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NHS DORSET CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMMITTEE

PRIMARY AND COMMUNITY CARE COMMISSIONING UPDATE

Date of the meeting 07/08/2019

Author R Payne, Head of Primary and Community Care

Purpose of Report This report provides an update on areas of work being undertaken to support delivery of our Primary and Community Care Commissioning Strategy and areas of CCG responsibility as part of full delegation.

Recommendation The Committee is asked to note the report.

Stakeholder Engagement NHS England / Local Medical Committee / Public Health / Clinical Leads / Primary Care Operational Group / Primary Care Reference Group / Member Practices

Previous GB / Committee/s, Dates

June 2019 Primary Care Commissioning Committee

Monitoring and Assurance Summary

This report links to the following Strategic Objectives

Prevention at Scale

Integrated Community and Primary Care Services

One Acute Network

Digitally Enabled Dorset

Leading and Working Differently

Yes [e.g. ]

Any action required?

Yes

Detail in report

No

All three Domains of Quality (Safety, Quality, Patient Experience)

Board Assurance Framework Risk Register

Budgetary Impact

Legal/Regulatory

People/Staff

Financial/Value for Money/Sustainability

Information Management &Technology

Equality Impact Assessment

Freedom of Information

I confirm that I have considered the implications of this report on each of the matters above, as indicated

Initials: RP

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Introduction

This report provides an update on a number of areas of Primary Care planning to support sustainability and transformation in line with our Integrated Care System (ICS) plans, Primary and Community Care Commissioning Strategy and GP Forward View ambitions.

The report contains priority work programme areas including Commissioning

and Contracting, Primary Care Network (PCN) development, Models of Care and Infrastructure Planning including Workforce, Estates and Technology.

Key highlights since last report

Ipsos Mori has published the 2019 Patient survey, in Dorset patient experience of General Practice services remains above the national average.

Primary Care Contracts have reduced from 98 in April 2016 to 81 now, despite this, patients generally have access to a GP within a three mile radius.

Eighteen PCNs have been approved with whole Dorset population coverage.

The 18-19 Clinical Commissioning Improvement Plan (CCLIP) made a significant contribution to system-wide working, including demand management and care pathway improvements as part of new models of care.

Primary Care budget uplifts have been secured and cost pressures for 19-20 now understood and being managed.

A Primary Care Internal Audit plan for 19-20 has now been agreed and the Terms of Reference for this work are attached at Appendix 1.

End of Life Care now forms part of our Personalisation Care programme.

Evidence that Integrated Community and Primary Care Services (ICPCS) investment has made a contribution to achievement of key system performance targets.

Estates and technology transformation now includes support for network development, with a network level property data set planned.

Primary Care workforce milestones are on target including the introduction of additional roles as part of the GP Contract Reform guidance.

Commissioning and Contracting

Primary Care Contract profile since Full Delegation

Since Full Delegation, the CCG has been working with Practices to improve sustainability and resilience. Table 1 below shows how the profile of General Practices in Dorset has changed over the last three years.

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Table 1: Profile of General Practice in Dorset since 2016

Data as at: Practices Branches Total Sites

April 2016 98 45 143

April 2017 93 50 143

April 2018 86 54 140

April 2019 84 53 137

The profile of General Practice in Dorset has changed as a result of a number of key drivers including:

Single-handed contractors retiring and choosing to close the Practice;

Resilience issues of small Practices of list sizes less than 5,000;

Long term sustainability concerns encouraging Practices to merge their contracts.

Whilst the number of contracts has reduced from 98 in April 2016 to 84 in April 2019, the number of site closures has only been a total of six in that period. The number of contracts has further reduced and as at 1 July 2019 there are 81 contracts with one additional closure making a total of seven closures and an increase in branches from 53 to 55.

Of the seven closures, four have been main Practices and three branches. Access to patients remains good across Dorset and despite the closures, dispersed patients generally have had access to a GP Practice within a three mile radius.

As Practices will be working closer together as part of a Network, we are anticipating that more Practices will choose to merge their contracts. So far over 2019 we are anticipating three mergers.

Primary Care Network (PCN) Directed Enhanced Service (DES)

Eighteen PCNs have been approved and cover the whole of the Dorset population. Each Network has appointed a Clinical Director.

The CCG has formally written to all Clinical Directors named on the registration applications and confirmed CCG support following engagement with NHS England (NHSE) and the Dorset ICS Leadership team, who have endorsed this decision. The PCN DES went live on the 1 July and all General Practices across Dorset are part of a PCN and Dorset has both full population and geographical coverage.

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In order to ensure appropriate governance, quality and contractual performance, the CCG is developing a contract assurance process with the aim of moving away from Practice assurance visits to Network assurance visits. Practice level quality monitoring will still be carried out, with visits being undertaken where there are any concerns associated with the Practice’s quality and resilience.

Clinical Commissioning Local Improvement Planning (CCLIP) 2018-19 Outcomes

The CCLIP is an incentivising specification that gives all Dorset GP Practices the opportunity to sign up to on an annual basis. In 2018-19 100% of Practices signed up.

The main focus of the CCLIP for 2018-19 was Diabetes and a focus on Demand Management, while other elements incentivised attendance at Membership and Locality meetings.

For the diabetes element, Practices were asked to run PRIMIS Diabetes reports looking at HbA1c, Blood Pressure and Cholesterol against national treatment targets uploading to CHART online. Payment was based on submission of the PRIMIS Diabetes Dashboard reports on a quarterly basis and submission of a written report summarising the impact of this work.

Table 2 below shows Dorset CCGs position of the three care processes and the variations between the lowest and highest performing practices. There were 17 Practices that had missing data.

Table 2: Three Care Processes

Care process

CCG Average Lowest achieving (Percentage of patients

on diabetes register meeting target)

Highest achieving (Percentage of patients

on diabetes register meeting target)

Blood pressure 57.1% 41.1 % 76.1%

Hba1c 25.1% 19.1% 50.7%

Cholesterol 62.4% 52.2% 79.7%

Many Practices developed triage schemes; stratifying patients into Red / Amber / Green groupings and recalling patients for initial diabetes review based on this.

Practices working as part of PCNs used the learning from this work to try to address local variation.

For the Demand Management element, localities focussed on either Cardiology, Dermatology or MSK.

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Dermatology: the localities focusing on Dermatology continued to support the procurement and roll out of a tele-dermatology app. The app enables colleagues in Primary Care to take photos of patients’ skin lesions in situations where they needed further advice from Dermatology Consultants in secondary care. As part of the CCLIP, representatives from each locality tested the different apps on the market, provided feedback on the App User guide prior to the roll out of the app to all Practices, and acted as ‘App Champions’, encouraging their localities to use the app and supporting them to do so. In the second half of the year localities took it in turns to attend the system-wide Dermatology meetings, alongside colleagues from the three Acute Hospitals and Dorset Healthcare.

This work has resulted in a reducing trend in referrals shown in Figure 1 below.

Figure 1 summarises Dermatology GP referral trend:

Last year the volume of GP referrals reduced by 7.0% (-866), with the majority of localities recording reductions, the exception being Mid Dorset.

Latest 2019 / 20 figures indicate a further 12.4% reduction when compared to same period in 2018 / 19. Overall the trend has stabilised and the size of the current year to date increase has reduced significantly over the latest 12 months.

The rate in North Dorset is artificially low, as referral activity to both Salisbury and Yeovil is not included in these figures.

Cardiology: the localities focusing on Cardiology contributed to some key pieces of system wide work in 2018 / 19. Cardiology consultants from secondary care developed three Cardiology pathways; the Palpitation Pathway, the Pan Dorset AF Pathway and the Pan Dorset Anticoagulation Pathway. The pathways were launched at the November Primary Care Membership event. The localities went on to provide additional feedback to a newly developed Heart Failure Pathway and the pathway was again updated to reflect the feedback.

The outcome of undertaking this improvement programme has resulted in a reducing trend in referrals as shown in Figure 2 below.

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Figure 2: Cardiology: GP referral trend

Last year the volume of GP referrals reduced by 2.0% (-170), with a split between the localities. Most notable were reductions in Bournemouth North (-16.6%) and Purbeck (-11.7%). Latest 2019 / 20 year to-date figures indicate a further 6.6% reduction.

Latest rolling 12 month figures highlight variation in the rate of Cardiology referrals per 1000 registered list size - the highest rate 17.5 per 1000 in Christchurch. The rate in North Dorset is artificially low, as referral activity to both Salisbury and Yeovil is not included in these figures.

MSK: the localities focusing on MSK developed an electronic template which for use by all GP Practices in Dorset when referring patients into the MSK triage service. The aim of this tool is to ensure the correct information is included on patient referrals to reduce the numbers of referrals being rejected and sent back to Primary Care. The representatives worked closely with Dorset Healthcare University NHS FT (DHC) and the CCG’s Systems Development Manager to develop this interactive template. This is due to be tested by the localities involved prior to launching.

The outcome of undertaking this incentive is showing a reducing trend in GP referrals as shown in Figure 3 below:

Figure 3: MSK: GP referral trend

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Last year the volume of GP referrals reduced by 19.3% (-2,401). Latest 2019 / 20 year-end figures shows a 22.8% reduction on comparable 2018 / 19 period.

This significant percentage shift remains a consequence of the MSK triage service (implementation mid October 2017), which initially led to a large drop in activity to a new benchmark which is now levelling out and showing a more consistent monthly pattern.

The rate in North Dorset is artificially low, as referral activity to both Salisbury and Yeovil is not included in these figures.

Overall, Primary Care, as part of the 2018 / 19 CCLIP, made some significant contributions to system-wide working, building relationships and ensuring Primary Care representation and input into system wide work. This has also supported greater understanding of Network development and working which will support and develop the maturity of PCNs.

CCLIP 2019-20 Planning Update

The CCLIP for 2019 / 20 formally incentivises the Network approach to improving quality. The CCG will use this to support Network development and maturity and provide a transition toward placed based commissioning.

Each PCN and their member Practices has been asked to review their own population health data and locality profile to determine what initiatives they will deliver (one for Prevention-at-Scale and one for Long Term Condition management). Appendix 2: 2019/20 CCLIP Focus areas, provides detail of each Network’s focus areas.

Special Allocation Scheme (SAS)

NHS England Wessex (NHSE) has provided a Service Specification to support the provision of services to patients who have been removed from their registered GP list due to their behaviour. Practices may remove a patient with immediate effect where the patient has committed an act of violence or behaved in such a way that the contractor, Practice staff, other patients, or those present at the place the services are provided, have feared or do fear, for their safety. The incident leading to the request for immediate removal must have been reported to the Police. (GMS Regulations, 2015)

The CCG has approximately 40 patients on the SAS, the majority of these are live in the East of the county.

In order to improve access, the CCG has commissioned a Practice in the East of the county to provide an outreach service in the West of the County.

The service started in May 2019 and will allow face-to-face consultations and assessments, which can be booked in advance to support planned management of healthcare issues.

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Resilience

We continue to work with NHSE to increase local resilience and sustainability.

Funding comes from both NHSE and Dorset CCG. In 2018 NHSE agreed to allow funding to be used at Network level to support Network resilience. To-date the funding has supported the following Networks:

Table 3: Resilience planning 2018-20

Year Funding Networks supported

2018 / 19 Total funding: £337,000 £237k from NHSE £100k from CCG

The Vale PCN Weymouth and Portland PCN Jurassic Coast PCN Blandford PCN East Dorset North Bournemouth PCN

2019 / 20 Committed funding to date: £369,000 £269k from NHSE £100K from CCG

Poole Bay and Bournemouth PCN Poole Central PCN Purbeck PCN Crane Valley PCN

Managing Finance with in-year list size changes associated with Closures

The CCG has developed a process for calculation of Local Enhanced Services’ (LES) payments to Practices when they have been affected by a local Practice closing. When a Practice closes and the patients are dispersed to other neighbouring Practices, their list size will be updated to reflect these changes for agreed LESs. Adjustments will only be made where there is a material change in list size due only to the closure of a Practice.

Phlebotomy Out of the Acute Hospitals into the Community

The activity has been shifted out into the community, however, cost pressures have been incurred and a review of these pressures is underway to inform required investment for 2020-21.

Investing in Primary Care

The Primary Care budget have been uplifted in 19-20 according to national funding changes to the GP Contract and locally agreed uplifts. The budget this financial year is the tightest that we have had in terms of expected costs, requirements and possible pressures. At month three, we are reporting the forecasted position to be within budget, however, there are a number of anticipated pressures to the budget that will need to be managed.

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Primary Care Delegated Budget

In line with the GP Contract changes, the delegated budget has been uplifted from £106m in 18-19 to £109m in 19-20, which represents a 3% increase. This year the managed cost pressures include:

The additional baseline costs due to the uplift received by Practices taking on patients from closures in 18 / 19;

Minor Surgery 19-20 budgets, which in line with the contract agreement, have been uplifted to 18-19 activity levels. These were significantly higher than last year and reflect the system wide pressures within MSK and Dermatology;

Retainers: although the scheme will hopefully mitigate costs from sickness and locum claims, we are already reached the anticipated additional number of people signing up to the scheme for this financial year;

Network DES: there is a small pressure within this budget due to the increase in Networks, as the additional role costs are linked to the number of Networks and not list size numbers in 2019-20.

Local Enhanced Services (LES)

As in 2018-19, the 2019-20 budgets have, in general, been uplifted by 1%, and have additionally increased by the annual release of the PMS premium. This represents an actual increase from £9.5m in 18-19 to £10m in 19-20.

The main concern for local contracts this financial year relates to phlebotomy. We are facing further costs to plan for current activity levels (due in part to a delay in the system planned roll-out of near patient testing), additional blood pickups including the transportation costs and purchase of pathology bags.

Transformation

As per the new Contract guidance, £1.2m is within the budget to cover the £1.50 per patient funding for Primary Care Networks. In previous years this also incorporated central costs, paid for directly by the CCG, to cover workforce planning, project management staff and infrastructure development. These now represent a cost pressure to the CCG, this is currently being supported with non-recurrent funding.

The IAGPS funding has also increased to £6 per head in line with national policy and guidance, which includes £1.6m funding for Primary Care.

From month three the funding allocated to a GP resilience budget, based on NHSE allocation, will be forecasting a significant overspend due to additional pressures that have already arisen in year.

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2019-20 Internal Audit Plan

An Internal Audit Plan for 2019-20 has now been agreed and the Terms of Reference for this work are attached at Appendix 1. The aim of the Internal Audit will not only be to gain assurance of controls and effectiveness but also support the identification of gaps and areas for consideration in an evolving PCN environment.

The audit work will cover:

PCN Development and Governance;

Processes to monitor contract quality via the CCLIP.

Primary Care Network Development

Good progress continues to be made to develop PCNs across Dorset, progress against milestones is shown in Appendix 3: Primary Care Network Development Plan 2019-20.

Models of Care

Patient Survey

The 2019 GP Patient Survey was recently published by Ipsos MORI on behalf of NHSE. The survey measures patient experience across a range of topics and compares our CCG with both national and regional results.

A more detailed analysis of this survey findings is provided in a separate paper to this Committee.

In Dorset 23,255 questionnaires were sent out (around 3% of the registered population) and 10,419 were returned completed (a response rate of 45%).

Overall the survey found that patient experience of GP services in Dorset compares very favourably with the rest of England (see table below):

87% of patients describe their experience as good, compared to a national average of 83%;

Most patients (81%) report it is easy to get through to their GP practice on the phone, compared with a much lower national average of 68%;

Access to on-line services is slightly above the national average (79% in Dorset compared with 76% nationally) with booking appointments on-line slightly below (11% in Dorset compared with 15% nationally).

It is worth noting that in many of the indicators surveyed there was a high interpractice variability and overall patient satisfaction for many indicators are marginally down when comparing with the survey results of 2018.

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Seven National Service Specifications

Seven national service specifications have been detailed within the NHS Long Term Plan for delivery within the Network Contract DES. The national service specifications have not been published yet but are expected to set national minimum requirements. These specifications are to be developed during 2019 / 20 and include:

Structured medication review and optimisation (commence 2020 / 21);

Enhanced Health in Care Homes (commence 2020 / 21);

Anticipatory care (requirements for high need patients, joint with community services);

Personalised care;

Supporting early cancer diagnosis;

CVD prevention and diagnosis;

Tackling neighbourhood inequalities - Vaccinations and immunisations review underway for changes to 2020 / 21 contract.

We are currently working closely with NHSE to develop our models of care work programme and ensure we align closely to the National priorities and to develop a place based focus for this work within our PCNs.

Place Based Planning

We are bringing End of Life Care under the Personalised Care programme of work. The initial intention is to support interested PCNs in a programme of focused work, through detailed engagement with people living and working in the PCN areas. Four films are in the process of being produced which provide examples of good personalised care in Dorset and tell the Dorset Story. The first meeting of a Leadership Group took place on 19 June which agreed specific actions and responsibilities to take this work programme forward.

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Enhanced Health in Care Homes (EHCH)

A new National Target around the delivery of a Data Security Protection Toolkit (DSPT) into care homes and subsequent setting up of NHSMail is to be confirmed over the next few months. Expected targets for Dorset is for 15% of Care Homes to have completed their DSPT entry level (Dorset currently stands at 9.5% for entry and standard level) and 10% of Care Homes to have an NHSMail account (Dorset currently stands at 3.3%). The CCG’s successful bids for funds in February 2019 are being used to support delivery and we are planning to achieve the target by March 2020. Two workshops have been delivered to Care Homes and a further round are scheduled for August – October 2019.

The CCG is working with stakeholders to offer one to one support to Care Homes through the use of ‘Digital Champions’. This work is being overseen by the newly developed Harnessing Data and Technology Sub Group (a sub group of the EHCH Steering Group). The team have also engaged with Care Homes by attending a round of events organised by Partners in Care, these discussions supported the planning for this work including the design and content of planned workshops. The Primary and Community Care team continue to work collaboratively with colleagues in Quality to ensure the newly developed Governance Structure for the programme is being embedded.

A mapping of Care Homes, taking into account PCN boundaries, is in progress. The ambition is for these to be used alongside a Care Home Dashboard to support Networks develop and improve their offer to care home residents.

The Red Bag Scheme facilitates a smoother transfer of care between the Care Home, SWAST and Hospital, resulting in fewer calls to the Care Home for health information and a reduction in length of stay when compared to patients without a Red Bag. This scheme was successfully relaunched in June 2019. Throughout May the team have presented at three cluster-wide Care Home events. We have also led engagement events in The Royal Bournemouth and Christchurch Hospitals (RBCH) and Poole Hospital (PHT). These events provided the opportunity to talk to clinicians who manage care home patients to spread the Red Bag message and also receive feedback on the scheme from the ward staff – this feedback will be included in discussions at the next Task and Finish Group. Dorset County Hospital (DCH) held their own engagement event. Each Trust and the care homes have nominated a Red Bag champion to support communications and staff training.

Telehealth: evaluation of the impact and outcomes of this pilot service into three care homes is being led by DHC in conjunction with Care Homes and other key partners. As part of this evaluation, the CCG are developing a film to highlight how the service has impacted on care homes, their residents and in turn the wider Primary Care system. The aim of this film is to generate broader discussion around the potential use of technology in providing care for this cohort of patients.

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Personalisation

Good progress continues to be made in Q1 following achievement of the 18-19 NHSE targets (Table 4). Targets for 19-20 have now been agreed and are set out in Appendix 4: Personalisation 2019 / 20 NHSE Targets.

Table 4: Personalisation development 18-19 Activity figures for the full year against NHSE target.

Activity data (number of people) 2018-19

Q1 Q2 Q3 Q4

Dorset Year Total

NHSE Target

2018-19

Patient activation 1245 1856 455 212 21866 16380

Equivalent to PAM - - 2527

Self-management support or health coaching

1174 2244 1288 378

Community-based approaches 233 482 1928 859

Personalised care and support plans

584 578 3992 1831

Personal health budgets and integrated personal budgets

141 158 1297 1596 530

Integrated Community and Primary Care Services (ICPCS) Planning

The table below shows good progress towards recruitment to posts by

Locality against the planned WTE. There has been progress between March and May with 66.7% of total posts now recruited to.

Table 5: Workforce Planning for ICPCS Model

Locality Planned WTE

Mar-19 Apr-19 May-19

Bournemouth Combined 22.90 10.77 7.77 7.77

Christchurch 5.00 5.20 5.20 5.20

East Dorset / North Poole 23.35 18.90 18.25 22.45

Mid Dorset 9.43 8.51 9.03 9.03

North Dorset 22.96 13.94 12.13 12.13

Poole Bay 10.01 11.01 10.01 10.01

Poole Central 13.70 3.10 3.00 3.00

Purbeck 7.90 5.40 5.39 5.39

West Dorset 11.13 6.13 9.12 9.12

Weymouth and Portland 15.10 9.68 11.60 11.60

Grand Total 141.48 92.64 91.50 95.70

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The three key areas of impact on system performance for the ICPCS investment is Occupied Bed Days, Delayed Transfers Of Care and >65 admissions. Table 6 shows overall achievement against target for 2018-19.

Table 6: ICPCS figures against targets

Area Target 2019 Achievement

Occupied Bed Days (OBDs) 1,839 1,804

Over 65s admission 53,081 53,251

Area Change in patients Change in bed days

Length of Stay (LoS) 7+ days -156 -3,057

LoS Over 21+ days -17 -195

North Bournemouth, Dorset West, Purbeck and Weymouth and Portland localities have shown improvement in all three key areas. Central Bournemouth and Christchurch had improved their final positions in at least one of the key areas.

In order to establish how the Localities have used the ICPCS investment and what this looks like in terms of Models of Care, a stocktake is underway. It is intended to offer a narrative to support the figures provided by the ICPCS dashboard. The stocktake itself is in the form of a visit to each area to meet with Primary and Community colleagues to talk through both their model for Frailty and the ICPCS investment as well as any future plans. At the time of writing, visits have taken place with North Dorset and Purbeck, with further visits to East Bournemouth, Central and North Bournemouth planned. All other Localities will be visited as part of this plan.

Population Health Management

Working closely with Public Health and our Business Intelligence team at ‘place’ level, we will support Networks on how to use resources, design services and improve population health and focus on Prevention at Scale. There will be greater emphasis on self-management, starting with diabetes prevention and management, asthma and respiratory conditions, maternity and parenting support and online therapies for common mental health problems. The team will work closely with the digitally enabled self-care programme to ensure a seamless approach is taken across Networks.

The Population Health Management (PHM) Development Programme is now at the stage where each of the three Localities are fully utilising data that has been linked and provided as part of the Intelligent Working Programme (IWP), and forms part of the Dorset Intelligence and Insight Service (DIIS). The analysis of this data has been supported by Optum through a series of workshops with each Locality. These localities and their respective areas of focus are: Weymouth and Portland – COPD and Primary Care Operating Model; North Dorset – Frailty; and East Bournemouth – Diabetes.

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Practices continue to be encouraged to use the GP Workload Tool at Practice level, which enables GP Practices to review their Demand and Capacity alongside appointment utilisation. As part of this, we are working with the Wessex LMC to consider how best to support the development of Primary Care business leadership to build capacity and capability in each Network.

Infrastructure and Workforce Planning

Estate

Appendix 5: Estates, summarises progress against key milestones.

ETTF Reserve Schemes

The ETTF Programme of capital investment will end in March 2021. The Programme in the NHSE South Region is under-committed and in late May 2019 local CCGs were invited to submit reserve bids (for schemes which are relatively small in value and sufficiently developed to ensure that full spend can be achieved before March 2021).

Of the 10 potential schemes submitted by Dorset CCG, four have been given either a Priority 1 or Priority 2 status. Further information (in the form of a Project Initiation Document) must be provided to NHSE by 30 June 2019 (for the Priority 1 schemes) and by 30 July 2019 (for the Priority 2 schemes).

Rapid decision making is anticipated, as full spend is required by 30 March 2021. Any funding approved will be awarded under Premises Costs Directions Rules (ETTF will fund only 66% of total project costs).

Rent Reviews and Rent Reimbursement

Currently Rent Reviews and Rent Reimbursement Process is administered by NHSE Wessex team on behalf of Dorset, Hampshire and IOW CCGs. It is proposed that this responsibility will transfer across to the individual CCGs on or before 31 March 2020. A member of the Dorset CCG’s Primary and Community Care team will spend one day per week working alongside the Wessex team at Oakley Road, Southampton. This will ensure that the CCG has the necessary skills and knowledge in-house before the planned transfer date.

Whilst there are huge benefits associated with the in-house management of this work, there are also resource consequences which will need to be planned for.

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Minor Improvement Grants 2019-20 and Forward Planning

Minor Improvement (or Premises Improvement) Grants (MIGs) have formed part of the NHSE managed minor Capital Programme. In previous years CCGs have been asked to bid for MIGs, with the available pot of funding being distributed to areas on a ‘fair shares’ basis. Funding is allocated under Premises Costs Directions rules (66% funding with the Practice contributing the remaining 34%). The notification of available funds always comes late in the year (late summer / autumn) and, not surprisingly, there has been no 2019 / 20 notifications yet. However, information shared on the national Strategic Estates Advisor network suggests that MIGs are to be phased out – with all Primary Care bids being considered under the STP Capital banner in future. Confirmation of the formal position is being sought.

MIGs have historically been used to support relatively small Primary Care premises projects which have improved the overall patient experience (e.g. the installation of automatic doors, the creation of fully accessible Reception desks, the development of additional clinical rooms in small extensions). The processes currently associated with STP Capital Bidding cannot be easily adapted to include these smaller items – there is therefore concern that in future it will become increasingly more difficult to support these small, but essential, projects.

Support for Network Development

Access to reliable and timely data will be critical for the developing PCNs. The property data-set is currently being refreshed at Network level. This developing data-set will incorporate information on the size and condition of Primary Care premises, as well as information on other local health and social care premises, information on local transport networks, information on planned housing developments and population growth.

Looking forward, there are plans to enhance the data-set further with space utilisation and cost of space information.

Workforce

Table 7 summarises progress against Key milestones:

Project Milestone Progress Report Next Steps

GP Numbers against target

521/512 On target for September 2020. 539 WTE GPs by March 2024.

Initiatives such as the GP Retainer Scheme and the GP Retention Programme are being used successfully in Dorset.

Review of GP Retainer Scheme processes underway.

ICPCS recruitment against target

92/143 (64%) Further work on ICPCS planning is required to better understand the shift from other health and social care organisations.

Whole system stocktake underway. Dorset HealthCare undertaking a review of internal staff movements to gather intelligence.

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Project Milestone Progress Report Next Steps

PCN additional roles against target

Clinical Pharmacists and Social Prescribing to be introduced from July 2019.

Additional roles will be recruited to as part of the Directed Enhanced service, one particular area of challenge is recruitment of the Clinical Pharmacist roles across the system. Confirmation of Baseline data for all reimbursable roles has been completed and submitted to NHSE.

Detailed workforce plans in development for both Clinical Pharmacy and Social Prescribing.

Baseline Data and Workforce Planning

A Dorset Workforce dashboard has been developed – the first Primary Care data collection took place in Q1 2019 / 20 and the outputs will be available from July 2019. This data will support workforce planning activity via a standard workforce planning toolkit and analysis of the dashboard.

Baseline data for reimbursable roles in post as at 31 March 2019 has been collected in advance of the workforce dashboard going live to inform the national return.

GP Retainer Scheme

Currently the GP Retainer Scheme is administered jointly by Health Education England (HEE) Wessex and NHSE Wessex (acting on behalf of Dorset, Hampshire and IOW CCGs). It is proposed that this NHSE responsibility will transfer across to the individual CCGs on or before 31 March 2020. Process mapping is currently underway.

The Retainer Scheme has been heavily promoted locally and has proved to be very popular, with overall numbers enrolled increasing significantly during 2019. Whilst this is a very positive outcome, it should be noted that this has created a cost pressure within the CCG.

Further work is underway to strengthen the CCG’s involvement in governance of the scheme to ensure we continue to retain GPs, but also manage down the associated cost pressure on the CCG, which has resulted from the current national model.

Recommendation

The Committee is asked to note progress with our Primary Care Commissioning Strategy and GP Forward View Programme delivery.

Author’s name and Title: Rob Payne, Head of Primary and Community Care Date: 19 July 2019

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APPENDICES

Appendix 1

Internal Audit Plan 2019/20 Terms of Reference

Appendix 2 2019/20 CCLIP Focus Areas

Appendix 3 Primary Care Network Development Plan 2019-20

Appendix 4

Personalisation: 2019/20 NHSE Targets

Appendix 5 Estates: Progress against Key Milestones