflow. Also recommend that a reference to workflow is included in relevant administration job descriptions.

• Ongoing support available to practices provided by the Practice Unbound helpdesk in relation to how other systems such as Docman, SNOWMED and EMIS work with the workflow process.

• Primary Care will conduct a further short survey during March 2019 to track progress of those practices that are in the early stages of implementation.

The Primary Care team will work with the GP Practices and localities to share the findings of this evaluation with GP Practices and take forward the next steps outlined above.

A quality impact assessment and equality impact assessment has not yet been completed for this national initiative, this will be undertaken.

A follow up review, including analysis of available workflow optimisation data and a follow up survey to compare with this baseline is scheduled to take place October to December 2019, with findings due in January 2020.

Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register): N/A


3

Implications: Legal and/or Risk Nil CQC Nil

Patient Safety Implementation of effective workflow optimisation, including relevant audit processes, aims to promote safe services.

Patient Engagement None

Financial NHS England have provided funding to support general practice in implementing this initiative (alongside active signposting), as part of the GP Forward View. Therefore these funds can be used to support any additional training requirements and plans.

Sustainability Effective correspondence management in general practice will support the sustainability and resilience of primary care.

Workforce / Training Training and support for GP Champions and Administrators in general practice to implement workflow optimisation effectively is in line with the GP Forward View.



Please provide detail within the body of the report No








No




Yes

Recommendations / Action Required: The Primary Care Commissioning Committees is asked to:

• Note the progress and learning from the workflow optimisation roll out to date. • Note the next steps being implemented to resolve challenges, share learning, celebrate

success and promote continued effective embedding of workflow optimisation.


4

Workflow Optimisation Evaluation

1. Workflow Optimisation Background

Workflow optimisation is included within the GP Forward View, as part of the 10 High Impact Actions to release capacity for care. This way of working focuses on effectively managing clinical correspondence within the GP practice, whereby clinical correspondence is redirected away from the GP where this can be done safely and efficiently by an Administrator or other member of the practice team. Through training in workflow optimisation and putting in appropriate processes, governance and audits, the practice is then able to reduce the amount of clinical correspondence processed by the GP.

GP Practices across Staffordshire have had the opportunity to have workflow optimisation training for a member(s) of their team and for a GP champion in the practice. This training was provided by Practice Unbound (previously known as Brighton & Hove). Additional funding is available as part of the GP Forward View to support ongoing training and development time to implement workflow optimisation effectively across the localities.

This evaluation has been undertaken to understand the views of GP Practices across the county on the impact and roll out of workflow optimisation to date, any challenges faced, how these can be overcome and opportunities for the future. To undertake the evaluation, surveys based on the training, implementation and the success of workflow within practice were cascaded out to all Practices across Staffordshire. Three surveys were developed to gather feedback from the GP Champion within the practice, the Practice Manager or implementation lead and the Administrator(s) involved. A total of 104 members of GP Practice staff across those three roles took part in the survey. In addition, one-to-one conversations were held by the GP Forward View CCG Practice Manager lead for Stafford and Surrounds CCG with a small sample of practices for a deeper understanding of their perspectives and a consideration of available workflow optimisation data took place.

2. Summary of Findings (see Appendices for further details)

GP Champion feedback Overall GP Champions were satisfied in the training they had received with 91% of them saying they would recommend workflow to other GPs and that the difference it has made to their practice is better. The majority have seen a time saving, on average between 1-5 hours a week with some GPs stating they have seen up to 10 + hours a week saved this is with around 70-90% of documents being processed. The GPs feedback that biggest challenges faced during the implementation was finding the time to conduct the audits and encouraging their practice staff to carry out the work then agreeing the best approach within practice such as which letters can be processed by the workflow team and ensuring all staffs needs are met. Practice Manager / Lead feedback Practice Managers felt that the training provided to them and their staff was of a good standard with 80% stating that they were satisfied. 72% of Practice Managers feedback that the impact that workflow has had on their practice is either good or very good with 70% + of documents being progressed through workflow. A number of practices have reported back that more training is required for staff and a peer support group would be helpful going forward. Practice Managers were asked within the survey if continuity plans were in place for managing unexpected staff absences, 58% of practices confirmed they had continuity plans in place and the 42% stated there were gaps such as not enough trained staff within their teams to cover and support. Practice Managers who have fully implemented workflow feedback the importance of having the GPs on board and ensuring dedicated administrators and GP time to conduct audits. Administrator feedback The majority of the administrators attended the face to face training sessions and they rated the quality of training received from ok to very good. 71% of members of staff said that workflow optimisation has had a positive impact on their practice by freeing up GP time; it allows documents to be dealt with on the day and a more effective turnaround of correspondents and clinic letters. 27% have not yet fully implemented workflow this is due to staffing capacity within the practice and requiring more trained staff. The other 2% gave a negative rating as it is not clear how workflow will integrate with Docman 10. 88% of practices have an involved GP Champion with audits taking place at least once a


5

month. Some members of staff feedback that the workflow role has freed up GP capacity and the difference workflow has made in the turnaround of clinical letters. Administrators have seen their own work capacity increase as well as their responsibility and it has become a role within its own right which is both challenging and rewarding.

3. Risks and Issues Identified

The following risks and issues have been identified through this evaluation process:

Risk or Issue Mitigation

Issue: Some GP Practices do not wish to participate in workflow optimisation training and/or implementation

Share the learning and positive impact across practices. One-to-one conversations to discuss concerns / support requirements. Facilitate discussions at Locality / Practice Manager meetings to encourage sharing of best practice and positive peer influence.

Issue: Data streams for all GP practices that have implemented workflow optimisation are not currently in place; therefore it is not possible to confirm the amount of workflow which is taking place.

The Primary Care Team to work with the Data Quality Team to explore potential opportunities to use data from clinical systems to understand levels of workflow optimisation.

Risk: Robust governance processes to effectively and safely manage workflow optimisation may not be fully implemented across all GP Practices

The Primary Care Team will work with GP Practices to advise that robust governance processes need to be in place to effectively and safely manage workflow optimisation, including encouraging practices to seek confirmation that indemnity cover is in place.

Risk: Robust contingency plans for effective clinical correspondence management may not be fully implemented across all GP Practices

The Primary Care Team will work with GP Practices to advise that robust contingency plans should be in place to enable continuation of workflow optimisation in the event of the trained Administrator’s absence.

4. Next Steps Building on the learning from this evaluation process, a small workshop took place with members of the Primary Care Team, GP Forward View Practice Manager Lead for Stafford & Surrounds CCG and a GP Practice representative to consider the results. As a result, the following next steps have been put forward to address the challenges raised and share learning: Action Lead Timescale Intended Outcome

1. Engage with GP Practices on the evaluation findings and request confirmation of governance & contingency planning

Contact all GP Practices to share findings, celebrate success and highlight next steps.

Primary Care Development Managers

February – March 2019

Raised awareness across all GP Practice of evaluation outcome. Raising awareness of governance processes


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Include in this communication a reminder to all practices to ensure: • Governance processes are in place (including

regular audits) in line with the training, to maintain quality.

• Contingency plan in place (should trained Administrator(s) not be available to workflow correspondence).

• Indemnity cover in place

This communication to be by email; included in a Practice News e-bulletin and highlighted at Practice Managers meetings (as appropriate).

One-to-one conversations will be held with practices that have highlighted concerns or issues to offer support.

and contingency planning across all Practices. Jointly resolving challenges or issues highlighted in individual practices.

2. Plans for further training and development opportunities to be co-developed (where not already in place) to support further roll out

Additional workflow optimisation training to be made available to GP Practices (arrangements led by localities directly or by the Primary Care Team).

Level of demand and type of training to be co-developed with GP Practices / localities, and to inform (not duplicate) any existing plans already in place. (For example could include a blend of peer support opportunities, e-learning, shadowing opportunities and/or face-to-face training). Training subject to funding availability. Robust governance processes (including regular audits) and effectively workflowing correspondence using Docman / clinical systems to be included in the training, as applicable. For those practices that have opted for continued access to Practice Unbound’s online learning and resource toolkit, the use of the helpdesk to resolve queries will be promoted.

Primary Care Development Managers And where applicable – Locality Leads

2019/2020 Additional GP Practice staff members trained in workflow optimisation, to further embedding within way of working.

3. Follow up with GP Practices that have not completed the survey to request feedback

In order to understand a complete picture of workflow optimisation across the county, any practices that have not completed a survey to have further opportunity to complete the survey and/or share feedback.

Primary Care Development Managers And relevant Practice Managers

January to March 2019

Workflow evaluation overview available across all GP Practices.

4. Facilitate shared learning and resolution of challenges

Offer to facilitate conversations at Practice Managers meetings (or other forums as appropriate) on sharing learning, resolutions to challenges and good practice.

Primary Care Development Managers

2019/2020 GP Practices have opportunities to share ideas, challenges, questions and good practice.


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5. Explore data streams to understand workflow

optimisation levels

The Primary Care Team to work with the Data Quality Team to explore potential opportunities to use data from clinical systems to understand levels of workflow optimisation.

Primary Care Development Managers And Data Quality Specialists

January to March 2019

Data available by individual GP Practices, localities and CCGs on workflow optimisation levels, to understand impact of way of working.

6. Gather case studies to share learning and impact

During 2019/20, a sample of case studies to be gathered and shared through e-bulletins and other communications (as appropriate) to promote workflow optimisation and the impact on practices.

Primary Care Development Team GP Forward View Lead Practice Manager (SAS CCG) GP Practice representatives

2019/2020 Bank of case studies gathered to share learning and demonstrate impact of workflow optimisation.


8

0 2 4 6 8 10 12

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

Appendix A: GP Survey Results 24 members of staff took part in the survey Q1. Can you please tell us which Clinical Commissioning Group (CCG) Locality you sit within?

CCG Locality % Answered Stafford and Surrounds Locality 25.00% 6 Cannock Chase Locality 16.67% 4 North Staffordshire Locality 29.17% 7 Stoke on Trent Locality 8.33% 2 South East Staffordshire Locality 0.00% 0 East Staffordshire Locality 0.00% 0 Seisdon Peninsula Locality 20.83% 5

Q2. What is your perspective on GP Champion training undertaken?

18 out of 24 GPs were very satisfied or satisfied with the workflow training that had been received. Those that were neither or very dissatisfied did not provide further comments. Two GPs did not rate the training undertaken and left comments, one commented and said they felt they did not need to attend the training for the information that was given and the other has not received any training as they have taken over the role as GP Champion.


9

0

1

2

3

4

5

6

7

8

10-30% 30-50% 50-70% 70-90% 90%+

Q3. Can you estimate on average how much time is saved a week? Time saved Responses 30-60 mins 2 1-3 Hours 7 4-5 Hours 5 6-7 Hours 1 8-9 Hours 10 hours + 4 Not sure 4 No time saved 1

On average GP Champions are seeing time saved. Those that commented not sure are in the early implementation stages so at present will see an increase in admin capacity while they learn and regular audits are conducted. Q4. Can you estimate the percentage of your documents being processed through workflow?

17 out of 24 stated that they are processing over 50% of their documents through workflow. Those in the lower percentage are in the early stages of implementation.


10

0 5 10 15 20 25

Better

About the same

Worse

Q5. What difference has workflow made to your practice? Overall the feedback from GP Champions is that workflow has had a positive impact on their practices. The GP that stated worse has not left any comments therefore we are unsure as to why it is worse. Q6. Are all governance measures in place? % Responses In place 62.50% 15 Currently being rolled out 37.50% 9 Not yet commenced 0.00% 0

The majority of practices have either governance measures in place or in the process of implementing them. None of the practices that took part in the survey are in a position where governance has not been considered. Q7. What challenges have you faced in your role as GP Champion and how have these been/are

being resolved? A number of the responses received from GPs were relating to audits stating that it has been a time consuming and tedious process and finding the time during a week busy to complete the audits. Other challenges that the GP Champions have faced are encouraging their practice staff to carry out the work, agreeing the best approach within the practices with other GPs such as which letters can be out through workflow and those letters that GPs need to see and ensuring that all GPs needs are met. There was feedback around the training and that the practices have identified that further staff require training in workflow.


11

0 5 10 15 20 25

Yes

No

Not sure

Q8. As the GP Champion is there any support that would be beneficial to you? A number of responses received from the GP Champions did focus on audits, GP would like some support with the audit process. Further training for GPs, a peer support group, updates via news letters and top tips from others would be helpful. Some comments received from GPs stated that some refresher training where GP Champions have the opportunity to bring their own notes to compare with others, discuss common issues with a problem solving session. There was feedback received that some practices would like some support with governance policies and processes. Q9. Do you have any lessons learned to be shared with GPs at other practices? % Responses Yes 41.67% 10 No 58.33% 14

14 out of 24 stated that they would not be in a position to share any learning with other practices. This is most likely down to capacity. Q10. Would you recommend workflow to other GP?

22 out of 24 GP Champions stated that they would recommend workflow to other GPs. The two GPs they answered no or not sure did not leave any comments.


12

0

5

10

15

20

25

30

35

Face to Face Online Mix (Face to Faceand Online)

Cascaded fromcolleague

Appendix B: Administrator Survey Results 44 members of staff took part in the survey Q1. Can you please tell us which Clinical Commissioning Group (CCG) Locality you sit within?

CCG Locality % Answered Stafford and Surrounds Locality 18.18% 8 Cannock Chase Locality 15.91% 7 North Staffordshire Locality 13.64% 6 Stoke on Trent Locality 25.00% 11 South East Staffordshire Locality 15.91% 7 East Staffordshire Locality 2.27% 1 Seisdon Peninsula Locality 9.09% 4

Q2. What type of Workflow Optimisation training have you undertaken?

If Online training was selected staff were asked how long did this taken to complete.

Time Responses 1 hour 2 6 hours 1 15 hours 1 21 hours 1


13

0 5 10 15 20 25

Very Good

Good

Ok

Poor

Very Poor

0 5 10 15 20 25 30 35

Positive

Not yet fully implemented

Negative

Q3. What are your views on the training you received?

Overall those that answered gave a rating from OK to Very Good. Those that gave the training a poor rating stated that the link kept crashing and the system crashed during the course so they were unable to complete the course. Q4. What are your views on the roll out on Workflow Optimisation within your practice?

Positive o Good support from GPs and Practice Manager o Reduced workload to GPs. Concerns-created backlog of work for administrators; documents often filed

by GPs without action o We break down the letters rather than all action on one letter. ie mark up workflow GP letters first and

then read code. o Step by step each week for progression, not thrown in at the deep end. o The GPs are seeing fewer letters - therefore having more time to spend on other matters o It has really helped with the processing of the patients correspondence.


14

0

2

4

6

8

10

12

14

16

18

Extremelyinvolved

Very involved SomewhatInvolved

Not so involved Not at all involved

Not yet fully implemented o Our staffing levels currently make it impossible to implement o Took a while to convince the GP's only implemented it last month o We need face to face training to be repeated o Our staffing levels currently make it impossible to implement

Negative o Not clear on how to integrate with Docman 10 Q5. Have you used the Helpdesk? Out of the 44 who answered only 2 had accessed the helpdesk. No comments were left of their overall experience of using the helpdesk. There were comments received that Practices weren’t aware there was a helpdesk. This is something that can be advertised to those Practices that have continued with their assess to the e-learning models with Practice Unbound.

Q6. How much is your GP Champion involved?

On average those that have had a positive experience of workflow within their practice their GP Champion has been hands on and involved during the implementation process. Feedback from some practices is that their GP Champion was very involved during the training process and now staff are trained and the process is implemented they are less involved which is would explain why the somewhat involved score is showing 13. Those practices that scored not so involved did not leave any comments as to why. The feedback from the practice that states their GP champion is not involved at all is due to one not yet being allocated.


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Q7. How frequently are audits undertaken?

How frequent % Responses Every day 2.27% 1 A few times a week 4.55% 2 About once a week 15.91% 7 A few times a month 4.55% 2 Once a month 34.09% 15 Less than once a month 38.64% 17

Looking at the table above on average practices are conducting audits once a month. Practices state that in the early implementation stages audits were done once a day and as staff have become more confident they are conducted less.

Some practices have feedback that audits are being conducted less than once a month but within their comments are they stating they are not taking place at all due to still being in the training process.

Q8. What difference do you feel it has made to your time and the practice? 24 out of the 42 that answered stated that they had seen a benefit in GP time or within their own administrative team. By having focused members of staff leading workflow it has freed up staff to concentrate on other roles. Example of positive comments below:

o It has made a huge difference to turn around of correspondence / clinic letters, Drs only have to read letters that require actions / medications changes etc

o The workflow role has certainly freed up GP time. It is now a job in its own right which is both challenging and rewarding

o Whilst it has increased workload for the administration staff it has allowed the GPs extra time to spend on their other tasks. Coding is now more consistent and documents are always dealt with on the day they are received.

o Workflow takes a lot longer for the coder at the time. However it does reduce workload at a later date for me. For the doctors it is great as they are not being sent documents that are unnecessary.

Comments that need to be noted

o We are struggling to train new members of staff who are new to read coding in general practice o There is a lot of clinical responsibility regarding reading every letter that we receive and making a

decision if that letter goes to a Dr or not. Our role is very time consuming and I don't feel like I will ever be up to date with letters, I actually have letters from April this year that I haven't even read yet. Hopefully this will change when we have employed a 3rd person.

o We need more hours to be able to meet our targets we have set ourselves, but it has made a big difference in the readcode being up to date and Doctors getting letter sooner.

o I feel that if I had protected time on a daily basis it would be extremely useful to the practice. I find the second monitor useful when processing the letters as it allows you to have a letter on the one screen and the patients record, and workflow optimisation template on the other.


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Q9. Do you have any ideas on how things can be improved to the roll out for Workflow and any

further support you would find helpful?

o Just try and get a system in place as soon as possible. I found it helpful talking to other practice staff and discussing how they managed workflow. I would like some more training with regard to auditing.

o Have a practice policy on how the GP's want it to be implemented, this makes it job slightly easier for the administrator to know where/who to send the information received.

o The initial training could have been improved for the reasons stated above. I did not feel very confident when I had had the initial training due to the fact that we were not doing it correctly and this was not picked up until 1/2 way through the last day

o The face to face sessions were not that helpful - would have preferred an online package with

handouts. It is very time consuming for the GP and takes much longer than indicated to become signed off in all specialities. Some kind of peer review/support would have been useful.

o Workflow optimisation doesn't seem to gel well with Docman 10, seem to be doubling up on work and there is a similar report that can be done using Docman 10 to enable the GP champion to look at the work that has been input and check on coding's etc...should he wish too.

o Make sure when starting up workflow, that the team is fully aware of what is being done and more precisely how the workflow is to be managed, moving forward. Be clear and concise on what is expected from the workflow team and discuss any difficulties that may arise

o It would be good for more than one staff member to be allowed to go on the face to face training as I think it would have been useful for all of our office staff to attend to have a better understanding. It has been very useful to have a set protocol written by our lead GP for us to follow as we were finding some of the things taught at the training were not needed/wanted by our GPs.

o You need sensible, confident administrators that can workflow accurately. Accurate coding (which is time consuming of course) , which brings me to Docman 10 and it's installation and whether or not this will help solve some problems or hinder us further.

o I'd suggest having someone to connect the remote connection to the computers before the training week. This solves stress and time and would mean making the most of the weeks training. id also suggest rolling out a work sheet to help coders ease their way into the process ... eg. week 1 - 111's and A&Es etc? As I believe many practices didn't have the same structured plan to go back with as we did and I found it really helpful to know what I'm doing and where im headed.

o It would be useful to have standard read codes across the gp surgerys so we are all coding the same

o The implementation time is at least a year. On site surgery visits from trainers in the early days would be useful

Q10. Would you like to share ideas and support peers in other practices?

26 out of 44 stated they would not like to share ideas. However those that be interested have suggested developing a peer support group and communicating via email, regular visits to each other practices and a facebook group.


17

0 2 4 6 8 10 12 14 16

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

Appendix C: Practice Manager Survey Results

36 members of staff took part in the survey Q1. Can you please tell us which Clinical Commissioning Group (CCG) Locality you sit within?

CCG Locality % Answered Stafford and Surrounds Locality 19.44% 7 Cannock Chase Locality 16.67% 6 North Staffordshire Locality 19.44% 7 Stoke on Trent Locality 16.67% 6 South East Staffordshire Locality 11.11.% 4 East Staffordshire Locality 2.78% 1 Seisdon Peninsula Locality 13.89% 5

Q2. What is your perspective on the Workflow Optimisation training undertaken within your

practice?

29 out of 36 were satisfied with the workflow training that had been received. Those that were neither or very dissatisfied did not provide further comments. 2 did not provide a rating but gave the below comments

o We are using Docman 10. Wokflow Optimisation seems to be duplicating what is already being added within Docman 10

o The training concentrated on practices using Docman 7, at the time we had not got Docman at all


18

Q3. What stage of the Workflow Optimisation roll out are you at in your practice?

18 out of 36 are fully implemented with 12 on going. 5 practices did not state what stage they were at in the process due to time constraints or members of staff that were originally trained have now left the practice.

Q4. Number of staff trained within your practice?

Training Type Total Number Trained Face to Face 61 Online 9 Mix (Face to Face and Online) 7 Cascaded from staff 39 Active Signposting 168

Those Practices that have completed the survey the majority have accessed the face to face training which those members of staff have then cascaded down to others within their practice. Only a small amount have access the online training that was made available to all following the initial face to face sessions.

While asking the managers to inform us the numbers of staff trained I asked them to tell us how many members of staff they have trained within active signposting. A total of 168 staff have been trained within 28 that answered.

0 2 4 6 8 10 12 14 16 18 20

Fully implemented

On going

Trainee Signed off

Just starting out

Not yet commenced


19

0 2 4 6 8 10 12 14

Very Good

Good

Ok

Poor

Very Poor

Q5. What impact has Workflow Optimisation had on the practice to date?

Overall the feedback from practices is that the impact of Workflow is that it is very good or good with a total of 26 scoring. Part this question we asked the practices to confirm if GP time had been saved. 19 practices answered and 17 have confirmed that they have been a saving in GP capacity. Other practices have stated that they are in the early days of implementation but can see the benefits to come. The practice that provided a poor rating are currently in a position where they have no trained members of staff due to maternity leave but are in the process of training a replacement.

Q6. How is Workflow Optimisation being managed within your staffing team?

e.g use of different roles, all undertaken by the same administrator, new roles developed?

The majority of practices have incorporated workflow into their current administrative teams. 7 practices have developed new roles creating a dedicated member of staff or team focusing on workflow to free up over members of staff. A number of practices have trained a senior administrator who has the cascaded the training down to other members of staff within the practice.


20

0 2 4 6 8 10 12 14 16

10-30%

30-50%

50-70%

70-90%

90%+

Q7. Can you estimate the percentage of your documents being processed through workflow?

The majority of practices are now processing 90%+ of their documents through workflow. Those at the 10-30% are in the very early stages of the implementation. One practice did feedback that they are processing 0 as they are using Docman. We asked practices to tell us what area of letters they were using workflow for and which areas in the future they plan to use. A large numbers of practices stated they were at the point of using it across all areas, some are planning to get to that stage. Others are working towards NHS 111, GP OOHs and A&E letters.

Q8. How have you prepared for GP/Administrator absences/changes that may impact on the

continuity of the workflow optimisation process in the practice? Stage % Responses Continuity plans in place 58.33% 21 Gaps identified and working on continuity plans 38.89% 14 Gaps identified and unable to develop a continuity plan 2.78% 1

More than half of the practices that responded stated that they have continuity plans in place by having a number of trained staff who are able to cover one another in the event of annual leave or absences. Those 14 practices that have identified gaps and are working on their continuity plans are in the process of training further staff by cascading training down or are awaiting further training sessions to be organised.


21

0

5

10

15

20

25

30

35

Yes No Not sure

Q9. Please share any ideas on how things can be improved to the roll out of workflow? e.g lessons learnt, support that would be beneficial, ideas to other practices just starting out

A number of ideas were received ranging from things that can be done within the practice to training and the communication. Within Practice

• The need of two scanners • It’s important to have all the GP’s on board • Dedicate an administrator and GP time • Need to be realistic about how many admin hours are required in order for this system to work

effectively and in a timely manner. Practices must be prepared to invest in admin time for this. Training

• More training required • Peer support group amongst colleagues

Q10. Would you recommend workflow to other practices?

29 out of 36 Practice Managers or Workflow Leads would recommend workflow to other practices with comments such as it has definitely created GP capacity. Those that stated no or not sure commented that Docman 10 provides the same features and that while it has saved clinician time it has added extra workload to admin.

Appendix D: One-to-One Conversations with Practices


22

Practice 1 Practice has been doing their own version of workflow for many years. The practice is small and has a Practice Manager and two part time staff. Current process is that the post comes in the Practice Manager goes through it and distributes accordingly. The letters then come back for coding only Practice Manager and one other member of staff codes. Next steps: Practice is intending to complete the Practice Unbound online training Practice 2 Practice is completing the Practice Unbound online training but is experiencing issues at their second practice site with the way the Docman was originally set up, this is because it is showing as all users rather than one member of staff. Practice has been in communication with Docman but it still not been resolved. Original trained member of staff has now left this practice. This has been raised with GP Champion and a decision has been made to wait until the installation of Docman 10 to ensure the set up is correct and then re-train staff. Practice 3 At present the practice are processing minor injury and A & E letters through workflow. One member of staff has left who was originally trained. The practice is currently down to one member of staff acctioning letters rather than two which has caused a slight delay. The GP Lead has carried out audits and talks to staff regarding any issues they are having with workflow. Practice has staff who attended the face to face training sessions but feedback that they were disappointed with the training received. Therefore staff don’t feel confident in starting workflow in the practice. Practice Manager has fed back on occasions when she has been asked about the workflow training. Next steps: Practice requires further training Practice 4 Practice has not signed up to the workflow training, practice Deputy Manager has accessed the training on line and another member of staff has looked at it but at the moment the practice does not have the staff capacity to start the programme. Practice 5 Practice is not trained in workflow. Practice was booked on the course in November 2017 via CCG but the session was pulled. Practice uses DOCMAN currently, Practice aren’t a pilot practice for the workflow management system / workflow administrator. Next steps: CCG to arrange workflow training session Practice 6 Practice have found workflow a slog. The two staff member trained up originally left the practice and it takes time to train new staff. Practice GP was unable to go to the training due to holidays and it took a long time for anyone to get back to the practice to arrange training for him. Therefore practice just starting it, all the training has been through the e learning system. Next steps: Practice have request come support. LS is contact with practice. Practice 7 Practice are starting to use workflow with GP champion. LS has been supporting the practice and has been to visit the practice and arranged for the practice to come and shadow the workflow process at Holmcroft surgery. Practice 8 Practice have feedback that the GPs have really benefitted from the workflow system but it is hard to quantify how many clinical hours have been saved. GP Champion continues to undertake an audit of 10 letters, of differing specialities, each quarter in order to ensure that the standards are being met. Two staff are trained and attended the face-to-face course which they didn't find very useful. The practice don't use the Dashboard and unsure how they can be supported in moving things forward as they are work flowing all of the letters coming into the surgery now. The challenges have been the extra hours required by the scanning operator, who is full-time and works flat out. If practice did have another scanner then probably could put more input into this as they could have more than one operator working.


1

REPORT TO:

East Staffordshire Clinical Commissioning Group

Enclosure: 8


Title: Primary Care Commissioning Committee Risk Register Update


Executive Lead(s): Exec Sign-Off Y/N Author(s): Sally Young: Director of Corporate Services, Governance & Comms Y Tracey Revill, Governance Manager

Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): N/A N (internal CCG work programme)

Action Required (select):

Decision Discussion For Assurance / For Information Purpose of the Paper (Key Points + Executive Summary):

This paper provides an update to the Primary Care Commissioning Committee about the risk register for those risks that the committee has oversight of. The attached register highlights all risks currently on the register as of 22 January 2019. The Audit Committee meetings in common discussed the full risk register at the December meeting and in particular about the contents of the register and how this should be improved as they were not assured by some of the mitigating actions recorded. Other CCG sub-committees have also echoed these comments. The Audit Committees have also asked that Executive Directors attend future meetings to present their risks and Directors will be receiving invitations to do so. The management and mitigation of risk is a key part of demonstrating we are an effective organisation and it is concerning that the Audit Committees are not assured with how we are currently doing this. It is important this is remedied quickly. Therefore, the Accountable Officer has agreed with the Director of Corporate Services, Governance & Comms that the following changes to the front cover will now include: - Scores for individual risks and the reasons, along with new risks and risks recommended for closure

with more narrative to explain this.

- This report will be developed by the Governance Team, however Execs should be prepared to provide detail of their particular risks in the meeting if requested by the Committee.

The Risk Register is shortly about to move onto a new electronic system (Datix), which should make it easier to update. The Governance Team will provide any support necessary to Execs and their Risk Owners to ensure that people are able to use the system and remain aware of the requirement for

consistent risk assessment (scoring and mitigating actions / consequences description)


2

Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register): N/A – all risks scoring 12+ are covered within the report

Implications: Legal and/or Risk Joint working legalities c/o CCG governance Frameworks, Committee TORs etc CQC n/a Patient Safety Risk, assurance + clinical governance duties of CCG Quality Committees Patient Engagement Risk, assurance + clinical governance duties of CCG Quality Committees Financial Risk, assurance + financial governance duties of CCG Committees Sustainability A positive governance culture secures ownership of the transformation agenda Workforce / Training Risk awareness + process training delivered as part of the OD agenda



Please provide detail within the body of the report n/a








n/a




n/a


The Primary Care Commissioning Committee is asked to:

(1) Note that assurances for risks have been sought and the register has been updated accordingly.

(2) Review and make any comments regarding the content of the Risk Register and identify if they require any further assurances in regard to the risks recorded.

(3) Approve the closure of the two proposed risks.


3

Risk Overview

• Scores for individual risks and the reasons

A summary of the current high-scoring risks (‘Inherent’ scores of 12 or above), whether jointly affecting all six Staffordshire CCGs or solely for the three South Staffordshire CCGs, shows the following. Further details are provided on the actual Risk Register itself, along with an indication of the trend for each risk as noted below: Score Ref. Descriptor Rationale

16 A1.54 GP Workforce: recruitment / retention Plans developed by GPFV Workforce Programme - approved by NHSE

16 A1.56 Investment: Delegated budget, failure to invest in Primary Care

Ledgers have been updated to reflect the forecast outturn and will be adopted.

16 A1.58 Quality: Outpatient referrals, admission and A&E activity known variations in practices

The QIF review has been completed.

16 A1.61 Primary Care Strategy Primary Care Strategy Group has been established with development engagement events planned for January and February 2019.

16 A1.66 Staffordshire wide network: core components

CCGs continue to work with service providers to ensure the network is safe from cyber attacks.

9 A1.57 Estates: Practice Leases and current lease arrangements

Short-term review of leases was completed in August 2018, estate requirements being considered.

6 A1.60 Engagement: failure to engage with primary care via localities

A meeting was held on 02 January 2019 to discuss the Membership Engagement group (MEG)

The full updates provided by risk owners for the above risks can be found on the attached risk register.

• New Risks and Risks recommended for closure

No new risks have been added to the Risk Register in this last month. There are two risks proposed for closure by Risk Owners this month: Score Ref. Descriptor Rationale

9 A1.55 Investment: Local Enhanced Services (LES)

Investment in primary care is underway with a support strategy being developed. Risk owner considers this risk can now be closed.

9 A1.59 Access: Extended hours provision Extended access service provision has been commissioned across all six CCGs from 01 September 2018, therefore risk owner considers this risk can be closed.

24

East Staffs CCG Transferred Risks: 11

North Staffs and Stoke-on-Trent CCGs Transferred Risks: 49

Cannock Chase / South East Staffordshire and Seisdon

Peninsula / Stafford and Surrounds CCGs

Transferred Risks: 31

South East Staffordshire and Seisdon Peninsula CCG Transferred Risks: 5

Cannock Chase CCG Transferred Risks: 2

23/01/2019

Recommend Closure

Ris

k R

ef SCOPE OF RISK

inc CONSEQUENCE

(Risk Description)

NATURE OF RISK

(Risk Type)

STAKEHOLDERS

(Org Name)

RISK TREATMENT & CONTROL MECHANISMS

(Initial Mitigating Actions to reduce to TARGET RISK SCORE - to be supplied).

(Including any policy or strategy implications)

TARGET

SCORE

(L x C)

Risk

Owner(s)

Directorate Trend CCG

A1

.54

WORKFORCE:

GP RECRUITMENT AND RETENTION: Failure to stabilise

General Practice due to national shortage of GPs /

Practice Nurses. This shortage also spans health and

social care, in particular community nurses and other

staff which may impact across the Staffordshire

footprint.

There is also a risk that due to the national workforce

shortage, which spans health and social care in

particular community nurses and other staff, this may

impact across the Staffordshire footprint.

GP WTE trajectory 545 wte compare to a 595 wte target.

80 GP retirements expected within 3 years and 40

vacancies over 18 months.

Higher than average GP to patient ratios, particularly in

Stoke-on-Trent and Stafford and Surrounds.

Clinical, Operational and Financial risks. Challenge

in delivery of constitutional targets which may

impact on patient care and performance. Failure

to support and develop sustainable Primary Care

and General Practice.

North Staffordshire CCG

Stoke-on-Trent C CG

Cannock Chase CCG

Stafford and Surrounds CCG

South East Staffordshire and

Seisdon Peninsula CCG

East Staffordshire CCG

Updated 03 January 2019

1. Workforce plans and action plan developed by GPFV Workforce Programme - approved by NHSE workforce plan, includes recruitment and retention,

international recruitment, training and development, new workforce models, Marketing Northern Staffordshire in partnership with BMJ. Monitored through

Primary Care Workforce Group.

3. International recruitment scheme in progress. Task and Finish Group established.

4. North Staffs GP Federation successful in becoming one of the 11 national GP Career Plus Pilot sites.

5. Resilience funding bids approved to support new workforce models in practices – ongoing support being provided..

6. Releasing Time to Care - 990 care navigators trained to direct patients to appropriate services. Peer support being implemented to encourage further

uptake of training and rollout

7. Releasing Time to Care - Brighton and Hove workflow training rolled out to practices. Evaluation has been completed and being reported to PCC in Feb

2019 and then Membership boards to share best practice to encourage wider uptake.

8. Practice Manager development funding plan continues to be rolled out via the Staffordshire training hub. 18/19 funding supporting two working at scale

events in spring 2019.

9. Baseline Exercise for workforce at Locality Level underway

Updated 26th September 2018

1. Workforce plans and action plan developed by GPFV Workforce Programme - approved by NHSE workforce plan, includes recruitment and retention,

international recruitment, training and development, new workforce models, Marketing Northern Staffordshire in partnership with BJM.

Manir

Hussain,

Deputy

Director of

Primary Care

Lynn Millar, Director of

Primary Care

=


Stoke-on-Trent CCG

Cannock Chase CCG




East Staffordshire CCG

A1

.55

INVESTMENT

LOCAL ENHANCED SERVICES

Variation in investment and service provision leading to

inequity for patients and poor outcomes.

There is a requirement to review all LESs to ensure that

they meet local need and there is equitable access to

services by practice populations and services are of high

quality and are cost effective.

The risk is that these services have not been reviewed

for sometime and there is a need to be assured of the

above requirements.

Operational, Clinical and reputational risk. Failure

to support and develop sustainable Primary Care

and General Practice.


Stoke-on-Trent CCG

Update December 2019:

1. Primary Care investment review is now underway, with a supporting strategy being developed as part of the overall PC strategy.

2. The following LES's have been prioritised and have action plans in place, proposed changes to be implemented by April 2019:

- Anticoagulation

- Spirometry

- Wound Care

- Shared Care

- Elderly Care Local Improvement Scheme (LIS) North only

3. PC investment steering groups have been established and met once, will continue to meet monthly throughout the review.

4. All initial engagement meetings have been completed across the 6 CCGs

5. All investments are now being managed and overseen centrally by the Head of PC Commissioning

Propose risk is closed


1. Primary Care Investment implementation plan has been developed to outline the timeline and process for reviewing the current funding arrangements.

Including LES, LIS, QIFs etc. This will be presented to the September PCC for approval.

2. Task and Finish Group established to oversee LES review.

3. Review will prioritise LESs where there is greatest risk to service delivery e.g. ACM, wound care, DMARDs.

Melanie

Mahon, Head

of

Commissioni

ng (Planned

Care)


Primary Care


Stoke-on-Trent CCG

A1

.56

INVESTMENT

DELEGATED BUDGET

Failure to invest in primary care resulting in an

underspend in the delegated commissioning budget and

a lack of investment in primary care. Failure to spend

the budget highlights a lack of planning in Primary Care

and poses a significant reputational risk to the CCG.

Operational, Clinical and reputational risk. North Staffordshire CCG

Stoke-on-Trent CCG


The ledgers have now been updated to reflect the forecast outturn and will be adopted going forward.

5. Social prescribing up and running from January 2019.

6. Other cost pressures are now being factored in and a new budget forecast outturn is in development.


1. July 2018: Proposal presented to PCC outlining the budget, the current commitments and expected cost pressures. The Committee approved the current

spending principles and next steps.

2. PLT proposal to be presented in September 2018.

3. Process and criteria for funding to be presented in October 2018.

4. Social prescribing project is likely to slip which will mean the allocation will not be fully spent, therefore proposal to invest into other projects include winter

and practice leadership will be developed by October 2018.

Manir

Hussain,

Deputy

Director of

Primary Care


Primary Care

=


Stoke-on-Trent CCG

A1

.57

ESTATES

PRACTICE LEASES

Current lease arrangements pose problems for

partnership model in terms of retirements and

attracting new partners.

UPDATE - 25/09/2018 - Emergent Risk in regards to

historical lease arrangements which may result in

financial impact on the CCGs

Clinical, Operational, Financial and reputational

risks. Failure to support and develop sustainable

Primary Care and General Practice.


Stoke-on-Trent CCG


Risk Owner advised no further update available at this time.


Head of Primary Care Development has reviewed this risk and there is no further update at this time.


1. Short term Lease review completed August 2018.

2. Clinical model for General Practice to be developed as part of Primary Care Strategy which will inform the future estates requirements and lease

arrangements.

3. Ambition to move to larger list sizes and development of new business models as described in the STP NMC Programme. Link to primary care strategy to

describe roadmap.

Manir

Hussain,

Deputy

Director of

Primary Care


Primary Care

=


Stoke-on-Trent CCG

A1

.58

QUALITY

OUTPATIENT REFERRALS, ADMISSIONS AND A&E

ACTIVITY

Known variation across Practices within the CCGs which

is leading to potentially higher than expected outpatient

referrals, admissions and A&E activity. There is potential

inequitable service provision.

Failure to identify quality / safety risks impacting

on patient outcomes / patient experience.


Stoke-on-Trent CCG


The QIF Review has been completed.

5. In SOT and NS a review of the QIF programme is underway to ensure this meets with differing variation.


1. Quality visits underway targeting high referring Practices and poor outcomes.

2. Task and Finish Group in place to put in place single benchmarking dashboard and reporting process in place to monitor practice performance.

3. Links to LES review which will aim to improve access to local enhanced services so all patients have equity.

4. Protect Learning Time Programme developed and first session delivered

Sarah Jeffery,

Head of

Primary Care


Primary Care

=


Stoke-on-Trent CCG

INHERENT

SCORE

(L x C)

RESIDUAL

SCORE (L

x C)

Version Control PRIMARY CARE COMMITTEE - 30 JANUARY 2019

VersionAuthor

Date

16

(4x4)

9

(3x3)

16

(4x4)

9

(3x3)

16

(4x4)

9

(3x3)

12

(3x4)

16

(4x4)

4

2X2)

12

(3x4)

=

=

=

Ris

k R

ef SCOPE OF RISK

inc CONSEQUENCE

(Risk Description)

NATURE OF RISK

(Risk Type)

STAKEHOLDERS

(Org Name)

RISK TREATMENT & CONTROL MECHANISMS

(Initial Mitigating Actions to reduce to TARGET RISK SCORE - to be supplied).

(Including any policy or strategy implications)

TARGET

SCORE

(L x C)

Risk

Owner(s)

Directorate Trend CCG INHERENT

SCORE

(L x C)

RESIDUAL

SCORE (L

x C)

=

=

=

A1

.59

ACCESS

EXTENDED HOURS PROVISION: Requirement for

extended hours provision within primary care for both

CCGs may adversely affect both resilience and quality of

care, resulting in inadequate care for the population.


risks. Risk of inadequate care for the population.


Stoke-on-Trent CCG

Updated December 2018

1. Extended Access services were commissioned across all 6 CCG on the 1st September 2018. This service included an element of additionality which allowed

practices to work differently together to help prevent this risk from becoming an issue. To date the CCG has not received any reports that risk has become an

issue, and based on informal feedback from some practices, this service has helped practices in terms of resilience and ensuring patients have better access

to appointments in general practice.

Propose risk is closed and reduced to a score of 4.

Previous Update

1. On track to procure and deliver extended access by 1st September 2018 in partnership with the North Staffs Federation.

2. Contract award approved by Governing Body - August 2018.

Melanie

Mahon, Head

of

Commissioni

ng (Planned

Care)


Primary Care

=


Stoke-on-Trent CCG

A1

.60

ENGAGEMENT

CCGS' FAILURE TO ENGAGE WITH PRIMARY CARE VIA

LOCALITIES: Resulting in a lack of engagement with and

by GP member practices and a lack of clinical input into

clinical commissioning.

Clinical, Operational and reputational risks. Risk of

lack of engagement with and by GP member

practices, and a lack of clinical input into clinical

commissioning.


Stoke-on-Trent CCG


5. Meeting arranged to discuss the Membership Engagement Group (MEG) meetings on 02 January 2019.

The Primary Care Committee has requested that this risk is increased from 4 (2x2) to 6 (3x2) until the newly formed Membership Engagement Groups are

established.


1. Primary Care Delivery Group re-established.

2. Management of Change complete and staff in place to support engagement of practices.

3. Engagement visits continue.

4. Review of 360 survey results underway. An action plan will be developed with the Comms and Engagement Committee to address issues identified by the

survey. Update to September 2018 PCC.

Sarah Jeffery,

Head of

Primary Care


Primary Care


Stoke-on-Trent CCG

A1

.61

PRIMARY CARE STRATEGY

LACK OF SINGLE, STRATEGIC PLAN FOR PRIMARY CARE

RESULTING IN FAILURE TO SUPPORT SUSTAINABLE

PRIMARY CARE GP 5 YEAR FORWARD VIEW: Failure by

CCGs' to plan to deliver and support GP 5 Year Forward

View.


risks.


Stoke-on-Trent CCG


5. Primary Care Strategy Group established, organisational development and engagement events are being planned for January and February 2019.


1. Proposal to develop a single primary care strategy for Staffordshire including details of investment for 2018/19 and longer term investment approved by

Primary Care Commissioning Committee 03/07/18.

2. GPFV implementation plan in place and will continue to deliver transform primary care to deliver sustainable general practice. Governance through NHSE

GPFV PMO and assurance to PCC through highlight reporting.

3. Engagement process to develop the clinical model with stakeholders will commence September 2018.

4. Primary Care Investment Plan reviewing current and future funding will be presented to the Primary Care Commissioning Committee in October 2018.

Manir

Hussain,

Deputy

Director of

Primary Care


Primary Care

=


Stoke-on-Trent CCG

A1

.66

The Staffordshire wide network is made up of core

components, namely:

1. N3/Health and Social Care Network (HSCN) link which

gives access to clinical systems.

2. Internet links.

3. Wide area network / local network (SSHIS central links

and individual practice links.

All of these components are at risk of cyber attack or

environmental impacts, such as links being impacted by

local building work. There is also a risk that overarching

infrastructure we use and this impacts our links as has

been seen during October/November by 4 outages.

There is advanced monitoring across our networks that

demonstrate the network is being hacked and our

defence systems continue to stop these attacks and

manage them effectively. The risk exists and is

heightened following the WannaCry incident in 2017.

Clinical, Organisational and reputational risk. Cannock Chase CCG





Stoke-on-Trent CCG


CCG continues to work with service providers to ensure the network is safe from cyber attack - which has included the installation of new intelligent services

to actively manage/block traffic that is suspicious. New higher capacity link for the clinical systems to use are in place in our Trentham data centre, our

remaining data centre (Stafford) is due to be upgraded on 16th Jan. Completing this national migration from N3 to HSCN will deliver wider benefits to the

system and improve resilience.

The CCG Primary Care Digital Lead continues to pull together a report to detail the recent outages and put forward recommendations to support business

continuity and security across the area. This was delayed due to some further incidents in November that impacted primary care as these events needed

review also and lead felt it important to bring these into the report to further support the work being done. We have now embedded a more responsive

process to ensure practices are informed ASAP of any threats/issues and the review will provide further solutions to support this. Business continuity for

primary care will be a focus area for improvement across the footprint so some supportive workshops and a best practice guide for business continuity in

relation to system outages will also be pulled together as a collaborative piece of work with CCGs, LMC, Practice reps and service providers (SSHIS,CSU).

Planning for business continuity events is scheduled for 14 Jan with SSHIS, CSU and CCG representatives.

Updated 21st November 2018: - CCG continues to work with service providers to ensure the network is safe from cyber attack - which has included the

installation of new intelligent services to actively manage/block traffic that is suspicious. New higher capacity links for the clinical systems to use - national

migration from N3 to HSCN will deliver wider benefits to the system and improve resilience.

The CCG Primary Care Digital Lead is pulling together a report to detail the recent outages and put forward recommendations to support business continuity

and security across the area. It is also important to ensure practices are informed ASAP of any threats/issues so review will look at potential solutions to this.

Business continuity for primary care will be a focus area for improvement across the footprint so some supportive workshops and a best practice guide for

business continuity in relation to system outages will also be pulled together as a collaborative piece of work with CCGs, LMC, Practice reps and service

providers (SSHIS,CSU).

Andy Hadley,

Primary Care

Digital

Programme

Lead


Primary Care= Cannock Chase CCG





Stoke-on-Trent CCG

16

(4x4)

9

(3x3)

6

(3x2)

16

(4x4)

6

(3x2)

6

(3x2)

9

(3x3)

16

(4x4)


1

REPORT TO:

East Staffordshire Clinical Commissioning Group Enclosure: 9


Title: Delegated Commissioning Month 9 2018/19



Alistair Mulvey N Anne Perry – Primary Care Finance Manager

Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): N/A N/A

Action Required (select): Decision Discussion For Assurance / For Information √

Purpose of the Paper (Key Points + Executive Summary): To inform the Board of the Month 9 position for East Staffordshire CCG underspend of £79k year to date with a forecast surplus of £211k. This paper provides an update on performance against the primary care budgets as at Month 9. The Committee is asked to note the financial position at Month 9.

Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register): Any overspends to be met by the CCG.

Implications: Legal and/or Risk N/A CQC N/A Patient Safety N/A Patient Engagement N/A Financial Delivery of financial plan Sustainability N/A Workforce / Training N/A


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Please provide detail within the body of the report √








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Recommendations / Action Required: The Primary Care Commissioning Committee is asked to receive the report.


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• Introduction

The Primary Care Commissioning Committee has responsibility for monitoring the primary care delegated budgets and this report presents an update on the current and forecast financial position of the delegated budgets at Month 9

• Primary Care Delegated Budgets – NHS East Staffordshire CCG

The increase in Global Sum has now been actioned and practices have been reimbursed backdated to 1st April. This has led to a year to date overspend of £206k partially mitigated by a £56k underspend on the Demographic Growth. Enhanced services are currently reporting a year to date underspend of £80k, due to Minor Surgery, Violent Patients Service and the Extended Access service. Locums & Premises are both reporting overspends of £40k & £33k respectively whilst QoF is reporting a year to date underspend of £44k. Reserves are reporting a year to date underspend of £162k due in the main to prior year surpluses. Forecast outturns have now been adjusted and we are now forecasting a surplus of £211k. This is due in the main to the Prior year surplus. The Global Sum forecast deficit has been mitigated by the forecast underspends on the Contingency and Balance to Allocation reserves. Enhanced Services and QoF underspends have mitigated the overspends on Premises and Indemnity. .

Budget £'000s

Actual £'000s

Variance £'000s

Budget £'000s

Actual £'000s

Variance £'000s

Core contractsGMS 8,278 8,485 206 11,038 11,038 0PMS 1,301 1,301 0 1,734 1,734 0PMS Reinvestment 270 270 0 361 361 0Demographic Growth 65 9 -56 86 289 203

9,914 10,065 151 13,219 13,422 203

Enhanced ServicesExtended Hours 134 79 -55 178 100 -78 LD Health Checks 72 72 0 96 96 0Minor Surgery 178 166 -12 238 238 0Violent Patients 31 18 -13 41 41 0

414 335 -80 552 474 -78

Other ServicesDispensing & Prescribing 642 642 0 911 911 0CQC Fees 572 572 -1 91 91 0Locums 37 83 46 49 73 24Seniority 117 111 -6 157 145 -12 Named GP for Safeguarding 12 12 0 16 16 0Medical Fees 4 4 0 6 6 0

1,385 1,425 40 1,229 1,241 12

PremisesRents 963 974 12 1,284 1,284 0Rates 172 188 16 181 198 17Water Rates 13 19 5 18 18 0Clinical Waste 30 30 0 40 40 0

1,178 1,210 33 1,523 1,540 17

QOF 954 910 -44 1,817 1,758 -59

Reserves0.5% Contingency Reserve 0 0 0 93 0 -93 Balance to Allocation Reserve Discretionary 0 0 0 102 0 -102 Indemnity Startpoint 0 0 0 72 0 -72 Indemnity budget moved to CCG re GPFV 0 0 0 -144 0 144Inflation 17 17 0 23 23 0Prior Year Balances 0 -179 -179 0 -183 -183

17 -162 -179 147 -160 -306

Sub Total 13,862 13,783 -79 18,487 18,276 -211

13,862 13,783 -79 18,487 18,276 -211

East Staffs CCGPrimary Medical Services - Delegated Budgets 2018/19

Month 9

Year To Date Forecast

meeting of the primary care commissioning committee monday

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