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Primary Care Committee Part I

MEETING5 December 2017 09:30

PUBLISHED1 December 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 Agenda5th December 2017 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, 5th December

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 3rd October 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

B01Integrated Primary Care Commissioning

Report KS 9:45 15 mins

B02Joint Primary Care Quality Review Group

Update EG 10:00 15 mins

B03 Productive PPI SJ 10:15 15 mins

P A R T C | 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

C01

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 10:40 10 mins

C02 Any Other Business CV 10:50 10 mins

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

D01 Chair’s Closing Remarks CV 10:55 10 mins

D02To resolve that the public now be excluded

from the meeting because publicity would CV 11:00 00 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 ]

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


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.

D03Part II Agenda Items:

Local Incentive Scheme11:00

Next meeting in public of the Committee:

Part A: Meeting Open

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1. Part A: Meeting Open 4

1.1. A01 Apologies, Declarations, Quorum

1.2. A02 Chair's Opening Remarks

1.3. A03 Minutes 3rd October 2017: Approval and Status of Actions 5

1.4. A04 Items for AOB

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Minutes of the meeting of the Primary Care Commissioning Committee (Part 1) held

on 3rd October 2017

Chair: Carol Varlaam Present: Carol Varlaam (CV) Lay Member, Patient and Public Involvement Dr Nicola Jones (NJ) CCG Chair Kimball Bailey (KB) Associate Lay Member James Blythe (JB) Managing Director Julie Hesketh (JHe) Director of Quality and Governance Stephen Hickey (SH) Lay Member, Governance Neil McDowell (NM) Director of Finance Andrew McMylor (AMc) Director of Primary Care Transformation Zoe Rose (ZR) West Wandsworth LCG Lead Dr Mike Lane (ML) Wandle Locality Lead Rebecca Wellburn (RW) Deputy Director Commissioning and Planning Nora Simon (NS) NHS England In attendance:

Emma Gillgrass (EG) Locality Management Lead Battersea; Merton and Wandsworth CCGs

Kate Symons (KS) Acting Head of Delegated Primary Care Commissioning, Wandsworth & Merton LDU

Tony Foote Note Taker, NEL CSU

17/022

Apologies, Declarations, Quorum

Apologies were received from: John Atherton, William Cunningham-Davis, Councillor Paul Ellis, Josh Potter and Chris Savory.

No conflicts of interest were declared.

17/023

Clinical Chair’s Opening Remarks

CV welcomed everyone to the meeting.

17/024

Minutes of Previous Meeting on 6th June 2017: Approval and Status of Actions

The minutes of the previous meeting on 6th June 2017 were agreed as an accurate record.

Verbal updates to two of the actions raised from the June meeting were then received.

17/018 Practice Deep Dive Review Report NJ commented that concerns among Practices regarding Capita remained. JB confirmed that the final responsibility for this lay with NHSE and they were aware of the concerns. NM commented that Capita, as part of the audit, had carried out further tests but their outcome was not yet known. CV asked whether, should the

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outcome of the audit be negative, the contract would be changed. JB said that would be a national decision and he would look into the further.

17/019 Finance Report With regard to the discussion about indemnity payments at the June meeting, NM stated that he had asked NHSE whether it was fair practice to incur the cost at the start of the year as there was no reimbursement until the end of the year. However, no response has been received to date.

JB

17/025

Items for AOB

There were no items put forward under any other business.

17/026

Integrated Primary Care Update Report

KS and EG joined the meeting. KS presented their paper on integrated primary care commissioning. Highlights were as follows:

Progress regarding the PMS Contract Review The PMS review in Wandsworth paused in 2016 and restarted in January 2017. A PMS Working Group was established with input from clinical leads, NHSE and the Primary Care Team to develop local PMS Premium indicators for inclusion in the new PM Contract.

The indicators are:

- Improvement in the provision of a comprehensive annual diabetes review in primary care

- Supporting the uptake of the influenza vaccine 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 final PMS offer for Wandsworth was received on 15th September and Practices have until 30th November to sign up to their contract, though it is hoped they will do this in early October.

Primary Care Commissioning Updates - The Lavender Hill site of the Clapham Junction Medical Practice is being

closed primarily because of access issues; permanent closure of the site is proposed with transfer of all services to 7, Farrant House. A business case has been submitted by the Practice which has been reviewed by NHSE and the primary care team.

- The Roehampton Surgery, which received a “Requires Improvement” rating in a CQC inspection in April 2016, has had input from the CCG, NHSE and the Practice Support Team. A CQC re-inspection in July 2017 rated the Practice as “Good”.

Key findings from the GP Patient Survey for Wandsworth Practices In the survey period January-March 2017, 1% of the total registered list responded, 86% of whom rated their Wandsworth GP Practice as Good. Wandsworth Practices scored higher than the national average on experience of their GP surgery, getting through to someone at the surgery by phone, ease of getting an appointment to see or speak with a GP or nurse, experience of making an appointment, waiting time to be seen, confidence and trust in their GP and satisfaction with opening hours.

However, the data indicated several areas, particularly access, that required further work. Work is already underway which may help address these.

There followed questions and comments from the Committee.

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The issue of flu jabs was raised, and were GPs providing these in care homes. NJ said that it would be normal practice for a visiting GP to provide jabs to residents, and ZR added that if a home resident was under the care of a District Nurse they would be able to do this. CV asked what would happen if a Practice rejected the PMS contract. AMc explained that it was not mandatory and in such cases the CCG would need to ensure that patients of such Practices could access the whole range of services from other sites.

With regard to the Lavender Hill site, JHe asked about what patient engagement there had been. KS confirmed that all patients had been kept informed of developments. More generally, SH suggested that the CCG should be challenging any practices in similar circumstances for their plans. KS confirmed an awareness of the broader issue and that a SWL review was “on our radar.” NJ commented that at a London level Wandsworth fared excellently in the Patient Survey.

The PCCC DISCUSSED the Integrated Primary Care Update Report.

17/027 Wandsworth CQC Outcomes

EG presented this item and explained that the CQC had published the report ‘The State of Care in General Practice 2014-17’ following its inspection of all GP Practices in England. The highlights for Wandsworth included:

- 98% of Wandsworth Practices were rated as “Good”. - Outstanding areas were recognised, especially where Practices had

identified and addressed the needs of specific groups of patients. - There were key issues across a range of areas including carers, staff,

complaints and medicines management. - EG said that four Practices were still rated as “Requires Improvement” and

work with these is ongoing.

Three practices were rated as “Outstanding” - Brocklebank Group Practice; Greyswood Practice; Putneymead Group Practice. A further eight Practices were recognised for having areas of outstanding practice. Areas identified for improvement, and remedial actions, included:

- Carers: Improving systems for identifying and supporting carers. The PACT (Planning All Care Together) contract has a service requirement to hold a carers’ register and provide a carers’ consultation and onward referral if required.

- Staff: An event in January 2017 focused on staffing and appraisals and the delivery of training and development opportunities for Practice staff is ongoing.

- Medicines Management: The prescribing team has reissued guidance to Practices regarding cold chain policies and the management of vaccines.

- Health and Safety: An event on Health and Safety and Infection Control was held in November 2016 for Practices.

- Patient Participation: two events have been held to improve patient engagement and other work is ongoing with Practices.

- Significant Events: Two events for Practices in September 2016 and in September 2017 focused on the use of the National Reporting and Learning System and the launch of new guidance on managing Serious Incidents in primary care.

There followed comments and questions from the Committee.

The outcome for Wandsworth was welcomed by all the Committee and congratulations extended to all those at the CCG who had contributed to this. JB asked whether there were any common attributes that defined “good” or “bad”

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practices, making it possible to predict where problems may arise. It was felt that there were a number of factors and each practice had its own distinctive circumstances, but practice management and practice nursing were highlighted as very important.

The PCCC DISCUSSED the Wandsworth CQC Outcomes Report.

17/028

GP Resilience Funding Update

The GP Resilience Programme is a national investment programme aiming to support Practices in becoming more sustainable and resilient. It is in addition to the Vulnerable Practices Programme already in place. Funding was first made available in 2016-17 including in Wandsworth and has been used for:

- List dispersal – support when practices close. - Demand Management - funding has been made available to GPs to attend

two workshops aimed at supporting them in demand management processes.

- CQC support - practices receiving “Requires Improvement” ratings by the CQC have been given funded support from the Practice Support Team.

- Clinical pharmacist bid - a number of Practices are being supported to develop a joint bid for the Clinical Pharmacists Scheme.

In 2017-18 this fund has been smaller, so there has been a London-wide process to prioritise and distribute the support. Twelve Wandsworth Practices were identified as part of 63 identified across South West London


NJ commented that it was very helpful to see what the funding had been used for and it was important to make sure that any projects supported were both impactful and improved resilience. CV noted the funding for list dispersal support and asked what happened to patients who do not reregister? NJ responded that most patients registered with other local practices and those that lived further away registered with practices closer to home. AMc commented that four practices had closed in recent years but there should not be any more in the foreseeable future.

The PCCC DISCUSSED the GP Resilience Funding Update.

17/029

Approach to Primary Care Quality

EG presented the item and explained that since April 2016 both CCGs have held delegated responsibility for primary care, including assessing and assuring quality and outcomes. With the establishment of the Merton and Wandsworth Local Delivery Unit in 2017 it is now proposed to set up a joint Primary Care Quality Review Group (PCQRG) across Merton and Wandsworth CCGs. A draft terms of reference was included in the paper presented proposed and set out the objectives, scope and authority, duties, membership and other aspects of the joint PCQRG.

The PCQR 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 services. It would review areas such as patient experience and clinical indicators to direct areas of focus and inform decisions about Practices, as well as identifying support where required. The next steps were to:

- Established a joint PCQRG - Review current data across both CCGs to measure quality - Review existing quality schemes and whether they can be expanded

across both CCGs

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- Review current issues in each CCG, how these are managed and what additional support is required.


The proposal of a joint group was welcomed but the need to also retain some local focus was highlighted. Also recognised was the need to involve the LMC although SH expressed some concern at the LMC being present at every meeting. JB responded that the LMC would represent providers (all GPs) as would be expected with other CQRGs such as those with St George’s or CLCH.

The PCCC APPROVED the approach suggested and its further development.

17/030

Royal Hospital for Neuro-Disability(RHND) Update

AMc provided a verbal report on this matter, explaining that the RHND comprised 260 beds with 50% of these occupied by patients with lifelong conditions. Since 1986 a GP has serviced the hospital, running it as a branch site. This arrangement is now coming to an end and, as Wandsworth has responsibility for these patients the following way forward is proposed:

- Safe handover via caretaker GP (ZR’s Practice) - Further caretaker arrangement, but for at least two years to allow time to

formulate a permanent solution.

ZR commented that RHND was different to a nursing home, having a number of young patients with complex needs. The hospital provides nursing care but this is not “joined up” with medical care. The GP who has previously provided care had been there for a long time and any change in arrangements will be significant for both staff and patients. JB stated that this would be a substantial addition for the CCG and NM highlighted the additional costs it would bring.

SH asked whether the proposed 2 year caretaker arrangement would be filled via tender and AMc confirmed that it would, adding that the biggest issue at RNHD would be IT capacity – patient movement, patient data, etc – and it could take a number of years to stabilise the situation. CV identified a number of concerns: who was responsible for governance at RHND; what was the role of the charity that runs RHND; had the hospital been reviewed by CQC. JHe commented that the CCG would set up groups to review quality and the CQC would be involved in monitoring this. The CQC had reviewed the hospital as part of a bigger inspection and found no great concerns about it. SH added that the charity can do as it wished, the CCG’s concern would be any impact on NHS services.

17/031

Finance Report

Primary Care Finance Report August 2017 (Month 5) NM highlighted the following from the report:

- The financial accounting for this area is done with NHS England staff working exclusively for SWL CCGs. Given that this team is now based locally, some of the communication and detail issues in the first year of operation should be addressed.

- For prescribing the CCG is relying on three months’ data for forecasting purposes.

- 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 of over-performance of £129k adverse variance with other primary care including prescribing showing an under-spend at year end of an estimated £489k favourable.

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- Five months’ results to 31st August show an under-spend 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.

- Small emergent savings within the core contract budgets, however, are partially offsetting the over-spend.

- Locum costs are currently £75k over budget despite the budget being set at the very large value incurred in the 2016/17 outturn.

- The results to date include a £32k underspend on the Personally-Administered Medicines budget but this underspend will erode later in the year when the flu season ‘kicks in’.

NM stated that with regard to prescribing there was a very changeable position. Prescribing is expected to achieve its planned level of QIPP but an additional saving of £0.5m in 2017/18 is expected due to the new reduced price for Pregabilin. It should also be noted that drugs classed as category M were expected to contribute significant sums to the CCG over and above the planned QIPP. NHSE have now said these price decreases will not be passed down but may become available in the latter part of the year

The PCCC NOTED the financial position noted in the paper for the period ending 31st August 2017.

17/032 Open Space and Other Matters to Note

There were no questions or other matters raised for this item.

17/033 Any Other Business

There was no additional business for discussion.

17/034 Chair’s Closing Remarks

The next meeting of the Primary Care Committee will not take place on 7th November 2017. A meeting date was set for 5th December 2017 and this would be confirmed.

ACTIONS

Item Lead

17/024: Minutes of Prvious Meeting – verbal updates Practice Deep Dive Review Report NM commented that Capita, as part of the audit, had carried out further tests but their outcome was not yet known. CV asked whether, should the outcome of the audit be negative, the contract would be changed. JB said that would be a national decision and he would look into the further.

JB

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Part B: Decisions and Discussions

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2. Part B: Decisions and Discussions 11

2.1. B01 Integrated Primary Care Commissioning 12

2.2. B02 Joint Primary Care Quality Review Group

2.3. B03 Productive PPI 15

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General Purpose – Integrated Primary Care

Commissioning Paper Author: Nora Simon & Kate Symons Sponsor: Andrew McMylor & William Cunningham-Davis Date: December 2017

Executive Summary

Context

This is report provides the Primary Care Committee with an update on how delegated

Primary Care commissioning is being managed in Wandsworth; providing an update on

some of the key programmes of work.

Question(s) this paper addresses 1. How are we progressing with the PMS Contract Review in Wandsworth?

2. What Primary Care Commissioning practice specific updates do the Committee need to

note?

3. What general contracting decisions have been made in the last quarter?

Conclusion 1. The Committee are asked to note the PMS Offer and contract documentation has now

gone out to all PMS Practices; with 21 out of 28 practices retuning their signed contracts.

2. The Committee are asked to note that we are now working towards the next phase in

the procurement of an emergency provider for the Primary Care Medical Services at the

Royal Hospital for Neuro Disability (RHND)

3. The Committee are asked to note the decisions taken over the last quarter.

Input Sought The 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

A N A L Y S I S

1. How are we progressing with the PMS Contract Review in Merton?

PMS Review Update

As previously reported to the Committee the Wandsworth PMS Practices have all received

their new PMS contract documentation which includes the agreed local premium

specifications. Practices were initially given until the 31st October to return the signed

contracts; with an option to extend this until the 30th November.

One to one sessions were held on the 24th and 25th October where practices were given the

opportunity to meet with the SWL Primary Care Contracting Team, to discuss the specifics

in their contract offer, including any financial, contractual or clinical queries that they may

have.

As a result of these questions received at these sessions as well as directly to the Team, a

Question and Answer sheet has been developed, which provides further clarification on

some of the pertinent questions raised at these meetings. The LMC has also had an

opportunity to review these Q&A’s and following final sign off these have now gone out to

all practices.

We are pleased to report that to date 21 out of the 28 Wandsworth Practices have returned

their signed PMS Contracts.

The Primary Care Contracting Team along with CCG colleagues are now engaged in the

mobilisation phase of the specifications and are working closely with IT colleagues to ensure

that the appropriate systems and templates are established to enable practices and the SWL

Primary Care Team to effectively implement and monitor the local specifications.

A presentation on our local PMS Offer has also been given to the Patient and Public

Involvement (PPI) Clinical Reference Group, who were very engaged in the subject matter

and showed interest in the work that had been undertaken. They were particularly interested

in the new PMS Premium indicators and it was agreed that we would continue to keep the

group updated on our progress in the future.

The next stage of the process is to look at equalization for the GMS Practices; and we are

working with the SWL Primary Care Contracting Team to begin this process. As previously

agreed this will be a phased implementation, starting from April 2018.

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

to note?

Royal Hospital for Neuro Disability Primary Care Provision

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In October we reported to the Committee that the service for the Royal Hospital for Neuro

Disability (RHND) needed to be tendered due to the current Dr retiring from delivering care

there since 1986. This was undertaken in two phases. Phase one was the caretaker phase,

whereby we undertook an emergency local mini procurement exercise with local practices

in Wandsworth of which we awarded the caretaking contract to Putneymead surgery as the

successful bidder in the procurement. They have stabilised the service and continue to

provide high quality care to these patients.

This arrangement is now coming to an end we now move to the more permanent contract.

This is a longer term contract to deliver care to these patients over the next 2 years and to

work with the RHND to develop pathways and to formulate a permanent solution for these

patients. The aim is to complete the procurement for the next phase by January 2018.

3. What general Primary Care Contracting decisions have been made in the last quarter?

The following details the primary care contracting decision made in the last quarter; under

business as usual arrangements. Where the contractual changes are detailed these

decision would have been made through the usual governance arrangements; and therefore

taken at Committee level.

C O N C L U S I O N

The Committee are asked to note the ongoing work that has been jointly implemented

across Primary Care under delegated commissioning arrangements.

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Wandsworth CCG P A G E 1 O F 9


General Purpose Author: Dr Sian Job Sponsor: Date: 5th December 2017

Executive Summary

Context General Practice is required to participate in Patient and Public Involvement activities as

part of their core contract, both GMS and PMS. Many GPs have historically not found this

work helpful. In this context a methodology for PPI has been introduced to ensure, now that

this is mandatory, practices have a productive outcome for both patients and the practices.

Question(s) this paper addresses

1. What evidence is available to demonstrate the views of Wandsworth practices

about Patient and Public Involvement?

2. What PPI tools are available to enable interaction between practices and patients

to generate positive results?

3. What is the framework of the project?

4. How is it being delivered into practices?

5. How will progress be documented?

Conclusion 1. GP Workshop report of January 2016 shows a beleaguered workforce of which >60%

rated Patient and Public Involvement (PPI) between 0 to 5 /10 as being useful.

2. Tools for practices include NHS guidance for Patient groups, Accessible information,

Friends and Family test, NHS Choices; Wandsworth Locality patient workshop wishes

for best practice, Community and Seldom heard group annual practice visits.

3. The framework suggests whole practice involvement and identification of groups who

find it more difficult to use the practice. Starting with a single group and the patient

journey for those in that group, improvements can be identified and an action plan

developed.

4. The programme will be delivered via the Quality agenda of the Federation, GP PPI

Lead practice visits and follow up activity.

5. A Productive PPI (PPPI) Practice Template has been devised to represent the practice

activities.

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Input Sought The Committee is asked for comments on the work to date and to recommend the Productive PPPI

Template for use by the practices.

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The Report

F U RT H ER C ONT EX T

Wandsworth has a tradition of PPI in General Practice, albeit not shared across all practices. A CCG-

wide workshop in 2014 involving the three locality Patient Groups noted good practice at both indi-

vidual practice level and throughout the organisation but not evenly distributed. PPI in General Prac-

tice was previously optional via the PPI DES. Subsequently PPI has become part of the core con-

tract, therefore embedded into the fabric of General Practice and is now mandatory.

A N A L Y S I S

How can we find out what GPs feel about PPI and how productive it might be?

A workshop was held in January 2016 to identify specifically how GPs related to PPI. This showed

that GPs viewed PPI as a variable activity, some positive comments and some frustrating and neg-

ative. When asked to mark out of 10 whether they felt PPI was a ‘necessary evil’ (0) or a ‘big help’ (10), more than three fifths scored 0-5.

This established the baseline for PPI in General Practice.

What PPI tools are available to enable interaction between practices and patients to generate posi-

tive results?

Following on from the DES guidance for PPI in General Practice, Patient Groups in all practices is

the basic requirement. More recently Accessible Information guidance addresses Equality and Di-

versity dimensions in practices. This ties in well with the annual practice visits to Community and

Seldom Heard Groups, introduced within the CCG 6 years ago. These are individual activities that

practices are expected to address in the course of their work as clinicians.

Friends and Family test and NHS choices provide further patient voices to inform practices.

What is the framework of the project?

The purpose of the project is to enable meaningful and productive dialogue between practices and

the people who engage with their services. Recognising the pressures on practices from many di-

rections, the project aims to enable the delivery of productive improvements with minimal additional

effort. The proposed activities are streamlined into current practice.

The framework suggests whole practice involvement, identification of groups who find it more difficult

to use the practice, choosing one group at a time and asking them about their patient journey, the

findings then leading to an action plan to improvements for the practices and patients.

Each member of the practice team is responsible for contributing to the patient experience and there-

fore part of the PPI ethos. Each person can ask themselves at any time the key question…’How is

it for the patient in front of me at this moment in time to experience the service I am delivering’

Building on this, patients and patient groups and patient groups can be identified who may find it

difficult to get the healthcare they need. The practice has the opportunity to address issues which

may prevent optimal care for these patient and to improve their experience in the practice.

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Practices can make connections with relevant third sector organisations for the patients with specific

needs. They could choose organisations to visit as part of the C&SHG GP Visits that fits in with the

group they are asking about their journey in the practice.

Existing Practice Patient Groups can take part in the activity and start to fulfil the requirement of

addressing the needs of people not represented in the group.

How is it being delivered in to practices?

Agreement has been reached within the CCG to introduce this project to practices through the Qual-

ity agenda of the Federation.

The Federation agreed to include the project within the MCP programme for GPs to launch it to all

surgeries.

The Wandsworth CCG PPI Lead has followed up with individual visits to some practices in each

locality to gather evidence about how this worked in reality.

How will progress be documented?

A template has been developed to enable practices to self-evaluate. This will demonstrate how the

Productive PPI agenda is being addressed noting as well as what worked well, what was more diffi-

cult to achieve. This is useful for the practice itself as well as their patient group, who can review

various components. It will also serve as a valuable resource for CQC inspectors who are increas-

ingly keen to see how Accessible Information and other policies are being implemented in practices.

Further the document can demonstrate to Practice Support teams where practices need help as well

as their successes. The Quality teams from both the Federation and the CCG can see very easily

how practices are fulfilling their contract requirements.

Update so far:

Following the introduction of the PPPI framework for practices in the Workshop in January

2017, 29 practices responded to the tasks set as a result of the presentation demonstrating

PPI work over and above what they would normally do. (See attachment.)

Individual practice visits have been done subsequently to identify how the proposal was work-

ing in house and so inform the implementation process.

Messages from these visits include:

Going through the process in the practice really helps to clarify the intention of whole practice

engagement to their role in PPI.

Addressing the needs of those less able to engage with the practice for their services will

improve the patient experience and ease the practice to provide best care for all their popu-

lation.

In the context of the complex demands for practices, one exercise addressing the needs of a

single group of less able people can achieve demands put in place from all the mandatory

PPI tools.

Collating all the activities on a template which can be familiar to the practice, the Practice

support teams, the quality leads for both the GP Federation and the CCG will enable good

practice to be lauded and gaps will highlight the needs where practices can be helped.

The template can be a tool do demonstrate easily and clearly how a practice is addressing the

requirements from guidance as well as engaging in real dialogue with patients who might find

it difficult to get what they need from the NHS.

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Next steps:

Induction of the practice support teams to the Programme and Template

To refresh the PPPI agenda in the practices by sending a reminder about the

programme and the Template for each practice to complete and discuss with their Practice

Support teams.

To identify a session for practices to come together to discuss their templates indication their

successes and sharing difficulties.

C O N C L U S I O N

PPI in General Practice is a longstanding programme of activity. Much as there are pockets of ex-

cellent PPI taking place in practices, recent evidence demonstrated that the majority of practices do

not find the process of engagement of great benefit for their practices.

The CCG has an opportunity to ensure that there is a way forward to make PPI in practices produc-

tive, enabling both Patients and Practices to both benefit from dialogue and make a difference to

their delivery and experience of care.

This programme endeavours to bring all the current guidance and PPI activity in practices under the

one umbrella of Productive Patient and Public Involvement, introducing a way of one activity fulfilling

all the CQC, NHSe and GP PMS and GMS requirements with real benefits.

ppendix 1 : PPI Template

Additional documents available on request:

1. Powerpoint summary for the MDP workshop and subsequently shared with all practices.

2. Tabulated results of the tasks following the MDP PPPI workshop.

For Reference

Edit as appropriate:

1. The following were considered when preparing this report:

The long-term implications Yes

The risks Yes

Impact on our reputation Yes

Impact on our patients Yes

Impact on our providers Yes

Impact on our finances Yes

Equality impact assessment Yes

Patient and public involvement Yes

Please explain your answers:

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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 re-

sponsibilities YES

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

stakeholders and communities YES

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

ered in the right setting YES

Develop the CCG as a continuously improving and effective commissioning organization

YES

Please explain your answers:

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

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

[My paper does comply]

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Productive Patient and Public Involvement (PPPI) Summary Template

Discussion Tool for Practice November 2017

Productive patient and public involvement within practices will help deliver an enhanced patient experience, and help practices meet contractual re-quirements around patent engagement and the Accessible Information Standard. Using this template will support evidence required by NHSE and CQC.

Areas Goal Suggestions for Delivery What is the practice already doing?

What are the practice plans for the next 12 months?

Whole practice engage-ment in PPI (Anyone in the practice can be asked about PPI activity by CQC)

All practice staff are aware of the principles of PPI and are starting to use them in their everyday work

Attend workshop to under-stand the requirements January 2017

Complete MDP February ‘17 Tasks for PPI following the workshop

In house whole practice meetings to discuss PPI and the way forward for the practice

Practice Patient Group (CQC will look for evi-dence of patient discus-sions)

To establish a patient group as close to the guidance as possible to comply with NHSE requirements

Face to face patient group meetings

Virtual patient groups

Open meetings on specific topics

PPI action plan developed by the PCG and practice

End of year review

Practice PPI newsletters

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Friends and Family Test (Mandatory)

Ensure that the greatest number possible complete the test in each practice. Use the F&F test template to address the needs of the practice by adding relevant questions as required. The results of the test are considered and actions gen-erated to address needs as they arise.

Consider all means of en-couraging patients to com-plete the test.

Ensure regular reviews are timetabled into the surgery management meetings

Facilitate actions to re-solve issues identified in the replies.

Productive PPI activity (Many practices who have had ‘Outstanding’ rather than ‘Good’ demonstrate exceptional PPI activity and this is a way of pursuing that goal)

Work with a selected group of registered patients to de-velop a mutual understand-ing of both their needs and what the surgery can offer to improve the patients’ experi-ence.

Understand the de-mographics of the practice

Identify potential groups to work with

Elect ways of approaching this group appropriate to their circumstances

Ask them the question ‘What is it like to use this surgery’ and all the ele-ments involved. (template provided)

Summarise the findings and subsequent discus-sion

Create a realistic set of actions in dialogue with the group.

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Community and Sel-dom Heard Groups (C&SHG) (CQC will be delighted to see how the practice is developing links with the Community to support and enhance the patient experience)

Patients in the group being consulted to be in touch with a community group relevant to their needs to support and help them live their lives bet-ter.

Identify community links relevant to the cohort of patients being in focus. E.g. Poor vision – link to Thomas Pocklington Trust. Post Stroke patients – link to Connect etc. (list of examples provided)

Make contact with the C&SHG

Visit and or invite the C&SHG into the practice, to discuss with the staff and the group of patients being consulted to help and support both

Accessible Information Standard (mandatory: will be get-ting increasing attention from 2017 onwards)

Address the guidance pro-vided for practices to include as many patient groups in need as possible

NHSE guidance imple-mented and exemplified. E.g. Registration question-naire adapted to include questions about additional needs.

Identify specific cohorts of patients on the list to en-sure that their needs are respected and comply with guidance.

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3.1. C01 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.

3.2. C02 AOB and Other Matters to Note

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4.1. D01 Chair's Closing Remarks

4.2. D02 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.

4.3. D03 Part II Agenda items:

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