primary care commissioning committee ‘committee in common’ · primary care commissioning...

Primary Care Commissioning Committee

‘Committee in Common’

Part 1 Date: 10 February 2016

Time: 1.00 – 3.00

Venue: Boardroom A, 2nd

Floor Becketts House, 2-14 Ilford Hill, Ilford, Essex IG1 2QX

Item Time Lead Attached

or verbal For Noting or Approval

1. Welcome and apologies 1.00 Chair –

Richard

Coleman

2. Declarations of interest 1.05 Chair Attached

3. 3.1 Minutes of last meeting

3.2 Actions log

1.10 Chair Attached For approval

For approval

4. Budget update 1.20 Tom Travers Attached For approval

5. Revised TOR 1.30 Sarah See Attached For approval

6. PMS update 1.40 Sarah See /

NHSE

Attached For noting

7. All PCC Committees:

Internal Audit – Co-commissioning

2.00 Sarah See Attached For approval


Quarter 3 delegated self-certificate

2.10 Sarah See Attached For approval

9. Quality report 2.20 NHSE Attached For noting

10. Contract Variations and Discretionary payments

(locum reimbursements)

2.30 NHSE Attached For noting


Remedial Breach Notices - Contract Compliance

2.35

NHSE

Attached

For approval

12. Havering & Barking and Dagenham PCC

Committees:

Dr Pervez – Change of CCGs

2.45

Sarah See

Attached

For noting

13. Risk register 2.50 Sarah See Attached For approval

14. Questions from public 2.55 Chair

15. Any other business 3.00 Chair

16. Date of next meeting:

9th

March 2015

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Register of interests 2015/16

Declaration of Primary Care Commissioning Committee members

Name Role Organisation Nature of interest

Amendment and date

Richard Coleman

Chair, Lay member Havering CCG

Richard Coleman Associates Ltd NIHR healthcare technology co-operative for GI disease, Enteric (hosted by Barts Health NHS Trust) 1-2-1 Social Enterprise PriceWaterhouseCoopers

Director/co-owner. Spouse also a director/co-owner. Chair of Steering committee Associate on pro bono basis providing mentoring to the NHS Nephew is a partner

Khalil Ali

Lay member, Redbridge CCG

St Francis Hospice, Havering Dr Joseph’s GP practice, Collier Row, Romford

Spouse is donor/contributor Family GP

Sahdia Warraich

Lay member, B&D CCG

The Forum for Health and Wellbeing

Director

2


Amendment and date

The Forum for Health and Wellbeing Trading Ltd Healthwatch Newham Healthwatch Waltham Forest Healthwatch Redbridge London Borough of Redbridge

Company Director Company Director (from 28/3/13) Company Director (from 8/2/13) Member (from April 2013) Spouse is a Councillor

Kash Pandya

Lay member Hillcroft College for women, Surbiton Essex Ministry of Justice Advisory Committee Health & Safety Executive Her Majesty’s Inspector of Constabulary Brentwood Citizen’s Advice Bureau Barking & Dagenham CCG

Council Member and Audit Chair Lay Member for appointment magistrates Independent Audit Committee Member Associate Inspector Generalist advisor Lay Member

3


Amendment and date

Havering CCG Redbridge CCG PricewaterhouseCoopers North Central London CCGs

Lay Member Lay Member Kiren Pandya (son) Management consultant Out of hours and 111 procurement panel chair

Added 25/8/15

Ah-Fee Chan

Secondary care consultant

North Middlesex University Hospital NHS Trust Nadia Medical Services Ltd (March 2015)

Consultant in Anaesthetics and Intensive Care Medicine Director of the company providing consultant services at a range of private facilities in London where practice privileges are given

Conor Burke

Accountable officer

Your business works (not trading) Redbridge college

Director Former Audit committee member

Tom Travers

Chief financial Officer Royal Free Foundation Trust Wife works in finance department

4


Amendment and date

Sarah See Director, Primary Care Transformation

North East London Foundation Trust (NELFT)

Spouse is a NELFT employee working in Redbridge CAMHS

Jacqui Himbury

Nurse director Nursing, Midwifery Council Nurse member – Fitness to Practice panels

Dr Waseem Mohi

Chair, B&D CCG Markyate Surgery Together First Limited (from May 2014) London Wellbeing Care Ltd

Salaried GP Shareholder Director

Dr Atul Aggarwal

Chair, Havering CCG Maylands Healthcare Maylands Healthcare Ltd Parkview Dental Practice Essex Medicare LLP which owns Westland Clinic, Hornchurch. Tenants are:- - InHealth (Diagnostic) (Jan 2014) - Nuffield Health (Brentwood) (Jan 2014) - Communitas Clinics

GP Partner (April 2013) Director and shareholder in onsite pharmacy (April 2013) Sister is NHS dentist within Havering Part owner

5


Amendment and date

(dermatology) (Aug 2014) HAVCO Havering Health Limited (from 2 September 2014) Saag Properties Services LTD

Father is a trustee Shareholder Partner at Maylands Surgery – (Dr Kendall) is a director (Nov 2014) Director (Jan 2011)

Dr Anil Mehta

Chair, Redbridge CCG

Fullwell Cross Medical Centre Metropolitan Police The cleaning company NHS England (Feb 2015) Healthbridge Direct (from September 2014) Fouress Enterprises Ltd

GP Partner Forensic Medical Examiner Owner - Sister in law GP Appraiser Shareholder Director

Frances Carroll B&D Healthwatch

TBC

Anne Marie Dean

Havering Healthwatch Havering Healthwatch One in Four

Chair and Executive Director Trustee

6


Amendment and date

Kent & Medway NHS Partnership Trust St John’s Ambulance

Non-executive Director Volunteer

Ian Buckmaster Havering Healthwatch

Havering Healthwatch Limited St John’s Ambulance

Director (13/3/2013) Volunteer

Cathy Turland Redbridge Healthwatch

TBC

Matthew Cole Director, Public Health LB of Barking & Dagenham

BHRUT Redbridge CCG

Spouse is a midwife at BHRUT Family GP is Chair of Redbridge CCG

Vicky Hobart Director, Public Health LB of Redbridge

None None

Cllr Steven Kelly

LB of Havering TBC

1

Draft PCC Minutes 13 January 2016 v1

Draft Minutes of the Primary Care Commissioning Committee (Committee in Common) held on 13 January 2016 at Barking Learning Centre 1.00pm

Present –Members

Richard Coleman (RC) Chair Lay Member, Havering CCG

Khalil Ali (KA) Lay Member, Redbridge CCG

Kash Pandya (KP) Lay Member, BHR Audit & Governance

Sarah See (SS) Director of Primary Care Transformation, BHR CCGs

Jacqui Himbury (JH) Nurse Director, BHR CCGs

Tom Travers (TT) Chief Finance Officer, BHR CCGs

In attendance

Lorna Hutchinson (LH) Assistant Head of Primary Care Commissioning, NHSE

Alison Goodlad (AG) Head of Primary Care, NHSE

Anne-Marie Keliris (AMK) Company Secretary, BHR

Dr Anil Mehta (AM) Chair, Redbridge CCG

Dr Waseem Mohi (WM) Chair, Barking & Dagenham CCG

Dr Atul Aggarwal Chair, Havering CCG

Natalie Keefe (NK) Head of Primary Care Transformation, BHR CCGs

Cathy Turland (CT) Chief Executive Healthwatch Redbridge

Terilla Bernard (TB) Barking, Dagenham and Havering LMC

Anne Marie Dean (AMD) Chief Executive Healthwatch Havering

Dr Ambrish Shah (AS) Redbridge LMC

Frances Carroll Chair, Healthwatch Barking & Dagenham

Apologies

Anne-Marie Dean Chair, Healthwatch Havering

Cllr Kelly LB Havering

Matthew Cole (MC) Director of Public Health, LBBD

Gladys Xavier (GX) Deputy director of public health, LBR

Sahdia Warraich (SW) Lay Member, Barking & Dagenham CCG

Conor Burke (CB) Chief Officer, BHR CCGs

Vicky Hobart (VH) Director of Public Health Redbridge

Action

1.

Welcome and Apologies for absence

The Chair welcomed those present and apologies were noted.

2. Declaration of Interests

Members noted the Committee’s Declaration of Interest Register and no further interests were declared relating to agenda items.

3. 3.1 Minutes of meeting held on 9 December 2015

The minutes of the previous meeting were agreed and would be signed by the Chair as a correct record.

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3.2 Actions log/matters arising Committee members noted the actions that had been taken and the following updates were noted: ACT27 NHS London Operating Model – SS reported that a meeting is planned with NHSE next week where a review on capacity of the primary care team will take place. ACT46 – SS reported that the recruitment of voting GPs and independent GP will commence shortly.

4. Budget update

TT presented the month 8 primary care commissioning budget update. The current overspend position at month 8 for each CCG’s primary care commissioning budget is as follows: Barking & Dagenham CCG £164k Havering CCG £263k Redbridge CCG £137k It was noted that each CCG were continuing to forecast a break even position and the budget transfer of the Lawns practice had not been included in the report. TT reported that a number of QIPP schemes are progressing and due to the reporting timeline a stronger QIPP and budget report is expected at the next meeting. KP questioned what will change if a breakeven position is being forecast. TT responded that there will be a number of credits from QIPP schemes which have not come through the system yet. The committee noted the report.

5. PMS update

SS updated the committee on the latest position of the PMS review. It was noted that since the last meeting there had been ongoing negotiations taking place between LMCs from across London and NHSE; the wording of the core contract was now finalised, negotiations will now focus on the KPIs and ‘offer’ specifications. Locally there had been a focus on the financial analysis of the contract as currently proposed; an impact analysis and Equality Impact Assessment will also be undertaken in the next few weeks. KA questioned if there had been a response to the request for the extension to the final deadline. SS confirmed that the three month extension had been approved but the timeline was still tight and the additional 3 months was to accommodate face to face practice negotiations. KA questioned what support will be available for practices who do not want to sign the new contract; SS responded that we need to understand the position of each practice, develop a fair and transparent transition plan, and if all else fails, under the regulations PMS contract holders have a right to revert back to the national general medical services (GMS) contract. AA commented that the current Havering PMS contract commissions 100 appointments per 1000 patients, and the system is likely to lose this additional capacity or pay more for it, based upon the proposals in the London offer. SS

3


confirmed this, agreeing that in December the benchmark for the core service of the new contract was 72 appointments per 1000 patients, therefore she acknowledged there is a gap which will be captured as part of the impact analysis. She added that there is still a significant amount of practice information missing which is currently being followed up by colleagues at NHSE. KA commented that given the tightness of the timeframe for commissioning intentions given at a London level and local level we are still some way off from agreeing the contract. AM questioned if each CCG are aware of PMS position. SS responded that the CCG does not hold all the detail of what each contract provides. NHSE wrote to individual practices but some responses are still outstanding. AMD questioned if the worse case scenario is being planned for and highlighted that patient care could be missed if this information is not gathered in time. SS responded that this is a complex situation and will produce a report for the next meeting setting out the whole position. Dr Shah suggested the involvement of the LMC to support practices in responding by the deadline, which was welcomed by NHSE. The committee noted the update.

SS DrSh /LH

6. APMS procurements – update

Loxford

Kings Park

Orchard village AG presented a report which updated on the three APMS procurements currently underway in BHR. It was noted that all PQQ submissions had been received and were currently being moderated and evaluated before moving into the ITT stage. AG reported that the CCG have been asked to put forward a designated officer to be part of the procurements project group and whether the CCGs wanted to commission any additional services on top of the core offer. SS reported that the CCGs holding position would be to reserve the right until the PMS review is complete, and if applicable, would commission as part of the approach to ensure equity of GMS contracts with PMS contracts. AA commented that it is important that the CCG are involved at the evaluation stage. KA highlighted concern at the lack of a PPI element in the PQQ stage. LH confirmed this is included in the ITT documentation as bidders need to detail how they will address patient experience. LH agreed to circulate the PQQ questions on patient experience. It was noted that no clinical lead would be able to evaluate the bids for any local contracts due to potential or perceived conflicts of interest. The committee noted the report and a further update would be received at the next meeting. The committee noted the report; SS to formally respond to NHSE regarding a holding position on additional services and confirming participation in the evaluation process.

LH

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7. Havering PCC Committee

Kings Park Surgery AG presented a report which set out the case for the contract provider of the King Park Surgery to receive an uplift to their rent reimbursement as an outcome of an additional room required by the practice to meet demand for appointments. KA questioned that given the increase in patients will additional staffing also be needed at the practice. LH confirmed that an additional clinician has been recruited. TT questioned if the CCG are currently paying void costs. LH confirmed no void costs are being paid as the space was allocated to another service. SS requested that decisions relating to estate should be reviewed by the finance and estates group before being presented to the PCC. NK suggested the CCG should have a policy on the process to be followed for similar requests as there was potential for these types of requests to increase. TT agreed, adding that a primary care estates strategy plan will be available shortly. AA questioned how assessments will be made on less clinical space if list sizes reduce. SS responded that this would be part of the 3 year cycle to review rent reimbursement and should also form part of the primary care estates strategy. Havering PCC Committee approved the request.

TT

8. Primary Care Transformation Funds 2016/17

NK presented a report which provided a brief of NHSE’s approach to the second year of the Primary Care Transformation Funding; she noted that the criteria and principles listed was subject to agreement the LMCs. Dr Shah commented the criteria could be discriminatory against smaller practices. WM agreed with this, adding that small practices also needed to be given opportunities to expand and did not want to limit single handed practices. SS welcomed the comments made and would reword these criteria as want to support training practices as well as single handed practices. WM suggested a clinician could input into this, SS agreed and reported that this would be via LMCs. JH requested clarity on risks. SS responded that the associated risk was no capital investment and wanted to have a transparent process for practices. The committee noted and agreed the aims, conditions, principles and next steps with rewording to criteria. An updated paper would be reviewed by the Committee once agreement had been reached with the LMCs.

NK

9. Risk Register

SS presented the risk register. CT referred to Spearpoint practice and was concerned that some patients did not know the practice was closing and suggested Healthwatch could work with the CCG to engage with these patients. SS responded that engagement with patients was ongoing with two further events planned and poster and leaflets available at practice reception but welcomed any additional support from Healthwatch. She added that the CCG were actively supporting staff in the practice to find

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alternative employment including sending CCG vacancies to those staff affected. KA welcomed the update and suggested there could be learning from previous less successful closures. The committee approved the risk register.

10. Questions from Public

There were no questions from the public.

11. Any Other Business

There was no other business.

12. Date of Next Meeting

The next meeting was confirmed as 10 February 2016.

Signed………………………………………………..Date………………………….

Actions Log

Log owner: Sarah See, Director of Primary Care Transformation

Log manager: Natalie Keefe, Primary Care Team

Last Update:

URN Action Part Raised Owner Deadline Completed Status Resolution / Comments / Document Ref

ACT27 NHS London Operating Model

Arrange a localised training session when the Operating Model

document is ready.

1 08/07/2015 Sarah See /

Jill Webb

TBC Open AG confirmed appropriate training programme at

venues in North East London will be organised-

update at January meeting.

ACT 33 Pathology Costs

Follow up on question raised at quality and safety committee

regarding pathology costs and the quantum of cost associated.

1 08/09/2015 Jacqui

Himbury

31-Oct-15 Open JH to provide update at January meeting.

ACT 35 Operating model

Page 27, section 2.4 on delegated responsibilities that were not in

the delegated agreement to be updated with stronger wording

around resources and budget associated to offer protection to the

CCG

1 07/10/2015 David

Sturgeon

30-Nov-15 Open MOU being discussed as part of NHSE/CCG review

of primary care commissioning resource/functions.

ACT 36 Budget update

NHSE to confirm if Redbridge budget had been uplifted to include

Loxford legacy issue to bring them in line with London APMS value

1 13/11/2015 Tom

Travers/Alis

on Goodlad

09-Dec-15 Open Pravin Bhalsod liaising with NHSE finance

ACT 37 QIPP Development/Monitoring

Details of final QIPP plans and progress against the plans to be

monitored regularly

1 13/11/2015 Sarah

See/Tom

Travers

13-Jan-16 Open TT to bring updated QIPP report to Committee

ACT 46 Governance of PCCC

Changes to the membership of the PCC were sent to NHSE.

Positive feedback has been received. NHSE agree to the inclusion

of 2 local voting GPs per Committee, subject to some conditions

such as recruiting an independent GP. SS agreed to discuss with

Audit Chair and Chairs outside of the meeting and respond to

NHSE.

1 09/12/2015 Sarah See 13-Jan-16 Open About to commence recruitment of local GPs and

independent GP.

ACT 47 PMS Contract Review

Gap and impact analysis to be completed around current services

and commissioning intention going forward

1 13/01/2016 Sarah See 19-Feb-16 Open Analysis has started - update at February meeting

ACT 48 APMS procurements

Circulate the PQQ questions on patient experience.

1 13/01/2016 Lorna

Hutchinson

10-Feb-16 Open

ACT 49 Approval of additional premises space

Set of principals to be included in the SEP around agreeing

additional space in health centres

1 13/01/2016 Tom

Travers

31-Mar-16 Open

ACT 50 Transformation fund

Update wording as discussed in committee and share for

agreement with LMC. Updated paper to be reviewed by the

Committee once finalised.

1 13/01/2016 Natalie

Keefe

31-Mar-16 Open Follow up discussions with LMC being organised for

late February

02-Feb-16

To: Primary Care Commissioning Committee From: Tom Travers, Chief Financial Officer Date: 29th January 2016 Subject: Primary Care Co-Commissioning – Month 9 2015/16 1.0 Purpose of the Report

The purpose of this report is to provide the Committee with a financial update for the Primary Care Co Commissioning budgets as at Month 9 2015/16.

2.0 Background/Introduction

Barking and Dagenham, Havering and Redbridge CCGs elected to undertake delegated responsibility from NHSE for Primary Care Co Commissioning with effect from 1st April 2015. This meant that the budget and expenditure relating to Primary Care would be reported and managed by each CCG going forward. The transition of these new arrangements has identified a number of reporting and information risks leaving the CCGs with a degree of uncertainty which must be addressed as a matter of urgency to ensure the effective management of the overall primary care financial position going forward.

3.0 Report Content

The Month 8 reported position for all three of the CCGs is a year to date over-spend with a predicted year end variance of breakeven. QIPP savings of 1.4% taken against APMS, GMS and PMS contracts during the budget setting process are now supported by fully costed up plans. QIPP figures are shown on the table below:

There has been a year on year growth of 2.4% in BHR’s weighted population from April 2014 to April 2015. The capitation report shows a slight growth of 0.2% year to 1st October 2015 (quarter 3). Demographic growth has been funded at 1.3% in 2015/16 financial plan therefore it is envisaged that the under-spend in population reserve will offset financial pressures in other areas. Overall, in absolute terms, the BHR CCGs population has seen an increase of 17,050 year on year with a slight growth of 1,712 in its normalised weighted population year to date.

B&D HAV RED Total

General Practice - APMS (54) (11) (40) (105)

General Practice - GMS (188) (246) (254) (688)

General Practice - PMS (149) (176) (137) (462)

Total BHR CCGs QIPP = (391) (433) (431) (1,255)

It is important to note that growth is net of list reduction emanating from the list cleansing QIPP project which is difficult to quantify. A summary of the capitation movement is tabled below.

A summarised analysis of the Month 9 position for each of the Barking and Dagenham, Havering and Redbridge CCGs is constructed within the tables below. Please note that budget and expenditure has been treated as follows:-

Budget The CCGs have now received a breakdown of the Primary Care Co Commissioning budget and this is shown within the below reports. The whole 2015/16 budget for The Lawns Medical Care Practice is shown in Barking and Dagenham CCG. The practice merged with the North Street Medical Care Practice, which is a Havering CCG practice, on the 1st June 2015. A budget transfer of £240k is to be actioned for Month 10 between the CCGs to reflect this. Redbridge CCG received a non-recurrent budget allocation of £233k for caretaking which is part of the reserves and is currently offsetting pressures including at The Loxford Practice as detailed below.

Expenditure Expenditure for all transactions relating to the month are posted to the ledger by NHSE on working day 1, this is broken down into nine expenditure headings. The CCGs are now receiving accruals reports however do not yet receive variance analysis that fits with reporting to the Primary Care Committee timescales. The CCGs and NHSE are working to design a process that provides detailed accruals

and variance analysis in a way which supports the Primary Care Committee reporting

requirements.

Expenditure for The Lawns Medical Care Practice from 1st June 2015 is shown in Havering CCG under the North Street Medical Care Practice although the budget from this time sits with Barking and Dagenham CCG. For Month 9 reporting this shows as £152k under in Barking and Dagenham CCG and £253k over in Havering CCG based on actuals. Redbridge CCG also has a pressure around the Loxford Polyclinic APMS contract. Due to the failed procurement a new contract has been agreed with the provider, The Practice, which has increased the annual cost by £265k. This covers bringing the core payment in line with the standard London APMS price, other reception costs to the building provider and costs for services to Springfield Nursing Home.

CCG

Normalised

weighted list as

at 01/04/2014

Normalised

weighted list as

at 01/04/2015

Year on Year %

Movement

Normalised

weighted list as

at 01/07/2015

Normalised

weighted list as

at 01/10/2015

Movement YTD % Movement

YTD

Barking &

Dagenham200,908 204,861 2.00% 202,260 204,868 7 0.00%

Havering 252,607 259,583 2.80% 261,658 261,046 1,464 0.60%

Redbridge 262,921 269,042 2.30% 266,581 269,284 241 0.10%

Total BHR 716,436 733,486 2.40% 730,499 735,198 1,712 0.20%

With the above noted the reported positions by CCGs are:

4.0 Risk

The CCGs and NHSE are working through detailed budget analysis and variance

reporting to manage the financial risk around the primary care budgets and cost

pressures.

Subjective Description

Annual

Budget

£000s

YTD

Budget

£000s

YTD Actual

£000s

YTD

Variance

£000s

Predicted

Year End

Value (PYEV)

£000s

PYEV Variance

£000s

C&M-Premises Cost Reimbursement 4,794 3,444 3,597 153 4,794 -

C&M-Other Premises costs 180 130 135 5 180 -

C&M-Dispensing/Prescribing Drs 55 41 41 (0) 55 -

C&M-Enhanced Services 1,185 889 910 21 1,185 -

C&M-General Practice - APMS 2,711 2,007 2,079 72 2,711 -

C&M-General Practice - GMS 8,561 6,336 6,469 132 8,561 -

C&M-General Practice - PMS 7,631 5,649 5,798 149 7,631 -

C&M-Other GP Services 500 717 376 (341) 500 -

C&M-QOF 1,921 1,441 1,477 37 1,921 -

Total 27,538 20,653 20,882 228 27,538 -

Barking and Dagenham CCG Primary Care Co Commissioning 2015/16

Month 9 - 31st December 2015


Annual

Budget

£000s

YTD

Budget

£000s

YTD

Actual

£000s

YTD

Variance

£000s

Predicted

Year End

Value (PYEV)

£000s

PYEV

Variance

£000s

C&M-Premises Cost Reimbursement 4,378 3,133 3,282 (149) 4,378 -

C&M-Other Premises costs 23 11 17 (6) 23 -

C&M-Dispensing/Prescribing Drs 187 140 140 0 187 -

C&M-Enhanced Services 1,638 1,229 1,245 (16) 1,638 -

C&M-General Practice - APMS 623 461 534 (73) 623 -

C&M-General Practice - GMS 11,457 8,480 8,764 (285) 11,457 -

C&M-General Practice - PMS 8,604 6,369 6,488 (119) 8,604 -

C&M-Other GP Services 896 1,032 642 390 896 -

C&M-QOF 2,711 2,034 2,075 (42) 2,711 -

Total 30,517 22,887 23,188 (300) 30,517 -

Havering CCG Primary Care Co Commissioning 2015/16



Annual

Budget

£000s

YTD

Budget

£000s

YTD

Actual

£000s

YTD

Variance

£000s

Predicted

Year End

Value (PYEV)

£000s

PYEV

Variance

£000s

C&M-Premises Cost Reimbursement 3,412 2,559 2,552 7 3,412 -

C&M-Other Premises costs 8 6 6 0 8 -

C&M-Dispensing/Prescribing Drs 116 87 87 0 116 -

C&M-Enhanced Services 1,610 1,207 1,207 0 1,610 -

C&M-General Practice - APMS 2,060 1,545 1,543 2 2,060 -

C&M-General Practice - GMS 12,522 9,392 9,475 (83) 12,522 -

C&M-General Practice - PMS 7,297 5,473 5,517 (45) 7,297 -

C&M-Other GP Services 521 391 397 (6) 521 -

C&M-QOF 2,828 2,121 2,157 (36) 2,828 -

Total 30,373 22,779 22,941 (162) 30,373 -

Redbridge CCG Primary Care Co Commissioning 2015/16


Barking and Dagenham Clinical Commissioning Group

Primary Care Commissioning Committee-in-Common Terms of Reference

February 2016

Revision History

Revision date

Summary of Changes Writer / Reviewer

Version

Nov 2014 First draft as part of delegated commissioning application Sarah See 1.0

Jan 2015 Amendments made to reflect feedback from NHS England as part of the application process

Sarah See / Rod McEwen

2.0

8 May 2015 Amendments to reflect changes in Delegation Agreement Sarah See 2.1

11 May 2015 Review and comments Rod McEwen 2.2

2 June 2015 Amendments regarding urgent meetings Sarah See / Rod McEwen

2.3

10 June 2015 Review and final comments by Primary Care Commissioning Committee members

Committee members

3.0

30 June 2015 Amendments around representatives of Local Medical Committees, HealthWatch and Health and Wellbeing Boards

Rod McEwen / Sarah See

4.0

29 Oct 2015 Amendments around proposed changes in GP representation

Sarah Everiss/Sarah See/Rod McEwen

5.0

1 Feb 2016 Amendments as suggest by NHS England following changes to the membership of the Committee. Further review may be necessary upon publication of a national CoI review currently being undertaken (Project Starlight)


6.0

3

Introduction

1. Simon Stevens, 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.

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

Service Act 2006 (as amended) (“NHS Act”), NHS England has delegated the

exercise of the functions specified in Schedule 2 to these Terms of Reference

(“ToR”) to NHS Barking and Dagenham CCG (“CCG”). The Delegation

Agreement is set out in Schedule 1.

3. The CCG has established the NHS Barking and Dagenham Primary Care

Commissioning Committee (“the 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.

4. NHS Havering CCG and NHS Redbridge CCG have agreed to establish a

committee (“committee-in-common”) with the same membership and the same

terms of reference as the committee established by the CCG (although

depending on the identity of the committee such members would not necessarily

have the right to vote on such committee (further particulars as are set at

paragraph 18 in Terms of Reference for each such committee)). The three

committees shall be known together as the BHR PCC Committee-in-Common.

Notwithstanding that the Committee shall also operate as a committee–in-

common, where it does so, it shall always do so in recognition of and cognisant

of the CCG’s own duties to the patients and population of Barking and

Dagenham.

Statutory Framework

5. 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. 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. These arrangements are set out in the separate delegation

agreements entered into by the CCG and NHS England dated 1 April 2015.

7. Arrangements made under section 13Z do not affect the liability of NHS England

for the exercise of any 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 and 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).

8. The CCG will also need to specifically, in respect of the delegated functions from

NHS England, exercise those duties 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).

9. The Committee is established as a committee of the CCG in accordance with

Schedule 1A of the NHS Act.

10. The CCG acknowledges that the Committee is subject to any directions made by

NHS England or by the Secretary of State.

Role of the Committee

11. The Committee has been established in accordance with the above statutory

provisions to enable the CCG to make decisions in common with NHS Havering

CCG and NHS Redbridge CCG on the review, planning and procurement of

primary care services within Barking and Dagenham, Havering and Redbridge,

under delegated authority from NHS England.

12. In performing its role the Committee will exercise its management of the

functions in accordance with the agreement entered into between NHS England

and the CCG, which will sit alongside the delegation and terms of reference.

13. The functions of the Committee are undertaken in the context of a desire to

promote increased co-commissioning to increase quality, efficiency, productivity

and value for money and to remove administrative barriers.

14. 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

delegated to the CCG under the terms of its delegation.

15. This includes the a number of functions that have been specified by the

Delegation Agreement (full particulars of which are set out in Schedules 2, 3 and

4), including:

Planning of the provider landscape in the area, including: decisions on

establishing new GP practices in an area and procurement of associated

Primary Medical Services contracts; decisions on practice mergers and

closures, and on any associated list dispersals; agreement on GP practice

boundary changes; and decisions on practice list cleansing.

Design and commissioning of urgent care for out of area registered

patients, including home visits as required.

Premises Cost Directions Functions, including: making decisions in

relation to applications for new payments or revisions to existing payments;

and premises and strategic estates planning.

Design and commissioning of Enhanced Services (“Local Enhanced

Services” and “Directed Enhanced Services”).

Design and offering of Local Incentive Schemes in addition or as an

alternative to the national framework (including Quality Outcomes

Framework or Directed Enhanced Services) provided they are voluntary and

have undergone consultation with the Local Medical Committees;

Primary Medical Services contract management including: the design of

PMS and APMS contracts and periodic contract reviews to ensure value for

money; monitoring of contracts with respect to observance of specifications

and quality standards; and performance management of poorly performing

practices.

Making decisions on discretionary payments (e.g., returner/retainer

schemes) in accordance with the Statement of Financial Directions.

16. In order to successfully deliver its delegated primary care commissioning

functions the Committee will need to carry out the following activities:

Management of the delegated budget for commissioning of primary medical

services in Barking and Dagenham. The Committee will ensure that the

required financial processes are in place for planning, reporting, risk

management, contingencies, probity and conflict of interest management. It

will also agree any Quality, Innovation, Productivity and Prevention (QIPP)

plans and manage their delivery.

The Committee is accountable for the development of the Primary Care

Strategy for Barking and Dagenham ("the Strategy"). The responsibility of

Strategy development in BHR will rest with the Primary Care Transformation

Programme Board (PCTPB), which will carry out key tasks such as

supporting the Joint Strategic Needs Assessment , designing the models of

care within the NHS England ‘Strategic Commissioning Framework for

Primary Care Transformation in London’, and leading consultations and

public and patient engagement. However, as the budget holder The

Committee will sign off the Strategy and will liaise with the PCTPB to ensure

that it is in line with the financial plan.

The Committee will take all decisions on investment, procurement and

contracting with regards to the strategy.

The Committee will review, investigate and manage unacceptable variations

in care by regularly reviewing information on outcomes, patient experience,

complaints, incidents and CQC reports. The Committee will also authorise

investigations into practices where there are concerns about quality of care,

liaising with the CQC and putting in place performance management

arrangements when necessary.

The Committee will also work with NHS England Regional Team to monitor

compliance of practices with key contracting processes (such as the

completion of annual practice declarations).

Geographical Coverage

17. The Committee will take decisions in respect of the population of NHS Barking

and Dagenham CCG.

Membership

18. The Committee shall consist of the following voting members:

Lay Member, Barking and Dagenham CCG

Lay Member, Audit Chair, Barking and Dagenham CCG

Accountable Officer, Barking and Dagenham CCG (Executive Member)

Chief Finance Officer, Barking and Dagenham CCG (Executive Member)

Nurse Director, Barking and Dagenham CCG (Executive member)

Director of Primary Care Transformation, Barking and Dagenham CCG

Secondary Care Consultant, Barking and Dagenham CCG

GP partner and/or GP Clinical Director and /or a GP employee of a Member

of Barking & Dagenham Clinical Commissioning Group (x 2)

An Independent GP

The following shall be in attendance as members of the Committee but shall be

non-voting:

Chair, Barking and Dagenham CCG

NHS England (NHS England representative)

Barking and Dagenham Health and Wellbeing Board (local authority

representative)

The Barking & Dagenham and Havering Local Medical Committee (BH LMC

representative)

Barking and Dagenham Healthwatch (HealthWatch representative)

Lay Member, Havering CCG

Lay Member, Redbridge CCG

Secondary Care Consultant, Redbridge CCG

Chair, Havering CCG and GP partner and/or a GP employee of a Member

of Havering Clinical Commissioning Group (x 2)

Chair, Redbridge CCG and GP partner and/or a GP employee of a Member

of Redbridge Clinical Commissioning Group (x 2)

Havering Health and Wellbeing Board (local authority representative)

Redbridge Health and Wellbeing Board (local authority representative)

Redbridge Local Medical Committee (Redbridge LMC representative)

Havering Healthwatch (HealthWatch representative)

Redbridge Healthwatch (HealthWatch representative)

A list of the individuals who hold these positions is set out in Schedule 3 to these

terms of reference.

19. The Chair of the Committee shall be Lay Member of a BHR CCG.

20. The Vice Chair of the Committee shall be Lay Member of a BHR CCG.

Meetings and Voting

21. The Committee will operate in accordance with the CCG’s Standing Orders. 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. Where 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 and the papers for the meeting shall be circulated in

accordance with his/ her instructions.

22. Each voting member of the Committee shall have one vote. The chair of the

Committee will work to establish unanimity as the basis for decisions of the

Committee. If, exceptionally, the Committee cannot reach a unanimous decision,

the chair will put the matter to a vote, with decisions confirmed by a simple

majority of those voting members present, subject to the meeting being quorate.

Quorum

23. The quorum shall be 5 voting members who shall include at least one lay

member and one executive member (as defined at paragraph 18 above) and at

least one GP partner or a GP employee of a Member of Barking & Dagenham

Clinical Commissioning Group.

24. If the committee cannot be quorate for the purposes of any business because of

the declarations of interest that have been made by its members, the committee

shall have the power to co-opt one or more lay members from another CCG’s

Governing Body onto the committee.

Frequency of meetings

25. The Committee will meet on a monthly basis on the 2nd Wednesday of each

month. After 12 months the frequency will be reviewed.

26. Meetings of the Committee:

a) shall be held in public, subject to the application of paragraph 26(b) below;

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 by 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.

c) the closed confidential part of the meeting (as provided for at 26 (b) above)

shall be referred to as Part 2 of the meeting and shall have a separate

agenda and minutes.

d) the Committee may resolve to exclude the representatives of the local

authority, Local Medical Committees and Healthwatch from Part 2 of any

meeting where it considers it is not appropriate for such representatives to

attend all or part of Part 2 of the meeting.

27. Members of the Committee have a collective responsibility for the operation of

the Committee. They will participate in discussion, review evidence and provide

objective expert input to the best of their knowledge and ability, and endeavour

to reach a collective view.

28. The Committee may call additional experts to attend meetings on an ad hoc

basis to inform discussions.

29. Members of the Committee shall respect confidentiality requirements as set out

in the CCG’s Constitution.

30. The Committee will present its minutes to the governing body of NHS Barking

and Dagenham CCG for information.

31. The CCG will also comply with any reporting requirements set out in its

constitution.

32. Terms of Reference will be reviewed on an annual basis.

Immediate and urgent decisions

33. There may be instances when the Committee is required to make a decision in

advance the regular full committee meetings in light of unforeseen

circumstances. Depending on the urgency of the matter such decisions may

need to be immediate (i.e. to be made 24 hours) or urgent (i.e. to be made in

timeframes longer than 24 hours but in advance of the next scheduled meeting).

34. The Director of Primary Care Transformation will decide when an immediate or

urgent decision is required and will initiate the decision making process.

35. In the instances where an immediate decision is needed the Director of Primary

Care Transformation will arrange a meeting with the Chair (or Vice Chair if the

Chair is not available) and the CCG Accountable Officer to take the decision.

Such decisions will only be taken in exceptional circumstances, such as the

need to close a practice due to clinical reasons or contractor death. Any

immediate decisions taken under this procedure will be presented at the next

Committee meeting.

36. In the instances when the Director of Primary Care deems it necessary to

request an urgent decision the Chair will be contacted. The Chair (or Vice Chair

if the Chair is not available within the required timeframes) may deem it

necessary to call a meeting at short notice outside the regular full committee

meetings, as set out in paragraph 21 above.

37. In these instances the meeting may be held by virtual means such as telephone,

email or internet conferencing, with papers circulated by email in advance to

members.

Accountability of the Committee

38. The CCG has Prime Financial Policies and Detailed Financial Policies and this

Committee shall act in accordance with the same.

39. For the avoidance of doubt, in the event of any conflict between these Terms of

Reference and the Prime Financial Policies and Detailed Financial Policies of the

CCG, the latter will prevail.

40. The Committee will have regard to the CCG’s duties to make arrangements to

secure that individuals to whom the services are being or may be provided are

involved in the planning of the commissioning arrangements by the group, and in

the development and consideration of proposals by the CCG for changes in the

commissioning arrangements where the implementation of the proposals would

have an impact on the manner in which the services are delivered to the

individuals or the range of health services available to them, and in decisions of

the CCG affecting the operation of the commissioning arrangements where the

implementation of the decisions would (if made) have such an impact.

Procurement of Agreed Services

41. Detailed arrangements regarding procurement will be set out in the delegation

agreement but for the avoidance of doubt, the Committee will consider the

CCG’s procurement law duties as set out inter alia in the following:-

The Public Contracts Regulations 2006 (as amended from time to time);

Overarching principles enshrined in the treat on the Functioning of the

European Union; and

The National Health Service (Procurement, patient Choice and Competition)

No.2 Regulations 1023 ("the S75 Regulations" ) and Monitor’s substantive

and enforcement guidance on the S75 Regulations or any such additional /

replacement guidance and/or regulations from time to time in force.

Decisions

42. The Committee will make decisions within the bounds of its remit.

43. The Committee will ensure that conflicts of interest are dealt with in accordance

with the CCG’s Constitution and Standards of Business Conduct Policies which

for the avoidance of doubt may include members (voting or otherwise) being

excluded from a decision and/or the discussions leading thereto.

44. All decisions taken in good faith at a meeting of the Committee shall be valid

even if there is any vacancy in its membership or it is discovered subsequently

that there was a defect in the calling of the meeting, or the appointment of a

member attending the meeting.

45. The decisions of the Committee shall be binding on NHS England and NHS

Barking and Dagenham CCG.

[Signature provisions]

Schedule 1 – Delegation Agreement

BarkingDagenham - PB signed.pdf

Schedule 2 – Delegated Functions

Delegated Functions Delegated CCG responsibilities

Planning and reviews Plan the commissioning of primary medical services, including:

Carrying out regular primary medical health needs assessments (to be developed by the CCG) to help determine the needs of the local population in the Area;

Recommending and implementing changes to meet any unmet primary medical services needs.

Planning the provider landscape

Develop the Primary Medical Services commissioning strategy and take the key planning decisions, including for:

Establishing new GP practices in the area;

Procurement of new contracts;

Closure of practices and branch surgeries;

Approving practice mergers and closures;

Dispersing the lists of GP practices;

Agreeing variations to the boundaries of GP practices;

Co-ordinating and carrying out the process of list cleansing

Urgent care services Manage the design and commissioning of urgent care services (including home visits) for patients registered out of area

Enhanced services commissioning

The CCG will agree on, design and commission enhanced services for the area by:

Assessing the needs of the local population;

Developing the necessary specifications and templates for the Enhanced Services;

Consulting with Local Medical Committees, Health and Wellbeing Boards and other stakeholders in accordance with the duty of public consultation;

Liaising with system providers and representative bodies to ensure that the system in relation to the Enhanced Services will be functional and secure; and

Supporting GPs to enter into data processing agreements and Data Controllers in to provide “fair processing” information.

Design of Local Incentive Schemes

Design and offer Local Incentive Schemes for GP practices in addition to or as an alternative to the national framework (i.e. QOF or DES), provided that such schemes are voluntary and have undergone consultation with the Local Medical Committee;

Procurement and new Contracts

Make procurement decisions in accordance with the NHS England procurement protocol, ensuring that any locally designed contract has undergone LMC consultation and can demonstrate that the scheme will improve care in the area.


Primary Medical Services Contract management

Manage the Primary Medical Services Contracts and perform NHS England’s obligations under the contracts, including:

Actively managing the performance of the counter-party to secure the needs of the service users, improve service quality and improve efficiency of provision;

Ensuring respect of quality standards, incentives and the QOF, observance of service specifications, and monitoring of activity and finance;

Assessing quality and outcomes (including clinical effectiveness, patient experience and patient safety);

Managing GP practices providing inadequate standards of patient care, conducting practice reviews, agreeing remedial action plans and issuing contract breach notices when necessary;

Managing variations to the relevant Primary Medical Services Contract or services;

Agreeing information and reporting with practices:

Agreeing local prices and ensuring value for money.

Keeping records of all contracts

Management of poorly performing practices

Make decisions in relation to the management of poorly performing GP practices, including in liaison with the CQC where there has been a reported non-compliance with standards (but excluding any decisions in relation to the performer’s list). This includes:

Ensuring regular and effective collaboration with the CQC and taking appropriate action to CQC findings;

Ensuring that risks are appropriately identified, managed and escalated;

Responding to CQC assessments of practices where improvements is required;

When a GP practice is placed into special measures lead a quality summit to develop an improvement plan and ensure the monitoring of the said plan;

Discretionary payments Make decisions on discretionary payments, including in relation to QOF, Enhanced Services and Local Incentive Schemes

Premises Cost Directions

Make decisions in relation to the Premises Costs Directions Functions concerning:

Applications for new payments and revisions to existing payments

Working together with other CCGs to manage premises and to carry out strategic estates planning;

Liaising with NHS Property Services Limited and Community Health Partnerships Limited.

Schedule 3 - List of Members

Position Individual name Committee role

Voting members

GP partner and/or a GP employee of a Member of Barking & Dagenham Clinical Commissioning Group x2

Dr Gurkirit Kalkat Clinical Director

Lay Member, Barking and Dagenham CCG Sahdia Warraich

Lay Member, Audit Chair, Barking and Dagenham CCG

Kash Pandya Vice Chair

Accountable Officer, Barking and Dagenham CCG

Conor Burke Executive member

Chief Finance Officer, Barking and Dagenham CCG

Tom Travers Executive member

Nurse Director, Barking and Dagenham CCG

Jacqui Himbury Executive member

Director, Primary Care Transformation, Barking and Dagenham CCG

Sarah See

Secondary Care Consultant, Barking & Dagenham and Havering CCGs

Dr Steven Ryan

An Independent GP TBC

Non-voting members

Barking and Dagenham Healthwatch Frances Carroll Chair

Barking and Dagenham Health and Wellbeing Board

Matthew Cole Director, Public Health

NHS England Alison Goodlad Head of Primary Care Commissioning

B&D and Havering LMC representative Terilla Bernard Support Officer

Barking and Dagenham CCG Dr Waseem Mohi Chair

Havering Clinical Commissioning Group


February 2016

Revision History

Revision date


Version

Nov 2014 First draft as part of delegated commissioning application

Sarah See 1.0



2.0

8 May 2015 Amendments to reflect changes in Delegation Agreement

Sarah See 2.1

11 May 2015

Review and comments Rod McEwen 2.2

2 June 2015

Amendments regarding urgent meetings Sarah See / Rod McEwen

2.3

10 June 2015

Review and final comments by Primary Care Commissioning Committee members

Committee members

3.0

30 June 2015

Amendments around representatives of Local Medical Committees, HealthWatch and Health and Wellbeing Boards


4.0

29 Oct 2015

Amendments around proposed changes in GP representation


5.0

1 Feb 2016 Amendments as suggested by NHSE following changes to the membership of the Committee. Further review may be necessary upon publication of a national CoI review currently being undertaken (Project Starlight)

Sarah See /Rod McEwen

6.0

3

Introduction







to a CCG.




(“ToR”) to NHS Havering CCG (“CCG”). The Delegation Agreement is set out in

Schedule 1.

3. The CCG has established the NHS Havering Primary Care Commissioning

Committee (“the 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.

4. NHS Barking and Dagenham and NHS Redbridge CCG have agreed to establish

a committee (“committee-in-common”) with the same membership and the same

terms of reference as the committee established by the CCG (although







of the CCG’s own duties to the patients and population of Havering.

Statutory Framework



the NHS Act.












(section 14Q);


















provisions to enable the CCG to make decisions in common with NHS Barking

and Dagenham CCG and NHS Redbridge CCG on the review, planning and

procurement of primary care services within Barking & Dagenham, Havering and

Redbridge, under delegated authority from NHS England.












4), including:





















practices.






services in Havering. The Committee will ensure that the required financial

processes are in place for planning, reporting, risk management,

contingencies, probity and conflict of interest management. It will also agree

any Quality, Innovation, Productivity and Prevention (QIPP) plans and

manage their delivery.


Strategy for Havering ("the Strategy"). The responsibility of Strategy

development in BHR will rest with the Primary Care Transformation




















17. The Committee will take decisions in respect of the population of NHS Havering

CCG.

Membership


Lay Member Havering CCG

Lay Member, Audit Chair, Havering CCG

Accountable Officer, Havering CCG (Executive Member)

Chief Finance Officer, Havering CCG (Executive Member)

Nurse Director, Havering CCG (Executive Member)

Director, Primary Care Transformation, Havering CCG

Secondary Care Consultant, Havering CCG



An independent GP

The following shall be members of the Committee but shall be non-voting:

Chair, Havering CCG



Havering Healthwatch (Healthwatch representative)

The Barking and Dagenham and Havering Local Medical Committee (B&D

and Havering LMC representative)




Chair, Barking and Dagenham CCG and GP partner and/or a GP employee

of a Member of Barking & Dagenham Clinical Commissioning Group (x 2)




representative)



Barking and Dagenham Healthwatch (Healthwatch representative)

Redbridge Healthwatch (Healthwatch representative)


terms of reference.

19. The Chair of the Committee shall be Lay Member of a BHR CCG

20. The Vice Chair of the Committee shall be Lay Member of a BHR CCG

Meetings and Voting














Quorum



least one GP partner or a GP employee of a Member of Havering Clinical

Commissioning Group.









a) shall be held in public, subject to the application of paragraph 266(b) below;








time;

c) the closed confidential part of the meeting (as provided for at 26(b) above)


agenda and minutes;













30. The Committee will present its minutes to the governing body of NHS Havering

CCG for information.


constitution.
















Committee meeting.








members.






















European Union; and



and enforcement guidance on the S75 Regulations or any such

additional/replacement guidance and/or regulations from time to time in

force.

Decisions


43. The Committee will ensure that any conflicts of interest are dealt with in

accordance with the CCG’s Constitution and Standards of Business Conduct

Policies which for the avoidance of doubt may include members (voting or

otherwise) being excluded from a decision and/or the discussions leading

thereto.






Havering CCG.



Havering - PB signed.pdf



Voting members

GP partner and/or a GP employee of a Member of Havering Clinical Commissioning Group x2

Dr Alex Tran

TBC

Clinical Director

TBC

Lay Member, Havering CCG Richard Coleman Chair

Lay Member, Audit Chair, Havering CCG Kash Pandya Vice Chair

Accountable Officer, Havering CCG Conor Burke Executive member

Chief Finance Officer, Havering CCG Tom Travers Executive member

Nurse Director, Havering CCG Jacqui Himbury Executive member

Director, Primary Care Transformation, Havering CCG

Sarah See

Secondary Care Consultant, Havering CCG Steven Ryan

An independent GP TBC

Non-voting members

Havering Healthwatch Anne-Marie Dean Chief Executive

Havering Health and Wellbeing Board Cllr Steven Kelly Chair


B&D and Havering LMC representative Terilla Bernard Support Officer

Havering CCG Dr Atul Aggarwal Chair

Redbridge Clinical Commissioning Group


February 2016

Revision History

Revision date


Version

Nov 2014 First draft as part of delegated commissioning application Sarah See 1.0



2.0

8 May 2015 Amendments to reflect changes in Delegation Agreement Sarah See 2.1

11 May 2015 Review and comments Rod McEwen 2.2

2 June 2015 Amendments regarding urgent meetings Sarah See / Rod McEwen

2.3

10 June 2015 Review and final comments by Primary Care Commissioning Committee members

Committee members

3.0

30 June 2015 Amendments around representatives of Local Medical Committees, HealthWatch and Health and Wellbeing Boards


4.0

29 Oct 2015 Amendments around proposed changes in GP representation


5.0

1 Feb 2016 Suggested amendments from NHSE following changes to membership of the Committee. Further review may be necessary upon publication of a national CoI review currently being undertaken (Project Starlight)


6.0

3

Introduction







to a CCG.




(“ToR”) to NHS Redbridge CCG (“CCG”). The Delegation Agreement is set out in

Schedule 1.

3. The CCG has established the NHS Redbridge Primary Care Commissioning

Committee (“the 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.

4. NHS Havering CCG and NHS Barking and Dagenham CCG have agreed to

establish a committee (“committee-in-common”) with the same membership and

the same terms of reference as the committee established by the CCG (although







of the CCG’s own duties to the patients and population of Redbridge.

Statutory Framework



the NHS Act.












(section 14Q);


















provisions to enable the CCG to make decisions in common with NHS Havering

CCG and NHS Barking and Dagenham CCG on the review, planning and

procurement of primary care services within Barking and Dagenham, Havering

and Redbridge, under delegated authority from NHS England.












4), including:





















practices.






services in Redbridge. The Committee will ensure that the required financial

processes are in place for planning, reporting, risk management,

contingencies, probity and conflict of interest management. It will also agree

any Quality, Innovation, Productivity and Prevention (QIPP) plans and

manage their delivery.


Strategy for Redbridge ("the Strategy"). The responsibility of Strategy

development in BHR will rest with the Primary Care Transformation




















17. The Committee will take decisions in respect of the population of NHS Redbridge

CCG.

Membership



Lay Member, Audit Chair, Redbridge CCG

Accountable Officer, Redbridge CCG (Executive Member)

Chief Finance Officer, Redbridge CCG (Executive Member)

Nurse Director, Redbridge CCG (Executive Member)

Director of Primary Care Transformation, Redbridge CCG




An Independent GP

The following shall be in attendance as members of the Committee but shall be

non-voting:

Chair, Redbridge CCG




Redbridge Healthwatch (Healthwatch representative)


Lay Member, Havering CCG

Secondary Care Consultant, Barking & Dagenham and Havering CCG

Chair, Havering CCG and GP partner and/or a GP employee of a Member


Chair, Barking and Dagenham CCG and GP partner and/or a GP employee

of a Member of Barking & Dagenham Clinical Commissioning Group (x 2)



representative)

The Barking and Dagenham and Havering Local Medical Committee (BH

LMC representative)

Havering Healthwatch (Healthwatch representative)

Barking and Dagenham Healthwatch (Healthwatch representative)


terms of reference.

19. The Chair of the Committee shall be Lay Member of a BHR CCG.

20. The Vice Chair of the Committee shall be Lay Member of a BHR CCG.

Meetings and Voting














Quorum



least one GP partner or a GP employee of a member of Redbridge Clinical

Commissioning Group.









a) shall be held in public, subject to the application of paragraph 26 (b) below;








time;

c) the closed confidential part of the meeting (as provided for at 26 (b) above)


agenda and minutes;













30. The Committee will present its minutes to the governing body of NHS Redbridge

CCG for information.


constitution.
















Committee meeting.








members.






















European Union; and



and enforcement guidance on the S75 Regulations or any such

additional/replacement guidance and/or regulations from time to time in

force.

Decisions


43. The Committee will ensure that any conflicts of interest are dealt with in

accordance with the CCG’s Constitution and Standards of Business Conduct

Policies which for the avoidance of doubt may include members (voting or

otherwise) being excluded from a decision and/or the discussions leading

thereto.






Redbridge CCG.



Redbridge PB signed.pdf



Voting members

GP partner and/or a GP employee of a Member of Redbridge Clinical Commissioning Group x2

Dr Shabana Ali

TBC

Clinical Director

TBC

Lay Member, Redbridge CCG Khalil Ali

Lay Member, Audit Chair, Redbridge CCG Kash Pandya Vice Chair

Accountable Officer, Redbridge CCG Conor Burke Executive member

Chief Finance Officer, Redbridge CCG Tom Travers Executive member

Nurse Director, Redbridge CCG Jacqui Himbury Executive member

Director, Primary Care Transformation, Redbridge CCG

Sarah See


Ah-Fee Chan

An Independent GP TBC

Non-voting members

Redbridge Healthwatch Cathy Turland Chief Executive

Redbridge Health and Wellbeing Board Vicky Hobart Director, Public Health


Redbridge LMC representative Dr Ambish Shah Chair

Redbridge CCG Dr Anil Mehta Chair

www.england.nhs.uk

PMS review

Key messages for CCGs

26 January 2016

• Timeline

• Approach to Transition and

Equalisation – the London position

• Engagement resources for CCGs

CONFIDENTIAL

www.england.nhs.uk

• The PMS Review will bring us a stage closer to the primary care sustainability plans and the implementation of the Strategic Commissioning Framework - SCF, creating a new vision for general practice representing the foundation for transforming primary care

• The financial information relating to the PMS review will be released to GP practices this week

• Discussions are continuing with London CCGs

• With this update is a draft London rationale presentation that CCGs can adapt for use in their meetings with GP practices, and also a PMS FAQ

• This update also includes a summary of engagement requirements

2

Key messages

www.england.nhs.uk

TimelineJan

Week

1 2 3 4

Feb

Week

1 2 3 4

March

Week

1 2 3 4

April

Week

1 2 3 4

May

Week

1 2 3 4

June

Week

1 2 3 4

29th End of Engagement

with LMC

London offer finalised with

LMC

29th CCG Financial

modelling complete

19th CCGs to

submit CIs

1st March commence

sending offers to

practices and

negotiation meetings

start

25th Start to book negotiation

meetings with practices or

start of formal consultation

meetings with local LMCs,

where Local CIs proposed

20th May

negotiations with

practices to conclude

27th May contract

amendments sent to

practices

1st June updated financial

information reviewed and

scheduled by finance

30th June new contract

and specifications

commence

Transition applications

assessed

Mid May - Transition

decisions made and

practices notified

CCG CIs reviewed by

DCOs and

recommendations made

Offers issued to

practices by end March

www.england.nhs.uk 4

Approach to Transition and Equalisation –

The London position

Transition - 2 years of transition is allowable for practices in line with national guidance.

Following further national clarification, it is confirmed that a longer transitional period can be

considered by regional teams with CCGs on a case by case basis as part of negotiations but

this will not be considered on a CCG wide basis. All transitional periods must end by March

2020/21.

CCGs are to give full explanation as to how they will transition to new services they have

advised they will be commissioning.

Equalisation – Equalisation to GMS in 2016/17 should be delivered where strategically and

financially possible. In cases where this is not possible, CCG areas will be required to set out

their plans for equalisation in their commissioning intentions submission in February 16 and

show strategic plans for achieving it as part of Sustainability and Transformation plans

submitted in June 2016. Plans will need to show equalisation before 2021 to ensure

equalisation is achieved in the planning period. Note that as a minimum, where CCGs have

not achieved funding equalisation within PMS practices this will need to be achieved by

2016/17.


Stakeholder engagement requirements

• CCGs identified stakeholder engagement requirements as part of their

response to the PMS review.

• In addition to engagement with GP practices, stakeholders identified

include:

• General public

• Patients

• Local authority

• Local LMC


Stakeholder engagement requirements

Actions:

• CCGs should be reviewing their communications plans to ensure planned engagement is taking place and remains appropriate.

• Likely communications actions will include:

• CCG led briefings for local patient/public engagement

• Ongoing discussions and engagement with local LMC, informing LMC of proposed CCG approach

• Engagement with local council, Healthwatch, etc.

• Placement of information on CCG websites as appropriate

• Internal (staff) communications if required

• In general, it is expected that CCGs will be using existing communications channels and forums to promote PMS-related messages


Local media interest

• Depending on local circumstances and any impact (real or perceived) in services provided, it is possible that the PMS review may result in adverse local publicity.

Actions:

• CCGs should identify the risk of adverse local publicity in PMS risk/issues recording

• CCG PMS leads should ensure that CCG press teams are fully briefed on any likely media issues and have prepared ‘lines to take’

• The PMS Review Team communications lead should be advised of any likely local media interest

• It is not expected that CCGs will proactively publicise PMS decisions to the local media, unless this is deemed appropriate to meet local requirements.

For more info contact the PMS Review Team Communications

lead, Stuart Notholt, at: [email protected]

Primary Medical Services

Impact Assessment

We are undertaking modelling to assess the impact of PMS

changes on BHR CCG Primary Care

Collate baseline data

Week 1: 27 Jan Week 2: 1 Feb Week 3: 8 Feb Week 4: 15 Feb

Develop baseline model

Plan, scope and

refine activities

Understand current

CCG analysis

Develop scenario model

template (understand tests

required)

Feed initial modelling

and progress into

PCC Comm

10 February

Model scenarios and

review findings

Build scenarios

Refine scenarios

around agreed

options

Document findings

and support

presentation

19 February

Equality Impact

Assessment

We are developing a model that will enable us to test

scenarios

Baseline PMS and

GMS view

Cost implications of

current vs proposed

new contract

Assess the Impact of

Changes

Reviewing Current/KPIs

Premium Services

Scenario Modelling

PMS contract value at practice

level is calculated using

weighted list sizes and per

patient PMS and premium

payments

Assess the cost implications

current vs proposed new

contract, incl. delivering KPIs

at each performance level by

each practice

Review the current

KPIs/premium services offered

by each practice to

understand what the impact

will be if these services are not

commissioned or covered by

other existing contracts.

Testing scenarios to compare

PMS contract with current

strategic intentions, and

support the assessment of

options to ‘configure’ different

local options

1

5

2 3

Assessing the impact of PMS

changes to GMS contracts

over a phased approach

4

Impact Analysis used to

determine

commissioning

Intentions

6

Engagement and agreement

of commissioning intentions

We need to define a small number of scenarios to test to

establish the impact

Low Impact High Impact

Risk of

switchover to

GMS contract

Phasing of GMS

arrangements

Refunding / re-

provision of

existing

services

Breadth of the

London KPIs

used

Services that

might be

provisioned

●Low switchover of

PMS to GMS

contracts

●Long phasing

period to equalise

practices

●Re-provisioning of

all services (Note

will have high

financial impact)

●Use of only

mandated KPIs

●No further services

are commissioned

(from existing

funds)

●Significant switch

over of all current

PMS practices

●Short period or

immediate

switchover

●Re-provisioning of

no services (Note

will have low

financial impact)

●Use of all KPIs

●Services are

commissioned

against all key

priorities

What specific tests would the group envisage testing against?

●Parts of the BHR

practice

community switch

over

●Phased plan which

moves in stages

●Balanced re-

provisioning which

takes into account

financial / quality

●Balanced use of

KPIs by quality /

financial value

●Consideration of

strategic priorities

The model will also allow us to test factors impacting the

Primary Care environment across BHR CCGs

● Impact on the services as they switch off or are re-provisioned

● Impact on commissioned cost over time for phasing in new arrangements

● Impact on practice sustainability of any financial changes

● Impact on the patients having to go elsewhere if the practices stop providing the

premium services

● Impact on funding streams where services need to be re-provisioned

These will feed into an Equality Impact Assessment which will describe the

expected impact and mitigations

BARKING & DAGENHAM, HAVERING

AND REDBRIDGE CCGS

Co-commissioning and Contract Management

FINAL

Internal Audit Report: 4.15/16

6 January 2016

Barking & Dagenham, Havering and Redbridge CCGS / Co-Commissioning and Contract Management 4.15/16 | 1

CONTENTS 1 Executive summary ...................................................................................................................................................... 2

2 Action Plan ................................................................................................................................................................... 8

3 Detailed findings ......................................................................................................................................................... 12

APPENDIX A: SCOPE .................................................................................................................................................... 23

APPENDIX B: FURTHER INFORMATION ..................................................................................................................... 25

For further information contact ........................................................................................................................................ 26

As a practising member firm of the Institute of Chartered Accountants in England and Wales (ICAEW), we are subject to its ethical and other professional requirements which are detailed at http://www.icaew.com/en/members/regulations-standards-and-guidance. The matters raised in this report are only those which came to our attention during the course of our review and are not necessarily a comprehensive statement of all the weaknesses that exist or all improvements that might be made. Recommendations for improvements should be assessed by you for their full impact before they are implemented. This report, or our work, should not be taken as a substitute for management’s responsibilities for the application of sound commercial practices. We emphasise that the responsibility for a sound system of internal controls rests with management and our work should not be relied upon to identify all strengths and weaknesses that may exist. Therefore, the most that the internal audit service can provide is reasonable assurance that there are no major weaknesses in the risk management, governance and control processes reviewed within this assignment. Neither should our work be relied upon to identify all circumstances of fraud and irregularity should there be any. This report is supplied on the understanding that it is solely for the use of the persons to whom it is addressed and for the purposes set out herein. Our work has been undertaken solely to prepare this report and state those matters that we have agreed to state to them. This report should not therefore be regarded as suitable to be used or relied on by any other party wishing to acquire any rights from RSM Risk Assurance Services LLP for any purpose or in any context. Any party other than the Board which obtains access to this report or a copy and chooses to rely on this report (or any part of it) will do so at its own risk. To the fullest extent permitted by law, RSM Risk Assurance Services LLP will accept no responsibility or liability in respect of this report to any other party and shall not be liable for any loss, damage or expense of whatsoever nature which is caused by any person’s reliance on representations in this report. This report is released to our Client on the basis that it shall not be copied, referred to or disclosed, in whole or in part (save as otherwise permitted by agreed written terms), without our prior written consent. We have no responsibility to update this report for events and circumstances occurring after the date of this report.

Debrief held 23 December 2015 Internal Audit

team

Nick Atkinson – Partner

John Elbake – Manager

Syed Ali – Assistant Manager

Susannah Young – Internal Auditor

Draft report issued 21 December 2015

Responses received 5 January 2016

Final report issued 6 January 2016 Client sponsor Sarah See – Director, Primary Care

Transformation

Distribution Sarah See – Director, Primary Care

Transformation

Natalie Keefe - Head of Primary Care

Transformation


1.1 Background

An audit of Primary Care Co-Commissioning and Contract Management was undertaken as part of the approved

internal audit periodic plan for 2015/16.

In May 2014, NHS England (NHSE) invited Clinical Commissioning Groups (CCGs) to come forward with expressions

of interest to take on an increased role in the commissioning of GP services. The intention was to give CCGs more

influence over the wider NHS budget and enable local health commissioning arrangements that can deliver improved,

integrated care for local people, in and out of hospital. According to NHSE documentation, the potential benefits of co-

commissioning for the public and patients include:

Improved access to primary care and wider out-of-hospitals services, with more services available closer to

home;

High quality out-of-hospitals care;

Improved health outcomes, equity of access, reduced inequalities; and

A better patient experience through more joined up services.

There are three co-commissioning models that CCGs can take forward. These are:

Full delegated responsibility for commissioning the majority of GP services;

Joint commissioning responsibility with NHS England; and

Greater involvement in GP commissioning decisions.

Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups were all approved for the title of

delegated commissioners on 17 February 2015; the groups assumed responsibility on 1 April 2015. This role involves

management of provider contracts, including 133 GP practices across Barking & Dagenham, Havering and Redbridge

(BHR). Despite each CCG having delegated responsibility BHR CCGs meet as a committee in common to discuss

primary care co-commissioning matters. As delegated commissioners Barking & Dagenham, Havering and Redbridge

CCGs are all budget holders for provider services.

In relation to performance managing GP contracts, BHR CCGs still have the risk on relying on a remote NHSE performance team. CCGs now have access to CQRS (Calculating Quality Reporting Service) which holds GP contract information however access is limited due to Information Governance rules. We confirmed that a contract list is maintained for all GPs with contract end dates (relevant for APMS contracts only). However as the contracts cannot be accessed by the CCGs, this raises doubt over whether their authority is truly separate and delegated from NHSE. As a key aspect of delegated commissioning and contract management, the CCG should clarify the status of GP contracts with NHSE, and access to them. To address this we have agreed that the CCGs will clarify the following arrangements with NHSE (although note these issues are common to all CCGs with delegated responsibilities from NHS England):

Provision for a local NHSE GP contract performance team and resource implications;

Access to GP contracts; and

Review of CCG operating plans.

All active performance cases are managed on a monthly basis. We were able to confirm this by review of the risk register, papers presented to the PCCC and action plan updates for one of the two current cases for the months June to December 2015.

1 EXECUTIVE SUMMARY


However we did confirm that NHSE have shared a mock-up template for the GP Commissioning and Contracting:

Quality and Performance Report with CCGs. BHR CCGs on 24 November and 2 December 2015 have relayed their

feedback (including PCCC lay representatives) on the template to NHSE. This includes concerns raised by the CCG

which was recently contacted by CQC for a practice visit undertaken where the practice was not participating in QOF.

From the information the CCG receives this would not have been flagged up. The CCGs are lobbying NHS England to

agree a revised template to ensure this current gap in proactive performance monitoring is addressed. This would

assist all CCGs with delegated commissioning responsibilities.

1.2 Conclusion

The conclusion below feeding into the overall assurance level is based on evidence obtained during the review. The

opinion focuses on those areas that are within the control of the CCGs and takes account of the fact that this is the

first year of fully delegated commissioning and there have been a number of issues in regard to how the process has

transferred, the availability and quality of information relating to finance and performance and access to contracts and

associated information governance issues. We note that these should be considered when assessing the level of

assurance provided as by their nature these issues impact on the CCGs and the effectiveness with which they can

fully undertake delegated commissioning.

Internal Audit Opinion:

Taking account of the issues identified, the Governing Bodies

can take reasonable assurance that the controls in place to

manage this risk are suitably designed and consistently

applied.

However, we have identified issues that need to be

addressed in order to ensure that the control framework is

effective in managing the identified risk.

1.3 Key findings

This report has been prepared by exception. The key findings from this review are as follows:

Effectiveness

All BHR CCGs are currently experiencing reported overspends against budgets held for provider services. As of November 2015 (Month 7):

o Barking and Dagenham CCG: year to date overspend of £170,000.

o Havering CCG: overspend of £308,000.

o Redbridge CCG: overspend of £217,000.

Despite the reported overspend the Chief Finance Officer for all BHR CCGs has stated that the year-end position

should breakeven. The CCG has started receiving budget reports from NHSE however the detail in the reports is

limited. This has been an issue for all CCGs in having difficulty in receiving the required information from NHSE to

enable full budgetary delegation to be effectively implemented.


The CCGs and NHSE are working to design a process that provides detailed accruals and variance analysis in a

way which supports the Primary Care Committee reporting requirements. Until the management of the ledger and

adherence to the monthly reporting timetable is adhered to, the CCGs continue to be exposed to the financial

risks of having insufficient budgets and unknown overspends/ cost pressures. This issue is in common with other

CCGs and we are aware that the Chief Finance Officer is taking this forward through discussions with NHS

England to try to obtain improved variance analysis from NHS England.

QIPP target savings (inherited from NHSE) taken against APMS, GMS and PMS contracts, of 1.4% have not yet been fully costed and incorporated into the budget plan. The QIPP plan was submitted in October 2015; therefore amendments have only recently been incorporated to support the budget setting process. This is outlined as one of the main pressures affecting financial performance. Clarification is also needed concerning responsibility for each CCG for undelivered QIPP savings. This has been effected by issues as set out above and as inherited from NHS England. However, the Chief Finance Officer believes the CCGs have moved to safeguard the position for 2015/16, as set out in the action plan below. (Medium)

Design and Application of and compliance with control framework

Overall we raised 4 medium and 2 low priority management actions in relation to the design and application of the

control framework. A summary of the recommended medium priority management actions is above and below:

To address the perceived lack of local clinical involvement in decision making, the CCGs on 6 November 2015 put forward their proposal to NHSE to change the clinical representation and voting membership of the committee for approval. This included revised terms of reference for each of the three CCG PCC Committees.

Approval was sought to increase the current independent GP voting member position to 2 GPs (a clinical director of the CCG and a GP partner or a GP employee of a Member of the CCG). These proposed changes will ensure a lay member/officer GP voting majority of 6:2. No other changes are requested. The CCG’s Committee will continue to meet as a committee in common. We confirmed that pending certain conditions (which include NHSE being a standing non-voting member and that an independent GP is included), NHSE approved the revised terms of reference on 9 December 2015.

Therefore each Committee will now have 2 local voting GPs, and an independent voting GP; the CCG Chair and LMC representative are non-voting members. We consider the changes made to be appropriate however recommend that the committee in common undertakes an annual review of local clinical involvement in decision making to ensure the CCGs’ ability to use local knowledge and experience to drive up performance and quality is preserved. (Medium)

Primary Care Co-Commissioning Committee: The Primary Care Commissioning Committee meets as a committee in common representing all three members of the BHR CCGs. They report to the respective BHR governing bodies and NHS England. The PCCC and respective governing bodies share members in the form of the Chief Accountable Officer, Chief Finance Officer and the lay member for governance. This is an efficient means of dealing with governance issues and of ensuring matters in common are dealt with once only. However we noted that to enhance the clinical independence that the CCGs were going out for advert at the time of our review. This may help to broaden the decision-making ability of the committee and to reflect the wider views of the stakeholders involved in delegated commissioning. (Medium)

Primary Care Transformation Strategy: The draft Primary Care Transformation Strategy has not yet been finalised. Without the strategy in place to outline how the CCGs will improve the quality and experience of primary care, there are no objectives set to work towards. (Medium)


1.4 Additional information to support our conclusion

Risk Control

design*

Non-compliance

with controls*

Agreed actions

Low Medium High

An increasing move

towards Co-

Commissioning increases

the risk in the clarity of

accountability and

Governance

arrangements in

determining effective

commissioning strategies

and methodologies

between neighbouring

CCGs.

6 (15) 4 (15) 2 4 0

Total 2 4 0

* Shows the number of controls not adequately designed or not complied with. The number in brackets represents the total number of controls

reviewed in this area.

1.5 Feedback from benchmarking for consideration

We have identified good practice at similar organisations which should be considered:

• In relation to primary care service procurement, having reviewed other CCG arrangements, BHR may wish to

consider clinical aspects of the service design to go through a Clinical Cabinet (led by GPs) and decisions on the

procurement route going through the PCCC. Such an arrangement may also address the local clinical

representation issue currently faced.

The purpose of such a Clinical Cabinet is to drive the development of GP-led, multi-professional clinical

commissioning across all members and to communicate and implement the CCG’s vision. The membership of the

Clinical Cabinet can consist of:

Clinical Governing Body Members, including GPs elected by CCG’s general practice membership from locality

collaboratives and by sessional GPs, and the Registered Nurse and Secondary Care Consultant members;

Practice managers (2) appointed following expressions of interest and interview process;

Public Health member nominated by the council; and

Clinical leads appointed to roles identified, defined and approved by the Clinical Cabinet

1.6 Additional feedback


We have identified the following examples of good practice during this audit:

• The Chief Officer has the overall responsibility within the three CCGs of the BHR group for Delegated

Commissioning, including the efficient and effective financial management of the Clinical Commissioning Groups,

as well as the improvement in quality of services provided to the local population. The Chief Officer is supported

by the Chief Finance Officer as well as the individual CCG chairs. The Chief Finance Officer is also responsible

for all three BHR CCGs.

• In January 2015 Barking & Dagenham, Havering and Redbridge (BHR) CCGs issued three individual

Submissions for Level 3 Delegated Commissioning and were notified in March 2015 that these plans were

approved. Each CCG received a letter of approval from NHSE sent on the 17 February 2015 to notify the CCG of

their new delegated commissioning responsibility. The letters were all signed by the National Director of

Commissioning Strategy, National Director of Commissioning Operations and the Chief Financial Officer. The

delegation agreements for each BHR CCG also had a specific agreement in place which had been signed by

authorised signatories from NHS England and the CCG.

• There is an approved Primary Care Co-Commissioning Memorandum of Understanding (MoU) in place between

the CCG and NHS England to provide understanding between the parties entering co-commissioning

arrangements and form an agreement on how they deliver primary care commissioning functions. The MoU is in

place as an annex to the Primary Care Co-Commissioning Operating Model. It is shared between all CCGs in

London with joint or delegated commissioning responsibilities; it was approved in October 2015. The MOU is not

specific to BHR CCGs or delegated commissioning status; therefore there is no signature or date from the either

the CCG or NHSE. However, documented in the October 2015 PCCC meeting minutes is the approval of the

operating model by each respective BHR committee. The MoU was thoroughly discussed and reviewed by the

BHR PCCC in October 2015. Queries concerning the approved operating model were raised and escalated to the

Director of Primary Care Commissioning at NHSE who was present at the meeting.

• In preparing the strategy, the CCGs held a number of Engagement Briefings and events with stakeholders,

including, GP member practices, patients, local voluntary sector organisations and the local authority with the aim

of understanding what was important to the local community. A range of meetings were held to collect feedback in

each of the local BHR areas as well as more general BHR wide events; as of July 2015, 395 individuals had been

engaged. Each BHR CCG compiled a report on public engagement in September 2015. It highlighted that 82% of

respondents to the survey were patients and logged their age, ethnicity and whether they considered themselves

disabled. Each report also contained a section on how the specific feedback has been actioned in the Primary

Care Transformation Strategy, emphasising the purpose of the engagement process. However we cannot give

assurance that the feedback acquired has been adequately reflected in the strategy without review of the

transformation document, which has not yet been issued.

• The Conflict of Interest Policy provides transparency and assurance to the public and other interested parties that

the CCG is free from any appearance of impropriety. BHR CCGs each outline in their respective constitutions

that they must comply with the policy for managing conflicts of interest. This reflects the requirements of section

140 of the 2006 Act and section 25 of the 2012 Act. The constitutions also include arrangements for declaring,

registering and managing interests. The ‘Standards of Business Conduct and Management of Conflicts of

Interest’ papers supplied by each BHR CCG were all updated in January 2015 to reflect new NHS guidance in

relation to co-commissioning released in November 2014. This new guidance outlined the need for strengthened

conflicts of interest policy and has developed an enhanced framework outlining the responsibilities and minimum

expectations of co-commissioners. Guidance states that the CCGs must: hold and maintain an appropriate

register of interests, make these accessible to the public, ensure policies and procedures are in place to manage

conflicts of interest and guarantee declarations of interest are made promptly. Each BHR CCG holds a uniformed

conflict of interest policy which has been approved by their respective governing body; it is also available to the

public via the CCG website. There is clear reflection of the new guidance, expressing the process for declaring

and registering an interest and the responsibilities of the commissioning group in managing these events.


• There are occasions when an urgent decision is required in between committees that cannot wait for the full

committee to meet. A Primary Care Commissioning Committee Urgent Decision-Making Process has therefore

been developed to explore the types of decisions that may require an urgent response and sets out a process for

urgent decision making. Guidelines for best practice are outlined in the ‘Co-Commissioning of Primary Care

Services Operating Model’; these principles are also reflected in the terms of reference for each CCG. The terms

in relation to urgent and immediate decision-making are identical across the BHR CCGs. A uniformed approach

to this type of event is key to mitigating risk and maintaining patient care. As immediate and urgent decisions are

made outside of the usual committee, only judgments necessary to maintain patient care should be made. Any

urgent decisions are reported to, discussed and recorded in the Primary Care Commissioning Committee

meetings. BHR CCGs have outlined that the responsible contact for urgent decisions is the Director of Primary

Care Transformation. In the event an urgent decision is required, the Director will meet with the Chair and CCG

Accountable Officer.

• BHR CCGs Governing Bodies meet every two months; recent Governing Body minutes, agendas and papers for

May, June and September 2015 show that members of the Primary Care Commissioning Committee were

present and contributed to the meetings. Updates are regularly submitted by the Director of Primary Care

Transformation to the governing bodies surrounding a range of Primary Care Commissioning matters including:

risks and issues to the CCG and local primary care system, development of the Primary Care Transformation

Strategy and the Personal Medical Services Review.


2 ACTION PLAN

Categorisation of internal audit findings

Priority Definition

Low There is scope for enhancing control or improving efficiency and quality.

Medium Timely management attention is necessary. This is an internal control risk management issue that could

lead to: Financial losses which could affect the effective function of a department, loss of controls or

process being audited or possible reputational damage, negative publicity in local or regional media.

High Immediate management attention is necessary. This is a serious internal control or risk management

issue that may, with a high degree of certainty, lead to: Substantial losses, violation of corporate

strategies, policies or values, reputational damage, negative publicity in national or international media

or adverse regulatory impact, such as loss of operating licences or material fines.

The table below sets out the actions agreed by management to address the findings:

Ref Findings summary Priority Actions for management Implementation

date

Responsible

owner

Risk: An increasing move towards Co-Commissioning increases the risk in the clarity of accountability and

Governance arrangements in determining effective commissioning strategies and methodologies between

neighbouring CCGs.

3.2 The Primary Care

Transformation Strategy

has not yet been finalised

and is currently in draft

form. Each CCG will have

their own version of the

strategy which is relevant

to their local area.

Medium Management will complete,

approve and implement the

Transformation Strategy.

This will be

presented to

Governing Bodies in

March 2016

Sarah See

3.3 No Transformation Action

Plan has yet been

created as the

transformation strategy

for BHR CCGs has not

been finalised.

Low Management will create a

transformation action plan

to ensure that projects

concerning primary care

are managed effectively

with clear, measurable

actions in place with

regular plan reviews. A

detailed plan will be

produced for 2016/17 and

a broader fiver year high

level plan.

March 2016 Sarah See

3.4 The Master Register of

Interests for Barking &

Dagenham, Havering and

Redbridge CCGs does

Low Management will add a

‘last reviewed’ date to the

register of interests so

anyone referring to the

January 2016 Marie Price



date

Responsible

owner

not currently include a

date to outline when the

register had last been

updated. Although the

date is referenced on the

CCG website, this

information should also

be on the document itself.

document can check it is

up to date.

3.5 The Primary Care

Commissioning

Committee that

represents Barking &

Dagenham and Havering

is missing an

independent GP member.

The missing voting

members from the PCCC

may result in the

narrower decision making

capability of the

committee.

Medium Appointment of an

independent GP for

Havering and Barking &

Dagenham to the PCCC,

ensuring a breadth of

opinion is consulted for

decision-making. The Job

Description is in place and

this will be going to advert

in January 2016.

31 January 2016 Sarah See

3.7 Financial reports

highlight that currently all

three BHR CCGs are

experiencing budget

overspends, but are

expected to break even

at the year end. QIPP

target savings of 1.4%

have not yet been fully

costed and incorporated

into the budget plan.

Issues were raised

concerning NHSE

reports; namely a lack of

detail surrounding

expenditure on

transactions. The report

acknowledged the need

for further management

however references to

‘on-going work’ are

vague, with no clear

action plan in place to

effectively monitor and

Medium

Ensure the QIPP plan is incorporated into the budget setting process to guarantee more accurate spending forecast and financial performance reports. Clarification is also needed concerning responsibility for each CCG for undelivered QIPP savings.

Completed for

2015/16

Tom Travers



date

Responsible

owner

manage the issues

raised.

3.8 To address the perceived

lack of local clinical

involvement in decision

making, the CCGs on 6

November 2015 put

forward their proposal to

NHSE to change the

clinical representation

and voting membership

of the committee for

approval. This included

revised terms of

reference for each of the

three CCG PCC

Committees.

Approval was sought to

increase the current

independent GP voting

member position to 2

GPs (a clinical director of

the CCG and a GP

partner or a GP

employee of a Member of

the CCG). These

proposed changes will

ensure a lay

member/officer GP voting

majority of 6:2. No other

changes are requested.

The CCG’s Committee

will continue to meet as a

committee in common.

We confirmed that

pending certain

conditions (which include

NHSE being a standing

non-voting member and

that an independent GP

is included), NHSE

approved the revised

terms of reference on 9

December 2015.

Medium The committee in common to undertake an annual review of local clinical involvement in decision making to ensure the CCGs ability to use local knowledge and experience to drive up performance and quality is preserved.

With the sign off

from the Chairs of

the CCGs this

should be completed

by 28 February 2016

to enable

involvement to be

active at Committee

from March 2016.

Sarah See



date

Responsible

owner

We consider the changes

made to be appropriate

however recommend that

the committee in common

undertakes an annual

review of local clinical

involvement in decision

making to ensure the

CCGs ability to use local

knowledge and

experience to drive up

performance and quality

is preserved.


3 DETAILED FINDINGS

This report has been prepared by exception. Therefore, we have included in this section, only those risks of weakness in control or examples of lapses in control identified

from our testing and not the outcome of all internal audit testing undertaken.

Ref Control Adequate

control

design

(yes/no)

Controls

complied

with

(yes/no)

Audit findings and implications Priority Actions for management

Risk: An increasing move towards Co-Commissioning increases the risk in the clarity of accountability and Governance arrangements in determining effective commissioning

strategies and methodologies between neighbouring CCGs.

3.1 There are 133 GP Practices within

Barking and Dagenham, Havering

and Redbridge CCGs, comprising

Personal Medical Services (PMS),

General Medical Services (GMS) and

Alternative Provider Medical Services

(APMS). A contract is in place with

each GP Practice which details the

terms and conditions of the services

to be provided between the CCG

(Commissioner) and the GP

Practices (Provider). The Contract

comprises the following:

the Particulars;

the Service Conditions; and

the General Conditions.

No Yes A Memorandum of Understanding

and operating model between

NHSE and London CCGs is now in

place however in relation to

performance managing GP

contracts, BHR CCGs still have the

risk on relying on a remote NHSE

performance team.

We confirmed that the CCGs now

have access to CQRS (Calculating

Quality Reporting Service) which

holds GP contract information

however access is limited due to

Information Governance rules.

The governance structure sent to

the BHR CCGs states that the

Primary Care Commissioning

Committee will be responsible for

the contracting of GP providers and

the management of these contracts.

However GP contracts are not

currently held at any of the BHR

CCGs.

These contracts are held by NHSE

and have not been novated to

N/A



control

design

(yes/no)

Controls

complied

with

(yes/no)


CCGs. This remains a national

issue as NHSE remain the statutory

commissioner.

We confirmed that a contract list is

maintained for all GPs with contract

end dates for APMS contracts.

However as the contracts

themselves cannot be accessed by

the CCGs, this raises doubt over

whether their authority is truly

separate and delegated from

NHSE. As a key aspect of

delegated commissioning and

contract management, the CCG

should clarify the status of GP

contracts with NHSE, their novation

and access to them.

3.2 The CCG has developed a Draft

Transforming Primary Care Strategy

to set out its commitment and

approach for improving the quality

and experience of primary care

services and to address challenges.

The strategy has not yet been

finalised and approved by the

governing bodies.

No Yes The Primary Care Transformation

Strategy has not yet been finalised

and is currently in draft form. We

have evidenced the stakeholder

engagement for the Strategy and

outcome reports to the PCCC. Each

CCG will have their own version of

the strategy which is relevant to

their local area. Due to the strategy

in development, it is not clear what

the Primary Care aims for the

current year are, how will they be

achieved (in absence of clear

actions for the year) and whether

the governance around it is fit-for-

purpose

Medium Management will complete, approve and

implement the Transformation Strategy.



control

design

(yes/no)

Controls

complied

with

(yes/no)


3.3 Measuring the outcomes delivered as

a result of the Transformation

strategy is critical to ensuring the

CCGs stay on track to deliver the

changes that are needed in primary

care. As a result a Primary Care

Strategy Action Plan is being

developed which details key

measurable actions to be achieved.

No No No Transformation Action Plan has

yet been created as the

transformation strategy for BHR

CCGs has not been finalised.

Low Management will create a transformation

action plan to ensure that projects concerning

primary care are managed effectively with

clear, measurable actions in place with regular

plan reviews. A detailed plan will be produced

for 2016/17 and a broader fiver year high level

plan.

3.4 A Register of Interests is maintained by each CCG with the BHR group detailing all interests declared by members, governing body members and employees of the BHR CCGs.

The Register is reported to every meeting of the Governing Body and details the following:

Name;

Role in CCG;

Organisation

Nature of Interest;

Amendment and date.

The Register of Interests is

accessible to all relevant staff and the

public through Barking and

Dagenham, Havering and Redbridge

CCG’s website.

No Yes We reviewed the Master Register of

Interests for Barking & Dagenham,

Havering and Redbridge CCGs. For

each register there was no date to

outline when the register had last

been updated. Although the date is

referenced on the CCG website,

this information should also be on

the document itself.

We reviewed the May, June and

September 2015 governing body

meeting minutes for all three BHR

CCGs and confirmed that the

register is presented at each

Governing Body meeting as a

standing agenda item. In the

sample of minutes reviewed no

conflicts of interests were noted.

Review of the quarter 2 delegated

function self-certification reports for

each BHR CCG highlighted that no

conflicts of interest have been

registered.

Low Management will add a ‘last reviewed’ date to

the register of interests so anyone referring to

the document can check it is up to date.



control

design

(yes/no)

Controls

complied

with

(yes/no)


We confirmed that the register of

interest for each CCG was available

and easily accessible to the public

through the CCG websites.

3.5 BHR CCGs have established a


Committee (PCCC) that meets in

common on a monthly basis to

oversee a number of processes

including:

Management of the primary care

budget

Review, planning and

procurement of primary care

services,

Management of GP contracts

Design of enhanced services

and local incentive schemes,

Approval of practice mergers

and changes.

A ‘terms of reference’ is in place for

each CCG that is regularly reviewed

with a revision history to document

the revision date, summary of

changes and writer/reviewer. The

documents outline voting and non-

voting membership of the PCCC, to

include representatives from each

BHR CCG ensuring the individual

needs of Barking and Dagenham,

Havering and Redbridge are met

Yes No The PCCC reports to each of the

BHR governing bodies, who in turn

report to their respective Health and

Wellbeing Boards.

Review of the PCCC meeting

minutes from the previous 3 months

have confirmed that the committee

meets monthly, with voting and

non-voting members in attendance

with representation from all three

CCGs.

Review of the terms of reference for

each CCG highlighted that Barking

& Dagenham, and Havering are

missing a secondary care

consultant member. An

independent GP member is also ‘to

be confirmed’.

We did confirm that the Secondary

Care Consultant for Barking &

Dagenham and havering had now

been appointed and the CCGs were

going out to advertise for the

independent GP position.

Medium Appointment of an independent GP for

Havering and Barking & Dagenham to the

PCCC, ensuring a breadth of opinion is

consulted for decision-making. The Job

Description is in place and this will be going to

advert in January 2016.



control

design

(yes/no)

Controls

complied

with

(yes/no)


despite the committee meeting in

common. A quorum is in place to

ensure decision-making is only

undertaken with 4 voting members

present.

The missing voting members from

the PCCC may result in the

narrower decision making capability

of the committee.

3.6 A Primary Care Provider

Performance Report is reviewed and

discussed on a monthly basis to the


Committee. The Primary Care

Provider Performance Report

focuses on quality issues from

providers to ensure that these are

highlighted, monitored, reported and

actioned in order to improve the

service provided.

CCGs are delegated commissioners

for the contracts, NHSE are

responsible for individual GP

competency and inclusion on the

performers list.

No Yes As the delegated commissioner any

queries concerning provider

performance should be identified

and escalated to the CCG to rectify

and manage. However performance

reports are currently being issued

by NHS England; these are

produced on a quarterly basis. The

governance structure and roles &

responsibilities outlined in the Co-

commissioning of Primary Medical

Services, PCCC Induction

Programme and the terms of

reference for the PCCC highlight

that the Primary Care

Commissioning Committee should

oversee performance management

and monitoring. None of the BHR

CCGs currently produce any

reports on provider performance;

once again challenging the

authority of the delegated

commissioner.

However we did confirm that NHSE

have shared a mock-up template

for the GP Commissioning and

Contracting: Quality and

N/A



control

design

(yes/no)

Controls

complied

with

(yes/no)


Performance Report with CCGs.

BHR CCGs on 24 November and 2

December 2015 have relayed their

feedback (including PCCC lay

representatives) on the template to

NHSE. This includes concerns

raised by the CCG which was

contacted by CQC about a practice

visit they undertook where the

practice were not participating in

QOF. From the information the

CCG receives this would not have

been flagged up. The CCGs are

lobbying NHS England to agree a

revised template to ensure this

current gap in proactive

performance monitoring is

addressed.

An NHSE Primary Care

Performance Paper concerning

BHR CCGs was obtained. Although

the paper was dated to 09/09/15,

the content of the paper relates to

the 2012/13 and 2013/14 financial

years, before the groups were

granted delegated commissioning.

This is a common issue due to data

and information availability and is

the same information used by

NHSE. The paper outlines provider

performance concerns including:

Number of Currently Open

Cases;

Number of New Cases Since

April;



control

design

(yes/no)

Controls

complied

with

(yes/no)


Key Issues

All active performance cases are

managed on a monthly basis. We

were able to confirm this by review

of the risk register, papers

presented to the PCCC and action

plan updates for one of the two

current cases for the months June

to December 2015.

3.7 Primary Care GP Services Co-

Commissioning Budgets 2015/16

have been set by NHS England. The

principles used in setting CCG

budgets have been to ensure that:

CCGs’ budgets are based on planned expenditure for 2015/16;

The budgets are fairly attributed, based on an equitable distribution of the resources available; and

Planned levels of QIPP are equally distributed on a monthly basis. NHS England will inform the CCG of the Primary Care GP Services Co-Commissioning expenditure which the CCG uploads into its ledger.

No No Review of the BHR CCG finance

report for August and November

2015 presented to the PCCC

highlighted a clear breakdown of

financial performance against

budget for each BHR CCG. The

report outlines the CCG annual

budget, YTD budget and YTD

Actual Expenditure. This

breakdown includes distinctions

between APMS, GMS and PMS

general practice. Currently all three

BHR CCGs are experiencing

budget overspends, but are

expected to break even at the year

end.

As of August 2015:

Barking and Dagenham CCG have an annual budget of £27,538,000 and a year to date overspend of £170,000.

Havering CCG has an annual budget of £30,517,000 and a

Medium

Ensure the QIPP plan is incorporated

into the budget setting process to

guarantee more accurate spending

forecast and financial performance

reports. Clarification is also needed

concerning responsibility for each

CCG for undelivered QIPP savings.



control

design

(yes/no)

Controls

complied

with

(yes/no)


year to date overspend of £308,000.

Redbridge CCG has an annual budget of £30,373,000 and a year to date overspend of £217,000.

QIPP target savings of 1.4%,

inherited from NHSE, taken against

APMS, GMS and PMS contracts,

have not yet been fully costed and

incorporated into the budget plan.

The QIPP plan was submitted in

October 2015, these amendments

need to be effectively incorporated

into the budget setting process as

currently this is one of the main

pressures affecting financial

performance. Liability of

undelivered QIPP savings remains

unclear.

The report highlighted risks of a

budget overrun associated with the

transition to a new commissioning

model and a lack of adherence to

the monthly reporting timetable.

This risk is reflected in the Primary

Care Commissioning Risk Log.

Issues were raised concerning

NHSE reports; namely a lack of

detail surrounding expenditure on

transactions. Although this problem

has been flagged, no extra

information reflecting actions taken

to mitigate the problem have been



control

design

(yes/no)

Controls

complied

with

(yes/no)


outlined. In addition to this BHR

CCGs PCCC have struggled with

the NHS England timetable for

listing accruals. Although the PCCC

have contacted NHSE to bring the

timetable forward, the request was

declined. The report acknowledged

the need for further management

however references to ‘on-going

work’ is vague, with no clear action

plan in place to effectively monitor

and manage the issues raised.

Until the management of the ledger

and adherence to the monthly

reporting timetable is adhered to,

the CCGs continue to be exposed

to the financial risks of having

insufficient budgets and unknown

overspends/ cost pressures.

3.8 Structures and the Reporting Lines

between the Governing Body and

Committees responsible for Primary

Care Commissioning are clearly

defined and are subject to periodic

review to ensure their continuing

appropriateness.

The Primary Care Commissioning

Committee meets as a committee in

common representing all three

members of the BHR CCGs. They

report to the respective BHR

governing bodies and NHS England.

The PCCC and respective governing

bodies share members in the form of

Yes No Review of the June, July and

August 2015 PCCC meeting

minutes highlighted that

representatives from all three BHR

CCGs were present at each

meeting.

Review of the governing body

meeting minutes for Barking &

Dagenham in June 2015 found that

individuals on the board were

unhappy with the PCCC focusing

on common issues rather than

focusing on issues related to their

CCG. The response to this was for

the Director of Primary Care

Medium The committee in common to undertake an

annual review of local clinical involvement in

decision making to ensure the CCGs ability

to use local knowledge and experience to

drive up performance and quality is

preserved.



control

design

(yes/no)

Controls

complied

with

(yes/no)


the Chief Accountable Officer, Chief

Finance Officer and the lay member

for governance.

The committee is made up of voting

and non-voting representatives from

each CCG as well as independent

clinicians and NHS England. PCCC

meeting minutes highlight discussion

of general BHR wide and specific

local group issues.

The current composition of the


Committee (which is the same for

each of the CCGs) comprises of -

Voting members:

2 lay members (Patient

Engagement member and Audit

Committee Chair)

4 officers (Chief Officer, Chief

Finance Officer, Director of

Nursing and Director of Primary

Care Transformation)

the secondary care consultant,

and

an independent GP (which

currently remains a vacancy)

Non-voting member:

The CCG Chair

Transformation to meet with a

Clinical Director to ensure specific

issues were raised at the PCCC.

The governance aspect lends itself

into empowerment of members –

and review of the CCGs NHSE Q2

self-certification suggests

scepticism from CCG members on

realisation of benefits of delegated

commissioning, especially over lack

of clinical representation. As a

result, members requested a vote

on whether to continue with

delegated co-commissioning, with

voting on 24th September 2015.

However this was deemed not to be

quorate. As a result the CCG

continues under delegated co-

commissioning arrangements by

default. To address the perceived

lack of local clinical involvement in

decision making which risks the

CCGs ability to use local knowledge

and experience to drive up

performance and quality, the CCGs

on 6 November 2015 put forward

their proposal to NHSE to change

the clinical representation and

voting membership of the

committee for approval. This

included revised terms of reference

for each of the three CCG PCC

Committees.



control

design

(yes/no)

Controls

complied

with

(yes/no)


Invited attendees:

Healthwatch, Health & Wellbeing

Board, the LMC and NHS.

Approval was sought to increase

the current independent GP voting

member position to 2 GPs (a

clinical director of the CCG and a

GP partner or a GP employee of a

Member of the CCG) . These

proposed changes will ensure a lay

member/officer GP voting majority

of 6:2. No other changes were

requested. The CCG’s Committee

will continue to meet as a

committee in common. We

confirmed that pending certain

conditions (which include NHSE

being a standing non-voting

member and that an independent

GP is included), NHSE approved

the revised terms of reference on 9

December 2015.

Each Committee will now have 2

local voting GPs, and an

independent voting GP; the CCG

Chair and LMC representative are

non-voting members. We consider

the changes made to be

appropriate however recommend

that the committee in common

undertakes an annual review of

local clinical involvement in decision

making to ensure the CCGs ability

to use local knowledge and

experience to drive up performance

and quality is preserved.


APPENDIX A: SCOPE

Scope of the review

The scope was planned to provide assurance on the controls and mitigations in place relating to the following risks:

Objective of the risk under review Risks relevant to the scope of the review

Commission high quality, safe and sustainable models of

care that deliver improved clinical outcomes and patient

experience.

An increasing move towards Co-Commissioning increases

the risk in the clarity of accountability and Governance

arrangements in determining effective commissioning

strategies and methodologies between neighbouring

CCGs.

Areas Considered:

The commissioning strategies and methodologies between the CCGs and the extent of which these are joined up.

The extent of the engagement with key stakeholders including patient and public engagement and how their views

were incorporated within the plans and strategies through the Co Commissioning cycle.

CCGs co-commissioning responsibilities require an increasing and continual focus, arrangements for managing

Conflicts of Interest when agreeing, awarding and managing contracts have been reviewed.

Contract management arrangements including the value for money aspect.

How the CCG monitors service delivery.

The capacity of the Lay Members etc. for carrying out their additional roles.

How the co-commissioning arrangements are aligned to support quality improvements in primary care services,

ensuring they are fit for purpose and able to support the shift in care out of hospital.

The governance arrangements for primary care a) decision making b) strategic development and implementation.

How quality and outcomes issues from providers are highlighted, monitored, reported and actioned in order to

improve the service provided.

The risks around the lack of clarity of responsibilities, particularly between the CCG and NHS England on agreeing

contracts.

Whether financial risks are taken into account and how these are actioned in tandem with NHS England. How

budgets including QIPP plans take into account these risks.


Limitations to the scope of the audit assignment:

• The scope of the work is limited to the areas listed in the ‘areas for consideration’ section above.

• All testing is on a sample basis for the period from April 2015 to the date of the audit.

• In addition, our work does not provide any guarantee against material errors, loss or fraud or provide an absolute

assurance that material error, loss or fraud does not exist.


APPENDIX B: FURTHER INFORMATION

Persons interviewed during the audit:

• Sarah See - Director, Primary Care Transformation -

• Natalie Keefe - Head of Primary Care Transformation

Documentation reviewed during the audit:

• Primary Care Transformation & Co-commissioning of Primary Medical Services, Governance Structure - April 2015.

• Primary Care Co-commissioning: NHSE Approval for Delegated Arrangements - February 2015. (Versions for Barking & Dagenham, Havering, Redbridge)

• Submission Pro Forma for Delegated Commissioning Arrangements - January 2015.

(Versions for Barking & Dagenham, Havering, Redbridge)

• Co-commissioning of Primary Medical Services, Induction Workshop Presentation - May 2015.

• Co-Commissioning of Primary Care Services, Operating model - September 2015

• Developing Primary Care Transformation Strategy, Report on Engagement – September 2015. (Versions for Barking & Dagenham, Havering, Redbridge)

• Developing the BHR Primary Care Strategies, Engagement Feedback – August 2015.

• Constitution – October 2014. (Versions for Barking & Dagenham, Havering, Redbridge)

• Managing Conflicts of Interest: Statutory Guidance for CCGs – December 2014

• Next Steps towards Primary Care Co-Commissioning – November 2014.

• Register of Interests 2015/16 (Versions for Barking & Dagenham, Havering, Redbridge)

• Delegation Agreement – April 2015. (Versions for Barking & Dagenham, Havering, Redbridge)

• Barking and Dagenham, Havering and Redbridge (BHR) Primary Care Transformation Programme Board, Terms of Reference – March 2015

• Primary Care Commissioning Committee-in-Common, Terms of Reference- June 2015 (Versions for Barking & Dagenham, Havering, Redbridge)

• Primary Care Committee Meeting, Finance Report – August 2015

• Primary Care Commissioning, Risk log – September 2015

• Governing Body Meeting Minutes – May 2015, June 2015, September 2015. (Versions for Barking & Dagenham, Havering, Redbridge)

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Excerpt from CCG assurance: delegated functions self-certification 2015/16. Publications Gateway reference: 03808

Annex A

CCG Assurance Framework 2015/16 Delegated Functions - Self-certification

CCG Name or joint committee of CCGs

Barking & Dagenham CCG

Quarter/year to which certification applies Q3 2015/16

1. Assurance Level

To support ongoing dialogue, CCGs are asked to provide a self-assessment of their level of assurance for each Delegated Function (as appropriate) .

Assurance Level Change since last period

Delegated commissioning Assured as good No change

OOH commissioning Limited assurance, requires improvement

No change

2. Outcomes

Briefly describe progress in last quarter towards the objectives and benefits the CCG set out in taking on delegated functions, in particular the benefits for all groups of patients <maximum 200 words>

Benefit Status Key obstacles to delivery Mitigating actions

Finance: ability to direct finance to where it is needed

R

The CCG has started receiving budget reports from NHSE however the detail in the reports is limited.

Until the management of the ledger and adherence to the monthly reporting timetable is adhered to, the CCG continues to be exposed to the financial risks of having insufficient budgets and unknown overspends/ cost pressures.

The Chief Finance Officer is liaising with NHSE finance team regarding issues.

Monthly budget reports received at the PCC Committee.

Highlight on –going issues as part of the NHSE London Primary Care Review.

Maximise opportunity via PMS review money to enable delivery of this benefit.

Reputation: ability to build reputation of high performing

A The CCG received its first quality and performance report from NHSE in Q2 (September). The report was a good

Develop a quality improvement programme / actively


primary care start however assurance of processes in place and early warning systems needs to be implemented.

manage underperformance issues. Establish links with CQC.

Feedback given to NHSE how quality and performance reports could be improved.

Workforce: influence workforce change

A

Working with local providers, supported the establishment of a Community Education Provider Network which will support cross boundary education and training. The CCG is linked to the Healthy London Partnership Workforce Programme.

Engage with HLP programmes to maximise opportunities / shape objectives of pan-London programmes to support local delivery.

Continue to influence CEPN work programme.

Discuss role of Care City to scope out workforce challenge can be addressed as a system response to align all transformation programmes.

Opportunity for increased self-determination and commissioning to meet local need

G

The Operating Plan and Memorandum of Understanding are being amended by NHS England to incorporate CCG feedback.

Many decisions will be determined by Standard Operating Procedures (SOPs) - these may be tested locally in the future in terms of supporting primary care transformation.

Continue to review outcomes of decisions made via SOPs via the PCC Committee – raise any issues with NHSE which don’t support local PC strategy.

NHSE Primary care Review provides the opportunity to review how delegation is implemented in London.

Commission across the entire patient pathway - supporting innovation and integration.

A

This is a long term, strategic objective that will require co-ordination of commissioning across primary, acute, community and mental health budgets.

An Accountable Care Partnership expression of interest was submitted on behalf of BHR health and social care system.

Scope out locality network model for piloting in 2016/17.

Optimise health services in line with local sensitivities G

The PMS review budget will provide opportunities for the CCG to commission elements of the Strategic Commissioning Framework, taking into account local sensitivities.

Develop work programme to deliver contract review (taking into account equity with GMS) – identify local commissioning intentions priorities.


Freedom to explore alternate contracting mechanisms and ability to design incentives tailored to local need

A

The delegated budgets provide little room for investment. CCG to explore additional incentive schemes for 2016-17.

Understand cost pressures to CCG budgets in context of the ‘ask’ of primary care – need to see as a system responsibility and understanding of expectations required from general practice.

Review opportunities from National allocations and mechanisms for supporting primary care at scale.

Opportunities to reduce local bureaucracy

A

Delegation has resulted in multiple new meetings and cumbersome decision-making arrangements between the CCG and NHSE.

Discuss with NHSE in regards to Operating Plan and Transition Plan to look how NHSE & CCG teams work together to support delivery.

Empowerment of Members

Involve clinicians as part of the governance, enabling their local clinical knowledge to drive up local performance standards.

A

Concerns regarding lack of clinical membership at the Primary Care Commissioning (PCC) Committee.

NHSE have agreed that there can be 2 local GPs and an independent GP as voting members on the Committee. These GPs vote on issues that they are not conflicted in. The CCG has gone out to advert for the independent GP post and hopes to have this position appointed to by March 2016.

A non- voting GP and a non-voting LMC representative will also be on the PCC Committee.

Prevention and health promotion in BHR are improved due to more GP involvement

A

This is a long term objective – plans developed to deliver upon the ‘Proactive’ indicators of the Commissioning Strategic Framework. A quality improvement dashboard is being developed as part of the transformation Programme.

Maximise opportunities with quality improvement agenda / dashboard / PMS review.

Urgent and emergency care is improved through alignment with primary care, resulting in lower

A

The Vanguard programme should enable realisation of this benefit.

Link with Vanguard programme in terms of synergy between planned and unplanned care within primary care transformation strategy


rates of inappropriate use and higher rates of satisfaction

and urgent care strategy.

OOH: Performance in OoH was largely satisfactory and improvement in performance against NQR achieved by the end of Q1 has continued to be maintained. However the provider has shared with commissioners its very challenged financial performance which was fully reviewed in Q2/3. This will have an impact on 16/17 negotiation which is likely to prove very challenging. This is the reason assurance is rated as ‘limited’.

3. Governance and the management of potential conflicts of interest in

relation to primary care co-commissioning (this section should be completed by those CCGs which undertake joint commissioning with NHS England as well as those that have delegated commissioning arrangements)

Co-commissioning OOH commissioning

Have any conflicts or potential conflicts of interest arisen during the last quarter?

No No

If so has the published register been updated?

No No

Is there a record in each case of how the conflict of interest has or is planned to be managed?

Not applicable Not applicable

Please provide brief details below and include details of any exceptions during the last quarter where conflicts of interest have not been appropriately managed

<maximum 200 words>

No conflicts of interest (CoI) to declare in Q3.

4. Procurement and expiry of contracts

Briefly describe any completed procurement or contract expiry activity during the last quarter in relation the Delegated Functions and how the CCG used these to improve services for patients (and if and how patients were engaged).

<maximum 250 words per Delegated Function>

There were no completed procurements or contract expiry activity during Qtr3.

OOH:

The Out of Hours Contract was signed off by both parties in Q2.


Local Incentive Schemes

Is the CCG offering any Local Incentive Schemes to GP practices?

Yes

Was the Local Medical Committee consulted on each new scheme?

Yes

If any of those schemes could be described as novel or contentious did the CCG seek input from any other commissioner, including NHS England, before introducing?

Yes

Do the offered Local Incentives Schemes include alternatives to national QOF or DES? If yes, are participating GP practices still providing national data sets?

No

Choose an item.

What evidence could be submitted (if requested) to demonstrate how each scheme offered will improve outcomes, reduce inequalities and provide value for money?

<maximum 250 words for each Delegated Function>

Local Incentive Scheme for Nursing homes and Cancer were agreed at the PCC Committee and taken to the CCG Investment Committee for approval.

Specifications available upon request.

5. Availability of services

Briefly describe any issues raised during the last quarter impacting on availability of services to patients (include if and how patients were engaged).


We continue to work closely with NHSE to resolve an ongoing, major contractual / performance issue to support resolution (Abbey Medical Practice); patient engagement at this stage would be premature. The CCG and NHSE met with the providers to further discuss the action plan which requires further work by the practice.

CQC have placed the practice into special measures therefore the PCC Committee sanctioned the issue of a second Remedial Notice in November 2015.

The PCC Committee remains concerned about the quality and safety of services being provided to patients and are seeking expert clinical and legal advice to explore other contractual sanctions.

Delegated commissioning

OOH commissioning

How many providers are currently identified by the CCG for review for contractual underperformance?

1 0

And of those providers, how many have been 1 0


reviewed and there is action being taken to address underperformance?

During the last quarter were any providers placed into special measures following CQC assessment?

Yes No

If yes, please provide brief details of each case and how the CCG is supporting remediation of providers in special measures

<maximum 50 words per case>

The CCG is working closely with NHS England on monitoring progress of the practice following their CQC inspection.

In the last 12 months has the CCG published benchmarked results of providers OOH performance (including Patient experience)

No

If yes, please provide link to published results:

6. Internal audit recommendations


Has internal audit reviewed your processes for completing this self-certification since the last return?

Choose an item. No

If so, what was their conclusion and recommendations for improvement?


Use this space to detail any other issues or highlight any exemplar practice supporting assurance as outstanding

The CCG works closely with NHSE colleagues to provide adequate assurance of commissioning responsibilities. During Q3, we continued to embed robust processes based on good practice and sound decision-making, identifying a number of risks & issues and put in place mitigating actions to become an effective ‘outstanding’ commissioner– that is, the CCG continues to manage well despite the uncertain environment during the transition.

Primary Care Commissioning Committee – October 2015 Minutes

PCCC Minutes 07.10.15 Part 1 signed.pdf



Primary Care Commissioning Committee – November 2015 Minutes

PCCC Signed Mins 13.11.15 Part 1.pdf


Primary Care Commissioning Committee – December 2015 Minutes in draft

Draft Part 1 PCC December 2015 v1 2rc.pdf


Risk Register – December 2015

Risk register.pdf


7. CCG declaration

I hereby confirm that the CCG has completed this self-certification accurately using the most up to date information available and the CCG has not knowingly withheld any information or misreported any content that would otherwise be relevant to NHS England assurance of the Delegated Functions undertaken by the CCG. I confirm that the primary medical services commissioning committee remains constituted in line with statutory guidance. I additionally confirm that the CCG has in place robust conflicts of interest processes which comply with the CCG’s statutory duties set out in the NHS Act 2006 (as amended by the Health and Social Care Act 2012), and the NHS England statutory guidance on managing conflicts of interest. Signed by Conor Burke, CCG Accountable Officer Name: Conor Burke Position: Chief Accountable Officer, Barking & Dagenham CCG Date: Signed by Kash Pandya, Audit Committee Chair Name: Kash Pandya Position: Audit Committee Chair Date:

Please submit this self-certification to your local NHS England (London) team at [email protected] and copy to [email protected] using the email subject ‘Delegated functions self-certification.’ 2015/16 Timetable and deadlines for submission

Q1 (Apr, May, June) – 16 October 2015

Q2 (Jul, Aug, Sep) – 30 November 2015

Q3 (Oct, Nov, Dec) – 29 February 2016

Q4 (Jan, Feb, Mar) – 31 May 2016




Annex A



Havering CCG

Quarter/year to which certification applies Q3 2015/16

1. Assurance Level





No change

2. Outcomes




R






Maximise opportunity via PMS review and Primary Care growth money to enable delivery of this benefit.

Reputation: ability to build reputation

A The CCG received its first quality and performance report from NHSE in Q2

Develop a quality improvement


of high performing primary care

(September). The report was a good start however assurance of processes in place and early warning systems needs to be implemented.

programme / actively manage underperformance issues. Establish links with CQC.



A






G






A




Optimise health services in line with local sensitivities

G

The PMS review and primary care growth budget will provide opportunities for the CCG to commission elements of the Strategic Commissioning Framework, taking into account local sensitivities.

Develop work programme to deliver contract review (taking into account equity with GMS) – identify local commissioning


intentions priorities.


A





A





A





A



Urgent and emergency care is improved through alignment with

A


Link with Vanguard programme in terms of synergy between planned and unplanned care


primary care, resulting in lower rates of inappropriate use and higher rates of satisfaction

within primary care transformation strategy and urgent care strategy.

OOH: Performance in OoH was largely satisfactory and improvement in performance against NQR achieved by the end of Q1 has continued to be maintained. However, the provider has shared with commissioners its very challenged financial performance which was fully reviewed in Q2,3. This will have an impact on 16/17 negotiation which is likely to prove very challenging. This is the reason assurance is rated as ‘limited’.





No No


No No


Not applicable No


<maximum 200 words>





There were no completed procurements or contract expiry activity during Qtr3. However the APMS contracts for King’s Park Surgery and the Orchard Village are part of NHS England’s Tranche 4 procurement Programme.


OOH:




No


No


No


No

Choose an item.



None in Q3.




No practices have been identified for case management in Havering in Q3.

There are practices approaching review but are not at present under case management. The CCGs’ primary care transformation & quality teams will undertake further quality analysis against these practices.


OOH commissioning


0 0

And of those providers, how many have been reviewed and there is action being taken to address underperformance?

0 0

During the last quarter were any providers No No


placed into special measures following CQC assessment?



N/A


No





Choose an item. No




The CCG works closely with NHSE colleagues to ensure continued smooth transition of commissioning responsibilities. We believe that during Q3, we continued to embed robust processes based on good practice and sound decision-making, identifying a number of risks & issues and put in place mitigating actions to become an effective ‘outstanding’ commissioner– that is, the CCG continues to manage well despite the uncertain environment during the transition.








Primary Care Commissioning Committee – December 2015 Minutes in draft




Risk register.pdf


7. CCG declaration










Annex A



Redbridge CCG

Quarter/year to which certification applies Q3 2015-16

1. Assurance Level





No change

2. Outcomes




R






Maximise opportunity via PMS review and Primary Care growth money to enable delivery of this benefit.

Reputation: ability to build reputation of high performing

A

The CCG received its first quality and performance report from NHSE in Q2 (September). The report was a good start however assurance of processes

Develop a quality improvement programme / actively manage


primary care in place and early warning systems needs to be implemented.

underperformance issues. Establish links with CQC.



A






G






A




Optimise health services in line with local sensitivities G

The PMS review and primary care growth budget will provide opportunities for the CCG to commission elements of the Strategic Commissioning Framework, taking into account local sensitivities.

Develop work programme to deliver contract review (taking into account equity with GMS) – identify local commissioning intentions priorities.



A





A





A





A



Urgent and emergency care is improved through alignment with primary care, resulting in lower

A


Link with Vanguard programme in terms of synergy between planned and unplanned care within primary care transformation strategy


rates of inappropriate use and higher rates of satisfaction

and urgent care strategy.

OOH: Performance in OoH was largely satisfactory and improvement in performance against NQR achieved by the end of Q1 has continued to be maintained. However the provider has shared with commissioners its very challenged financial performance which was fully reviewed in Q2/3. This will have an impact on 16/17 negotiation which is likely to prove very challenging. This is the reason assurance is rated as ‘limited’.





No No


No No


Not applicable Not applicable


<maximum 200 words>





There were no completed procurements or contract expiry activity during Qtr3. However the APMS contract at Loxford Polyclinic (The Practice Loxford) is part of NHS England’s Tranche 4 procurement Programme.

OOH:





No


No


No


No

Choose an item.



None in Q3.




Spearpoint Surgery

In December 2015, Redbridge Primary Care Commissioning Committee reviewed an options appraisal regarding the future provision of primary medical services to patients registered at the Spearpoint Surgery. The Committee approved the dispersal of Spearpoint Surgery with the practice to close on 31st March 2016. The decision took into account the fact that the practice has undergone two previous failed procurements and lack of financial viability of the small list size. This decision was communicated to the local MPs, Healthwatch, Councillors and the Health Scrutiny Committee and all patients registered at the practice. Registered patients will be supported in finding a new GP Practice. A follow up letter will be sent to patients nearer the time of closure.

The Practice Loxford

The CCG continues to work closely with NHS England to performance manage The Practice Loxford following an adverse CQC inspection in 2014. The CCG and NHSE are monitoring the practice’s progress an improvement plan on a regular basis.

Barkingside Practice

The CCG with NHSE successfully managed the relocation of Barkingside Practice into Kenwood Gardens in December 2015. Patients were informed in writing about


the relocation of their practice. Ongoing management of contractual concerns is taking place.

OOHs:

None


OOH commissioning


2 0

And of those providers, how many have been reviewed and there is action being taken to address underperformance?

2 0

During the last quarter were any providers placed into special measures following CQC assessment?

No No



N/A


No





Choose an item. No




The CCG works closely with NHSE colleagues to ensure continued smooth transition of commissioning responsibilities. We believe that during Q3, we continued to embed


robust processes based on good practice and sound decision-making, identifying a number of risks & issues and put in place mitigating actions to become an effective ‘outstanding’ commissioner– that is, the CCG continues to manage well despite the uncertain environment during the transition.







Primary Care Commissioning Committee – December 2015 Minutes




Risk register.pdf


7. CCG declaration









To: The BHR Primary Care Joint Committee From: Dean Musson, NHS England Programme Office Date: 10 February 2016 Title: Quality and Performance Report

SUMMARY: This report provides information on quality and performance, at a CCG level. It is a draft format that is being developed between NHS England and CCGs, to provide an enhanced, standardised report to support commissioning committees. The report draws on available data sets:

- GP Patient Survey; - Quality & Outcomes Framework; and - Friends and Family returns.

An explanation of what these datasets include and measure is set out on the relevant tab of the attached report. NHS England (London) has had to redact two of its data sets from this report (eDeclarations and General Practice Outcomes Standards (GPOS). This is because NHS England central clearance is required to present these information sources at an aggregated level, as they are not current available in the public domain. A summary of GP contractual variations is also included in this report, which has previously been reported on separately, in line with NHS England’s Operating Model. Whilst an analysis of the data within the report has been provided, NHS England and CCG commissioners are now in the process of discussing their joint response and clarifying what actions will be taken by one or both organisations where they have concerns about practice results which show a statistically significant variation from the norm. This will be developed for the next quarterly report. A summary of CQC practice outcomes is planned to be included in this report, once the CQC have covered a greater number of practices in BHR.

2

It also draws on information collated by Medical Directorate (performer reporting) and Contract teams (contract information) at NHS England. The analysis within this report has currently been developed between NHS England PC and Medical Directorates, the latter of which continue to be responsible for Performer issues. It is anticipated that reports will increasingly include CCG relevant information about general practice, and be authored by both CCGs and NHS England. This will ensure the most relevant information and associated analysis is factored in to determining what actions may be needed to address what appear to be outlying concerns. This report is produced quarterly. Not all supporting data sets are refreshed quarterly, however. Where this is the case that section of the report will be repeated (and clearly labelled) based on the previous quarter, until fresh information is available. It should also be noted that data sets are refreshed at different points, and cover differing time periods. The report is produced for Part 1 of the committee. The information is therefore at a summary level. Specific issues will be sensitive and confidential. They will be considered in Part 2 of the meeting, if a decision is required. Underlying detail behind this data would be used to assure delivery, i.e. all sources would be used to triangulate to identify potential practice level issues.

RECOMMENDATIONS: The Committee is asked to consider and note report contents.

AUTHOR CONTACT: Name: Dean Musson E-Mail: [email protected]

DOCUMENT CONTROL

Version Date Amendments Approved by:

Version 1.0


To: The Redbridge Primary Care Commissioning Committee The B&D Primary Care Commissioning Committee Havering Primary Care Commissioning Committee

Item: Discretionary Payments & Contract Variations processed Author: Mark Lockwood, Primary Care Contract Manager

Date: 10 February 2016

Purpose: For Information

Executive Summary:

The respective committees are asked to note the recent contract variations and locum reimbursements processed in January 2015.

Reimbursement for Claims for Locum Cover

CCG Type of Cover

Start Date of Claim

End Date of Claim Comment Cost

B&D Maternity 27/04/2015 28/09/2015 Payment for April – Sept 2015 £9752.23

Redbridge Maternity 17/04/2015 28/09/2015 Payment for August - Sept 2015 £5395.23

Redbridge Maternity 22/05/2015 01/02/2016 Payment for December 2015 £3853.73

Contract Variations

CCG Name Practice

Code

Contract type i.e. GMS/PM

S

Contract holder i.e. practice

name

Contract Variation i.e. new partner/

removal

Details of change i.e.

new/removed partner

name

Effective date of change

Comments

Barking & Dagenham

F82015 GMS Hedgemans Surgery

Removal of a Partner

Dr Parveen Masud

31 December 2015

Agreed and sent to SBS

Havering F82051 PMS Labernaum Health Centre


Dr R Kumar 23 January 2016


Havering F82031 GMS Dr Behesthi & Sanomi


Removal of Dr Beheshti

01 April 2016 Agreed and sent to SBS

Havering F82607 GMS Spring Farm Surgery

24hr Retirement

Dr Jawad 27 February 2016


To: Barking & Dagenham, Havering and Redbridge Primary Care Commissioning Committees From: Lorna Hutchinson, Assistant Head Primary Care Commissioning,

NHS England Date: 10 February 2016 Subject: Remedial Breach Notices

Executive summary: GP practices are required to make an annual declaration of their compliance against a number of contractual and regulatory indicators. This information is compiled by the Regional team to provide reports to the CCG Committees to support the quality assurance of GP services. Where a practice fails to make the annual declaration, the Provider may be in breach of the GMS Regulations 2004; part 5 clause 81/PMS Regulations 2005 part 5 clause 77. Appropriate contractual action may be taken by the CCG in order for the practice to remedy the breach.

Recommendations: The respective CCG Primary Care Committees are asked to:

Approve the issuing of remedial breach notices where practices have failed to make annual returns for 2015/16

Note the next steps for reviewing and reporting GP contractual compliance

1. Purpose:

1.0 The purpose of this report is to inform the respective Committees of the outcome of the first phase of reviewing GP practice annual returns for compliance with contractual and regulatory indicators

1.1 Where practices have not made this mandatory annual return, Committees are being informed of the appropriate contractual action that can be taken for Assurance management.

2. Introduction

2.0 NHS England introduced as a national requirement, for GP practices to submit annual returns of contractual compliance though an electronic Declaration (eDEC). This is aligned to the national policy on ‘Assurance Management for Primary Medical Care’.

2.1 The introduction of eDEC was aimed at standardising the collection of relevant information from GP practices as part of the Primary Care Assurance Framework.

2.2 GPs are required to declare annual compliance against a number of regulatory and statutory requirements via a web portal, https://www.primarycare.nhs.uk which is accessible to practices during a set six week period.

2.3 In November 2015, the London region team wrote out to all practices London wide

requesting the completion of the electronic declarations during the period 4th November to 16th of December 2015.

2.4 In December 2015, practices were reminded to complete the declaration prior to the

close down of the web portal on 16 December.

3. Key Findings

3.0 Following the close down, a London-wide report listing the practices with nil returns was completed. 3.1 Across BHR CCGs 15% practices (average) were identified as not having made the

mandatory return (ref. Table 1)

Table 1

Organisation Name Total Number of Practices

Number of practices with Nil

returns Percent of Nil returns

NHS Barking & Dagenham CCG 39 7 17.95

NHS Havering CCG 47 6 12.77

NHS Redbridge CCG 46 6 13.04

*Source: Primary Care Web Tool

4. Summary

4.0 Providers who have not made the annual return for 2015/16 are in breach of the terms of the GMS Regulations 2004, part 5 clause 81 or PMS Regulations Part 5, clause 77 therefore. Remedial notices will be issued to practices to take action to remedy the breach. Practices will be required to make manual self-declarations within 7 days.

5. Next Steps

5.0 Remedial notices to be issued to Providers who have not submitted annual returns within the timescale

5.1 Where Practices have submitted returns and specific areas have been validated as non-compliant, there will be follow up with each practice on a case by case basis to address issues identified. Where deemed appropriate and proportionate, contract action may be taken e.g the issuing of formal breach notice for the practice to remedy non-compliance.

5.2 An analysis of the level of GP practices’ compliance with the contractual indicators will

feed into the next CCG’s quality performance report.

https://www.primarycare.nhs.uk/

To: Barking and Dagenham and Havering Primary Care Commissioning Committees

From: Sarah See, Director Primary Care Transformation


Subject: The migration of Dr Pervez from Barking and Dagenham CCG to Havering CCG

Executive summary

Barking and Dagenham and Havering PCCC is hereby asked to formally approve the signing of the

requisite Health & Social care Information Centre form to reflect the migration of Dr Pervez from

Barking and Dagenham CCG to Havering CCG and thereby allow the appropriate messaging and

financial transactions to take place.

Recommendations

The committees are asked to formally approve the signing of the HSCIC GP Practice migration/CCG

boundary changes form by the authorised senior manager of both CCGs.

1.0 Purpose of the Report

The purpose of this report is to seek the formal approval to the signing of the Health & Social care

Information Centre form so as to allow the data and financial flows to reflect the migration of Dr

Pervez from Barking and Dagenham CCG to Havering CCG.

2.0 Background/Introduction

2.1 NHS England seeks the formal sign off by the PCCC to complete the governance process for Dr

Pervez’s migration.

3.0 Report Content

Dr Pervez ran his main surgery from Barking and Dagenham and a branch surgery from

Havering. Dr Pervez has now re-located his main surgery to Havering and closed his surgery in

Barking and Dagenham although he remains for the time being a Member of Barking and

Dagenham CCG. The PCCC will recognise that a holder of a primary medical services contract

must be a member of a CCG and that whilst he or she does not have to be a member in the CCG

from where the services are provided it is clearly preferable for this to be the case.

In January 2015 Havering CCG made an application to NHS England for Dr Pervez to become a

Member of their CCG. The application was in fact made conditional upon NHSE being satisfied

that any consultation had been made and having assured themselves of any financial issues.

Nevertheless, NHS England granted the application in May 2015 (albeit NHS England have

subsequently advised that its implementation has been delayed to 1 April 2016 it is understood

so that the relocation can take effect at the start of the financial year and thereby limit the impact

of commissioning services, financial transference and reporting).

The PCCC is asked to note that in the event the consultation which was conducted by NHS

England to relocate Dr Pervez from Barking and Dagenham to Havering was criticised by the

London Borough of Barking and Dagenham. However, whilst it was acknowledged by NHS

England that more time should have been afforded to the consultation no formal challenge was

made and it is considered that no outstanding issues remain.

NHS England have now advised that the only further steps to undertake in order to effect the

migration of Dr Pervez is the completion of the HSCIC GP Practice migration/CCG boundary

changes form, a copy of which is annexed hereto. Where a GP practice is in successful in

gaining agreement to move CCG such change must be reflected within the NHS and Social Care

systems and services. The HSCIC GP Practice migration/CCG boundary changes form requires

sign off from the geographical area team (NHS England), the current CCG (in this case Barking

and Dagenham CCG), the new host CCG (Havering CCG) and the GP practice migrating (Dr

Pervez).

Sign off will give HSCIC (the organisation data service (ODS)) the authority to move the

hierarchy within the data files supporting the NHS and Social Care systems and services and will

also permit the financial capitation attributed to Dr Pervez to be realigned to the new host CCG

(Havering). The PCCC is asked to note that whilst no formal application has of yet been made to

amend the Constitution of Barking and Dagenham CCG to remove Dr Pervez as a Member that

the CCG has obtained the agreement of the Barking and Dagenham Members to Dr Pervez

being able to give short notice to leave B and D CCG by 1 May 2015 should he give such notice.

No such notice was given as Dr Pervez remained a Member of Barking and Dagenham for the

current financial year and for the sake of good order the Members of Barking and Dagenham will

be advised in their General Meeting in March that Dr Pervez will be leaving Barking and

Dagenham CCG. The Members of Havering CCG will also be advised in their General Meeting

of March that Dr Pervez will join their CCG as a Member on 1 April 2016.

In the circumstances the committees are asked to formally approve the signing of the HSCIC GP

Practice migration/CCG boundary changes form by the authorised senior manager of both

CCGs.

The form will then be submitted to the local area team at NHS England.

4.0 Resources/investment

4.1 There are no financial implications arising from the report save that the financial capitation

attributable to Dr Pervez will be realigned to Havering CCG.

5.0 Equalities

5.1 The consultation exercise was undertaken by NHS England.

6.0 Risk

6.1 No risks are currently identified.

7.0 Managing conflicts of interest

7.1 No conflicts of interest have been identified.

Attachments:

1. The HSCIC GP Practice migration/CCG boundary changes form

Author: Rod McEwen Legal and Governance Adviser

Solicitor and in house Counsel for Barking and Dagenham, Havering and Redbridge Clinical

Commissioning Groups


Risk Log

Last updated:

URN Impact on Risk and impact Date Opened Part Owner Mitigating Action Prob Imp Severity Category Status Next review Next action / comments

RSK1 BHR CCGs NHS England Finance reporting

Financial reporting is still not fully in place as

accrual information is not provided and there

needs to be more engagement from NHSE

Regional (London) Finance team to provide a

narrative to explain variances. If this is not

delivered in the coming months it may result in

the CCG struggling to carry out effective

planning and monitoring, including QIPP

planning.

16-Mar-15 1 Tom

Travers

Continued engagement at senior level to

obtain the right monthly information and

engagement.

3 3 9 Operational Open 01-Mar-16 Accruals are still provided at

CCG level rather than

practice level which means

practice level reporting is

incomplete. CCG finance is

in discussions with NHSE

finace team to try and

resolve.

RSK3 BHR CCGs NHS England RT support

Inadequate support from the NHS London

Commissioning Team (e.g. due to resourcing

issues) results in inadequate fulfilment of

delegated functions and BHR having to dedicate

additional resources to management.

16-Mar-15 1 Sarah

See

NHSE commissioning a review of all

PCC resources both at NHSE and CCG's

3 4 12 Operational Open 01-Mar-16 NHSE have commissioned

Ernest and Young to

complete a review of

Primary Care OD. CCGs

asked to complete a

template of PCC resources.

RSK5 All PMS contract review

There is a risk that this may not be able to be

delivered by the expected deadline in March.

Relationship between practices / members and

the Committee may be challenged if difficult

decisions have to be made, leading to

resistance and poor relationships with practices.

24-Mar-15 1 Sarah

See

Local working group meeting monthly.

Project plan and Comms plan developed.

Members drop in sessions arranged for

each borough in January.

Presentations at practice managers

forums, comms circulated to practices.

Presentations and briefings currently

underway at each of the boroughs

HOSC/HASS

3 4 12 Reputational Open On-going Currently completing gap

and impact analysis to

inform commissioning

intentions for submission on

19.02.16

RSK6 All List size inflation

Infrequent practice list size maintenance results

in high list size inflation and subsequent global

sum inflation, impacting on the GP services

budget

09-Apr-15 1 NHS

England

NHS England have committed to

commissioning a quarterly list size

cleansing process which the CCG will

need to be sighted on to ensure effective

communications to practices

2 2 4 Financial Open On-going Quarterly monitoring of list

size growth.

RSK10 BHR CCGs Budget overrun

Significant additional costs are transferred to

the CCG that are not covered by the primary

care budget and result in CCG having to fund

the shortfall from the general commissioning

budget

30-Mar-15 1 Tom

Travers

This risk is mitigated through a budget

increase negotiated by BHR as part of

the Delegation Agreement

2 5 10 Financial Open On-going All cost pressures collated.

Awaiting for NHSE finance

department to confirm

outstanding detail.

RSK11 All Committee members training

Primary Care Commissioning Committee

finance induction is not sufficient due to NHS

England Finance not being able to provide

information.

20-May-15 1 Sarah

See /

Alison

Goodlad

NHS London have proposed a finance

specific induction workshop

1 2 2 Operational Open 11-Nov-15 Training needs have been

discussed with NHSE.

Awaiting update from NHSE

RSK14 Redbridge

PCCC

The Practice Loxford APMS Contract.

Assurance sought to establish that provider is

meeting the minimum capacity requirements of

72 appointments per 1000 weighted patients.

01-Jun-15 1 Alison

Goodlad

Provider required to provide evidence of

meeting this capacity requirement

2 3 6 Patient care or

patient safety

Open On-going Update at February

Committee.

RSK15 B & D PCCC Lawns Medical Centre / North Street Medical

Centre merger

The merger has created a void space at the

Lawns which is still under lease and will need to

be paid. This will impact the delegated budget.

03-Jun-15 1 Sarah

See /

Tom

Travers

This is a legacy issue which needs to be

referred to NHS England in terms of

finance.

2 2 4 Financial Open On-going The resolution of this issue

will be monitored to ensure it

does not impact the

delegated budget in

2016/17.

RSK19 All QIPP delivery: failure to deliver upon primary

care QIPP (B&D £391k/Havering

£433k/Redbridge £431k) may impact upon BHR

CCGs planned surplus 15/16 & 16/17

- relations between the GB and members

- reputational risk with other stakeholders

01-Dec-15 1 Sarah

See /

Tom

Travers

1. Worked with NHSE QIPP project team

to identify schemes as part of national

review to identify QIPP teams

2. Scope out QIPP ask in context of cost

pressures (to release NR funds to BHR)

3. Create efficiencies in primary care

commissioning decisions

4 3 12 Financial Open on-going Monitor planned QIPP to

track in year delivery

Liaise with NHSE to

understand delivery against

target for their initiatives.

NHSE have advised unable

to confirm savings to date.


06-Jan-16

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