primary care committee - part i - wandsworth ccg care... · 10/3/2017 · a03 minutes 6th june...

Primary Care Committee - Part I

MEETING3 October 2017 09:30

PUBLISHED29 September 2017

W A N D S W O R T H C C G P A G E 1 O F 2

Board Intelligence Hub template

Primary Care Committee Agenda03/10/17 at 9:30 East Putney

Meeting of the Primary Care Committee

Held in Meeting Rooms 1/2, 73-75 Upper Richmond Road, East Putney

on Tuesday, 3rd October 2017

P A R T A | M E E T I N G O P E N S T A R T D U R A T I O N

A01 Apologies, Declarations, Quorum CV 9:30 5 mins

A02 Chair’s Opening Remarks CV 9:35 5 mins

A03Minutes 6th June 2017: Approval and

Status of ActionsCV 9:40 5 mins

A04 Items for AOB CV 9:45 00 mins

P A R T B | D E C I S I O N S A N D D I S C U S S I O N S

B01 Integrated Primary Care Update Report KS 9:50 20 mins

B02 Wandsworth CQC Outcomes EG 10:10 15 mins

B03 GP Resilience Programme Update EG 10:25 10 mins

B04 Approach to Primary Care Quality EG 10:35 15 mins

B05Royal Hospital for Neuro Disability Update

(verbal)AMc 10:50 10 mins

P A R T C | M A N A G E M E N T R E P O R T S

C01 Finance Report NM 11:00 15 mins

P A R T D | O P E N S P A C E A N D O T H E R M A T T E R S T O N O T E

D01

Open Space: Public Questions

Members of the public present are invited to

ask questions of the Committee relating to

the business being conducted. Priority will

be given to written questions that have been

received in advance of the meeting.

CV 11:15 10 mins

D02 Any Other Business CV 11:25 5 mins

W A N D S W O R T H C C G P A G E 1 O F [ X ]W A N D S W O R T H C C G P A G E 1 O F [ X ]



P A R T E | M E E T I N G C L O S E

E01 Chair’s Closing Remarks CV 11:30 5 mins

E02

To resolve that the public now be excluded

from the meeting because publicity would

be prejudicial to the public interest by

reason of the commercially sensitive or

confidential nature of the business to be

conducted in the second part of the agenda.

CV 11:35 00 mins

E03Part II Agenda Items:

Minutes from the previous meeting 11:35

Part A: Meeting Open

Page

1. Part A: Meeting Open 4

1.1. A01 Apologies, Declarations, Quorum

1.2. A02 Chair's Opening Remarks

1.3. A03 Minutes 6th June 2017: Approval and Status of Actions 5

1.4. A04 Items for AOB

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Minutes of a meeting of the Primary Care Committee held on 6th June 2017

Present: Carol Varlaam (CV) Lay Member Patient and Public Involvement (Chair)Stephen Hickey (SH) Lay Member GovernanceKimball Bailey (KB) Associate Lay MemberAndrew Neil (AN) Secondary Care DoctorNicola Jones (NJ) CCG Clinical ChairJames Blythe (JB) Managing DirectorAndrew McMylor (AM) Director Transforming Primary CareNeil McDowell (NM) Director FinanceRebecca Wellburn (RW) Deputy Director Commissioning and PlanningZoe Rose (ZR) West Wandsworth LCG LeadJamie Gillespie (JG) Healthwatch WandsworthWilliam Cunningham-Davis NHS England(WCD)

In attendance:Sandra Allingham (SA) (Minutes)

17/012 Apologies for AbsenceReceived from Chris Savory, Amer Salim, Anthony Farnsworth, Mike Lane, John Atherton, and Julie Hesketh. The meeting was quorate.

17/013 Declarations of InterestJB – Wife employed at SGH

Item B02 GP Resilience List Dispersal Scheme – NJ, practice in receipt of additional funding relating to dispersal of practice list.

17/014 Minutes from the previous meeting held on 7th February 201717/005 Primary Care Plan – Emma Gillgrass.

Subject to the above amendment, the Minutes were agreed as being an accurate record.

17/015 Matters Arising17/005 Primary Care Plan – Funding links to GP Forward View – Work has been taken forward to address issues raised by NHS England as part of the assurance process. One area still remains amber rated, but there was confidence this will be changed to green.

External funding information – The request for funding information from the Local Authority (LA) has been taken forward.

E-Referral – No quick wins have currently been identified.

17/006 Integrated Primary Care Report – Work around Carers has been included in the next iteration of the BCF, which was now ready for sign off.

17/008 New Pharmacy Contract – The information regarding pharmacy QOF will be circulated. Currently there was nothing for the CCG to do, but to keep a watching brief.

WCD

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17/011 Meetings in public – The PCC meetings had been flagged with Healthwatch, and would continue to be flagged.

17/016 Integrated Primary Care ReportThe report provides an update on work done following the previous report. The following points were highlighted from the report:

Two practice closures, due to retirement, in the last quarter – Inner Park Road Surgery, and Balham Hill Medical Practice.

CQC inspections – two reports outstanding

Action areas outstanding at Putneymead and Brocklebank practices – detail provided in the report.

Comments and questions were noted:

St Paul’s Cottage Surgery – CQC rating of Green has now been reported.

CQC Inspections – The table provided in the report was useful, but it would be helpful to have the total picture available. This would be included in the next report to the Committee.

Benchmarking of CQC visits – Performance of Wandsworth practices compares favourably with other CCGs across the country. No concerns had currently been identified. CQC had also undertaken a benchmarking review of outcomes, with no outliers identified.

Outstanding rating – To achieve an Outstanding rating, practices would need to be able to evidence how good practice has had a positive impact on patient care.

Smaller practices were more likely to receive a rating of Requires Improvement, as much of the CQC inspection is process driven, and smaller practices often did not have the capacity to implement some processes. It was, therefore, important for the CCG to look at all information from soft intelligence sources, in order to establish a more rounded picture.

The content of the report was noted.

AM

17/017 GP Resilience List Dispersal SchemeThe scheme has been developed in order to support practices registering patients from practice lists that are being dispersed. The scheme was developed and discussed with the Wandsworth LMC and previously circulated to Lay Members for approval. All practices have been offered the opportunity to sign up to the scheme.

As previously reported, two Wandsworth practices have recently closed. The list size of both practices was small - it was agreed that both of these would not be re-procured and would, therefore, be dispersed. As stated in the scheme, Resilience Money has been used to support those practices receiving patients from the dispersed lists, for a period of six months. Practices will need to register a minimum of twenty-five patients within that period in order to receive a payment of £20 per patient.


The Resilience Money has been important in providing support to those practices that have taken on additional patients.

It was important for the Committee to understand, through lessons learned, what the cost will be for dispersal of patient lists, and how this could impact on prioritisation areas. It was noted that £170k has been allocated from 16/17, with much of the funding ring-fenced for schemes such as this.

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Information relating to vulnerable patients is identified as part of the dispersal process.

The scheme has now been adopted across London and fits with the national criteria.

Small practices in Wandsworth – There were approximately six/seven practices currently with list sizes under five thousand.

The tracking database for patients included on lists to be dispersed was not sufficient to provide an accurate position at this time.

The majority of Wandsworth practices now have good CQC ratings but it was still important to think about sustainability of small practices. Currently, there was a good level of care for vulnerable patients being provided.

The content of the report was noted.

17/018 Practice Deep Dive Review ReportA survey had been undertaken across Wandsworth to understand what practices were saying following the delegation of primary care commissioning to the CCG, and any particular specific issues. This work had arisen from the due diligence process, to find out how practices operate on a day-to-day basis, and ensure that all information was up-to-date.

A questionnaire covering a number of areas had been sent out to practices. A desktop review was then done on the completed questionnaires received. Visits were made to those practices that had not completed the questionnaire, or where limited information had been provided. The visits had been well received by practices and provided the opportunity for concerns and issues to be raised, as well as identifying areas of good practice.

Five areas were pulled out from the desktop review, some of which were outside the CCG’s control – information is detailed in the report. Concern was raised from practices regarding finance, and the perception that there was less access to funding for other services not included in the baseline budgets. Further work was being done to identify all potential schemes that could go into practices, which could potentially change practice earnings.

The next steps were outlined in the report, although it was noted that timelines had not yet been identified against the work streams.


The Committee was happy to support and take forward any issues on behalf of the CCG if required, and appropriate.

PCSE (Primary Care Support England) service – There is evidence that the service provided through Capita has improved, with fewer issues now being raised. The questionnaires had been sent out to practices last Autumn, with visits to practices undertaken in the last quarter. This improvement should be reflected in any additional survey. However, there were still some system issues, particularly regarding immunisation data, which would need to be resolved.

Estates – The issues identified by practices around estates, had already been identified from the Estates Review previously undertaken. One issue was highlighted regarding health centres and service charges – this was a national standard issue which was being worked through.

The report did not provide a sense of resolution regarding the two main issues around Capita and estates. A follow-up report on these two issues was requested to demonstrate the progress made. The report should reflect the WCD/

AM

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position for both Wandsworth and Merton.

As part of the year-end review, External Audit had noted a significant risk regarding payments to external agencies undertaking work on the CCG’s behalf. It was recommended that a review was undertaken of the range of contracts, with a list of all payments and responsibilities to be pulled together as part of that review.

Future plans in practices – This had been included as a section in the questionnaire, but not drawn out as a specific issue. Forward looking information can be included in the follow-up report.

Following discussion of the report, it was agreed that a follow-on report should be presented to the Committee, providing an update on the key issues around Estates and Capita, looking at improvements and how these could be measured, and review of contracts and payments.

NM

17/019 Finance ReportThe following points were noted:

16/17

Underspend of £1.6m, predominantly driven by an under-spend in prescribing of £1.2m.

Delegated commissioning budgets – Break-even position forecast, with mitigations built in. £300k under-spend reported.

Risks:o Relocation of NHSE contracting and finance staff into SWL should

address some of the issues around reliance on external organisations, and finance information, which will enable improved forecasting.

17/18

Budgets – Some of the detail was still being worked through with the NHSE team, which will be taken through the Finance Resource Committee.

There is a pressure against allocation, but the detail of this will need to be understood. There is potential for some mitigations to be put in place.

The budget setting process approved by the Board, assumed allocation would equal expenditure. A potential pressure has been flagged around the cost of CQC and indemnity now being picked up by the CCG.


CQC and indemnity – NHSE response would state that, for this financial year, these costs have been included in the baseline.

Medical indemnity payments – This has now been included in the GP contracts for 17/18, but no payments have previously been made to practice. This position would be checked.

It was important to label payments included in the baseline, once they are identified. It would require all parties to work together to understand the position, which was a national issue.

ZR

NM

17/020 Open SpaceNo questions received.

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17/021 Any Other BusinessNone.

There being no further business, the meeting closed at 10:45.

Date of next meeting: 18th July 2017

ACTIONS

Ref No. Item Lead

17/015 New Pharmacy Contract – To be circulated to Committee members. WCD

17/016 Primary Care Integrated Report - Table outlining the total picture regarding CQC inspections to be included in the next report.

AM

Practice Deep Dive Review - Follow-up report to be provided on issues around Capita and Estates to demonstrate the progress. The report should reflect the position for both Wandsworth and Merton.

WCD/AM

17/018

A review to be done identifying the range of contracts to external organisations, with a list of all payments and responsibilities to be pulled together as part of that review.

NM

Medical Indemnity Payments – Position regarding payments to practices to be checked.

ZR17/019

Baseline payments - Payments included in the baseline to be labelled, once they are identified.

NM

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Part B: Decisions and Discussions

Page

2. Part B: Decisions and Discussions 10

2.1. B01 Integrated Primary Care Update Report 11

2.2. B02 Wandsworth CQC Outcomes 18

2.3. B03 GP Resilience Programme Updates 27

2.4. B04 Approach to Primary Care Quality 31

2.5. B05 Royal Hospital for Neuro Disability Update (verbal)

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General Purpose – Integrated Primary Care

Commissioning PaperAuthor: Kate Symons & Emma Gillgrass Sponsor: Andrew McMylor Date: 3rd October 2017

Executive Summary

Context

This is report provides the Committee with an update on how primary care delegated commissioning is being managed though both the contractual and quality management processes as well as providing an update to the Committee on the progress of key work programmes.

Question(s) this paper addresses1. How have we progresses the PMS Contract Review in Wandsworth?2. What Primary Care Commissioning Practice Specific Updates do the Committee need

to note?3. What are the key findings from the GP patient Survey for Wandsworth Practices?

Conclusion1. The Committee are asked to note that the PMS Contract and local Premium offer was

sent to all PMS practices on the 15th September 2017, and they have up until the 30th November 2017 to sign their new contracts.

2. The Practice are asked to note the detail in the practice specific updates that relates specifically to the Clapham Junction Site closure; and the Roehampton Surgery who have now received a CQC rating of ‘Good’.

3. The GP survey has been reviewed by the Primary Care Quality Review Group and areas where we have score higher than the national average have been identified; as well as areas where we could focus more support.

Input SoughtThe Committee are asked to note the detail included within this paper, and the progress made under delegate commissioning arrangements.

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The Report

F U R T H E R C O N T E X T

This report provides the Committee with an update on how primary care delegated

commissioning is being managed though both the contractual management processes

available as well as through our new approach to managing quality in primary care.

A N A L Y S I S

1. How have we progressed the PMS contract Review in Wandsworth?

We have previously reported to the Committee and the Executive Management Team on

our progress in developing our local PMS Contract and Offer for Wandsworth. Following a

pause in the process in 2016; the PMS review in Wandsworth was re-started in January

2017. A PMS Working Group was set up with input from clinical leads, NHS England and

the Primary Care Team, with the aim of developing the local PMS Premium indicators to be

included in the new PMS Contract.

The PMS Premium

The PMS Premium relates to the locally designed service areas that we have been

developing as part of this review process. We have utalised the opportunity afforded to us

under delegated primary care commissioning to look at the quality of the previous indicators

and work in a more broader sense to ensure that the new indicators are fit for purpose,

provide value for money, and are clinical appropriate for the population of Wandsworth.

Below provides the Committee with the high level detail of the local indicators included in

the new PMS Premium:

Improvement in the provision of a comprehensive annual diabetes review (8 care

processes) in Primary Care

Supporting the uptake of Influenza Vaccination in Primary Care

Supporting Improvement in the Uptake of Childhood Immunisations

Supporting the uptake of Bowel Cancer Screening in Primary Care

Increasing the use of Referral Management Software in Primary Care

Make A Difference (MAD) Alerts

The PMS Premium Demographic Element

This was is referred to as the PMS Premium Optional Service element in the current PMS

Contract. Introduced in 2012; it included two additionally payments offered to PMS Practices

relating to a Deprivation Scheme and A Children Under 5 Scheme, both of which were

introduced to provide some mitigation for the introduction of the Carr-Hill weighting in

recognition of the additional workload that was associated with these cohorts of the

population.

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Registered Patients in Deprived Areas

There is a recognised link between higher levels of social deprivation and an increased

prevalence of physical and mental illness. It is also recognised that health outcomes are

significantly worse in areas with high levels of deprivation. With an increased prevalence of

disease comes an increase in demand for primary care services and additional capacity is

required to ensure that these populations have good access to primary care services.

The PMS Working Group recognised that there has been a shift in IMD index in

Wandsworth; as the borough has become slightly less deprived. It was however felt that

there are still areas in Wandsworth with some of the most deprived populations and as such

this scheme is still relevant for our practices and patient population.

Supporting the Management of Children in Primary Care (Under 5’s)

General Practice consultation rates for children aged between 0-5 years are higher than any

other age group. This population have a high incidence of acute illness often requiring same

day assessment and advice. Where a practice has a higher proportion of children under the

age of five, it is recognised that there is significant challenge to meeting quality targets such

as childhood immunisations and the management of child protection cases particularly

difficult; often contributing to a higher GP workload.

Next Steps

After a number of meetings with the PMS Review Group as well as actively engaging with

our Local Medical Council (LMC) Colleagues we were able to agree the final PMS Offer for

Wandsworth. Wandsworth PMS Practices received this offer and all associated practice

documentation on the 15th September. Practices will have up to the 30th November reading

time should they require it although we hope that as many practices as possible will be able

to sign up to their contract, on or around early October.

Two dates have been scheduled in October for practices to have half hour one to one slots

with the contracting team should they wish to discuss their offer in more detail.

We will continue to provide the Committee with regular updates on the progress and sign-

up of the new PMS Contract.

2. What Primary Care Commissioning Practice Specific Updates do the Committee need

to note?

Clapham Junction Site Closure

Clapham Junction Medical Practice has requested to close its Lavender Hill site at 263

Lavender Hill SW11 2JD. The practice has two sites, Lavender Hill and Farrant House, with

a combined practice list size of 3169.

The primary reason for requesting the closure is that the site is not adequate for provision

of services to the elderly and physically disabled patients who use wheel chairs and mobility

scooters and also parents with young children in prams. The Lavender Hill site is a house

conversion with awkward access to the premises and no scope for adaptations needed for

disabled access and disabled toilet. The premises has 3 consulting rooms and 2 out of the

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3 consulting rooms can only be accessed via stairs, so patients who cannot take the stairs

have to wait for the ground floor consulting room to become free to be seen. There is also a

small waiting room that cannot accommodate all patients waiting to be seen if there are 2 or

more clinics running simultaneously.

The Lavender Hill site has been closed since 14th January 2017 due to flooding, with repairs

projected to take several months. All services have been transferred to the Farrant House

site and are running smoothly. The lease for this property was also expiring in February

2017, therefore the practice took this opportunity to review the business continuity plan and

the practice made the decision to not renew the lease for a building that they considered

what was not fit for purpose. It is important to note that the CQC had also commented on

the site’s inability to meet the needs of elderly patients and patients with physical challenges.

The practice are proposing a permanent closure of the Lavender Hill site with transfer of all

services to 7 Farrant House. This will allow the practice to be compliant with equality and

diversity components of health and social care. It will improve the clinical service and care

provided to certain vulnerable groups of patients. Consolidating all clinical care and services

under one roof will ensure smooth and non-disrupted service that can arise from lack of

administrative or clinical staff. The practice have stated that a majority of the patients are

used to going to both sites and they are also familiar with the GPs as they cover both sites.

The Practice have submitted a Business Case which has been reviewed by NHS England

and the Primary Care Team. This has also been considered in light of the local context and

capacity within the area, and discussed at the Primary Care Operational Group where it was

felt that there was no reason to not support the permanent site closure.

Roehampton Surgery

The Committee have previously been updated on the CQC rating at The Roehampton

Surgery; where the practice received a Requires Improvement Rating following an

inspection in April 2016. The practice was supported by both the CCG and NHS England

colleagues in developing their systems and services and action plan as part of the Requires

Improvement management process. The practice received a follow-up CQC visit in January

2017 and although they had shown improvements in some areas, the practice was still rated

as Requires Improvement.

It was agreed at the PCQRG that additional focused support would be provided via the

Practice Support Team

Following this additional support the practice was re-inspected by the CQC in July 2017 and

we are pleased to report that the practice has now received an overall rating of Good.

3. What are the key findings from the GP patient Survey for Wandsworth Practices?

The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data

about patients’ experiences of their GP practices. Ipsos MORI administers the survey on

behalf of NHS England. The most recent data, reviewed in the Primary Care Quality Review

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Group was collected in the survey period January – March 2017. This showed that 86% of

patients rated their Wandsworth GP practice as “Good”.

Survey questions come under 11 headings:

Accessing your GP service

Making an appointment

Waiting times

Last GP appointment

Last Nurse appointment

Opening Hours

Overall experience

Managing your health

Your state of health today

Planning your care

Some questions about you

There are also questions about:

Out of Hours

NHS Dentistry

The sample sizes for individual practices are very small so this should be taken into account

when analysing the data. Within Wandsworth 3.7% of the registered list size was sent a

survey. The response rate was 28% which equates to 1% of the total registered list size.

The data shows that Wandsworth practices scored higher than the National Average on the

following key areas:

Overall how would you describe your experience of your GP surgery? (% Good)

Generally how easy is it to get through to someone at your GP surgery on the phone?

(% Easy)

Last time you wanted to see or speak to a GP or nurse from your GP surgery were you

able to get an appointment to see or speak to someone? (% Yes)

Overall how would you describe your experience of making an appointment? (% Good)

How do you feel about how long you normally have to wait to be seen? (% Don't wait

too long)

Did you have confidence and trust in the GP you saw or spoke to? (% Yes)

How satisfied are you with the hours that your GP surgery is open? (% Satisfied)

It was identified from the data that the areas that potentially need further work are:

Making an appointment – convince of appointment

Getting through to the GP practice on the phone

Helpfulness of receptionists

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A number of areas of work are already under way which may have an impact on these areas

including:

8-8 GP hubs – patients can now access GP appointments 8am-8pm seven days a

week

A number of new receptionist development course commissioned through the

Wandsworth Community Education Provider Network (CEPN)

There are a number of practices that have been identified in the bottom five practices across

the 10 key questions where it may be beneficial to work with these practices on an individual

basis to identify any areas of support required. The Primary Care Quality Review Group

continue to review these results and are working with the practice support team to identify

practices that may need further support.

C O N C L U S I O N

The Committee are asked to note the ongoing work that has been implemented across Primary Care under delegated commissioning arrangements.

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For ReferenceEdit as appropriate:

1. The following were considered when preparing this report:

The long-term implications [Yes]

The risks [Not applicable]

Impact on our reputation [Not applicable]

Impact on our patients [Yes]

Impact on our providers [Yes]

Impact on our finances [Not applicable]

Equality impact assessment [Not applicable]

Patient and public involvement [Not applicable]

Please explain your answers:

2. This paper relates to the following corporate objectives:

Commission high quality services which improve outcomes and reduce

inequalities [Yes]

Make the best use of resources, continually improve performance and deliver

statutory responsibilities [Yes]

Continually improve delivery by listening to and collaborating with our patients,

members, stakeholders and communities [No]

Transform models of care to improve access, ensuring that the right model of care

is delivered in the right setting [Yes]

Develop the CCG as a continuously improving and effective commissioning

organisation [Yes]


3. Executive Summaries should not exceed 1 page. [My paper does]

4. Papers should not ordinarily exceed 10 pages including appendices.

[My paper does]

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Strictly Confidential Board Intelligence Hub template

Wandsworth CQC OutcomesAuthor: Emma Gillgrass Sponsor: Andrew McMylor, Dr Zoe Rose Date: 03/10/17

Executive Summary

Context

The Care Quality Commission (CQC) is the independent regulator of health and adult social

care in England. They monitor, inspect and regulate services to make sure they meet

fundamental standards of quality and safety, and publish their findings to enable people to

choose their care.

In September 2017 the CQC published a report “The state of care in general practice 2014-

2017” following its three year programme to inspect every GP practice in England.

This report identified that in England, as of 16th May 2017 86% of practices were rated as good and

4% as outstanding overall (with re-inspections), whilst 8% were rated as Requires Improvement and

2% as Inadequate overall.

As of April 2017 all GP Practices in Wandsworth have been inspected and rated by the

CQC, with 98% currently rated as “Good”.

Question(s) this paper addresses

1. How have Wandsworth practices performed in their CQC inspections?

2. What areas of outstanding practice were identified?

3. What were the key issues identified in Wandsworth CQC reports and how have these

been addressed?

Conclusion

1. 98% of Wandsworth practices are rated as “Good” overall

2. A range of outstanding areas were recognised, especially where practices have

identified and addressed the needs of specific groups of patients

3. Key issues were identified across a range of areas included carers, staff, complaints

and medicines management. These are being addressed through the Members

Quality and Engagement Scheme and the Practice Support Team

Input Sought

The Primary Care Committee is asked to note this report.

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The Report


From October 2014, the Care Quality Commission (CQC) initiated a new inspection regime

to inspect and rate every GP practice in England. Initial inspections to all practices were

completed by April 2017. Practices were inspected across five key questions, considering

the extent to which they are safe, effective, responsive, caring and well-led. They were then

rated in one of four categories; outstanding; good; requires improvement; or inadequate.

The reports that are published about each care provider are based on what was found when

the service was inspected, information from ongoing monitoring of services and information

from the provider, patients the public and other organisations.

Practices receive an overall rating and then additional ratings across five areas:

Are services safe?

Are services effective?

Are services caring?

Are services responsive to people’s needs?

Are services well led?

Ratings are also given to care for specific groups of people:

Older people

People with long term conditions

Families, children and young people

Working age people (including those recently retired and students)

People whose circumstances may make them vulnerable

People experiencing poor mental health (including people with dementia)

Practices rated good or outstanding overall will then move to be inspected at a maximum

interval of 5 years, dependant on their initial report, providing ongoing accurate data and

confidence that quality has not significantly changed. Practices rated requires improvement

or inadequate overall, or where concerns are raised, will be inspected more frequently. The

CQC is currently reviewing its approach to inspections of GP practices for the coming 5

years.

All reports are published on the CQC website and are available to the public. Care providers

must also display the ratings they are given in the places they provide care, somewhere that

people using the services can easily see them. They must also display their rating on their

website (if they have one).

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A N A L Y S I S

1) How have Wandsworth practices performed in their CQC inspections?

All Wandsworth GP practices were inspected in the two year period March 2015 to March

2017. As of 21st September 2017 there is one practice rated as “Requires Improvement”

with all other practices in Wandsworth now rated ”Good”.

Appendix 1 sets out the current ratings by practice, key areas and population groups. This table lists 43 practices as for two practices their branch sites were inspected and rated individually, rather than as one practice.

Following the first inspection of each practice there were 4 practices rated as “Requires Improvement” overall and a further 12 that were rated “Good” but with one area rated as “Requires Improvement”. Following improvements made within these practices, as of 21st September 2017, only one practice in Wandsworth is still rated as “Requires Improvement” (initial inspection was only in March 2017 so they have not been re-inspected yet) and two practices rated “Good” but with one area of “Requires Improvement”.

2) What areas of outstanding practice were identified?

Within Wandsworth three practices each had one of the key areas rated as “Outstanding”.

In addition eight further practices had areas of outstanding practice identified.

Key areas rated as Outstanding:

Brocklebank Group Practice – Well ledThe practice had policies and procedures in place to monitor patients who had appointments in the acute and emergency care system and followed up missed appointments. This included following up patients who have not attended outpatient appointments, guiding patients through their patient journey when faced with cancer diagnosis, and the following up of patients not attending appointments for their dementia care.

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Greyswood Practice – ResponsiveA practice led initiative had been put in place to send birthday cards to all patients registered with the practice aged one to three years of age. The birthday cards were used to inform parents, carers and families of the long term benefits and recommended uptake of immunisations. Cards with the same information were also sent to all new born patients and their mothers. The practice were able to demonstrate the practice level for the pre-school booster improved from below 50% in 2011 to 93% in the last quarter of 2014 and continues at this level into 2015.

Putneymead Group Practice – Responsive

The practice has an in-house counselling service with six to 10 counselling sessions per week, including Saturdays, seeing 110 -120 patients every week. The practice has collated information assessing the impact of counselling by comparing patient scoring on the Patient Health Questionnaire (PHQ - test used to assess severity of depression) and the Generalised Anxiety Disorder Assessment (GAD- test used to assess severity of anxiety symptoms) before and after counselling. Of the 62 patients reviewed 73% showed an improvement in PHQ scoring while 82% had improved GAD scores. The practice also conducted a survey of patients using services. Ninety seven percent of the 170 patients asked stated that their counsellor listened to them and treated their concerns seriously and 90% had confidence in their counsellors' skills and techniques

The practice supported four practices in the CCG which did not have sufficient numbers of staff to complete NHS health check during 2014-15. The number of health checks then increased in three of the practices, compared to 2013/14, by 37%, 113% and 257%. In 2015 one of the practices declined the practice's continuing support as they felt sufficiently resourced to provide the checks independently. The other two practices increased the number of health checks in 2015/16 comparative to 2013/14 by 382% and 886%. It was estimated that the support from the practice's healthcare assistants enabled an additional 1290 health check to be undertaken in these practices between 2014 and 2016

Other areas of outstanding practice:

Bridge Lane Group Practice The practice had developed and ran a primary care led alcohol service for the benefits of its own patients and patients from other practices in the area. On piloting the clinic the waiting time for patients to receive treatment was reduced from 18 weeks to 18 days.

Falcon Road Medical Practice The practice vision and values were embedded in the organisations structure and prioritised good quality patient care. The practice had a mission statement with a clear vision and set of values for the practice. This has been developed with all staff who have shown their support and commitment to the values by signing a copy on display in the staff break area. The mission statement and vision and values were also clearly displayed on the practice website, in the reception area and throughout the practice including on documents, information leaflets and posters produced by the practice.

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Grafton Medical Partners

The practice commissioned a citizens advice service weekly due to the level of social needs required by the practice’s population group. This had been provided for the last two years

The practice employed an in-house pharmacist to assist with medicine reviews, who specifically focussed on a review of prescribing for patients in a local nursing home. The practice were performing above the local CCG target for antibiotic prescribing for 2015/16 and were one of the highest performers in the CCG area for anti-inflammatory safe prescribing

The practice provided the over 75s with an information pack which included a booklet produced in conjunction with the Patient Participation Group entitled ‘Local Services for Older People’. This contained detailed information about support and welfare services, social services, voluntary organisations and support for ethnic minority groups

The practice organised a Christmas Jumper Day and a raffle, the proceeds were used to fund transport for older patients who experience difficulties in getting to and from the practice

St Pauls Cottage Surgery The practice identified lower uptake for cervical screening amongst particular patient groups, in particular Asian women. They engaged a local Asian women's group and set up their own practice group for Asian women, led by a female GP who spoke Urdu, and the practice nurse. Asian women on the practice list were contacted and invited to attend an event to learn about the services offered at the practice including how to make appointments, to discuss healthy lifestyles, diet and exercise as well as national screening programmes for breast, bowel and cervical cancers. The event also included information on stress, domestic violence and abuse. Information was provided in English and Urdu and the women had the opportunity to ask questions and seek advice in the group and privately. Six patients attended the group session and directly following the practice engagement event, two of the patients booked appointments for their cervical screening. We spoke to a representative of the practice's Asian women's group who told us how important the event was to the people who attended and the wider community in sharing information and removing barriers to care.

Southfields Group Practice The practice had identified a number of patients who were in need of regular medical support and monitoring for their health conditions, but were frequently not attending appointments. On investigation, these patients were not able to make their own way to the practice and would instead use the ambulance service to attend the local hospital accident & emergency (A&E) department. A practice funded trial of booking identified patients a return taxi journey for their appointment was successful in increasing attendance for routine appointments at the surgery and reducing the need for these patients to use A&E and ambulance services. This scheme is predominantly used by elderly patients with multiple healthcare needs but GPs can provide this service to any patient where needed.

Thurleigh Road Practice The practice recognised that their relatively high proportion of children and young people, particularly those aged under 5, were also frequent service users. This prompted the practice to set up and run parenting courses for local families. The practice has seen a reduction in out of hours Accident & Emergency (A&E) department admissions since the courses started, prompting the local CCG to roll out the courses to other practices.

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Tooting Bec Surgery The practice were completing regular audits, and were able to demonstrate that learning and improvements had been made to the practice services, which benefitted patient care and outcomes.

Tudor Lodge Health Centre The practice worked closely with specialist colleagues to provide high quality care to patients with long term conditions. The nurse delivered joint monthly clinics with the CCG's diabetes specialist nurse for diabetic patients whose conditions were difficult to manage, and joint monthly clinics with the CCG's chronic obstructive pulmonary disease (COPD) specialist pharmacist for patients with COPD. Examples were provided of patients whose conditions has been quickly brought under control as a result of receiving this expert input. The practice also invited hospital consultants to provide educational sessions to clinical staff, for example an endocrinologist had recently given a talk on diabetes care.

3) What were the key issues identified in Wandsworth CQC reports and how have they

been addressed?

All CQC reports were reviewed and areas where practices needed to make improvement

identified. A number of key themes emerged. The top areas were:

Carers: improve systems for identifying and supporting carers

Staff: Recruitment checks/DBS; access to mandatory training; appraisals

Medicines Management: Cold chain policies; management of vaccines

Complaints: review policies, ensure effective arrangements for identifying, recording and managing complaints

Health and Safety: Infection control; fire safety; legionella; management of safety alerts

Patient participation: reintroduce a patient group, review patient group terms of reference

Significant events: Ensure that there is a clear system in place for reporting and recording significant events and a system for monitoring actions taken to improve safety in the practice

Addressing the themesThe Members Quality and Engagement Scheme (MQES) and the Quality Contract have been used to address the majority of the areas above.

Carers: Within the PACT (Planning all care together) contract there is a service requirement around carers. Practices are funded to hold a carers register and provide a carers consultation to offer support and onward referral if required. All practices are signed up to PACT and the Federation hold the overarching contract. For 2017-18 one of the MQES tasks for practices is around updating their carers registers and ensuring the have processes for identifying and providing support to carers

Staff: The January 2017 event focused on staffing and appraisals. The Community Education Provider Network (CEPN) work to deliver training and development opportunities for all practice staff

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Medicines Management: This was raised with the prescribing team who have re-issued guidance to practices around cold chain policies and management of vaccines

Complaints: This was part of the July 2016 task for practices, to review their complaints policy and update or develop a new policy if required

Health and Safety: An event was held in November 2016 for practices focusing on Health and Safety and Infection Control

Patient Participation: Two events have been held with the CCG PPI clinical lead with practices around patient engagement, to share good practice and support practices in developing their patient engagement. There has also been ongoing work by the PPI clinical lead with practices. One of the 2017-18 MQES tasks is around practices improving the uptake of the Friends and Family test and then using the feedback from this and other sources to address the issues raised by patients

Significant Events: An event for practices in September 2016 focused on the use of the National Reporting and Learning System, as well as launching newly produced local guidance on managing Serious Incidents in Primary Care. This was reiterated at a follow up event in September 2017

Where practices have needed specific support this has been provided through the Practice Support Team working with the individual practices. The team were also able to provide support to a new practice manager in advance of the practice’s inspection.Ongoing quality issues are reviewed and managed through the Primary Care Quality Review Group.

C O N C L U S I O N

Across Wandsworth GP practices 98% are now rated as “Good” by the CQC. Significant work has been done with practices to address areas identified a requiring improvement and this work will continue through the Primary Care Quality Review Group.The Primary Care Committee are asked to note this report.

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Appendix 1

O – Outstanding; G – Good; RI – Requires Improvement;I – Inadequate

Date of Visit /

Review

Over-all

score

Sa

fe

Eff

ec

tiv

e

Ca

rin

g

Re

sp

on

siv

e

We

ll L

ed

Old

er

Pe

op

le

LT

C

Fa

mili

es,

ch

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n,

YP

Wo

rkin

g a

ge

Vu

lne

rab

le

Po

or

me

nta

l h

ea

lth

Alton Practice 05/05/16 Good G G G G G G G G G G G

Chartfield Surgery 13/10/16 Good G G G G G G G G G G G

Danebury Avenue Surgery 6/4/17 Good G G G G G G G G G G G

Heathbridge Practice 17/03/16 Good G G G G G G G G G G G

Mayfield Surgery 09/05/17 Good G G G G G G G G G G G

Putneymead Group Practice 24/11/16 Good G G G O G G G G G G G

The Student Medical Centre 24/11/17 Good G G G G G G G G G G G

Roehampton Surgery 27/07/17 Good G RI G G G G G G G G G

We

st

Wa

nd

sw

ort

h

Tudor Lodge Health Centre 24/01/16 Good G G G G G G G G G G G

Battersea Fields Practice 24/02/16 Good G G G G G G G G G G G

Battersea Rise Group Practice 16/12/15 Good G G G G G G G G G G G

Begg Practice 08/09/16 Good G G G G G G G G G G G

Bolingbroke MC 19/01/16 Good G G G G G G G G G G G

Bridge Lane Group Practice 30/06/16 Good G G G G G G G G G G G

Clapham Junction MP 03/01/17 Good G G G G G G G G G G G

Falcon Road Practice 28/07/16 Good G G G G G G G G G G G

Lavender Hill Group Practice 01/10/15 Good G G G G G G G G G G G

Queenstown Road Surgery 20/07/16 Good G G G G G G G G G G G

The Junction 16/03/17 RI RI G RI G G RI RI RI RI RI RI

Batt

ers

ea

Thurleigh Road Practice 02/02/16 Good G G G G G G G G G G G

Balham Health Centre 27/02/16 Good G G G G G G G G G G G

Balham Park Surgery 18/03/15 Good G G G G G G G G G G G

Bedford Hill Family Practice 06/10/16 Good G G G G G G G G G G G

Brocklebank Group Practice 06/10/16 Good G G G G O G G G G O G

Chatfield Health Care 18/02/16 Good G G G G G G G G G G G

Earlsfield Surgery 27/03/17 Good G G G G G G G G G G G

Elborough Street Surgery 23/05/17 Good G G G G G G G G G G G

Furzedown 19/03/15 Good G G G G G G G G G G G

Grafton: Upper Tooting Rd 01/12/16 Good G G G G G G G G G G G

Grafton: Macmillian Way 05/01/17 Good G G G G G G G G G G G

Grafton: Trevelyn House 09/11/16 Good G G G G G G G G G G G

Nightingale Practice 15/11/16 Good G G G G G G G N/A N/A G G

Open Door Surgery 17/05/16 Good G G G G G G G G G G G

Southfields Group Practice 16/02/16 Good G G G G G G G G G G G

Streatham Park Surgery 13/09/16 Good G G G G G G G G G G G

St Paul’s Cottage 16/05/17 Good G G G G G G G G G G G

Greyswood Practice 20/03/15 Good G G G O G G G O G G G

Haider Practice 31/08/16 Good G G G G G G G G G G G

Tooting Bec Surgery 10/03/15 Good G G G G G G G G G G G

Tooting South MC 05/04/16 Good G G RI G G G G G G G G

Triangle Surgery 20/02/17 Good G G G G G G G G G G G

Trinity Medical Centre 20/03/17 Good G G G G G G G G G G G

Wan

dle

Wandsworth MC 26/01/16 Good G G G G G G G G G G G

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The risks [Yes]

Impact on our reputation [Yes]



Impact on our finances [Yes]

Equality impact assessment [Yes]

Patient and public involvement [Yes]




inequalities [Yes]




members, stakeholders and communities [Yes]




organisation [Not applicable]


3. Executive Summaries should not exceed 1 page. [My paper does comply]


[My paper does comply]

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GP Resilience Funding updateAuthor: Emma Gillgrass Sponsor: Andrew McMylor Date: 03/10/17

Executive Summary

Context

The General Practice Resilience Programme is a national investment programme, which aims to support practices become more sustainable and resilient. This is in addition to the Vulnerable Practices Programme already in place for those practices identified as most in need of support.


1. How is the GP Resilience Funding being used in Wandsworth?

Conclusion

1. The resilience funding is being used to support practices in a variety of ways,

including a list dispersal schemes and support to address issues raised in CQC

reports

Input Sought

The Primary Care Committee are asked to note this report and the support being provided

to practices.



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The Report


The General Practice Resilience Programme is a national investment programme, which aims to support practices become more sustainable and resilient. This is in addition to the Vulnerable Practices Programme already in place for those practices identified as most in need of support.GP Resilience funding was first made available in 2016-17 and has continued, at a reduced

level, into 2017-18.

In addition to the resilience funding Wandsworth CCG has a number of existing mechanisms including the Practice Support Team, Quality Contract and Members Quality Engagement Scheme that will be utilised to deliver support to practices.

A N A L Y S I S

1) How is the GP Resilience Funding being used?

2016-17

In 2016-17 the GP Resilience Funding was allocated to individual CCGs. Within Wandsworth this has been used to support practices in a number of ways.

List Dispersal SupportWithin the last nine months two Wandsworth practices have given notice of their intention to close, due to partner retirement. Both lists were less than 3000 patients and it was agreed that the lists would be dispersed. A scheme to provide funding for practices taking on patients from the two list dispersals was put in place to address the demand placed on the receiving practices taking on a significant number of patients, as it was recognised that there was a high level of need, above that usually expected from new registrations. This was based on a scheme developed by NHS England and Merton CCG and agreed with the Merton LMC. Ten practices have so far received support thorough this scheme to register 1400 patients.

Demand ManagementThe practices in West Wandsworth have been able, for several years, to access a GP service at Queen Mary’s Hospital which provides a limited number of on the day appointments which can help practices meet demand. This service was decommissioned from 1st October 2017. To support West Wandsworth practices during the service closure, the GP resilience funding was used to enable the practices to attend two bespoke workshops. These workshops aim to support practices to look at demand management processes, scheduling and minimising DNAs.Eight practices will have received support through this route.

CQC supportWhere practices have received “Requires Improvement” CQC reports the Practice Support Team has been funded to work with these practices to address the issues identified and support them in making improvements ahead of their re-inspection. The team has also been

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able to support a new practice manager ahead of the practice’s CQC visit to ensure everything was in place.Three practices have received support through this route so far.

Clinical pharmacist bidA number of practices are being supported to develop a joint bid for the Clinical Pharmacists Scheme. If successful this will help support the practices with capacity and demand. Clinical pharmacists are able to resolve day-to-day medicine issues and consult with and treat patients directly. This includes providing extra help to manage long-term conditions, advice for those on multiple medications and better access to health checks.

2017-18

In 2017-18 the GP Resilience fund is considerably smaller and so it was agreed that there would be a London –wide process to prioritise and distribute the support. A “heat map” was produced by the Healthy London Partnership, rating practices against a range of criteria. The CCG was then able to review and amend or add practices to the list.Practices were also invited to self-nominate themselves for support. All applications (from the heat map and the self-nominations) were reviewed by a London-wide panel. Following this 12 Wandsworth practices were identified, as part of 63 identified across South West London. Further conversations have been had with these practices to identify their specific needs.This information is being collated by the SWL team who are identifying where there are existing programmes that could support practices, where there are common issues that could be addressed across a number of practices or where bespoke support is required.

C O N C L U S I O N

The Primary Care Committee are asked to note this report and the support being provided

to practices.

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The risks [Yes]




Impact on our finances [Not applicable]

Equality impact assessment [Not applicable]





inequalities [Yes]








organisation [Not applicable]





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Approach to Primary Care QualityAuthor: Emma Gillgrass Sponsor: Andrew McMylor Date: 28/09/17

Executive Summary

Context

Since April 2016 both Merton and Wandsworth CCG’s have held delegated responsibility for Primary Care, GP Contracts. This includes responsibility for assessing and assuring quality and outcomes of these services. This responsibility is currently addressed in different ways across Merton and Wandsworth. With the creation of the Local Delivery Unit in 2017 it has been agreed to look at aligning the approaches to primary care quality across Merton and Wandsworth CCGs.


1. What is the proposed approach to quality in primary care?

2. What are the next steps?

Conclusion

1. It is proposed to set up a joint Primary Care Quality Review Group across Merton

and Wandsworth CCG’s to oversee quality in primary care and develop a combined

approach

2. The next steps include setting up a Joint PCQRG and reviewing data and quality

improvement schemes across the two CCGs

Input Sought

The Primary Care Committee is asked to approve this approach and its further development.



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The Report


In April 2016 both Merton and Wandsworth CCGs took on delegated responsibility for GP

contracts. This included responsibility for the quality of these services. For other key provider

services, such as St Georges Hospital, Out of Hours and Community Services a Clinical

Quality Review group takes on this role.

Within Merton CCG primary care quality issues have been managed and discussed through

the Primary Care Operational Group and Care Quality Committee, and support provided to

practices by the Locality Managers and Clinical Leads.

In Wandsworth CCG a clinically led Primary Care Quality Review Group (PCQRG) was

established in April 2016, with responsibility for overseeing the quality of services provided

by GP practices. An approach to quality was then developed, in conjunction with member

practices and other stakeholders, and presented to the Wandsworth Primary Care

Committee in June 2016. The key aspects of the approach are the Primary Care Quality

Review Group, the development of a local quality tracker and a Practice Support Team.

The PCQRG has responsibility for overseeing the quality of services provided through the

core GP contracts. It reviews a range of data and information in order to seek assurance on

the quality of services and also identify any areas, or individual practices that may require

support. The PCQRG will then identify what support is available, what further work may be

required and monitor progress.

The local quality tracker collates information and data about individual practices, from a

variety of sources. The aim is to provide an overview of quality within and between practices.

This is then used to identify, in conjunction with existing quality measures and other available

data, practices that may need additional support. There is currently a South West London

project to look at developing a single dashboard across CCGs.

The Practice Support Team was created to provide additional support to practices, with regard to quality. This is provided by a multidisciplinary team of local GPs, Practice Managers, Practice Nurses, along with Locality Managers and other CCG staff where relevant and is now managed by the Wandsworth Federation.

In the last year there has been a focus on the CQC reports of Wandsworth GP practices.

Reports, and action plans where appropriate, have been reviewed by the PCQRG and

where support was required the Practice Support Team have been able to work with the

individual practices. Most recently one Wandsworth practice received a “Requires

Improvement” CQC report following an inspection in January 2017. Following the support

and input from the Practice Support Team the practice is now rated as “Good”.

As Merton and Wandsworth CCGs are now working as a single Local Delivery Unit it was

agreed to look to align the two approaches to managing quality in primary care.

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A N A L Y S I S

1) What is the proposed approach to quality in primary care?

It is proposed that a single Primary Care Quality Review Group is established across Merton and Wandsworth CCGs to oversee the quality of services provided by the GP practices. This group will then lead on the development of a wider combined approach to quality in primary care.

The Joint Primary Care Quality Review Group would monitor national and local quality standards as well as holding Providers to account for any contractual requirements relating to clinical quality and safety of the services. This group would review a range of areas such as patient experience and clinical indicators to direct areas of focus and inform decisions about practices, as well as identifying support for practices where required.

Draft Terms of Reference for this group are set out in Appendix 1.

Having a single group across the two CCG’s will allow wider sharing of good practice and learning, as well avoiding duplication, as many areas reviewed will be similar across the two CCG’s. It will look to bring together the experience and knowledge from both Merton and Wandsworth, with local insight retained through the involvement of clinicians from both CCGs.

2) What are the next steps?

The next steps in developing a single approach to primary care quality across Merton and Wandsworth are:

Establish a Joint PCQRG across Merton and Wandsworth

Review the current data available across the two CCGs to measure quality

Review existing schemes for improving quality and whether there are opportunities to expand these across both CCGs

Review current issues in each CCG, how these are being managed and what additional support may be required

C O N C L U S I O N

The Primary Care Committee is asked to approve this approach and its further development.

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Appendix 1Merton and Wandsworth LDU

Joint Primary Care Quality Review Group

Terms of ReferenceDRAFT

1) Introduction

The single common definition of quality for the NHS encompasses three dimensions: clinical effectiveness, patient safety and patient experience. Quality should be at the centre of all discussions with providers to achieve the best possible health outcomes for patients.

The commissioning of General Practice has been delegated to the CCG by NHS England (NHSE) from 1st April 2016. Core contracts are currently held with individual GP practices in the form of PMS, APMS or GMS contracts and as well as additional local contracts (previously Local Enhanced Services).

This increased responsibility means there needs to be an overarching, unified approach to monitoring, reviewing and improving quality across primary care. To ensure all the services commissioned in primary care are delivered to the same high level.

2) Objectives

To monitor nationally and locally set quality standards with regard to Merton and Wandsworth GP Practice contracts.

To ensure that appropriate mechanisms are in place to monitor, and hold Practices to account for, contractual requirements around clinical quality and safety of service.

To identify and provide support to practices to ensure they are able to meet requirements around quality and to improve services.

To be the primary commissioner / provider forum for addressing issues that have the potential to negatively affect clinical outcomes for patients to ensure continuous improvement of services.

3) Scope and Authority

The focus of the Primary Care Quality Review Group will be the delivery of the GP Practice contracts commissioned under the remit of Merton and Wandsworth CCG’s. Additional local contracts may feed in to this group but will be managed in a separate forum. Individual clinician performer issues will be managed by NHSE.

The PCQRG is not responsible for reviewing services contracted by other commissioners, such as the Local Authority, however matters of concern may be raised with the appropriate commissioners should they arise.

Should any aspect of service quality not be achieved the PCQRG will be responsible for agreeing the actions needed to address this.

The following items should be regularly reviewed:

Significant incidents

Quality KPI's

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Local quality data (to include Family and Friends Test, QOF, General Practice Outcome Standards, Workforce development data)

CQC Reports

Feedback from practice visits

Progress against any Provider improvement plans

Alerts from other care providers about GP Services

Financial impact on practices

Each meeting will have a theme around one aspect of quality to allow deeper analysis.

4) Duties

To receive and analyse information relating to patient safety, clinical effectiveness and patient experience to gain assurance on the quality of care and clinical outcomes for patients.

Where commissioners are not assured, PCQRG members will discuss and agree action plans with the Locality Team and others who will work with the practice to address quality concerns. This will be fed into the Primary Care Committees and if there is an immediate quality concern this would be escalated to the Integrated Governance Committee.

To monitor progress against action plans related to service development or improvement plans.

To ensure that feedback from patients is captured and used to shape any developments in Primary Care provision and development.

To escalate matters of concern to relevant bodies.

5) Membership

CCG Primary Care Clinical Lead, GP - Chair (Clinical)

Deputy Director of Quality and Lead Nurse (Clinical)

Locality GP Clinical Leads - Wandsworth and Merton (Clinical)

Primary Care Nurse (Clinical)

Director / Deputy Director Primary Care Transformation

Locality Managers

Primary Care Contracts Lead

Primary Care Development Lead

Commissioning Directorate Representative

Patient Representation

NHSE

LMC

Invited according to agenda

Battersea Healthcare CIC (The Federation)

Merton Federation

CQC

GP Practice Representatives

Infection Control

LMC

Medicines Management

Public Health

Safeguarding

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6) Quorum

Five members to include:

Chair (GP)

Additional GP

Locality Manager

Quality Team rep

One other member

7) Meetings

The CQRG will meet monthly with a minimum of ten meetings per year.

8) Reporting

AccountabilityThe PCQRG will be accountable to the Integrated Governance Committee, a committee of the CCG Boards.

RelationshipsThe PCQRG will have a working relationship with:

Primary Care Committees

Primary Care Operational Groups

9) Secretariat

Papers will be circulation one week in advance of the meeting

Papers should be submitted 10 days in advance of the meeting

Potential agenda items for discussion should be submitted to the Chair

The business programme will be updated regularly to reflect items to be discussed

10) Review

The terms of reference will be reviewed on an annual basis.

Date Agreed: ddmmyyDate for Review: ddmmyy

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The risks [Yes]




Impact on our finances [Yes]

Equality impact assessment [Yes]





inequalities [Yes]








organisation [ Not applicable]





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Part C: Management Reports

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3.1. C01 Finance Report 39

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Wandsworth Clinical Commissioning Group

Primary Care Finance Report –August 2017 (Month 5)

Neil McDowell – Director of Finance

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Wandsworth Clinical Commissioning GroupPCC - October 20172 29/09/2017

1. Month 5 Background & Overview

2. Month 5 Primary Care Overall Position

3. Primary Care Narrative

4. Recommendations

Contents

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Wandsworth Clinical Commissioning Group29/09/2017 PCC - October 20173

• Background• Primary Care Delegated Commissioning was introduced 1st April 2016. • The financial accounting for this area is done with NHS England staff working exclusively for South West

London CCGs. • Given that this team are now based locally this should address some of the communication and detail

issues experienced in the first year of operation.• This paper reflects information available to the CCG to support the financial position in the period ending

31st August 2017.• For prescribing we are relying on 3 months data for forecasting purposes.• It should be noted that this position includes general primary care commissioning that has always been the

responsibility of the CCG as well as picking up other areas of primary care expenditure which have always been under the responsibility of their CCG from its programme allocation.

• Overview• Primary care expenditure overall has a favourable variance of £72k year to date and a forecast outturn

variance of £360k favourable.• Primary care delegated budgets is showing a forecast over performance of £129k adverse variance with

other primary care including prescribing showing an under spend at year end of an estimated £489k favourable.

• The following slides will give more detail behind these numbers

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2. Primary Care PositionAugust 2017

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Wandsworth Clinical Commissioning Group

Five months results to 31st August are showing an underspend of £92k on the issued budget, however the forecast allows for a deterioration as one-off benefits in year have been identified in the current year to mask a trend of overspend. The one-off benefit taken at month 5 have been generated from un-utilised accrual values raised in 2016/17, and created a £318k credit to expenditure in the month and year to date. As the enhanced services and QOF have now been all but finalised the figures are secured. The forecast variance is due to the issued budget reflecting the allocation received being below the currently committed level of expenditure under existing contractual obligations.

There are however small emergent savings within the core contract budgets partially offsetting the overspend. The PMS core contract budget included an allowance for those patients who were still registered on a closed practice as at 1st April but these should be out by second quarter list sizes, saving £31k in the year to date and forecast. The GMS core contract budget has a saving of £50k in the year to date and £100k in the forecast as a practice closed at the end of May saving the June monthly payment, the practice patients were dispersed so have appeared elsewhere in the second quarter list sizes. The forecast for PMS core contract costs also includes an £22k over-spend attributable to payments for the Royal Hospital of Neurological Diseases patients. The closures mentioned above have also led to premises costs savings of £3k in the year to date but set to save £27k by year end. The year to date and forecast for DES costs now reflect the latest position in sign-up, and record a saving of £28k on budget in the year to date. Seniority costs are currently £14k over budget as the phasing out of the payments has achieved smaller reductions than those assumed in the budget. Locum costs are currently £75k over budget, despite the budget being set at the very large value incurred in 2016/17 outturn. Whilst predicting the call on this budget is problematical; no variance on budget is included in the forecast, as there may be no further calls for locum costs support. The 2017/18 GMS contract settlement has removed elements of CCG discretion over whether to allow payments, by stipulating cases where locum cost support must be provided. The results to date include a £32k under-spend on Personally Administered Medicines budget, but this under-spend will erode later in the year when the flu season “kicks in”.

29/09/2017 PCC - October 20175

3. Primary Care NarrativeAugust 2017

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• Prescribing is expected to achieve its planned level of QIPP, but an additional saving is expected due to the new reduced price for Pregabalin, which is expected to save the CCG £0.5m in 2017/18.

• However shortages of generic supplies nationally are pushing a large number of drugs into the temporary NCSO ( No Cheaper Stock available ) category in the Drug Tariff for FP10 prescribing by GPs from the generic category M.

• As a result some pressures are being seen in the first quarter which has revised our forecast down from the previous months.

• It should be noted that drugs classed as category M were expected to contribute significant sums to the CCG over and above the planned QIPP. NHS England have now said that these price decreases will not be automatically passed down but may come available in the latter part of the year.

• The other area of underspend is due to an expected non recurrent benefit from the community adult services contract for which our Multi speciality Community Provider (MCP) is leading on. This will materialise in the second half of the year and is linked to vacancies within this contract that wont be recruited to before the end of the financial year. Current estimate is circa £0.5m but will be reviewed each month.

• All other areas of primary care are broadly in line with a small pressure on the NHS 111 contract and some unbudgeted one off costs for the PMS review.

3. Primary Care Narrative (Continued)August 2017

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4. Recommendations

The Primary Care Committee are asked to:

1. Note the financial position as reported in this paper for the period ending 31st August 2017.

2. Note that the CCG is reliant upon NHSE for supporting information.

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Part D: Open Space and OtherMatters to Note

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4.1. D01 Open Space: Public Questions Members of the public present areinvited to ask questions of the Committee in relation to the business beingconducted. Priority will be given to written questions that hve been received inadvance of the meeting.

4.2. D02 Any other business

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Part E: Meeting Close

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5.1. E01 Chair's Closing Remarks

5.2. E02 To resolve that the public now be excluded from the meeting becausepublicity would be prejudicial to the public interest by reason of thecommercially sensitive or confidential nature of the business to be conducted inthe second part of the agenda.

5.3. E03 Part II Agenda items:

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primary care committee - part i - wandsworth ccg care... · 10/3/2017 · a03 minutes 6th june...

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