primary care commissioning committee...2019/07/10 · held in public session on friday 18 november...

PRIMARY CARE COMMISSIONING COMMITTEE

HELD IN PUBLIC SESSION ON FRIDAY 18 NOVEMBER 2016 1:00pm – 3:00pm THE BOARD ROOM, 3RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE,

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

AGENDA

Item Presented by

1 Apologies Mr S Wellings

2

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

Mr S Wellings

3 Questions from the Public Mr S Wellings

4 Minutes of last meeting held on Friday 21 October 2016 Enclosed Mr S Wellings

5 Matters Arising/Action Log Enclosed Mr S Wellings

6

Contractual 6.1 Report from the Primary Care Operational Group

Enclosed

Mrs J Robinson

7 Quality 7.1 Report from the Quality and Safety Team

Enclosed

Mrs C Brunt

8

Finance 8.1 Finance Report

Enclosed

Mr P Cowley

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

10 Risk Register Enclosed Mr D King 11 Any Other Business

12

Date and Time of Next Meeting Friday 16 December 2016 1pm – 3pm The Board Room, Third Floor, Brierley Hill Health and Social Care Centre

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MINUTES OF THE MEETING HELD IN PUBLIC ON FRIDAY 21 OCTOBER 2016 THE BOARD ROOM, 3RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE,

VENTURE WAY, BRIERLEY HILL, DY5 1RU

Quorum: A meeting of the Committee will be quorate provided that at least four members are present of which one must be either the Chair or Vice Chair of the Committee and one must be the Chief Finance Officer/Deputy Chief Finance or Chief Nursing Officer. ATTENDEES: Members Mr S Wellings Non-Executive Director for Governance, Dudley CCG (Chair) Mrs S Johnson Deputy Chief Finance Officer, Dudley CCG Dr D Pitches Consultant in Public Health, Dudley MBC In Attendance Dr V K Mittal GP Representative Mr T Thomik Dudley LPC Representative Dr T Horsburgh Clinical Lead for Primary Care, Dudley CCG Mrs J Robinson Primary Care Contracts Manager, Dudley CCG Mr P Cowley Senior Finance Manager, Dudley CCG Ms J Emery Chief Executive, Healthwatch Dudley Mrs J Jasper Lay Member for Patient and Public Involvement, Dudley CCG Mr B Dhami Contracts Manager, NHS England (West Midlands) Mr D Stenson Patient Opportunity Panel Representative Mrs J Taylor Commissioning Manager for Primary Care, Dudley CCG Mr R Franklin Patient Insight Specialist, Dudley CCG Miss E Williams Graduate Placement, Dudley CCG Miss T Jeavons Primary Care Contracts Support Officer, Dudley CCG Mrs A Nicholls Head of Intelligence and Analytics, Dudley CCG Minute Taker: Mrs R Gretton Personal Assistant, Dudley CCG Mr Wellings welcomed members of the public for attending the Committee and explained how the meeting would be run. The Committee was informed that it would not be quorate for decisions made and any decision agreed by voting members in attendance would need the ratification from those other deciding members in addition. 1. APOLOGIES FOR ABSENCE Apologies were received from: Mrs L Broster, Head of Communications and Public Insight, Dudley CCG Dr A Catto, Secondary Care Clinician, Dudley CCG Mr M Hartland, Chief Operating and Finance Officer, Dudley CCG Mrs E Smith, Governance Support Manager, Dudley CCG Mrs C Brunt, Chief Nurse, Dudley CCG Mrs A Nicholls, Senior Contract Manager, NHS England (West Midlands) Dr C Handy, Non-Executive Director for Quality & Safety Mr D King, Director of Membership Development and Primary Care, Dudley CCG

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2. DECLARATIONS OF INTEREST To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item: GP members declared a standing interest, particularly with regards to the contractual items, although they do not have a voting position on the Committee. Mr Stenson declared his standing interest as an Associate Non-Executive Director for Black Country Partnership Foundation Trust. 3. QUESTIONS FROM THE PUBLIC Mr Wellings had received no questions from the public. 4. MINUTES FROM THE PREVIOUS MEETING HELD ON 30 SEPTEMBER 2016 The minutes of the Committee held on 30 September were accepted as a true and accurate record. 5. MATTERS ARISING/ACTION LOG MATTER ARISING The action log was discussed and updated accordingly with the following points noted: PCCC/JAN/2016/6.2 This action was noted to be for discussion on the agenda PCCC/FEB/2016/6.1 This action was noted to be for discussion on the agenda PCCC/APR/2016/9.1 The Committee was informed that no further update was available PCCC/SEPT/2016/10 This item was noted to be for discussion on the agenda PCCC/SEPT/2016/10 This item was noted to be for discussion on the agenda 6. CONTRACTUAL 6.1 REPORT FROM THE PRIMARY CARE OPERATIONAL GROUP UTCOMES FOR HEALTH UPDA Mrs Robinson spoke to this item to update the Committee on the issues discussed at the Primary Care Operational Group (PCOG) held on 5 October 2016. The Committee was informed that there had been one contractual change which requested the resignation of one partner to convert to a sole contractor. A decision to defer the agreement of the contract variation was made pending a full business case for the future plans of the practice. No further contractual changes were received by the group. An update was provided to the group in relation to the situation at Stourside Medical Practice with regard to the closure of Coombswood Branch Surgery. The Committee was informed that the lease had been signed by both landlord and tenant. Considerable concern was noted from members of the public in attendance at the Committee meeting in Halesowen on 30 September and subsequently a listening event was held on 13 October to allow public concerns to be voiced.

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It had been previously stated that the practice would re-open on 17 October 2016 for which CCG representatives had visited the Coombswood Surgery prior to this date and felt the condition of the practice was not conducive to the provision of medical services. The practice was instructed by the CCG to undertake a deep clean of the site, Public Health were commissioned to carry out an Infection Control Audit, IT Services attended to ensure IT equipment was fully operational and a commitment was made by the CCG for the practice to be open as soon as possible. It was agreed that the 17 October would remain as the opening day, but purely for reception services only. It was noted that communication had been made to patients via posters and leaflets in the main surgery site. The Committee was informed that the remedial breach notice does not become satisfied until medical services continue to be provided and this currently remains unresolved. The CCG Director of Primary Care had commissioned a lessons learned review by independent internal auditors, for which timescales will be determined following a scoping exercise. Following question from the Committee it was reported that rental payments by the CCG had commenced from 1 October 2016. The Committee was informed that seven members of the public had attended along with practice representatives to the evening event held on 13 October. Challenges were received from people expressing concerns in relation to the general situation at the practice and a report was generated from a Healthwatch perspective based on all comments raised which had been shared with the practice. Ideas and suggestions were suggested for the practice moving forward and the Patient Participation Group members in attendance were encouraging for other patients to become involved in the group. It was reported that Healthwatch would be following up with the practice and it was felt that the event was a positive one. The Committee noted that members of the public needed to be kept appraised of the developments in relation to the re-opening of the practice and it was hoped that the practice would soon resume the full range of medical services. It was recommended by the Committee that an update be obtained from the practice with regard to re-opening to patients and, in addition, a report be requested detailing services provided from the practice. ACTION: MRS ROBINSON The Committee noted that this had been a very exceptional circumstance that which the learning from could be shared nationally. A counter fraud report was received by the group, commissioned by NHS England following an accusation that patients had been inappropriately added to QOF registers. No evidence to support any allegation of fraud was found, but recommendations were included within the report which included for the practice to cleanse and verify disease register data and subsequently for the CCG to undertake a QOF review of those registers. It was agreed by the Primary Care Operational Group that this exercise would need to take place and be completed by 31 March 2017. Following this, NHS England had agreed to carry out a joint review in conjunction with the CCG. The Committee was informed of an update received from NHS England in respect of primary care support services. It was reported that two of the senior leaders at Capita had stepped down and a team of NHS England representatives had been “embedded” within the primary care support services. The CCG continue to log issues with NHS England on a weekly basis with assurance that these are raised with Capita. The Committee noted their disappointment at this situation.

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Resolved:

1) The Committee noted the actions of the Primary Care Operational Group for assurance 2) The Committee recommended that an update be gained from the practice in relation to an

opening date and a report detailing services be provided to PCOG 6.2 REPORT ON THE CLOSURE OF MARKET STREET SURGERY Mr Franklin spoke to this item to update the Committee on the outcomes of the branch closure of Market Street Surgery. It was noted that the Committee approved the closure of the branch practice on 15 March 2016, when as part of the closure a recommendation was made for the Practice Manager to undertake a review of both patients and staff to measure the impact of the closure. The Committee was informed that since the closure, 229 new patients had joined the practice, with 33 choosing to leave. No complaints had been received by the practice in regard to the closure and the main concerns raised by the patient survey related to car parking, online access and the telephone system currently in place. It was reported that 10% of staff surveyed felt that their travel time had increased and 5% felt that their workload had increased to an unmanageable level. Resolved:

1) The Committee noted the report for assurance 6.3 REPORT ON THE CLOSURE OF MASEFIELD ROAD SURGERY Mr Franklin spoke to this item to update the Committee on the outcomes of the branch closure of Masefield Road Surgery on 1 May 2016. The Committee was informed that 24 patients had chosen to leave the practice. It was reported that no additional home visit requests had been made since the branch closure and the main concerns raised by patients were in regard to parking, online access and telephone calls. Subsequent to the branch closure, most staff surveyed felt that there had been minimal impact, however some had raised issues around room availability and increased home visits but reported a more manageable workload. The Committee noted that parking around the surgery had historically been an issue, though it was reported that some developments had since been made in the centre of Lower Gornal with a redesigned flow system around the bus station along with a small increase in parking spaces. Resolved:

1) The Committee noted the report for assurance Mr Franklin left the meeting 6.4 DUDLEY QUALITY OUTCOMES FOR HEALTH – PHASE TWO PILOT UPDATE Mrs Taylor spoke to this item to update the Committee on the ‘Dudley Quality Outcomes for Health’ (DQOFH) Phase two pilot. The Committee was informed that 40 of the 46 practices are piloting the new framework and continued feedback is received in relation to the framework and supporting materials. It was reported that the EMIS alerts system had now been developed to support delivery of the new framework and had been piloted in 10 practices. It was noted that this is now fully deployed across all 40 practices.

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A phase two evaluation had commenced with feedback received from practices in two ways. Firstly, feedback had been received via a Survey Monkey across all 40 practices and additionally, through a case study involving 8 practices chosen in relation to demographics, list size, previous QOF achievement and their participation in the phase one evaluation. It is hoped that the majority of the evaluation will be undertaken during September and November with a report to Committee in December. In addition, the Committee was informed that two Nurse Education events had taken place to support the delivery of the framework; both events were well attended and received excellent feedback. The Committee was informed that template utilisation rates are actively monitored in comparison to the Long Term Conditions population, where a dramatic variation had been noted amongst practices. Those practices with a utilisation rate under 20% had been contacted to understand the barriers and noted that reasons fell into two main categories; firstly, predominantly around confidence in using the template and secondly around the infrastructure and skill mix changes required for delivery. It was reported that preliminary indicator findings are included within the report and are presented for assurance purposes. Within the report, is a potential process for re-base lining the thresholds and financial weighting based on the first 6 months of practice achievement. This is in line with managing the potential conflicts of interest that may be caused. It was reported that there are a number of external factors highlighted within the report for consideration by the Committee, which act as barriers to a fully operational contract ready for 2017/18. The main factor described informed the Committee that the national contract offer is not released until December. The Committee was informed that any offer made will be based on six months’ worth of data, presenting the risk that practices may decide to revert back to QOF. Subsequent to discussion at the LTC Steering Group, a recommendation to the Committee was made to consider that the framework is offered as an additional pilot under similar terms and conditions for the period 2017/18. This is supported by preliminary feedback received from the evaluations team. Dr Mittal left the meeting Concerns around performance against the existing QOF indictors was highlighted to the Committee, particularly around the Learning Disabilities (LD) Directed Enhanced Services (DES) and the Unplanned Admissions DES, in terms of risks associated for a second consecutive year where performance against these measures is not remunerated directly and what level of impact that will have on achievement. Assurance was given to the Committee in regard to the Local Incentive Schemes (LIS) and DES that all information within those schemes had been transferred and incorporated into the business rules that support the indicators. Resolved:

1) The Committee noted the report for assurance 2) The Committee noted and approved the process for determining the thresholds and financial

weighting for a substantive contractual offer in 2017/19 to be made 3) The Committee approved that the DQOFH framework is offered as a pilot for 2017/18

6.5 PRIMARY CARE EXTENDED ACCESS – WINTER SCHEME 2016-17 Mrs Taylor spoke to this item to present a proposal to commission Primary Care extended weekend access during a Winter Local Incentive Scheme (LIS). It was reported that the CCG are under obligation from NHS England to commit financial resources toward improving patient access during the winter period. In addition, this is a key driver in the GP Five Year Forward View and also as a Vanguard site there is significant pressure to move towards a solution to

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provide 7 day access for primary care. The Committee was informed that in the previous two years, the CCG had offered an extended access LIS, although the uptake had been low. Practices had reported that the LIS did have some impact on reducing routine weekly demand, but not on the urgent care system. The proposal includes two components; Component One requires signing of a Data Sharing Agreement (DSA) for input of the EMIS Remote Consultation, which will allow practices to share clinical records under strict Information Governance (IG) terms and allow practices to work collaboratively. Component Two is for extended weekend access, which has two options; Option A will be in line with that offered in last year’s proposal to offer extended weekend access to practices own registered population. Option B will be for the provision of extended access to their own and other practices registered population and includes certain stipulations around appointment availability. In addition, within the specification, use of the appointments is noted not to be for the management of routine long term conditions. The Committee was informed that signing of the DSA as part of Component One, will be remunerated at £100 and Component Two; Option A is funded in line with the 2015/16 scheme and that Option B will contain a 25% uplift compared to Option A. Risks were noted to be associated with Option B but it was reported, subsequent to previous year’s uptake, this would be low. In response to the risk, mitigation risks had been included, which note capitation rates and or scheme timescales. A potential budget of £700k had been allocated but a definitive budget would not be known until practices had responded.

Mr Nicholls entered the meeting It was requested that within Component One the wording around signing of the DSA is amended so as not to reflect a possible understanding that all DSA’s signed would be remunerated at £100, it would only pertain to this scheme component. The Committee was informed that Option A would be offered from 1 November and Option B offered from 1 December. It was requested once a date had been finalised that the LPC be informed.

ACTION: MRS TAYLOR From a patient perspective, it was highlighted that communication would need to be clear around access to records as this may pose some reservations. It was reported that the scheme gains explicit consent on two occasions from the patient and had full IG sign off. Resolved:

1) The Committee approved the proposal for commissioning a Primary Care extended weekend access during winter LIS

2) The Committee agreed that the LPC be informed of the commencement date once finalised 7. QUALITY 7.1 QUALITY AND SAFETY REPORT Mrs Taylor spoke to this item to highlight key points within the report on behalf of the Quality and Safety Team. The Committee was informed of two CQC reports published since the last Committee meeting; Wychbury Medical Group A CQC rating of good overall for all domains had been received. Norton Medical Practice Norton Medical Practice had been rated as good for the ‘Safe’ domain following a requires improvement rating. It was noted that this was the only domain inspected.

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The Committee was informed that Coseley Medical Centre had been inspected for the first time. It was reported that a CCG ‘mock inspection’ was carried out at Quincy Rise Surgery following their overall inadequate rating. Serious Incidents (SIs) No new SIs had been reported since the last meeting and currently three remain open. Infection Prevention & Control (IPC) The Committee was informed that seven IPC audits scheduled for 2016/17 had been carried out with all seven practices rated as green overall. Datix It was reported that progress had been delayed due to mapping data issues for the NRLS reporting. This had now been addressed and work continues to finalise the configuration, with testing during October. Resolved: 1) The Committee received the report for assurance 8. FINANCE 8.1 FINANCE REPORT Mr Cowley spoke to this item. The Committee was informed there had been no change to the budget delegated to the Committee since previous reports and a breakeven position is still expected against those budgets. Two items had been factored in; the proposed winter access scheme and the proposal to amalgamate the minor surgery schemes. It was reported that there was a small forecast underspend against the CCG core budgets as in previous months. A background was noted by the Committee in regard to the minor surgery LIS and DES schemes and it was reported that a proposal for future years relates to the two schemes to become amalgamated, with the expectation that the new single scheme would be paid for in its entirety from the delegated budget. A second proposal reported, from this point forward, all minor surgery spends would be reported against the delegated allocation in preparation for a new contract next year. The impact that this would have on the budget was highlighted within the report. Resolved:

1) The Committee received the report for assurance 2) The Committee approved in principle the commissioning of a single Minor Surgery LIS I

2017/18, with a further paper to be presented to the Committee prior to final approval 3) The Committee approved the proposal to report Minor Surgery LIS expenditure against the

delegated allocation, alongside the Minor Surgery DES

9. PERFORMANCE 9.1 PERFORMANCE REPORT Mr Nicholls spoke to this item to update the Committee on the PCAT and analysis of high and low performer practices.

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The Committee was informed that the PCAT tool continues to develop and evolve and now includes the first information on the DQOFH. In addition, the NHS Choices section had been updated and now contains further information. With regard to reporting to GP practices, it was noted that this remains problematic, though a solution had possibly been found allowing the tool to be lifted out into the Cloud environment for data to be linked which is being pursued. As an interim measure, practice reports will be available via PDF document. It was reported that work had taken place on standardisation by deprivation in Dudley and further in depth detail around deprivation was described within the report. The Committee was informed that items on page 5 relate to a comparison between two practices which illustrates a different picture practice by practice. Following a recent Membership event when this data was presented to practices, it was noted that there is an enthusiasm from practices now wanting to have this data and a small group will be working together towards developing the data further. It was suggested that a section be included for CCG key targets as a further development of the tool. The Committee recommended it would be useful to have a report on under 18’s, in terms of educating on the use of services.

ACTION: MR NICHOLLS Resolved:

1) The Committee noted the report for assurance 2) The Committee recommended a report looking at under 18 data

Mr Nicholls left the meeting 10. NATIONAL FLU IMMUNISATION PROGRAMME 2016/17 Mrs Robinson spoke to this item to update the Committee on the Influenza Immunisation Programme 2016/17. The Committee was informed that as in previous years, NHS England had commissioned the annual flu immunisation programme through general practice and community pharmacy. The report outlines target groups with more of a focus on children and pregnant ladies. CCG representatives had met with NHS England and the local Public Health Team to outline CCG responsibilities which are covered within the report. It was noted that promotion will be via the Stay Well This Winter Campaign. It was reported that any lower performing practice would be highlighted to the CCG who will work with NHS England and practices in understanding the reasons why and to help promote the campaign. It was noted that table 2 within the report shows 2015/16 uptake and table 3 shows the targets for 2016/17. Resolved:

1) The Committee noted the report for assurance 11. PRIMARY CARE COMMISSIONING COMMITTEE – REVISED TERMS OF REFERENCE

Mrs Jasper left the meeting

Ms Johnson spoke to this item to present to the Committee a revised draft of the Terms of Reference (TOR) for comment and approval. The Committee was informed of amendments within the report, noting the addition of section 8 in relation to statutory requirements in the management of conflict of interests. Slight formatting changes were reported, which are specifically in regard to standardising a CCG format.

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The Committee’s focus was drawn to the final page of the TOR in regard to the Membership section. The Committee recommended that an LPC Representative also be included in the Non-Voting Members. The Committee recommended, for inclusion within the Quorum section, that specific voting members cannot have nominated representatives due to their roles within the Committee, but those members that do have a nominated representative that this is made clear with sufficient seniority and formal nomination. A similar process for those non-voting members was also recommended. A point for accuracy reasons was highlighted under section 7.17, where it was noted that the “Local Enhanced Services” should read ‘Local Improvement Scheme’ and in addition reflected in schedule 1. The Committee was informed that the Membership and Decision Making sections are the key sections and if any comments or feedback could be made in regard to any further changes prior to formal approval that these are made to Ms S Johnson or Mrs E Smith. Resolved:

1) The Committee noted the report for approval 2) The Committee agreed for any comments or feedback to be forwarded to Ms Johnson or Mrs

Smith 12. RISK REGISTER Mrs Robinson spoke to this item. Each risk was discussed and members were asked to consider whether the residual score should change since the last Committee and if any additional risks should be added. Risk 34: The impact of significant individual performance issues in relation to primary medical services that could result in removal of GP member from the Performer’s List. No change. Risk 50: Failure of member practices to meet the standards of the Care Quality Commission risks continuity of service provision in member practices. No change. Risk 59: The ability of member practices to fulfill their contractual obligations and provide primary medical services as a result of difficulties recruiting substantive GPs No change. Risk 69: Loss of Primary Care Medical Services as a result of increasing overheads and financial pressure on member practices beyond their control i.e. increasing cost of medical indemnity insurance, rent increases and financial sustainability of operating branch surgery sites. No change.

Risk 81: The reputational risk to the CCG through branch closures The Risk to provision of primary medical services arising from branch surgery closures It was noted that the risk description for this risk had been changed, but recommended that this be further amended to include ‘The unforeseen risk….’ Risk 96: That increases in the cost of facilities management and service charges of buildings owned by NHS Property Services (NHSPS) may destabilize the finances of General Practices, leading to loss of services. The Committee noted an outdated timescale for this risk, which would need to be updated. Risk 100: Unexpected branch closure due to dispute between landlord and tenant. The committee recommended this risk for closure Risk 105: Lack of resilience within primary care workforce and the fragmented nature of current GP provision results in a failure to meet patient demand. The Committee recommended this risk for closure

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Risk 118: Lack of clinical and managerial capacity and capability for primary care to deliver the required transformation and operate primary care at scale No Change. Risk 119: Poor quality GP estate that compromises the ability of practices to deliver General Medical Service contracts No Change. Risk 120: Quality and Safety compromised by the use of online consultations (reduction in face to face consultations) The Committee noted the new risk and recommended that this be referred back to the Quality and Safety Team for further understanding before it is accepted.

ACTION: MRS ROBINSON Resolved:

1) The Committee accepted the updated Risk Register with the aforementioned comments

13. ANY OTHER BUSINESS Mr Thomik informed the Committee that it had been announced that funding cuts proposed to pharmacy will be going ahead. It is unknown what impact this will have and the Committee recommended that a report be brought to the Committee with further information. ACTION: MR THOMIK 14. DATE AND TIME OF NEXT MEETING Friday 18 November 2016 1pm – 3pm The Board Room, Third Floor, Brierley Hill Health & Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Name Title

Signed Date

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PRIMARY CARE COMMISSIONING COMMITTEE OUTSTANDING ACTION LIST – 18 NOVEMBER 2016

MEETING

REFERENCE ACTION LEAD STATUS DATE COMPLETED

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

Mr Cowley In Progress

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

Mr King In Progress

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

Mr King In Progress

PCCC/OCT/2016/6.1

Report from the Primary care Operational Group It was recommended that an update be obtained from the Coombswood practice in relation to re-opening to patients and a report received from the practice detailing services provided

Mrs Robinson In progress

PCCC/OCT/2016/6.5 Primary Care Extended Access – Winter Scheme 2016/17 It was requested that the LPC be informed of the finalised commencement date once known

Mrs Taylor In Progress

PCCC/OCT/2016/9.1 Performance Report The Committee recommended a report be presented on under 18 data

Mr Nicholls In Progress

PCCC/OCT/2016/12 Risk Register The Committee recommended that risk 120 be referred back to the Q&S Team for further understanding

Mrs Robinson In Progress

PCCC/OCT/2016/13

Any Other Business The Committee recommended that a report be brought for information in relation to the announced funding cuts to pharmacy

Mr Thomik In Progress

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Date of Committee: 18 November 2016 Report: Update from the Primary Care Operational Group

Agenda Item: 6.1

TITLE OF REPORT: Update from the Primary Care Operational Group

PURPOSE OF REPORT: To update the Committee following the Primary Care Operational Group meeting held on 2 November 2016

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

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

KEY POINTS:

• The group provides assurance that there are no contractual

breaches to be issued for any Dudley practice • The group considered and recommends the contractual changes

set out below in the recommendations • The group considered the quality and safety issues that are set

out in the quality and safety report • Seven practices self refer and are supported for GP Resilience

Programme • Update received in respect of the closure of Coombswood

surgery

RECOMMENDATION:

The Committee is asked to:

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

• Approve the contractual changes recommended by the group as follows:

• St James Medical Practice – Removal of 1 partner effective 23 December 2016

• Note the changes to the board of directors of Qof Doc with immediate effect

FINANCIAL IMPLICATIONS: Not applicable

WHAT ENGAGEMENT HAS TAKEN PLACE: Not applicable

ACTION REQUIRED: Decision Approval Assurance

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

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

meeting held on 3 November 2016.

2.0 CONTRACTING ISSUES

2.1 PRIMARY CARE CONTRACTUAL CHANGES

2.2 The group considered the following contractual changes for noting and approval by the Committee:

St James Medical Practice removal of 1 partner resulting in

sole contractor Effective date: 23 Dec 16

High Oak Medical Practice 3 directors resign from Qof Doc Immediate effect

2.3 The group considered the consequences of the contractual change at St James Medical Practice

and received a business case outlining plans for continuity of service. The group agreed that the Director of Primary Care and GP Engagement lead will meet with the remaining partner to discuss contingency arrangements and longer term business plans. The group accepted the application and were assured that adequate steps had been taken to replace the sessions provided by the outgoing doctor to ensure that the provision of primary medical services would not be affected

2.4 High Oak Medical Practice is operated by the directors of Qof Doc under an APMS contract. The APMS contract is with Qof Doc as a legal entity therefore no variation is required to the contract, the Committee is asked to note the changes.

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

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

2.7 On Friday 30th September 2016, Dudley CCG were informed that the lease had been signed and

the tenants were given access to the Coombswood property to recommence services.

2.8 On inspection of the property by the Chief Nurse, Infection Control and Medicines Management, the practice were advised of remedial action to ensure the safety of patients before clinical services commenced.

2.9 The practice has since experienced further issues in relation to heating the building and the CCG position remains that this practice cannot open its doors to provide clinical services until it is safe to do so.

2.10 The CCG has been very clear with the practice about actions required and we will continue to support them until these are complete.

3.0 GP FORWARD VIEW – GP RESILIENCE PROGRAMME

3.1 Committee members received details of the GP resilience fund at their meeting held in September 2106.

3.2 The funding is being devolved to, and managed by NHS England’s local teams.

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3.3 PCOG received details of those practices that have self-referred and noted that all applications had been supported by the CCG.

3.4 The programme does not require matched funding and the menu of support available will provide help for practices with urgent pressures and includes:

o diagnostics; o operational HR and IT advice; o coaching and supervision; o practice management support; o rapid intervention and management support for practices at risk of closure; o workforce issues, and o management and improvement.

4.0 QUALITY & SAFETY ISSUES

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

Safety report to the Primary Care Commissioning Committee. 4.2 There are no issues in the quality and safety report that require contractual actions to be taken

against any practice. 5.0 RECOMMENDATION

The Committee is asked to: • Note the actions of the primary care operational group for assurance • Approve the contractual changes recommended by the group as follows:

St James Medical Practice – Removal of 1 partner effective 23 December 2016 • Note the changes to the board of directors of Qof Doc with immediate effect

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Date of Committee: 18 November 2016 Report: Draft Memorandum of Understanding for the Primary Care Hub

Agenda Item: 6.2

TITLE OF REPORT: Draft Memorandum of Understanding for the Primary Care Hub

PURPOSE OF REPORT: To provide the Committee with details of the primary care hub proposal for 2017/18

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

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

KEY POINTS:

• Draft memorandum of understanding details the offer by the Primary Care Hub for 2017/18 - attached

• Sets out the support offered and for 2017/18 will be consistent for all CCG’s

• The draft MOU is in the process of being reviewed by Mrs J Robinson, Primary Care Contracts Manager and Mr P Cowley, Senior Finance Manager

• NHS England has remove some support for 2017/18

RECOMMENDATION:

The Committee is asked to: • Note the draft proposals for the Primary Care Hub for 2017/18 • Agree the functions and tasks assigned to the CCG and Primary

Care Hub as set out in the draft MOU • Agree that the final version of the MOU can be approved by Mrs J

Robinson, Mr P Cowley and Mr D King

FINANCIAL IMPLICATIONS: Applicable if the CCG wish to purchase additional capacity

WHAT ENGAGEMENT HAS TAKEN PLACE: Not applicable


1 | P a g e

NHS England Primary Medical Services Commissioning in 2015/16

Draft West Midlands Memorandum of Understanding for the Primary Care Hub

1 6.2(b) MOU - Delegated CCGs v1 19 (2)

Draft West Midlands Memorandum of Understanding (MOU) for the Primary Care Hub Version number: 1.19 (second formal draft, amended) First published: 12 October 2015 Updated on: 28th October 2016 Final Version Published:

Contents

1. Introduction .......................................................................................................................... 3

2. Principles ............................................................................................................................. 4

3. Ways of working .................................................................................................................. 4

3.2 Detailed working arrangements for 2017/18 ..................................................................... 4

3.3 Detailed working arrangements – Key Contacts ............................................................... 4

4. Ways of working .................................................................................................................. 5

4.1 Functions of the HUB ...................................................................................................................................... 5

4.2 Financial Management Support ...................................................................................... 13

5. Staffing Resources ............................................................................................................ 15

5.1 Principles of working together ............................................................................................ 15

6. Resolving issues .................................................................................................................. 16

7 Role of the CCG Network Group ....................................................................................... 16

7.1 Performance Reporting ............................................................................................................................... 17


1. Introduction The Primary Care Hub provides support to our 14 Clinical Commissioning Groups (CCGs) in NHS England West Midlands as part of delivery of their delegated functions. The purpose of this memorandum of understanding is to set out the principles and detailed working arrangements between the Primary Care Hub (‘the Hub’) and CCG commissioners for the agreed term (2017/18) as well as the governance in place. The following table identifies the current co-commissioning level as at September 2016 (Nb. Subject to change in April 2017)

CCG Current Status

South Warwickshire Fully delegated Herefordshire Joint

commissioning

Redditch & Bromsgrove Wyre Forest

Fully delegated Fully delegated

South Worcestershire Fully delegated

Coventry & Rugby Greater Collaboration

Warwickshire North Joint commissioning

Birmingham Cross City Fully delegated

Birmingham South Central Fully delegated

Sandwell and West Birmingham

Fully delegated

Dudley Fully delegated

Walsall Fully delegated

Solihull Joint commissioning

Wolverhampton Joint commissioning


2. Principles The following principles are proposed to support effective fully delegated and joint commissioning of Primary Medical Services:

• The Primary Care Hub will support and advise each CCG where appropriate, in line with regulations and directions.

• The Hub will not be part of the NHS England assurance process for CCGs. • Working arrangements have been co-designed between the Primary Care Hub, CCG

commissioners & NHS England Commissioners • Arrangements will aim to make the best use of NHS resources to enhance primary care

commissioning to improve quality, outcomes and value. • Arrangements will be practical, reduce duplication and minimise additional workload. • The aim is to not destabilise the commissioning resources required for CCGs or NHS

England to discharge their respective functions effectively. • The Primary Care Hub and CCGs will conduct business in an open and transparent way.

3. Ways of working 3.2 Detailed working arrangements for 2017/18 The following areas have been considered to define working arrangements

• Governance – decision making • Governance – reporting and information sharing • Quality and performance assurance and improvement • Incident management and reporting • Complaints management and reporting • Financial management / reporting • GP premises development • Management of urgent operational challenges

These working arrangements will be kept under review during 2017/18 and refined as necessary with updates reflected in further iterations of the Policy Book for Primary Medical Services 3.3 Detailed working arrangements – Key Contacts Key interfaces between the Primary Care Hub team and teams within CCGs are included in relevant Key Contact sheets.

3.4 CCG commissioning priorities

Much of the work of the Primary Care Hub is to deliver support, advice, administration and finance activities. Each CCG will however have local priorities that may require Primary Care Hub advice. A named Primary Care Hub Contracting and a named Primary Care Finance lead will work with each CCG co-commissioning lead to identify and agree how they can be supported by the


Primary Care Hub. The Primary Care Hub will do everything it can to flexibly support CCGs to deliver their responsibilities under co-commissioning, where appropriate. 4. Ways of working 4.1 Functions of the HUB The Hub will support the delivery of functions specified in Clause 6 of the Delegation Agreement for those CCGs who have opted for full delegation. It is proposed that the Hub will, however, support all CCGs signed up to the MOU in a consistent manner.

All work relating to the processes listed below will be carried out in line with the relevant Regulations and NHS England policies. This is irrespective of whether it is the Hub or the CCG carrying out the function in question.

A set of Standard Operating procedures aligned to the policies will underpin the day to day work of the Hub and these are defined in the Policy Book for Primary Medical Services. In line with the Delegation Agreement1, CCGs maintain the responsibility for: I. Decisions in relation to Enhanced Services; II. Decisions in relation to Local Incentives Schemes, including the design of such schemes; III. Decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices; IV. Decisions about commissioning Urgent care for out of area registered patients; V. The approval of practice mergers; VI. Planning primary medical care services in the Area, including carrying out needs assessments; VII. Reviewing primary medical services in the Area; VIII. Decisions relating to the management of poorly performing GP practices; IX. Managing the funds delegated to the CCG for the purpose of meeting expenditure in respect of the Delegated Functions; X. Premises Costs Directions Functions; XI. Co-ordinating a common approach to primary care commissioning with other commissioners in the Area; and

XII. Such other ancillary activities that are necessary to support the above functions

The Hub will support the delivery of the Delegated functions in line with the grid below:

1 Delegation Agreement available here https://www.england.nhs.uk/commissioning/pc-co-comms/resources/


https://www.england.nhs.uk/commissioning/pc-co-comms/resources/

Responsibility

Activity CCG The Hub I. Decisions in relation to Enhanced Services;

o Share national specifications and templates for Directed Enhanced Services (DESs) when released in order to facilitate annual sign up process.

o Produce letters to all practices inviting them to participate in DESs o CCG to produce letters and return to HUB

o Distribute, log and receive responses from practices. o Routine reports will be relayed to CCGs so they may contact practices

who have not signed up

o Agree related arrangements e.g. plan for Extended Hours Access. o Plans received will be forwarded to CCG lead for approval and a

timeframe agreed for turnaround

o Monitor performance against DESs by individual practice in line with agreed schedule

o Hub to produce reports where CCG are not able to access data

o Manage and respond to queries from practices relating to DESs

o Produce draft report on performance against DESs by individual practice in line with agreed reporting periods

o July – Report detailing practice sign up to Enhanced Services o Extended Hours and Minor Surgery

o Quarterly Report detailing activity claimed by practices o End of Year Report detailing activity claimed by practices

o Avoiding Unplanned Admissions and Learning Disability o Offer AUA and LD services to practices on CQRS o CCGs are able to access reports directly via CQRS


o PPV

o Hub to support in relation to process and template

II. Decisions in relation to the establishment of new GP practices (including branch surgeries) and the closure of GP practices.

o Advice and Guidance due regard to NHSE policies and procedures for primary medical services

o Compiling the paper(s) for Primary Care Committee with respect to the establishment of new GP practices and the closure of GP practices.

o Advice and Guidance on procurement o Advice and Guidance on mobilisation of new practices o Advice and Guidance regarding exit plans and managing list dispersals of

closing practices o Advice and Guidance on caretaking arrangements for practices

o Procurement of new practices o Implementation of mobilisation plan of new practices o Implementation of exit plans and managing list dispersals of closing practices o Implementation of caretaking arrangements

III. The approval of practice mergers.

o Advice and Guidance due regard to NHSE policies and procedures for primary medical services

o Prepare relevant paperwork for Primary Care Committee with respect to the proposed merger

o

o Implementation of merger process and action plans


IV. Decisions relating to the management of poorly performing GP practices.

o Advice and Guidance around monitoring contractual and quality performance of all constituent GP practices.

o Monitoring of contractual and quality performance of all constituent GP practices.

o Advice and Guidance in identifying practices of concern including nature of the issue (contractual versus quality)

o Identify practices of concern including nature of the issue (contractual versus quality) and determine next steps in line with agreed framework.

o Advice and Guidance with due regard to Regulation and NHSE policies and procedures for primary medical services including advice on taking contractual action (as required) and monitoring impact.

o Have due regard to regulation and NHSE policies and procedures for primary medical services and take contractual as required and monitor impact

o Advice and Guidance in identifying any individual performer issues and raising these with the NHSE medical directorate.

V. Managing the funds delegated to the CCG for the purpose of meeting expenditure in respect of the Delegated Functions

o See section 4.2 for Financial Management Support

VI. Premises Costs Directions Functions;

New premises developments and improvement grants: o Create the strategic framework for premises developments and improvement

grants.

o General advice and support on planning applications, eoi’s from practices, visits to practices


o Invite practices to submit proposals/business cases for premises

developments/improvement grants.

o Review practice proposals in detail, including cost-benefit analysis, VFM (revenue consequences).

o Consult with LMC regarding schemes prioritised for approval.

o Prepare paper(s) for Primary Care Committee

o Work with individual practices to implement proposals within required timescales.

o Produce regular update reports, as required, for CCG sign off.

o Sign off reports to Primary Care Committee.

Rent reviews: o Produce and maintain a three-yearly schedule of rent reviews for each GP

practice.

o Liaise with the District Valuer regarding the rent and rates payment for each practice.

o Issue letter/form to each practice notifying them of their new rent and rates reimbursement level

o Inform each CCG of agreed new rent reimbursement levels

o Manage associated challenges and any subsequent appeals related to rental figures

o Produce quarterly reports to enable financial updates to be made.

Other premises related issues: o Manage all other premises related issues as appropriate, in line with the

Premises Costs Directions, with CCG sign off. Visit practices as required.


o S106/Planning Applications: support CCGs regarding responses to relevant

planning applications, specifying S106 funding requirements.

o S106/Planning Applications: maintain a register of agreed S106 funding in an up to date state.

o Managing the successful bids and developments from the first round of PCIF

o Discuss and prioritise ETTF bids with practices to submit to national portal

o Managing applications and implementation process for ETTF scheme and any subsequent schemes at both local and regional levels

o Visit Practices with CCG colleagues as required to discuss ETTF schemes and other funding streams

XI. Co-ordinating a common approach to primary care commissioning with other commissioners in the Area

o Co-ordinating the dissemination and implementation of guidance relevant to

medical contracts

o Implement the dissemination and implementation of guidance relevant to medical contracts

o Participating in relevant local and national networks to ensure standardisation and dissemination of best practice

XII. Any other activities necessary to support the above functions

o Attendance at CCG Primary Care Committee and Primary Care Operational Group or equivalent

o Advice and guidance on the administration of paperwork for contract variation applications (e.g. 24 hour retirements, partner changes)

o Manage the administration of paperwork for contract variation applications following CCG Primary Care Commissioning Committee decisions


o Preparation of statutory contract changes

o Responding to day to day contract related queries

o Liaison with PCSE regarding routine contract related matters

o Advice and Guidance on the management of patient allocations

o Management of patient allocations o Liaison with PCSE regarding non-routine contract related matters

o Advice and Guidance on supporting the resolution of issues resulting from unexpected events impacting on practices (e.g. contractor death) with a view for CCGs to manage operationally and implement

o Manage operationally and implement the resolution of issues resulting from unexpected events impacting on practices (e.g. contractor death)

o Manage the administration of the Violent Patients Scheme

o Accepting referrals and placing with CCG commissioned service o Informing patient

o Management of Clinical Waste Contracts

o Supporting the coordination of data returns (e.g. workforce returns, annual e-declaration etc)

o Management of SLAs to ensure that enabling IT services are provided to contractors (NHSmail support, Registration Authority, Information Governance support and Clinical Safety & Assurance)

o Management of the approval of requests to go live with Electronic Prescribing Release 2

o Support the management of Prime Minister’s Challenge Fund schemes


o Management of Prime Minister’s Challenge Fund schemes o Management of DSQS subject to national

clarification o Producing quarterly reports on activity per CCG

o Advice and Guidance on use of CQRS

o Administration of Users on CQRS

o Offer Enhanced Services to practices on CQRS

o Process achievement approvals for QOF via CQRS


4.2 Financial Management Support The development of the HUB ensures that CCGs and NHS England West Midlands retain access to established primary care finance expertise. The following table identifies the support available to CCGs from the Primary Care Finance Hub. The services detailed below are predicated on CCGs authorising restricted access (i.e. Zero approval limit/zero general ledger approval) to NHSE West Midlands Finance Hub staff to access the following responsibilities on CCG ledgers:

• GL Staff/Manager (Manager access restricted to enable support in code combinations) • Non PO Approval • Payables Enquiry • Payables Helpdesk • Web ADI

A set of Standard Operating procedures aligned to the policies will underpin the day to day work of the Hub and these are contained within the Method Statement embedded below. There is scope for individual CCGs to refine the offer by determining the level of support they wish to receive from the Hub. This will be clearly identified in an agreed functions/list specification for each CCG at the commencement of the Hub service.

The table below outlines the support available to CCGs The services proposed would support CCGs through all stages of the financial reporting process from payments to month end reporting.

GP Services Finance Method Statement - V


Reference Function Function Required

1 Payments 1.1 PCO Payment Schedule / 1.2 Locum Reimbursements /

1.3 Premises Reimbursements – Water Rates and Clinical Waste

/

1.4 Premises Reimbursements – Non Domestic Rates / 1.5 Premises Reimbursements – Rents / 1.6 Directed Enhanced Services / 2 Ledger Monitoring

2.1 GP Payment Reconciliations / 3 Financial Reporting

3.1 Forecasting / 3.2 Month End Reporting / 3.3 Reporting / 3.4 Financial Planning / 3.5 Year End Accounts / 4 Other Functions

4.1 Cash Forecasting / 4.2 Pension Pay Over / 4.3 Bank Account Changes / 4.4 Practice Payment Queries / 4.5 Non PO Invoice Coding / 4.6 Freedom of Information Requests / 4.7 GP Services Queries /


5. Staffing Resources

For the purposes of Primary Medical Services commissioning in 2016/17 and 2017/18, the Primary Care Hub comprises of all of the NHS England Primary Medical Care Services Contracting Team and the GP Services Finance team with support from the Medical and Nursing and Quality Directorates as required The working structure of the NHS England West Midlands Primary Care Hub is illustrated in the Fig 1. The current Hub staffing structure is set at an appropriate level to undertake the functions outlined. The workload for primary care commissioning and primary care finance however can also be variable and unpredictable. In recognition of this, a regular assessment of workload and capacity will be undertaken.

• The Hub will aim to provide equitable support to each CCG and will endeavour to effectively balance competing priorities.

• In the rare event where a CCG requires support that exceeds the available resources or existing scope of the Hub then the DHOPC and/or HoF will initiate a discussion with CCGs about how that can be resourced e.g.

o CCG securing / funding additional resource o PC Hub securing additional resource (potentially through a CCG). o CCG agreeing with other CCGs to focus the PC Hub resource temporarily on a

specific issue o CCG divert internal resource and backfill as necessary o Solution may require a combination of the above

The first line for resolving any concerns relating to support from the Primary Care Hub would be between the Deputy Head of Primary Care (DHOPC) for Contracting matters and the Head of Finance for financial matters and the designated CCG Lead.

5.1 Principles of working together It is proposed that the Hub will work with CCGs on the delivery of the Primary Medical Services Commissioning function:

• The Hub team will work across all CCGs but in addition each CCG will have direct access to the Hub through a named lead.

• The Deputy Head of Primary Care (DHOPC) will lead the Hub on a day to day basis and manage the business interface with each individual CCG through Senior Contract Managers.

• The Primary Care Hub Finance Lead will lead the GP Finance Team on a day to day basis and manage the business interface with each individual CCG.

• The DHOPC and HoF will highlight resource constraints and propose solutions where there may be a risk to delivering against workplan.

• The Hub Team members will routinely attend CCG Primary Care Commissioning Committees where identified as a member / invitee of the committee.


• The Hub will provide regular reports to each CCG as agreed • It is also proposed that the DHOPC/HoF & an NHS England West Midlands Director

hold joint review meetings with CCGs to discuss the functioning of the Hub.

Fig 1: Simplified Image of the governance and relationships between the Hub and CCGs

6. Resolving issues

7 Role of the CCG Network Group The CCG Network, in line with its ToRs:

• Provide oversight of a Memorandum of Understanding (MOU) between all the CCGs and the Primary Care Hub

• Ensure that the Primary Care Hub and CCGs deliver against their respective roles and responsibilities as set out in the MOU and agreed working arrangements

• Continue to facilitate the Primary Care Hub and CCGs in response to common themes, risks, issues arising in year

• Provide advice, guidance and development support to the Primary Care Hub and CCG Teams team

Governance of the Hub CCG A CCG D

etc CCG C CCG B

MOU between NHS England and CCG.

Hub delivering functions

As agreed with CCGs

CCG Reference Group

Operational Functions of the Hub


7.1 Performance Reporting The Primary Care Hub will provide quarterly reports at CCG level summarising performance including activities completed during the previous period and highlighting risks / issues. Quarter Performance report 1 End July 2 End October 3 End January 4 End April

Key themes will be extracted from the CCG level reports to summarise the Hub activity trends and common risks / issues. This information will be presented the CCG Network meeting. This is in addition to regular reports provided to the CCG to support commissioning decisions, quality and financial governance.


DUDLEY CLINICAL COMMISSIONING GROUP


Date of Meeting: 18 November 2016 Report: Quality & Safety Report

Agenda Item No: 7.1

TITLE OF REPORT: Quality and Safety Report

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

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

MANAGEMENT LEAD: Caroline Brunt, Chief Nurse

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

KEY POINTS: • Three CQC inspections have been completed

• Five CQC reports have been published

RECOMMENDATION:

The Primary Care Commissioning Committee is asked to:

• Note this report for assurance

FINANCIAL IMPLICATIONS:

None to report

WHAT ENGAGEMENT HAS TAKEN PLACE: N/A

ACTION REQUIRED: Assurance

Page 1 of 4

DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE – 18 November 2016 QUALITY & SAFETY REPORT

1 Introduction

1.1 A primary care quality and safety report is provided to the CCG Quality and Safety Committee (QSC) and CCG Primary Care Operational Group (PCOG) monthly. This report is a material summation of the report submitted to the QSC in September plus any additional information identified after the QSC report was finalised.

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

2 CQC Inspections

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

2.2 There have been five CQC reports published since the last meeting. • Clement Road Medical Centre have been rated as good overall and for all domains except the

safe domain which requires improvement • High Oak Surgery have been re-inspected following a previous requires improvement rating for

the safe domain. They are now rated as good for all domains.

• Links Medical Practice have been rated as good overall and for all domains except the safe domain which requires improvement

• Castle Meadows Surgery have been re-inspected following a previous requires improvement rating for the safe domain. They are now rated as good for all domains.

• Bilston Street Surgery have been re-inspected following a previous requires improvement rating for the safe domain. They remain rated as requires improvement for this domain, as well as now being rated as requires improvement overall and for the well-led domain.

2.3 Dudley Partnerships for Health have been re-inspected following a previous inadequate rating.

2.4 Thorns Road Surgery and The Limes Medical Centre have both been re-inspected following a previous requires improvement rating for the safe domain.

3 Serious Incidents (SIs)

3.1 Two new SIs have been reported since the last meeting. Currently, there are six open SIs. Support is continuing to be provided by the Q&S team to ensure robust RCAs are carried out and documented.

4 Infection Prevention & Control (IPC)

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

5 Service Developments

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

Page 2 of 4

APPENDIX A: Overview of CQC Inspections (as of 09/11/16)

Practice Name Visit Date Report Published

Overall rating

Safe

Effective

Caring

Responsive

Well Led

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

Good

Good

Good

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

Good

Good

Good

Good

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

Good

Good

Good

Good

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

Good RI Ina

d

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

Good

Good

Good

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

Good

Good

Good

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

Good

Good

Good

Good

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

d

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

Good

Good

Good

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

d Good

Good

Good

Good

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

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

od Good

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

Good

Good

Good

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

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

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

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

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

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

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

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

Clement Road Surgery 25/08/2016 12/10/2016

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

Bilston Street – follow up (3) 06/09/2016 09/11/2016

The Waterfront Surgery – follow up 06/09/2016

High Oak Surgery – follow up 14/09/2016 19/10/2016

Page 3 of 4

Practice Name Visit Date Report Published

Overall rating

Safe

Effective

Caring

Responsive

Well Led

Links Medical Practice (Netherton) 20/09/2016 31/10/2016

Castle Meadows Surgery 04/10/2016 01/11/2016

Coseley Medical Centre 06/10/2016

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

Thorns Road Surgery 21/10/2016

The Limes Medical Centre 27/10/2016

Key:

Good Inadequate Requires Improvement Outstanding

Page 4 of 4

DUDLEY CLINICAL COMMISSIONING GROUP


Date of Report: 18 November 2016 Report: Finance Report

Agenda item No: 8.1

TITLE OF REPORT: Primary Care Commissioning Finance Report

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

AUTHOR OF REPORT: Mr P Cowley, Senior Finance Manager

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

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

KEY POINTS:

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

• Following quarterly List Size changes and financial review, a break-even position is still expected to be achieved against co-commissioning budgets.

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

RECOMMENDATION: Committee is requested to • Note the reported financial position for assurance.

FINANCIAL IMPLICATIONS: As above.

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ACTION REQUIRED: Decision Approval Assurance √

1 | P a g e

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

Contents Financial Overview p2 Financial Detail p3

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

Financial Overview

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

2

Budget Allocations

Performance against Budget

Primary Care Co-

Commissioning

£39,863k

CCG Core Commission

ing £856k

Delegated Co-Commissioning is forecast to break even at the end of the financial year. CCG Core Commissioning budgets are expected to underspend by £44,600, mainly as a result of expected underspends against the Practice Engagement LIS.

Allocation Breakdown

Delegated Co-Commissioning

The forecast expenditure level against delegated budgets continues to reflect a break-even position, following a quarterly review of expenditure and changes to practice list sizes and contract payments. A detailed breakdown of the changes, and their impact upon reserves, is shown below:

3

Summary Position

Changes following Quarterly Review

A number of changes have been made to budgets to reflect the quarterly review of co-commissioning costs, as well as the movement of costs associated with the Minor Surgery LIS into co-commissioning budgets. These changes, and their effect on delegated co-commissioning budgets are shown below.

• GP Contract – costs have increased by £24,000 due to Q2 list size changes. Funding for this increase in costs has been taken from reserves.

• QOF and Enhanced Services – as agreed at the previous Committee, Minor Surgery LIS costs have transferred into this budget. A budget of £183,000 has been transferred from reserves to meet these costs.

• Premises Costs – Forecast expenditure has reduced by £17,000, with a reduction in business rates at 3 premises being offset by an increase in forecast clinical waste charges. No budget has been transferred in respect of this change

• Other GP Services – Seniority payments have increased by £15,000, reflecting changes to the entitlements of GPs to these payments. No budget has been transferred in respect of this change

Area

Original Budget (£'000)

Movement (£'000)

Revised Budget (£'000)

GP Contract 25,881 24 25,905QOF and Enhanced Services 6,726 183 6,909Premises Costs 4,774 - 4,774Dispensing/Prescribing Drs 255 - 255Other GP Services 818 - 818Reserves 1,409 (207) 1,202

Total 39,863 0 39,863

These changes have reduced uncommitted reserves to £683,966, slightly below the £700,000 maximum commitment against the Winter Extended Access LIS. However, the forecast underspend against Primary Care development budgets (see overleaf) more than offsets this difference and would be available to fund this difference should the scheme be 100% committed.

AreaBudget (WTE)

Annual Budget(£'000)

Forecast Variance(£'000)

GP Contract 25,905 - QOF and Enhanced Services 6,909 (1)Premises Costs 4,774 (21)Dispensing/Prescribing Drs 255 - Other GP Services 818 22Reserves 1,202 -

Total - 39,863 (0)

CCG Core Commissioning

4

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

£20,000. The cause of this underspend is the under-establishment of the Nurse Mentoring Team and a reduction in the cost of the GP with Special Interest following a change of roles.

• The Practice Engagement LIS is currently forecast to underspend by

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

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

Recommendation: • Committee is asked to note the reported financial position for assurance.

AreaBudget (WTE)

Annual Budget(£'000)

Forecast Variance(£'000)

Primary Care Training 70 - Nurse Mentors and EVTS 0.84 196 (20)Practice Engagement LIS 591 (30)Primary Care Investments - 6

Total 0.84 856 (45)

PRIMARY CARE CO-COMMISSIONING

Recurring

(£000's)

Non Recurring

(£000's)

Total

(£000's)

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

Notified Resource Adjustments

0

0

0

0

0

0

Total Notified Resource Allocation 0 0 0

Anticipated Resource Adjustments

Total Potential Resource Allocation 0 0 0

Appendix 1: Revenue Resource Limit

Period : October 2016

CCG RESOURCE LIMIT 2016/17 : CO-COMMISSIONING 39,863 0 39,863

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

Period : October 2016

Dudley Clinical Commissioning Group

Primary Care Co-Commissioning WTE

Budget

WTE

Actuals

Annual Budget

£000's

Year to date

Budget £000's

Year to date

Actual £000's

YTD

Variance

£000's

General Practice - GMS 25,433 14,819 14,819 0

General Practice - APMS 472 274 272 (2)

QOF 2,155 1,003 1,003 0

Enhanced Services 4,754 2,998 2,998 (1)

Premises Cost Reimbursement 4,765 3,097 3,087 (10)

Other Premises Costs 9 5 5 0

Dispensing/Prescribing Drs 255 149 149 -

Other GP Services 2,020 908 920 12

Primary Care Co-Commissioning Total 39,863 23,253 23,253 (0)

Primary Care Development WTE

Budget

WTE

Actuals

Annual Budget

£000's

Year to date

Budget

£000's

Year to date

Actual

£000's

YTD

Variance

£000's

Primary Care Training - - 70 41 41 (0)

Nurse Mentors and EVTS 0.84 0.90 196 114 112 (2)

Practice Engagement LIS - - 591 344 327 (18)

Primary Care Investments - - - - 6 6

Primary Care Development Total 0.84 0.90 856 499 485 (14)


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

Agenda Item:9.0

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

PURPOSE OF REPORT: To present to the Committee the final version of the Terms of Reference, Version 2.2 for assurance.

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

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

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

KEY POINTS:

• Following on from the PCCC Committee in October, general amendments have been made to incorporate the standard CCG format

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

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

• Updates have been made to the Schedules • Membership has been amended to reflect LPC representation and to

specifically identify nominated representatives for the Chief Finance Officer and Chief Quality & Nursing Officer.

• These have been taken to Board for ratification.

RECOMMENDATION: The Committee is asked to discuss the recommendations and approve in principle TOR Version 2.2

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE: • Governance Team


1 | P a g e

Governing Body’s

Primary Care Commissioning Committee

Terms of Reference – Version 2.2

AMENDMENT HISTORY VERSION DATE AMENDMENT HISTORY V1.0 December 2014 First Draft of PCC TOR V1.0 May 2015 Presented to Board for approval V2.0 October 2016 Governance Team reviewed with PC Team V2.1 November 2016 Further changes made to the nominated representatives &

quoracy REVIEWERS This document has been reviewed by: NAME DATE TITLE/RESPONSIBILITY VERSION Paul Lewis-Grundy May 2015 Governance Manager V1.0 Emma Smith October 2016 Governance Support Manager V2.0 Julie Robinson October 2016 Primary Care Contracts Manager V2.0 Daniel King November 2016 Director Membership Development &

Primary Care V2.1

APPROVALS This document has been approved by: VERSION BOARD/COMMITTEE DATE V1.0 Dudley CCG Board May 2015 V2.0 Primary Care Commissioning Committee 21 October 2016 V2.1 Dudley CCG Board 10 November 2016 V2.2 Primary Care Commissioning Committee TBC NB: The version of this policy posted on the intranet must be a PDF copy of the approved version. Please note that any changes to these Terms of Reference must be done in line with the Terms of Reference Development Guidance. Changes must be agreed at Committee and ratified through the Governing Body. The Governance Team must be included in any revision to ensure that the statutory duties are unaffected and in line with the CCGs Constitution.

1 | P a g e

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

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

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

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

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

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

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

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

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

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

2. Membership

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

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

2.2 The voting membership will include all independent members of the governing body except

the Chair of the Audit Committee; the Chief Officers excluding the Chief Accountable Officer; and the Public Health representative. That is:

• Lay member for Governance (Chair) • Lay member for Quality & Safety (Vice Chair) • Secondary Care Specialist Doctor • Chief Operating & Finance Officer (or their nominated representative the Deputy Chief

Finance Officer) • Chief Quality & Nursing Officer (or their nominated representative the Quality & Patient

Safety Manager) • Public Health representative

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

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

2 | P a g e

must be documented. 2.4 The Vice Chair of the Committee will be appointed by the Committee members. 2.5 Other people that will normally be in attendance (members but non-voting) will include a:

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

2.6 Governing Body elected GPs, Clinical Executives, NHS England representation, other GP

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

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

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

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

present of which:

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

their nominated representatives as stated in the membership section 5. Frequency of meetings 5.1 The Committee will formally meet on a monthly basis. There may be a need for the

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

5.2 Meetings of the Committee shall:

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

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

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

budget delegated to the CCG by NHS England for the purpose of commissioning primary

3 | P a g e

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

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

Orders and Prime Financial Policies will prevail in the event of any conflict between these terms of reference and the aforementioned documents.

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

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

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

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

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

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

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

England, exercise those functions set out below:

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

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

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

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

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

4 | P a g e

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5 | P a g e

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

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

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

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

7.18 The CCG will also carry out the following activities:

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

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

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

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

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

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

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

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

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

9. Relationship with the Governing Body

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

discharging its functions.

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

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

governing body for information by the Chair of the Committee.

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

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

7 | P a g e

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

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

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

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

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

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

8 | P a g e

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

02-Nov-16

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

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

ID Original Date Last Review (Committee

Date)

Last Update (Risk

Amended)

LIN

K T

O

CO

RPO

RA

TE

OB

JEC

TIVE

(SEE

K

EY A

BO

VE)

Risk Description Accountable Committee

Accountability Sponsor & Owner

Management Lead

P I

Initial Risk Score (PxI)Score

before any controls are

in place.

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place. / Where are we failing in making them effective. For example lack of training or no regular review of performance

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

(R) P (R) I

Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

ActionsTo improve control, ensure delivery ofprincipal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

34 22/04/2013 21/10/2016 07/03/2016 2

The impact of significant individual performance issues in relation to primary medical services that could result in removal of GP member from the Performers' List

PCC Steve Wellings Dan King 4 4 16

GP Contracts / AppraisalsPeer Review AuditTraining and EducationGMC RegistrationGP under performance referred to the NHS England Professional & Practice Information Gathering Group (PIGG)

None identified. None identified 2 1 2 =

Primary Care Operational Group reporting into Primary Care Commissioning Committee and Quality and Safety Committee

GMC RegistrationTwo way communication between the CCG PCOG and the PIGG at NHS England

GP / Nurse MentoringCommissioning of Services for Primary CareGP Education, training and Development

On-going

50 04/08/2014 21/10/2016 15/07/2016 2

Failure of member practices to meet the standards of the Care Quality Commission risks continuity of service provision in member practices.


Relationship with the Link Inspector at the CQC who is invited to attend the Primary Care Operational Group (PCOG).Training and Development with Practices to help them manage inspections.Blue Stream online academy. Quality Assurance Manager for Primary Care appointed and in post. PCOG and PCC following NHS England "Framework for responding to CQC inspections of GP practices". CCG has support process and package in place for all practices.

Further develop the working arrangements with NHS England Professional & Practice Information Gathering Group.

None identified 4 3 12 =

All CQC inspection reports considered in the Primary Care Operational Group and coordinated actions in place between CCG, NHS England and CQC.

CQC Reports and associated action plans from GP Practices.

Develop a quality framework and Care Quality Review Meeting (CQRM) for Primary Care

On-Going

Residual risk score increased from 9 to 12 as a result of CQC inspection and statutory enforcement notices issued to Quincy Rise

59 29/10/2014 21/10/2016 27/05/2016 3

The ability of member practices to fulfil their contractual obligations and provide primary medical services as a result of difficulties recruiting substantive GPs


Developing and implementing the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing and investing in the clinical and non clinical infrastructure and estate to deliver the model.

N/A 3 3 9 =

Engagement visits with all GP practices. Workforce data collection. Developing and investing in the clinical and non clinical infrastructure and professional development to implement the new model of care.

NHS England and Health Education England commitment to training and professional development. New models of care team supporting the Dudley Vanguard MCP model of care and development.

Successful bids to the new models of care team for additional investment and support to enable the implementation of the new model of care.

On-Going Residual Risk score to be considered by the Committee

69 22/05/2015 21/10/2016 15/07/2016 2

Loss of Primary Care Medical Services as a result of increasing overheads and financial pressure on member practices beyond their control i.e. increasing cost of medical indemnity insurance, rent increases and financial sustainability of operating branch surgery sites.


Developing and implementing the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing and investing in the clinical and non clinical infrastructure and estate to deliver the model.

None identified. N/A 1 3 3 =

Engagement visits with all GP practices. Workforce data collection. Developing and investing in the clinical and non clinical infrastructure and professional development to implement the new model of care. Successful bids to the new models of care team for additional investment and support to enable the implementation of the new model of care.

New models of care team supporting the Dudley Vanguard MCP model of care and development.

Education, training and support. Providing access to specialist advice and support. Coordinating and supporting practices liaising with NHS property services regarding rent increases. Investing in systems and creating processes that enable improvements in practise efficiency i.e. practice development programmes. Implementation of the new model of care including successful bid to the new model of care team for additional investment, and the development and implementation of the estates strategy.

Publication of the GP Forward View

Mar-17

81 05/10/2015 21/10/2016 21/10/2016 1The risk to provision of primary medical services arising from unforseen branch surgery closures.


GP Practices need to undertake statutory Consultation and apply to CCG, which has full authority to decide on an application

None None 3 3 9 =Application considered by PCOG decision by PCCC

NHS England Policy which CCG adopted under delegated primary care commissioning

Support GP Practices in the consultation process.Primary Care contracts manager meeting practices to take through contractual process in terms on branch closures.Finance & IT provide advice on financial advice and IT infrastructure advice.

Oct-16 Changes made to Risk Description for clarity of purpose

96 17/06/2016 21/10/2016 21/10/2016 4

That increases in the cost of facilities management and service charges of buildings owned by NHS Property Services (NHSPS) may destabilise the finances of General Practices, leading to loss of services.

PCC Steve Wellings Daniel King 2 3 6

The CCG has set up a working group of affected practices to ensure visibility of issues and co-ordinate practice responses, and has offered to act on practices’ behalf in dealing with NHSPS to resolve existing disputes.

Further development of CCG and practice relationships with NHS Property Services is required.

2 3 6 =Liaise with NHS Property Services on behalf of General Practices and use tenants’ forum to identify common issues and approaches to resolution

Dec-16

100 31/05/2016 21/10/2016 19/08/2016 1 Unexpected branch closure due to dispute between landlord and tenant PCC Steve Wellings Daniel King 4 4 16 General Medical Services

Contract. None

General Medical Services limited when matter relates to private legal dispute disrupting the provision of General Medical Services.

3 3 12 = Regular reports to PCOG and PCCC

Press statements, briefing to MP, Health Overview and Scrutiny Committee

Direct rental payments arranged with landlord, legal advice sought to facilitate dispute, public communication on the dispute and actions taken to resolve.

Sep-16

Risk created from Committee in August 2016 Julie Robinson to complete a New Risk Form. Time Limited Risk - which has now been resolved and the practice is due to open ???RECOMMENDATION TO AUDIT COMMITTEE TO CLOSE THE RISK AS THIS HAS NOW BEEN RESOLVED.

105 08/06/2016 21/10/2016 30/09/2016 4B

Lack of resilience within the primary care workforce and the fragmented nature of current GP provision results in a failure to meet patient demand


Developing and implementing the new model of care - Dudley Multispecialty Community Provider (MCP). NHSE GP Resilience Programme. Dudley Primary Care Development Group & investment.

None None 2 2 4 =

Primary Care Development Steering Group reports to Primary Care Commissioning Committee.

Implementation updates provided to NHS England and New Care Models Team.

None identified Mar-17

RECOMMENDATION TO AUDIT COMMITTEE TO CLOSE THE RISK AS THIS IS COVERED UNDER RISK 59

3. Improving quality and safety 3A Ensure on-going safety and performance of the system4. System effectiveness

4B Primary Care contract

STRATEGIC AIMS1. Reducing health inequalities2. Delivering best possible outcomes

4A Procure the MCP

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

OBJECTIVES 2016/17

2A Ensure appropriate procurement of secondary care services2B Public engagement on model and procurement2C Develop the CCG: Fit for purpose for the future2D Performance management of the system and Value Propisition (VP) implementation

ID Original Date Last Review (Committee

Date)

Last Update (Risk

Amended)

LIN

K T

O

CO

RPO

RA

TE

OB

JEC

TIVE

(SEE

K

EY A

BO

VE)

Risk Description Accountable Committee

Accountability Sponsor & Owner

Management Lead

P I

Initial Risk Score (PxI)Score

before any controls are

in place.

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place. / Where are we failing in making them effective. For example lack of training or no regular review of performance

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

(R) P (R) I

Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

ActionsTo improve control, ensure delivery ofprincipal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

118 08/06/2016 21/10/2016 30/09/2016 1A

Lack of clinical and managerial capacity and capability for primary care to deliver the required transformation and operate primary care at scale


Primary Care Development Steering Group established and co-ordinating and developing plans to enable practices to improve and change.


Primary Care Development Steering Group reports to the Primary Care Commissioning Committee

Primary Care Commissioning Committee reports to NHS England

None identified Mar-17This Risk was approved by the Committee subject th sponsor being changed to Steve Wellings

119 08/06/2016 21/10/2016 30/09/2016 4B

Where there is poor quality estate that compromises the ability of practices to deliver General Medical Service contracts


Primary Care Estates Strategy and participation and support of CCG to enable access to National funding streams.


The CCG agreed its Estates Strategy. Practical support available to practices to prepare and access National funding streams.

None identified None identified On-goingThis Risk was approved by the Committee with the alterationsas outlined.

120 08/06/2016 21/10/2016 3A

Quality and safety compromised by the use of online consultations (reduction in face to face consultations)

PCC 0 0 NEWThis has been dsicussed at Q&S and they have decided it was PCCC

GLOSSARY

ABBREVIATIONS Abbreviation Meaning #NOF Fractured Neck of Femur

£K £1,000 equivalent

A&E Accident and Emergency

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

nominated staff members as well as assessment of services)

ACRA Advisory Committee on Resource Allocation

ACS Acute Coronary Syndrome

AD Assistant Director

AfC Agenda for Change

AHSN Academic Health Science Networks

ALE Auditors Local Evaluation

ALOS Average Length of Stay (in hospital)

AMI Acute Myocardial Infarction

AMMC Area Medicines Management Committee

Anti-D An antibody occurring in pregnancy

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

ARIF Aggressive Research Intelligence Facility

ASAP As soon as possible

AVE Advertising Value equivalent

BACs Bank Automated Credit

BCC Black Country Cluster

BCG Bacillus Calmette-Guerin

BCPFT Black Country Partnership NHS Foundation Trust

BCUCG Black Country Urgent Care Group

BFT Behavioural Family Therapy

BLCCB Black Country Local Collaborative Commissioning Board

BME Black Minority Ethnic

BMJ British Medical Journal

BPAS British Pregnancy Advisory Board

BSCCP British Society of Colposcopy and Cervical Pathology

CAB Citizens Advise Bureau 1

CABG Coronary Artery Bypass Graft

CAO Chief Accountable Officer

CAMHS Children and Adolescent Mental Health Service

CASH Contraception and Sexual Health

CAT Change Agent Team

CBSA Commissioning Business Support Agency

CCBT (CBT) Computerised Cognitive Behavioural Therapy

CCF Capable Care Forum

CCG Clinical Commissioning Group

CCRN Comprehensive Clinical Research Networks

CDC Clinical Development Committee

CEO Chief Executive Officer

CFO Chief Finance Officer

CHADD The Churches Housing Association of Dudley & District Ltd

CHC Continuing Healthcare

CHD Coronary Heart Disease

CIS Community Investment Strategy

CMO Chief Medical Officer

CNST Clinical Negligence Scheme for Trusts

CNT Community Nursing Team

CONNECT Mental Health information website for staff

COSHH Control of Substances Hazardous to Health Regulations 2002

CPA Care Programme Approach

CPN Community Psychiatric Nurse

CRL Capital Resource Limit

CRRT Community Rapid Response Team

CSSD Central Sterile Services Department

CT scan Computer Topography

CQNO Chief Quality and Nursing Officer

CQUIN Commissioning for Quality and Innovation

CQRM Clinical Quality Review Meeting

CVD Cardio Vascular Disease

CWAS Coventry and Warwickshire Audit Services

DACHS Directorate of Adult Children and Housing Services

DCS Dudley Community Services

DCVS Dudley Community Voluntary Service

DES Directed Enhanced Service

DfES Department for Education and Skills

DGFT Dudley Group Foundation Trust

DNA Did not attend 2

DoH Department of Health

DoLS Deprivation of Liberty Safeguards

DoS Directory of Service

DTC Diagnostic and Treatment Centre

DWMHPT Dudley and Walsall Mental Health Partnership Trust

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

E&D Equality and Diversity

EAU Emergency Assessment Unit

EBME Electro Bio-Mechanical Engineer

ECA Extra Care Area

ECM Every Child Matters

ECT Electroconvulsive Therapy

ED Emergency Department

EI Early Implementer

EI Early Intervention

EMI Older People with Mental Illness (Elderly Mentally Ill)

EPP Expert Patients Programme

EPR Electronic Patient Record

ERMA Emergency Response & Management Arrangements

ERT Enzyme Replacement Therapy

ESR Electronic Staff Record

FCEs Finished Consultant Episodes

FED Forum for Education and Development

FHS Family Health Services

FIP Computerised data collection facility used by community health teams.

FMC Facility Management Centre

FOI Freedom of Information

FYE Full Year Effect

GMS General Medical Services

GOWM Government Office for the West Midlands

GP General Practitioner

GPAQ General Practice Assessment of Quality

GPwSI GPs with Special Interest

GU Genito-urinary

GUM Genito-urinary Medicine

HCAI Healthcare Associated Infections

HEE Health Education England

HENIG Health Economy NICE Implementation Group

HF Heart Failure

HIC Health Improvement Centre 3

HIV Human Immunodeficiency Virus

HPA Health Protection Agency

HPS/S Health Promoting Schools / Service

HPU Health Protection Unit

HR Human Resources

HSC Health and Safety Commission

HSCQC Health and Social Care Quality Centre

HSE Health and Safety Executive

HT Home Treatment

HV Health Visitor

IAPT Improved Access to Psychological Therapies

IC Infection Control

ICAS Independent Complaints Advocacy Service

ICNA Infection Control Nurses Association

ICP Integrated Care Pathway

ICSM Interim Customer Services Manager

IFR Individual Funding Request

IG Information Governance

IOSH Institute of Occupational Safety and Health

IT Information Technology

IUCD Intrauterine Contraceptive Device

JCAB Joint Clinical Advisory Board

JCC Joint Consultative Committee

JD Job Description

JE Job Evaluators

JM Job Matching

KLOE Key lines of enquiry

KSF Knowledge and Skills Framework

KPI Key Performance Indicators

LAA Local Area Agreement

LAC Looked After Children

LAT Local Area Team

LBC Liquid Based Cytology

LD Learning Disability

LDP Local Delivery Plan

LEA Local Education Authority

LIFT Local Improvement Finance Trust

LIG Local Implementation Group

LIT Local Implementation Team

LMC Local Medical Committee 4

LNG Local Negotiating Committee

LPS Local Pharmaceutical Scheme

LRF Local Resilience Forum

LTC Long Term Conditions

LVD Left Ventricular Dysfunction

LVSD Left Ventricular Systolic Dysfunction

MAPA Management of Actual and Potential Aggression

MAU Medical Assessment Unit

MBC Metropolitan Borough Council

MDT Multi Disciplinary Team

MIMT Major Incident Management Team

MIRE Major Incident Response Executive

MLSOs Medical Laboratory Scientific Officers

MRSA Methicillin Resistant Staphylococcus Aureus

MSS Medium Secure Service

NCA Non contract activity

NCB National Commissioning Board

NCRS National Care Record System

NELHI National Electronic Library for Health Information

NICE National Institute for Clinical Excellence

NGMS New General Medical Services

NHS National Health Service

NHSCPT NHS Community Practice Teacher

NHSCSP NHS Cancer Screening Programme

NHSE NHS England

NHSLA NHS Litigation Authority

NHSP National Healthy Schools Programme

NICE National Institute for Clinical Excellence

NOF New Opportunities Fund

NPfIT National Programme for IT

NPSA National Patient Safety Agency

NRF Neighbourhood Renewal Fund

NRLS National Reporting and Learning System

NRT Nicotine Replacement Products

NSF National Service Framework

OAT Out of Area Treatment

OBD Occupied Bed Day

OD Organisational Development

ODM Oesophageal Doppler Monitoring

OOH Out of Hours 5

OSC Overview and Scrutiny Committee

OT Occupational Therapist

PALS Patient Advice and Liaison Service

PAF Positive Assurance Framework

PAS Patient Administration System

PAU Paediatric Assessment Unit

PbR Payment by Results

PC Personal Computer

PCDB Primary Care Delivery Board

PCCC Primary Care Commissioning Committee

PCDC Primary Care Development Committee

PCOG Primary Care Operational Group

PCT Primary Care Trust

PDF Portable Document Format

PDP Personal Development Plan

PDS Personal Dental Services

PDSA Plan, Do, Study, Act

PDU Professional Development Unit

PE Pulmonary Embolism

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

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

PEAT Patient Environment Action Team

PEC Professional Executive Committee

PEPP Pooled Budget External Placement Panel

PFI Private Finance Initiative

PGD Patient Group Directives

PICU Psychiatric Intensive Care Unit

PID Project Initiation Document

PIN Personal Identification Number

PMLD Profound and Multiple Learning Difficulties

PMS Primary Medical Services

PPA Prescription Pricing Authority

PPG Patient Participation Group

PPIF Patient and Public Involvement Forum

PSA Public Service Agreement

PSHE Personal and Social Health Education

PTCA Percutaneous Transluminary Coronary Angioplasty

Q&A Questions and Answers

Q&S Quality & Safety

QA Quality Assurance 6

QIPP Quality, Innovation, Productivity and Prevention

QMAS Quality Management and Analysis System

QOF Quality and Outcome Framework

QPDT Quality and Practice Development Teams

RACPC Rapid Access Chest Pain Clinic

RAS Respiratory Assessment Service

RCA Root Cause Analysis

RES Race Equality Scheme

RHH Russells Hall Hospital

RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

RMO Responsible Medical Officer

RRL Revenue Resource Limit

RSL Register Social Landlords

RTT Referral to Treatment Target

SAP Single Assessment Process

SEPIA Mental health computer system

SFBH Standards for Better Health

SFI Standing Financial Instructions

SIC Statement of Internal Control

SLA Service Level Agreement

SRE Sex and Relationship Education

SSD Social Services Department

SSDP Strategic Services Development Plan

STI Sexually Transmitted Disease

STRW Support, Time & Recovery Worker

TB Tuberculosis

TIA Transient Ischaemic Attack

TP Teenage Pregnancy

TPT Teenage Pregnancy Team

TTO To Take Out

UCC Urgent Care Centre

UHBT University Hospital Birmingham Trust

Vaccs & Imms Vaccinations and Immunisations

WAN Wide Area Network

WCC World Class Commissioning

WIC Walk in Centre

WMAS West Midlands Ambulance Service

WMCSU West Midlands Commissioning Support Unit

WMHTAC West Midlands Health Technology Advisory Committee

WMSCG West Midlands Strategic Commissioning Group 7

WMSSA West Midlands Specialised Services Agency

WTE Whole Time Equivalent

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primary care commissioning committee...2019/07/10 · held in public session on friday 18 november...

Documents