Kirklees CCG Primary Care Commissioning Committee 9.00 am, Wednesday 28 April 2021 To be held as a VIRTUAL meeting
Agenda
Members Initials Role Apologies Beth Hewitt (Chair) (BH) Lay Member: Patient and Public Involvement - Hilary Thompson (Vice- (HT ) Lay Member: Finance and Remuneration - Chair) Ian Currell (ICu) Chief Finance Officer - Carol McKenna (CM) Chief Officer - Penny Woodhead (PW) Chief Quality and Nursing Officer - Martin Wright (MW) Lay Member: Audit and Governance -
In Attendance Dr Ibrar Ali (IA) Independent Medical Advisor - Stacey Appleyard (SA) Healthwatch Representative - Dr Dil Ashraf (DA) Chair, Council of Members - Dr N Chandra (NC) Local Medical Committee Representative - Laura Ellis (LE) Head of Corporate Governance - Jan Giles (JG) Senior Manager Practice Support and - Development Dawn Ginns (DG) NHSE Representative - Danielle Hodson (DH) Assistant Internal Audit Manager (agenda item - 9) Dr Abid Iqbal (AI) Independent GP Advisor - Dr Bert Jindal (BJ) Local Medical Committee Representative - Diane Lane (DL) Practice Support and Development Manager - (agenda item 10) John Laville (JL) Patient Representative - Dr Yasar Mahmood (YM) GP Member - Dr Steve Ollerton (SO) GP Member - Martin Pursey (MP) Head of Contracting and Procurement - Vacancy Health and Wellbeing Board Representative Catherine Wormstone (CW) Head of Primary Care Strategy and - Commissioning Rob Willis (RW) Head Of Financial Reporting and Accounting - Mahmood Yaqoob (MY) Other Primary Care Professional Practice - Member
Primary Care Commissioning Committee Meeting – 28 April 2021 1 Agenda ITEM TIME BY PAGE 1. Welcome, Apologies and Declarations of Interest To open the meeting with introductions; note and record any apologies; 9:00 BH Verbal and declare any interests outside the committee. 2. Vision and Values - BH 4 Attached for reference. 3. Accuracy of Minutes from the last meeting of GH and NK CCG Primary Care Commissioning Committees Greater Huddersfield CCG PCCC – 24 February 2021 9.05 BH 5 North Kirklees CCG PCCC – 10 March 2021 To agree and ratify the minutes and pick up on any matters arising and outstanding actions.
4. Questions from Members of the Public. 9.10 BH -
5. Primary Care Commissioning Committee Terms of Reference - To outline the detail in the Terms of Reference. 9.15 LE 25 Contact: Head of Corporate Governance 6. Operational Group Terms of Reference - For approval. 9.25 CW 40 Contact: Head of Primary Care Strategy and Commissioning
ITEMS FOR ASSURANCE TIME BY PAGE 7. Primary Care Budgets / Finance Report - To receive the finance update. 9.30 RW 49 Contact: Head of Financial Reporting and Accounting 8. Contracting Update - To note the update. 9.40 MP 62 Contact: Head of Contracting and Procurement 9. Internal Audit Report – Primary Care - To receive and note the report. 9.50 DH 67 Contact: Assistant Internal Audit Manager 10. Introduction to the Primary Care Dashboard - To note the update 10.00 DL 90 Contact: Practice Support and Development Manager
COMFORT BREAK (10.10 - 10.15)
ITEMS FOR CONSIDERATION AND DECISION TIME BY PAGE 11. Temporary Branch Closures - For review. 10.15 CW 117 Contact: Head of Primary Care Strategy and Commissioning 12. Committee Work Plan - To review the draft work plan. 10.30 LE 129 Contact: Head of Corporate Governance Primary Care Commissioning Committee Meeting – 28 April 2021 2 Agenda ITEMS FOR CONSIDERATION AND DECISION TIME BY PAGE 13. Notification of Urgent Decisions - For information. 10.40 LE 131 Contact: Head of Corporate Governance 14. Date and Time of Next Meeting The next meeting of the Kirklees Primary Care Commissioning 10.45 - Verbal Committee has been scheduled for 9.00 am, 23 June 2021, via Microsoft Teams
The committee is recommended to make the following resolution: “That the press and public be excluded from the meeting during the consideration of the remaining items of business as they contain confidential information as set out in the criteria published on the CCG’s website, and the public interest in maintaining the confidentiality outweighs the public interest in disclosing the information.”
ITEM Time By Page 15. Declaration of Interests 10.55 BH Verbal 16. Accuracy of Minutes from the last meeting of GH and NK CCG Primary Care Commissioning Committees (private session), Matters Arising and Action Log Greater Huddersfield CCG PCCC – 24 February 2021 11.00 BH 144 North Kirklees CCG PCCC – 10 March 2021 To agree and ratify the minutes and pick up on any matters arising and outstanding actions 17. Look ahead to the next 12 months - To consider upcoming business. LE/ 11.05 Verbal Contact: Head of Corporate Governance / Head of Primary Care Strategy CW and Commissioning 18. Receipt of Minutes To receive the following minutes for information purposes:- Practice, Quality and Contracting Group: 27 January / 10 February / 23 March 2021 11.15 All 156 Primary Care Commissioning Committee Operational Group: 23 February 2021
19. Items to bring to the attention of member practices and Governing 11.20 All Verbal Body 20. Any Other Business 11.25 BH Verbal To discuss any other business raised and not on the agenda.
Meeting Checklist and Close
Primary Care Commissioning Committee Meeting – 28 April 2021 3 Agenda NHS Kirklees Clinical Commissioning Group Vision and Values
Vision
No matter where they live, people in Kirklees live their lives confidently and responsibly, in better health, for longer and experience less inequality.
Values
Working Together for Patients Respect and Dignity Everyone Counts Compassion Improving Lives Commitment to Quality of Care
4 Minutes of the Greater Huddersfield Primary Care Commissioning Committee held at 9.00 am on Wednesday 24 February 2021 held as a VIRTUAL meeting
Committee Members Beth Hewitt (Chair) (BH) Lay Member: Patient and Public Involvement Hilary Thompson (Vice- (HT) Lay Member: Finance and Remuneration Chair) Jenny Cullearn (JC) Practice Manager Practice Representative Ian Currell (ICu) Chief Finance Officer Dr Steve Ollerton (SO) GP Practice Representative and CCG Chair Martin Wright (MW) Lay Member: Audit and Governance
In Attendance Dr Ibrar Ali (IA) Independent Medical Advisor Laura Ellis (LE) Head of Corporate Governance Jan Giles (JG) Senior Manager Practice Support and Development Lindsay Greenhalgh (LG) Head of Medicines Management (minutes 60-61) Dr Bert Jindal (BJ) Local Medical Committee Representative Diane Lane (DL) Practice Support and Development Manager (minutes 57-65) Jen Love (JL) Practice Support and Development Manager (minutes 57-65) Martin Pursey (MP) Head of Contracting & Procurement (minutes 54-63) Rob Willis (RW) Head of Financial Reporting and Accounting Catherine Wormstone (CW) Head of Primary Care Strategy and Commissioning
Minutes Helen Robinson (HR) Governance Officer
Apologies Dawn Ginns (DG) NHSE Representative Carol McKenna (CM) Chief Officer Penny Woodhead (PW) Chief Quality and Nursing Officer
No members of the public were present.
054 Welcome, Apologies and Declarations of Interest
Apologies were received as set out above.
Conflicts of Interest
Minutes of the last meeting (Minute 56) – A number of individuals had been conflicted on an item at the last meeting. As the minutes were for approval only, it was anticipated that this could be managed without needing to take any further
Minutes of the Primary Care Commissioning Committee held on 24 February 2021 (DRAFT) 5 Page 1 of 11
action to manage the conflict. The same item was scheduled for later on the agenda, so any discussion could be managed under that item.
(Primary Care Budgets/Finance Update - Although not foreseen (and therefore not declared) at this point in the meeting, it emerged during the Finance Update that the practice representatives had a direct financial interest in relation to a comment made regarding the under spend against the core delegated co-commissioning budget. They declared this as soon as it emerged and it was agreed that they would take no further part in that specific discussion, as recorded in minute 57 below.)
Primary Care Dashboard (Minute 59) – All practice representatives declared a direct non-financial professional interest in this item as it monitored the performance of each practice. As this was a generic high level discussion, the potential conflict was noted, and everyone allowed to fully participate. This would be kept under review, if discussions moved onto specific practices.
PCN Additional Roles Reimbursement Scheme (Minute 61) – since issuing the papers, following advice from NHS England, it had been agreed that a discussion would not be held on this item. Therefore there was no conflict to manage within the meeting.
055 Vision and Values
The Greater Huddersfield CCG Vision and Values had been circulated and were noted.
056 Accuracy of Minutes from 16 December 2020, Matters Arising and Action Log (A number of individuals had been conflicted on an item at the last meeting. As the minutes had been for approval only, it had been anticipated that this could be managed without needing to take any further action to manage the conflict. The same item had been scheduled for later on the agenda, so any discussion could be managed under that item.)
The minutes of the meeting held on 16 December 2020 were APPROVED as a correct record.
The Action Log was reviewed as follows:-
28b – GP Patient Survey 2020 – GP Patient Survey and dashboard data to be added to the agenda for the next Clinical Directors meeting. Update 24/02/21: This was outstanding due to other priorities, but remained on the workplan for that meeting. CLOSED
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39a – Review of the opening arrangements for Keldregate - branch surgery of B8528 – The Grange Group Practice during the COVID-19 pandemic – IPC team to be asked to visit the premises prior to the next review, and provide feedback. Update 16/12/20: This was not due until February 2021. OPEN
39b – Review of the opening arrangements for Keldregate - branch surgery of B8528 – The Grange Group Practice during the COVID-19 pandemic – HH to check if any feedback had been received by Healthwatch from patients regarding Keldregate. OPEN
46a – Primary Care Budgets/Finance Update – RW to inform JG which practices remained outstanding in terms of tiers 1 and 2, and any exceptional circumstances to be identified. Update 24/02/21: Completed, no practices remained outstanding. CLOSED
46b – GP Patient Survey 2020 – MP to write to the remaining practices outlining the agreed deadline date, and the implications of this. Update 24/02/21: There was no longer a requirement for letters to be sent to practices. CLOSED
48 – Primary Care Network Additional Roles Reimbursement Scheme – JG to ask VD for an update on the Mental Health Practitioner role, and feedback to the Committee. Update 24/02/21: A presentation had been delivered to the CCG/Clinical Directors meeting regarding this role, and a further meeting was scheduled. CLOSED
49a – Interpreting Service for patients in General Practice – High level data on usage of the interpreting service to be shared with members, when capacity permitted. Update 24/02/21: JL was in the process of pulling this information together. CLOSED
49b – Interpreting Service for patients in General Practice – MP to explore when an uplift was last applied to the contract and whether there was a risk of such a request in the extended period. Update 24/02/21: MP confirmed that an uplift had not been applied to the existing contract, and had not been requested for the period of the contract extension. This contract would be included in a review of all contract uplifts which was about to be undertaken. CLOSED
057 Primary Care Budgets/Finance Update (Although not foreseen (and therefore not declared previously), it emerged during the item that the practice representatives had a direct financial interest in relation to a comment made regarding the under spend against the core delegated co- commissioning budget. They declared this as soon as it emerged and it was agreed that they would take no further part in that specific discussion.)
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RW presented a report updating the Committee on the primary care budgets and actual expenditure at Month 10.
RW informed the Committee that the CCG had received an additional system development funding of £0.813m, and table 2 outlined how this had been allocated.
At month 10, the CCG was forecasting to spend £44.358m against an annual budget of £44.806m, resulting in a favourable variance of £0.448m. The CCG was forecasting an under spend of £0.274m against its core delegated co- commissioning budget of £36.330m. This was as a result of the release of prior year accruals, of which the main contributing factor was an under spend in respect of PMS Premium funding of £0.194m.
(JL joined the meeting.)
BJ stated that this under spend was contentious, and that in his opinion the CCG should get the money out to provider services. He highlighted that the GH approach was inconsistent with the approach taken in North Kirklees and Wakefield CCGs.
(JC and SO declared direct financial interests in this specific issue, and it was agreed that they would take no further part in that specific discussion.)
ICu stated that he had met with BJ and considered this point, however he did not feel personally able to support it. He pointed out that it was an under spend of £274k against a budget of £36m, and that in the previous year there had been an over spend of £140k which had not then been taken off the total. Each year the CCG aimed to spend the budget in the best possible way, but a small under spend on the budget was not unrealistic.
ICu went on to explain that there were differentials present, which Equitable Funding would go some way towards addressing. He added that NK had a scheme in place due to the Mid Yorkshire acute footprint, and the larger backlog of referrals, while GH linked to CHFT and therefore there were smaller referral numbers involved. He stated that it would be difficult to pick up the NK scheme and drop it in to GH at this point in the year.
CW added that 2020/21 had not been a typical year, and that the CCG had gone above and beyond it’s commitment to protect primary care income during the year.
BJ stated that he felt it unfair that GH practices had been given no credit for the work carried out with secondary care.
(JC and SO ‘rejoined’ the meeting. DL joined the meeting.)
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RW drew attention to Table 4 in the paper, which showed the primary care COVID- 19 budgets of £1.665m and forecast expenditure of £1.497m. Following a question, it was clarified that the LMC had received an allocation of £5k per CCG in respect of additional costs incurred through extra meetings in the first six months of the pandemic.
Finally, RW informed the Committee that all practices had now signed up to Equitable Funding, with the exception of two practices that were subject to specific financial arrangements i.e. time limited PMS and APMS contracts.
The Primary Care Commissioning Committee: NOTED the contents of the report.
058 Contracting Update
MP introduced the paper, which provided an update to the Committee on a number of contracting issues about which it had been felt that the Committee should be aware.
He highlighted the following points: Changes to the policy and guidance manual to reflect ongoing development and changes in the commissioning and contractual management landscape. GP Online Consultation Software - NHS Digital advice was to not enter into any new procurement during 2020 until a new framework was released for both online and video consultation. Therefore there was a requirement to consider aligning the E-Consult Health Ltd contract by extension until the end of March 2022. National contract variations - The Standard Medical Services Contract Variation Notices for GMS, PMS and APMS contracts had been published in December 2020. Extended Access - Following approval at December’s Governing Body meeting, the Extended Access service commissioned from LCD would be extended. This would be enacted via a direct award of a new contract for 12 months from 1 April 2021.
MP confirmed that the national contract variations should not have any implications for any incorporation requests previously received, as the CCG had asked for assurances above and beyond the original guidance.
The Committees were also informed that online training was now available following the changes to the policy and guidance manual, including the topic of incorporation.
IA asked whether the Big Word Interpreting Service was able to do three-way consultations, with the majority of consultations now taking place virtually rather than face to face.
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ACTION: MP/JL to check whether The Big Word supported three-way consultations.
The Primary Care Commissioning Committee:
RECEIVED and NOTED the Contracting Update.
059 Primary Care Dashboard Quarterly Update (All practice representatives had declared a direct non-financial professional interest in this item as it monitored the performance of each practice. As this was a generic high level discussion, the potential conflict was noted, and everyone allowed to fully participate. This would be kept under review, if discussions moved onto specific practices.)
DL introduced the paper, which provided an update on developments to the dashboard, highlighted data of note to the Committee, and outlined the application of the dashboard in supporting the CCG to fulfil its delegated duties.
DL pointed out that the screening data in the dashboard dated back to October 2020 as there was a reporting lag, but that the Practice Support team had been working with practices to ensure screening was taking place.
DL highlighted a slowly improving picture for Physical health checks for people living with severe mental illness (SMI).There had also been an improvement in relation to childhood immunisations.
A slight improvement was evident in relation to Learning Disability Healthchecks, but practices were still falling behind the 75% target. Vicky Dutchburn was reported to be working on a supportive plan for practices in order to help them to achieve the target. JC stated that her practice had focussed on meeting the target, but that COVID-19 did make this harder. She also added that it was not possible to indicate on the clinical system that a Learning Disability Healthcheck had been carried out.
It was agreed that the Learning Disabilities cohort presented multiple challenges, and that alternative approaches may be needed to ensure that the healthchecks were taking place.
BJ stated that the LMC wanted a data sharing agreement in order for the dashboard to be shared across practices, but DL pointed out that all GH practices were already signed up to a data sharing agreement and the dashboard was published on the intranet on a monthly basis. This meant that each practice’s data was fully visible, and also shared within PCNs.
The Primary Care Commissioning Committee:- NOTED the contents of the report.
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(LG joined the meeting.)
060 COVID-19 and Vaccination Update
CW gave a presentation which updated the Committee on the progress of the vaccination campaign locally.
CW stated that the sites were currently vaccinating those in the Joint Committee on Vaccination and Immunisation (JCVI) priority cohort 6, high risk adults under 65 years of age. JC reported that her practice had been told to focus on cohort 6, as the larger sites such as the John Smiths Stadium were targeting cohort 5 (65-70 year olds). SO queried the consistency of which cohorts were being targeted across the patch, and suggested that CW check with the Clinical Directors who they were calling in at present. ACTION: CW to check with each Clinical Director which cohort they were currently calling for vaccination, to ensure a consistent approach was being followed.
It had been flagged that the Cathedral House site was due to be used for vote counting in the upcoming local elections, although CW was confident that plans could be made to work around this.
IA enquired whether the local figures suggested an increase in the uptake of the vaccination in the BAME population. CW stated that several conversations had taken place, especially within the Greenwood PCN, regarding the low uptake and alternative routes for reaching the population, such as through reminders at Friday prayers and pop-up clinics near mosques. Although the BAME population had shown a lower uptake of the vaccination, the numbers of those receiving it were still significant and higher than those for the flu vaccination. ACTION: It was agreed that the Committee would receive an update on the impact of community champions on vaccine uptake at the next meeting.
SO called for action over pop-up clinics, as the CCG had been discussing them for several weeks now. He also suggested that there should be a point when primary care were told to stop sending patients to Cathedral House, and refocus on delivering primary care instead, with other options continuing to be available for vaccinations such as the John Smiths Stadium and Community Pharmacy. CW stated that she thought this point would be set nationally, and until then the DES was still being delivered in line with the national guidance.
BJ raised a question around transportation of the vaccine to GP sites, and LG stated that the issue of moving vaccines had been raised nationally. Currently the national stance remained to minimise the movement of vaccine wherever possible.
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LG had also pushed back about whether the vaccine could be used after 24 hours, but was awaiting a response. She did not anticipate that transportation between sites would get easier in the near future.
The Primary Care Commissioning Committee: NOTED the verbal update.
061 Primary Care Network Additional Roles Reimbursement Scheme – Underspend Proposals (Since issuing the papers, following advice from NHS England, it had been agreed that a discussion would not be held on this item. Therefore there was no conflict to manage within the meeting.)
CW referred to the paper which had been circulated prior to the meeting, which had described some slippages in recruitment of the additional roles and put forward proposals to support the under spend. CW stressed that there had been no definitive national guidance on this at the point the PCNs had put the proposals together. DG, on behalf on NHSE, had advised that further discussions take place with the PCNs to ensure that the CCG continued to work within the parameters of the scheme. It had therefore been suggested that the item be taken to an urgent decision meeting following those discussions, rather than being discussed further in this meeting.
The Primary Care Commissioning Committee: AGREED with the proposal to take the Additional Roles Reimbursement Scheme Decision to an urgent decision meeting, once further discussions had taken place with the PCNs.
(LG left the meeting.)
062 Review of Keldregate – branch surgery of B8528 The Grange Group Practice
JG introduced the report which asked the Committee to consider an application from the practice to remain closed for a further period of six months.
JG acknowledged the limitations of the Keldregate premises during the COVID-19 pandemic, but felt that the requested six months was too long. She advised that the practice had taken a number of actions to support access for patients who had previously used the Keldregate branch surgery.
SO pointed out that the premises issues were not unique to Keldregate, and stressed that there was no other provision in the immediate local area if the branch site remained closed. It was acknowledged that building work in the Bradley area may also have an impact on the practice.
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BJ stated that the PCNs were due to carry out a full estates review, and that the Keldregate issue should be considered in the context of the Greenwood PCN as a whole.
It was noted that two outstanding actions remained on the Committee’s action log in relation to the practice, for the IPC team to be asked to visit the premises prior to the next review, and for Healthwatch to check if any feedback had been received from patients regarding Keldregate.
The Committee considered that three months was a considerable period in light of the pandemic, and agreed that restrictions and social distancing rules may have changed before the review period had passed.
The practice had previously made clear their intention to look at the long term future of the branch site, but the Committee was clear that the proper process as outlined in the Policy and Guidance Manual would be followed in relation to that. The practice was therefore in the process of developing a patient engagement document regarding the longer term plans. The Committee’s role today focussed on the short term limitations of the site in relation to the pandemic.
Concerns were raised regarding the timeline for the patient engagement process around the longer term plans for the branch site, and JG confirmed that she had requested further information on this.
The Primary Care Commissioning Committee: REVIEWED the application for the continued temporary closure of Keldregate – branch surgery of B8528 – The Grange Group Practice. SUPPORTED the temporary closure of Keldregate due to the limitations of the premises during the Covid-19 Pandemic. APPROVED the extension of the temporary closure for a further three months rather than the six months requested by the practice. AGREED to undertake a further review in May 2021.
063 University Quality Outcomes Framework
JL introduced the report which sought the Committee’s approval for an extension to the current funding for the 2021/22 local Quality Outcomes Framework (QOF) for the University Health Centre.
JL explained that in February 2020 the Committee had approved the proposed 2020/21 scheme for a period of twelve months with the agreement that a Task and Finish Group would convene in order to review the scheme and make further recommendations for any future indicators to be included or removed, and to ensure that any new scheme would support the health and wellbeing of registered patients
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whilst also being appropriate and achievable for the practice. However, due to the pandemic there hadn’t been the opportunity to progress the work as intended.
The paper proposed a twelve month extension to the current 2020/21 scheme, along with an uplift in line with the list size increase over the year of 1.1%. This would allow further work to be undertaken to design a new scheme for 2022/23.
IA stressed that the review should be started in September 2021, due to the amount of work involved.
BH asked whether students not attending the University this year due to the pandemic had affected the scale of the uplift. JL stated that it was lower due to fewer new students registering with the practice but that the practice had not questioned the proposed uplift in the proposal. It was acknowledged that the list size may increase as students returned to University.
SO pointed out that there had been a 3% uplift on the standard QOF, compared to the 1.1% in the proposal for the University practice. A comparative uplift had been considered, but it had been agreed that it was a well-funded scheme for what the practice achieved, and in addition the University practice was able to access some of the normal QOF.
(MP left the meeting.)
ICu added that the practice had a separate scheme as they were not able to access all of the standard QOF, but that it was also included in the disadvantaged practice scheme which would be continuing for 2021/22. He stated that the Equitable Funding review had been applied to all other practices, and that a review of the total funding of the University practice was needed over the next 12 months. This would form part of the role of the Task and Finish Group.
The Primary Care Commissioning Committee: APPROVED the twelve month extension to the current local enhanced scheme (QOF) of £144,693 for the year 2021/22.
064 Notification of Urgent Decisions
LE introduced the paper which outlined the urgent decision processes which had been put in place as a result of the COVID-19 pandemic.
She reported that since the last meeting of the Committee, the urgent decisions process had been used on one occasion in Greater Huddersfield. This had been for the following reason: - February 21 Review - Provision of Kirklees Essential Domains, Local Enhanced Services and PMS Premium Schemes During Covid-19
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The urgent decisions process would remain available, although as from 30 November 2020 meetings were no longer being routinely scheduled. Notification of any decisions taken would continue to be reported to the Committee, and would also be published on the CCG’s website.
The Primary Care Commissioning Committee: NOTED the urgent decisions taken under the urgent decision procedure.
065 Date and Time of Next Meeting
The first meeting of the Kirklees Primary Care Commissioning Committee had provisionally been scheduled for 9.00 am on Wednesday 28 April 2021, via Microsoft Teams.
The Primary Care Commissioning Committee then RESOLVED: “That the press and public be excluded from the meeting during the consideration of the remaining items of business as they contain confidential information as set out in the criteria published on the CCG’s website, and the public interest in maintaining the confidentiality outweighs the public interest in disclosing the information.”
The public part of the meeting concluded at 10.52 am.
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Minutes of NHS North Kirklees CCG Primary Care Commissioning Committee Meeting held at 09.00am on 10 March 2021 as a VIRTUAL meeting
Present:
Members Hilary Thompson (Chair) (HT) Lay Member, Finance and Remuneration (Chair of meeting) Ian Currell (ICu) Chief Finance Officer Beth Hewitt (BH) Lay Member, Patient and Public Involvement (minutes 61-65) Dr Oliver Hirst (OH) Independent GP Advisor Dr Abid Iqbal (AI) Independent GP Advisor Carol McKenna (CM) Chief Officer Martin Wright (MW) Lay Member, Audit & Governance
In Attendance Laura Ellis (LE) Head of Corporate Governance Dr N Chandra (NC) LMC Representative Joanne Davis (JD) Senior Primary Care Support Manager Dr Nadeem Ghafoor (NG) Governing Body – GP Member Dawn Ginns (DG) NHS England representative Stacey Appleyard (SA) Healthwatch Representative Dr Mohammed Hussain (MH) Chair, Council of Members John Laville (JL) Patient Representative Dr Khalid Naeem (KN) Governing Body – GP and Clinical Chair Martin Pursey (MP) Head of Contracting and Procurement Sarah Sowden (SS) Governing Body – Advanced Nurse Practitioner Rob Willis (RW) Head of Financial Reporting and Accounting Penny Woodhead (PW) Chief Quality and Nursing Officer Catherine Wormstone (CW) Head of Primary Care Strategy and Commissioning
Minutes Helen Robinson (HR) Governance Officer
Apologies - One member of the public and one member of practice staff were in attendance.
56 Welcome, Apologies and Declarations of Interest
The Chair opened the meeting. There were no apologies for absence.
Draft (Public) Minutes – NK Primary Care Commissioning Committee –10 March 2021
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Conflicts of Interest
Minutes of last meeting (Minute 58) – Members of the Committee had declared interests in Primary Care Network Additional Roles Reimbursement Scheme (Minute 50) and Notification of Urgent Decisions (Minute 52) at the last meeting. As the minutes were being reviewed for accuracy, the potential conflict was noted and no further action was required.
Primary Care Dashboard (Minute 63) - All practice representatives and GPs declared a direct non-financial professional interest in this item as it monitored the performance of each practice. As this was a generic high level discussion, the potential conflict was noted, and everyone allowed to fully participate. This would be kept under review, if discussions moved onto specific practices.
Notification of Urgent Decisions (Minute 64) – Practice representatives and GPs declared a direct financial interest in the urgent decision notified, however it was being brought for notification and assurance only, it was agreed that no further steps were needed to manage the conflict.
57 Visions and Values
The NK Values and Behaviours had been circulated with the agenda and were noted.
58 Accuracy of Minutes of the last Meeting held on 13 January 2021, Matters Arising and Action Log (Members of the Committee had declared interests in Primary Care Network Additional Roles Reimbursement Scheme (Minute 50) and Notification of Urgent Decisions (Minute 52) at the last meeting. As the minutes were being reviewed for accuracy, the potential conflict had been noted and no further action was required.)
The minutes of the meeting held on 13 January 2021 were APPROVED as a correct record.
The Action Log was reviewed as follows:-
50 – Primary Care Network Additional Roles Reimbursement Scheme – CW/JG to circulate a summary of each of the ARRS roles to Committee members. Update 10/03/21: In progress. CLOSED
There were no matters arising.
59 Review of Branch Closure Arrangements
JD presented a report updating the Committee on the status of the temporary closure of some of the North Kirklees practice branch sites. Draft (Public) Minutes – NK Primary Care Commissioning Committee –10 March 2021
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It was noted that the Brewery Lane branch surgery at The Sidings practice had reopened on 1 March 2021.
The Committee was also informed that the temporary closure of the Bond Street Branch of Wellington House Surgery would continue until 14 May 2021, due to the premises being unsuitable for use due to COVID 19 restrictions and guidance still in place at this time.
JD then brought the Committee’s attention to York House, the branch surgery of Cherry Tree Practice, which had been closed since the start of the pandemic in March 2020. JD stated that, disappointingly, the CCG had only recently been made aware of this temporary closure. There had reportedly been no notice on the surgery door, and no mention of the closure on the practice website, and so concerns were raised around whether patients had been made aware of the closure.
Cherry Tree Surgery were now requesting retrospective approval from the CCG in relation to the branch closure, which was stated to be due to social distancing guidance not being able to be followed in York House building.
It was agreed that JD would work with the practice to ensure they were aware of the correct procedures going forward.
KN queried whether a longer term strategy was required for Gomersall and Birkenshaw, considering the impact of several branch sites being closed in this area. CW responded by stating that the CCG had secured a resource to carry out a full PCN estates review. However, CW clarified that the closures under discussion today were due to the impact of COVID-19 guidelines and procedures, and not due to unsuitable premises per se.
The Primary Care Commissioning Committee: 1. REVIEWED the updates on temporary branch closure arrangements provided for the following practices: - B85015 Wellington House Surgery – branch at Bond Street - B85652 The Sidings – branch at Brewery Lane. 2. SUPPORTED until 14 May 2021 the continuation of the temporary branch closure at B85015 Wellington House – branch at Bond Street which was unable to safely and efficiently re-open due to premises limitations. 3. NOTED that the branch surgery (Brewery Lane) at B85652 The Sidings had re- opened on 1 March 2021. 4. AGREED retrospective approval for the temporary branch closure at B85655 Cherry Tree Surgery, branch at York House, until 14 May 2021, which was unable to safely and efficiently re-open due to premises limitations. Draft (Public) Minutes – NK Primary Care Commissioning Committee –10 March 2021
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5. AGREED that the decision to support the continuation of the temporary branch closures would be reviewed again at the next meeting of the Kirklees Primary Care Commissioning Committee, or on a change in the national standard operating procedure.
60 COVID-19 and Vaccination Update
CW gave a presentation which updated the Committee on the progress of the vaccination campaign locally.
CW stated that good progress was being made with vaccinating those in the Joint Committee on Vaccination and Immunisation (JCVI) top 6 priority cohorts, alongside commencing second doses, and around 139,000 vaccinations had been delivered across Kirklees to date, with 60,000 of those being in NK.
The Prime Minister’s recent visit to the Al-Hikmah vaccination centre had been very positively received.
With regards to health inequalities and the focus on the BAME population, support was being received from Local Authorities and Community Champions.
The CCG was currently considering setting up pop up sites close to religious venues.
Moving vaccines between sites continued to be a challenge, but a process for this was now in place.
The main challenge faced by Primary Care was now maintaining business as usual, alongside continuing to deliver the vaccination campaign.
The Primary Care Commissioning Committee: NOTED the verbal update.
(BH joined the meeting.)
61 Primary Care Budgets/Financial Update
RW presented a report updating the Committee on the Primary Care Co- Commissioning (PCCC) budgets and forecast out-turn expenditure at Month 10.
RW reported that the CCG had received budgets for primary care for the year of £36.205m. Table 1 showed a movement of £822k within the Primary Care budget, which included additional system development funding of £633k which was then broken down further in table 2.
RW explained that the CCG had allocated funds to the Co-commissioning budget of £107k from the equitable funding reserve which had been planned for following Draft (Public) Minutes – NK Primary Care Commissioning Committee –10 March 2021
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implementation of Tier 1 and 2 elements in October 2020. The finance team had also worked to align budgets resulting in additional COVID-19 allocations being allocated to COVID schemes of £171k and a reduction in CCG held budgets of £0.089m.
The Committee was informed that at month 10, the CCG was forecasting spending £35.918m against an annual budget of £36.205m resulting in a favourable variance of £288k. Further to this, the CCG was forecasting that it would overspend against its planned expenditure on COVID costs by £35k.
RW added that some lines would need to be reviewed in light of becoming a new CCG.
JL asked whether there had been any tangible benefits from the non-recurrent schemes that had been implemented, and practice representatives stated that MJOG and Ardens had been particularly useful resources during the pandemic.
RW updated the Committee regarding the numbers of practices that had signed up to Equitable Funding from 1 October 2020. All but 6 PMS practices had opted in from October, but it would apply to all practices except the APMS practice from 1 April 2021.
Finally, RW stated that regime announcements were being awaited before anything could be brought to Committee regarding future financial plans.
The Primary Care Commissioning Committee: NOTED the contents of the report.
62 Contracting Update
MP introduced the paper, which provided an update to the Committee in respect of a number of contracting issues that it was felt that the Committee should be aware of.
MP drew attention to an error in section 6.1 of the report, which wrongly stated that 7 practices had elected to have the equitable funding variation effective from 1 April 2021, when in fact it was only 6.
MP highlighted the changes that had been made to the policy and guidance manual to reflect ongoing development and changes in the commissioning and contractual management landscape. A link to the manual was shared during the meeting, and would be circulated via the primary care bulletin.
The Primary Care Commissioning Committee:
RECEIVED and NOTED the content of the Contracting Update.
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63 Primary Care Dashboard Quarterly Update (All practice representatives and GPs had declared a direct non-financial professional interest in this item as it monitored the performance of each practice. As this was a generic high level discussion, the potential conflict was noted, and everyone allowed to fully participate. This would be kept under review, if discussions moved onto specific practices.)
JD introduced the paper, which provided an update on developments to the dashboard, highlighted data of note to the Committee, and outlined the application of the dashboard in supporting the CCG to fulfil its delegated duties.
JD informed the Committee that the dashboard had not altered much since the last update in November 2020.
The Committee was informed that as a result of the latest wave of the pandemic and the demands on practices as a result of the roll out of the vaccination programme, no further assurance visits had taken place, although the Primary Care team had given both informal and formal support to practices when required.
JL commented on the poor performance highlighted in relation to ‘Physical health checks for people living with severe mental illness (SMI)’. Various practice representatives provided assurances that the CCG was not an outlier in this area, that there had been data quality issues, and that if all 9 elements weren’t completed the system would show as if nothing had been done rather than the elements that had. OH added that he was aware that practices had made efforts to carry out the health checks. It was suggested that the Operational Group consider carrying out a deep dive in this area. It was also highlighted that community champions and voluntary sector organisations could play a role in reaching this population.
The Primary Care Commissioning Committee:- NOTED the contents of the report, and did not identify any areas for discussion or further assurance.
64 Notification of Urgent Decisions (Practice representatives and GPs had declared a direct financial interest in the urgent decision notified, however as it was being being brought for notification and assurance only, it had been agreed that no further steps were needed to manage the conflicts.)
LE introduced the paper which outlined the urgent decision processes which had been put in place as a result of the COVID-19 pandemic.
She reported that since the last meeting of the Committee, the urgent decisions process had been used on one occasion in North Kirklees. This had been for the following reason:
Draft (Public) Minutes – NK Primary Care Commissioning Committee –10 March 2021
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- February 21 Review - Provision of Kirklees Essential Domains, Local Enhanced Services and PMS Premium Schemes During Covid-19 .
The urgent decisions process would remain available, although as from 30 November 2020 meetings were no longer being routinely scheduled. Notification of any decisions taken would continue to be reported to the Committee, and would also be published on the CCG’s website.
The Primary Care Commissioning Committee: NOTED the urgent decision taken under the urgent decision procedure.
65 Date and Time of Next Meeting
The first meeting of the Kirklees Primary Care Commissioning Committee had provisionally been scheduled for 9am on Wednesday 28 April 2021, via Microsoft Teams.
The Primary Care Commissioning Committee then RESOLVED: “That the press and public be excluded from the meeting during the consideration of the remaining items of business as they contain confidential information as set out in the criteria published on the CCG’s website, and the public interest in maintaining the confidentiality outweighs the public interest in disclosing the information.”
The public part of the meeting concluded at 10.01 am.
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GH and NK ACTION LOGS PRIMARY CARE COMMISSIONING COMMITTEE 2020/21 (Public) Date Action Owner Action Due Date Progress Status Raised Ref (Initials) Review of the opening arrangements for Keldregate - branch surgery of B8528 – The Grange Group Practice during the COVID-19 pandemic 28.10.20 39a PW Feb 21 OPEN IPC team to be asked to visit the premises prior to the next review, and provide feedback.
Review of the opening arrangements for Keldregate - branch surgery of B8528 – The Grange Group Practice during the COVID-19 pandemic 28.10.20 39b HH Dec 20 OPEN HH to check if any feedback had been received by Healthwatch from patients regarding Keldregate.
Contracting Update MP/JL to check whether The Big Word 24.02.21 58 MP/JL April 21 OPEN supported three-way consultations.
COVID-19 and Vaccination Update CW to check with each Clinical Director which cohort they were 24.02.21 60a currently calling for vaccination, to CW April 21 OPEN ensure a consistent approach was being followed. 23 COVID-19 and Vaccination Update It was agreed that the Committee would receive an update on the 24.02.21 60b impact of community champions on CW April 21 OPEN vaccine uptake at the next meeting.
24 NHS England and NHS Kirklees Clinical Commissioning Group Primary Care Commissioning Committee Terms of Reference
Version: 1.0
Approved by: Governing Body
Date Approved 14 April 2021
Date issued: 14 April 2021
Guidance and advice: Terms of reference produced using the NHS England Model terms of reference for delegated commissioning arrangements. Page 1 of 15 25 Contents 1. Introduction ...... 3 2. Statutory Framework...... 3 3. Roles and Responsibilities of the Committee ...... 4 4. Membership ...... 5 5. Meetings and Voting ...... 7 6. Accountability of the Committee ...... 9 7. Decisions ...... 10 8. Conduct of the Committee ...... 10 9. Reporting Arrangements ...... 11 10. Review of Terms of Reference ...... 11 Annex A – Delegation Document ...... 12
Page 2 of 15 26 1. Introduction
1.1. NHS England has invited Clinical Commissioning Groups (CCGs) to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG’s preference for how it would like to exercise expanded primary medical care commissioning functions. NHS Kirklees CCG has applied for full delegation of the primary medical services commissioning functions.
1.2. In accordance with its statutory powers under Section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in the Delegation document annexed to these Terms of Reference to NHS Kirklees CCG.
1.3. The CCG has established the Primary Care Commissioning Committee (‘Committee’). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.
2. Statutory Framework
2.1. NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Annex A: Delegation document, in accordance with Section 13Z of the NHS Act.
2.2. Arrangements made under Section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the NHS England Board and the CCG.
2.3. Arrangements made under Section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:
a) Management of conflicts of interest (Section 14O)
b) Duty to promote the NHS Constitution (Section 14P)
c) Duty to exercise its functions effectively, efficiently and economically (Section 14Q)
d) Duty as to improvement in quality of services (Section 14R)
e) Duty in relation to quality of primary medical services (Section 14S)
Page 3 of 15 27 f) Duties as to reducing inequalities (Section 14T)
g) Duty as to promote the involvement of each patient (Section 14U)
h) Duty as to patient choice (Section 14V)
i) Duty as to promoting integration (Section 14Z1)
j) Public involvement and consultation (Section 14Z2)
2.4. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:
a) Duty to have regard to impact on services in certain areas (Section 13O)
b) Duty as respects variation in provision of health services (Section 13P)
2.5. The Committee is established as a committee of the Governing Body of NHS Kirklees CCG in accordance with Schedule 1A of the NHS Act.
2.6. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.
3. Roles and Responsibilities of the Committee
3.1. The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary medical care services in Kirklees, under delegated authority from NHS England.
3.2. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and NHS Kirklees CCG, which will sit alongside the delegation and terms of reference.
3.3. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.
3.4. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under Section 83 of the NHS Act.
3.5. This includes the following:
GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing breach/remedial notices, and removing a contract).
Page 4 of 15 28 Newly designed enhanced services (‘Local Enhanced Services’ and ‘Directed Enhanced Services’).
Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF).
Decision making on whether to establish new GP practices in an area.
Approving practice mergers.
Making decisions on ‘discretionary’ payment (e.g. returner/retainer schemes).
3.6. The CCG will also carry out the following activities:
Plan, including needs assessment, primary medical care services in Kirklees.
Undertake reviews of primary medical care services in Kirklees.
Coordinate a common approach to the commissioning of primary care services generally.
Have oversight and review the financial plans for primary medical care services in Kirklees.
Take procurement decisions in respect of primary medical services. These shall be in line with statutory requirements and guidance, the CCG’s Constitution and Standing Orders and the Delegation Agreement between NHS England and the CCG.
4. Membership
4.1. The Committee shall consist of:
Core membership:
Lay member leading on patient and public involvement
Lay member leading on audit, governance and conflict of interest
Lay member leading on finance and remuneration
Chief Officer
Chief Finance Officer (or nominated deputy)
Page 5 of 15 29 Chief Quality & Nursing Officer (or nominated deputy)
Two External Independent Advisors (non-conflicted and external GPs)
Required attendees:
Head of Primary Care Support & Development (or nominated deputy)
Head of Contracting & Procurement (or nominated deputy)
Head of Corporate Governance (or nominated deputy)
Representative of NHS England
4.2. Other individuals shall be required to attend according to the business being considered by the Committee.
4.3. The Committee may invite such other person(s) to attend all or any of its meetings, or part(s) of a meeting, in order to assist it in its decision-making and in its discharge of its functions as it sees fit. Any such person may speak and participate in debate, but may not vote.
4.4. The Committee will invite the following to appoint a representative to attend its meetings and participate in the way described in paragraph 4.3:
Health & Well-Being Board
Local Healthwatch
Council of Members
Local Medical Committee (2 representatives – one from Huddersfield Division and one from Dewsbury Division)
Patient Group Representative
4.5. The Committee will also invite 3 Governing Body GP Members/Other Primary Care Professional Practice Members (including at least 2 GPs) to attend its meetings and participate in the way described in paragraph 4.3.
4.6. Substitutions
Committee members with substitutes listed above may be substituted by that person only. For a substitution to take effect, the Chair of the Committee shall be notified in advance of the meeting. The substitution will be recorded in the minutes.
Page 6 of 15 30 4.7. Chairing
The Chair and Vice Chair of the Committee will be appointed from the Lay Member: PPI and Lay Member: Finance and Remuneration.
5. Meetings and Voting
5.1. The Committee will meet bi-monthly, with additional meetings scheduled if required.
5.2. The Committee shall adopt the Standing Orders of NHS Kirklees CCG insofar as they relate to the:
a) Notice of the Meetings
b) Handling of Meetings
c) Agendas
d) Circulation of papers
5.3. For the avoidance of doubt, in the event of any conflict between the terms of the Delegation and Terms of Reference and the Standing Orders or Standing Financial Instructions of any of the members, the Delegation will prevail.
5.4. Conflicts of Interest
If any member has an interest, financial or otherwise, in any matter and is present at the meeting at which the matter is under discussion, he/she will declare that interest as early as possible and act in accordance with the CCG’s Conflicts of Interest Policy and Constitution.
5.5. Voting
In line with the CCG’s Standing Orders, it is expected that decisions will be reached by consensus. Should this not be possible, then a vote of members will be required, the process for which is set out below:
Majority necessary to confirm a decision – simple majority of those present and voting
Casting vote – Chair
Dissenting views – dissenting views must be recorded in the minutes
Page 7 of 15 31 5.6. Quoracy
5.6.1. The Committee will be quorate with four members present; this must include:
Two from: Lay Member (Audit and Governance), Lay Member (Patient and Public Involvement), and Lay Member (Finance and Remuneration). This must include the Chair or Vice-Chair.
One External Clinical Advisor.
At least one of the following: Chief Officer, Chief Finance Officer or Chief Quality and Nursing Officer.
5.6.2. Members of the Committee may participate in meetings by telephone or by the use of video conferencing facilities where they are available and with prior agreement from the Chair. Participation by any of these means shall be deemed to constitute presence in person at the meeting.
5.6.3. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interest, the chair of the meeting shall consult with the Accountable Officer on the action to be taken.
5.7. Admission of the Public and Press
5.7.1. Meetings of the Committee shall, subject to the application of 5.6.2, be held in public.
5.7.2. The Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.
5.8. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.
Page 8 of 15 32 5.9. Secretariat
Support to the Committee will be provided by the CCG’s Governance & Corporate Team. Duties will include:
Agreement of the agenda with the Chair.
Circulation of agendas and supporting papers to Committee members five working days prior to the meeting.
Drafting of minutes for approval by the Chair within five working days of the meeting
Keeping an accurate record of attendance.
Matters arising and issues to be carried forward.
Maintaining an ongoing list of actions, specifying members responsible, due dates and keeping track of these actions.
Advising the Committee on pertinent areas/issues.
Enabling the development and training of members.
6. Accountability of the Committee
6.1. The Committee has delegated authority from the Governing Body to make decisions within the bounds of its remit. Specifically:
Financial plans in respect of primary medical services.
Procurement of primary medical services.
Practice payments and reimbursement.
Investment in practice development.
Contractual compliance and sanctions.
6.2. The decisions of the Committee shall be binding on NHS England and NHS Kirklees CCG.
6.3. The Committee is authorised by the Governing Body to investigate any activity within its terms of reference. It is authorised to seek any information it requires within its remit, from any employee of NHS Kirklees CCG or member of the
Page 9 of 15 33 Governing Body, and they are directed to co-operate with any reasonable request made by the Committee.
6.4. The Committee is authorised by the Governing Body to commission reports or surveys it deems necessary to help fulfil its obligations, within the budget available.
6.5. In exceptional cases, the Committee is authorised to obtain legal or other independent professional advice and secure the attendance of advisors with relevant expertise if it considers this necessary. In doing so, the Committee must follow any procedures put in place by the Governing Body for obtaining legal or professional advice. The Governing Body is to be informed of any issues relating to such action.
6.6. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.
7. Decisions
7.1. The Committee will make decisions within the bounds of its remit.
7.2. The decisions of the Committee shall be binding on NHS England and NHS Kirklees CCG.
7.3. The Committee will produce an executive summary report which will be presented to West Yorkshire and Harrogate Locality Team of NHS England and the Governing Body of NHS Kirklees CCG each quarter for information.
8. Conduct of the Committee
8.1. All members will have due regard to and operate within the Constitution of the CCG, Standing Orders, Standing Financial Instructions and other financial procedures.
8.2. Members of the Committee will abide by the ‘Principles of Public Life’ (The Nolan Principles) and the NHS Code of Conduct.
8.3. Members of the Committee shall respect confidentiality requirements as set out in the CCG’s Constitution.
Page 10 of 15 34 8.4. The Committee will undertake an annual self-assessment of its own performance against the terms of reference. Any resulting changes to the terms of reference should be submitted for approval by the Governing Body.
9. Reporting Arrangements
9.1. The Committee shall submit its minutes to West Yorkshire and Harrogate Locality Team of NHS England and the Governing Body of the CCG for information following each meeting. The Chair of the Committee shall draw to the attention of the Governing Body any issues that require disclosure to the full Governing Body, or require executive action.
10. Review of Terms of Reference
10.1. These terms of reference will be formally reviewed by the committee on an annual basis, but may be amended at any time.
10.2. Any proposed amendments to the terms of reference will be submitted to the Governing Body for approval. Changes will not be implemented until after an application to NHS England to vary the constitution has been agreed.
10.3. A record of the date and outcome of reviews is kept in the CCG’s Governance Handbook.
END
Page 11 of 15 35 Annex A – Delegation Document Delegation by NHS England
1 April 2021
Delegation by NHS England to NHS Kirklees CCG
Delegation
1. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended) (“NHS Act”), NHS England has delegated the exercise of the functions specified in this Delegation to NHS Kirklees CCG to empower NHS Kirklees CCG to commission primary medical services for the people of Kirklees.
2. NHS England and the CCG have entered into the Delegation Agreement that sets out the detailed arrangements for how the CCG will exercise its delegated authority.
3. Even though the exercise of the functions passes to the CCG the liability for the exercise of any of its functions remains with NHS England.
4. In exercising its functions (including those delegated to it) the CCG must comply with the statutory duties set out in the NHS Act and/or any directions made by NHS England or by the Secretary of State and must enable and assist NHS England to meet its corresponding duties.
Commencement
5. This Delegation, and any terms and conditions associated with the Delegation, take effect from 1 April 2021.
6. NHS England may by notice in writing delegate additional functions in respect of primary medical services to the CCG. At midnight on such date as the notice will specify, such functions will be Delegated Functions and will no longer be Reserved Functions.
Page 12 of 15 36 Role of the CCG
7. The CCG will exercise the primary medical care commissioning functions of NHS England as set out in Schedule 1 to this Delegation and on which further detail is contained in the Delegation Agreement.
8. NHS England will exercise its functions relating to primary medical services other than the Delegated Functions set out in Schedule 1 including but not limited to those set out in Schedule 2 to this Delegation and as set out in the Delegation Agreement.
Exercise of delegated authority
9. The CCG must establish a committee to exercise its delegated functions in accordance with the CCG’s constitution and the committee’s terms of reference. The structure and operation of the committee must take into account guidance issued by NHS England. This committee will make the decisions on the exercise of the delegated functions.
10. The CCG may otherwise determine the arrangements for the exercise of its delegated functions, provided that they are in accordance with the statutory framework (including Schedule 1A of the NHS Act) and with the CCG’s Constitution. 11 The decisions of the CCG Committee shall be binding on NHS England and NHS Kirklees CCG.
Accountability
12. The CCG must comply with the financial provisions in the Delegation Agreement and must comply with its statutory financial duties, including those under sections 223H and 223I of the NHS Act. It must also enable and assist NHS England to meet its duties under sections 223C, 223D and 223E of the NHS Act.
13. The CCG will comply with the reporting and audit requirements set out in the Delegation Agreement and the NHS Act. 14 NHS England may, at its discretion, waive non-compliance with the terms of the Delegation and/or the Delegation Agreement. 15 NHS England may, at its discretion, ratify any decision made by the CCG Committee that is outside the scope of this delegation and which it is not authorised to make. Such ratification will take the form of NHS England considering the issue and decision made by the CCG and then making its own decision. This ratification process will then make the said decision one which NHS England has made. In any event ratification shall not extend to those actions or decisions that are of themselves not capable of being delegated by NHS England to the CCG.
Page 13 of 15 37 Variation, Revocation and Termination
16. NHS England may vary this Delegation at any time, including by revoking the existing Delegation and re-issuing by way of an amended Delegation.
17. This Delegation may be revoked at any time by NHS England. The details about revocation are set out in the Delegation Agreement.
18. The parties may terminate the Delegation in accordance with the process set out in the Delegation Agreement.
Signed by ……………………………. Richard Barker NHS England Regional Director – North East & Yorkshire for and on behalf of NHS England
Page 14 of 15 38 Schedule 1 –Delegated Functions a) decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts, including but not limited to the following activities: i) decisions in relation to Enhanced Services; ii) decisions in relation to Local Incentive Schemes (including the design of such schemes); iii) decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices; iv) decisions about ‘discretionary’ payments; v) decisions about commissioning urgent care (including home visits as required) for out of area registered patients; b) the approval of practice mergers; c) planning primary medical care services in the Area, including carrying out needs assessments; d) undertaking reviews of primary medical care services in the Area; e) decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list); f) management of the Delegated Funds in the Area; g) Premises Costs Directions functions; h) co-ordinating a common approach to the commissioning of primary care services with other commissioners in the Area where appropriate; and i) such other ancillary activities as are necessary in order to exercise the Delegated Functions.
Schedule 2- Reserved Functions a) management of the national performers list; b) management of the revalidation and appraisal process; c) administration of payments in circumstances where a performer is suspended and related performers list management activities; d) Capital Expenditure functions; e) section 7A functions under the NHS Act; f) functions in relation to complaints management; g) decisions in relation to the GP Access Fund; and h) such other ancillary activities that are necessary in order to exercise the Reserved Functions;
Page 15 of 15 39 Primary Care Name of Meeting Meeting Date 28/04/2021 Commissioning Committee Primary Care Operational Title of Report Agenda Item No. 6 Group Terms of Reference Jan Giles Report Author Senior Primary Care Public / Private Item Public Manager Catherine Wormstone Dr Ibrar Ali/Dr Abid Iqbal Head of Primary Care Clinical Lead Independent Medical Responsible Officer Strategy and Advisors Commissioning
Executive Summary This paper presents the draft Terms of Reference for the Primary Care Operational Group (the group). The purpose of the group is to manage the functions delegated from NHS England and Improvement and to make recommendations to the Primary Care Commissioning Committee to ensure that the Clinical Commissioning Group fulfils its duties in respect of primary medical care.
Previous Considerations blank blank blank Name of meeting Meeting Date
Name of meeting Meeting Date
Recommendations It is recommended that the Primary Care Commissioning Committee :
1. Receives the report 2. Approves the Terms of Reference for the Kirklees Primary Care Operational Group (PCOG) 3. Provides recommendations about the Terms of Reference so that the group has an effective framework for delivering its responsibilities.
Decision ☒ Assurance ☐ Discussion ☒ Other:
Implications
Page 1 of 4
40 Quality and Safety implications (including The group provides assurance on delegated whether a quality impact assessment has responsibilities in terms of practice quality and been completed) receives quality alerts. Items of concern are escalated to Primary Care Commissioning Committee in accordance with the CCG’s Quality Assurance process. Engagement and Equality Implications Elements of the group’s work will include the (including whether an equality impact need for patient engagement and the assessment has been completed), and health consideration of equality and health inequalities inequalities considerations implications Resources / Financial Implications (including There are significant staffing resources required Staffing/Workforce considerations) to carry out the duties of the group.
Sustainability Implications None arising from this report
Has a Data Protection Impact Assessment Yes ☐ No ☐ N/A ☒ (DPIA) been completed?
Strategic Objectives All Risk (include risk None identified (which of the CCG number and a brief objectives does this description of the relate to?) risk) Legal / CCG None identified Conflicts of Interest None identified Constitutional (include detail of any Implications identified / potential conflicts)
Page 2 of 4
41
1. Introduction 1.1 This paper presents the draft Terms of Reference (TOR) for the Primary Care Operational Group (the group). The purpose of the group is to manage the functions delegated from NHS England and Improvement (NHSEI) and to make recommendations to the Primary Care Commissioning Committee (PCCC) to ensure that the Clinical Commissioning Group (CCG) fulfils its duties in respect of primary medical care.
2. Detail 2.1 The Primary Care Operational Group (PCOG) is a newly established group for Kirklees CCG. The purpose of the group is to manage the functions delegated from NHSEI and to ensure that the CCG fulfils its duties in respect of general practice. The group must have effective systems in place to support, monitor and report on the fulfilment of these duties.
2.2 The predecessor bodies in Kirklees CCG (North Kirklees CCG and Greater Huddersfield CCG) both had similar groups and the learning from these groups has been taken forward to inform the establishment and draft TOR for the Kirklees Primary Care Operational Group.
2.3 Proposed membership of the group provides links across teams within the CCG and with key external organisations (NHSEI and Public Health within the Local Authority) to ensure that gaps and duplications are minimised. The scope of membership ensures that practice quality, contracting and commissioning are effectively triangulated.
2.4 It is proposed that the Primary Care Operational Group should meet monthly. The meeting will take place the second Wednesday of each month so that issues that are due to be presented to the PCCC can be discussed and considered by the Primary Care Operational Group and the key points of the discussion can be used to inform papers for PCCC.
2.5 There are a number of key focus and engagement groups which should feed into the work of the Primary Care Operational group and the wider development agenda for Primary Care Networks. These support key areas of national and local primary care strategy and have a number of ‘deliverables’ in 2021/22. These should focus on :
Primary Care Workforce – Including the support and deployment of ARRS roles to PCNs Primary Care Infrastructure – Including Estates, Digital and IT.
2.6 Again, both predecessor CCGs had separate groups with varying membership and had their origins in NHS England GP Forward View (GPFV) structures. As the national GP Forward View strategy documents reach the end of their lifespan, both of these areas remain vital to the sustainability and resilience of primary care but with the added dimension of supporting the development of Primary Care Networks. It is proposed to
Page 3 of 4
42 establish two sub groups that will focus on the primary care elements of workforce and infrastructure for Kirklees. Whilst many aspects of work will link back to the remit of PCCC, they will also need to link with wider Kirklees strategic meetings that involve wider system partners and NHS England.
2.7 There may also be defined pieces of work, such as the re-procurement of a primary medical services contract, that would require the establishment of “task and finish” groups under the oversight of the Primary Care Operational Group. These will be established when necessary and progress updates provided to PCOG.
3. Next Steps 3.1 The discussion at PCCC and any recommendations will be taken to the Primary Care Operational Group and implemented.
4. Recommendations It is recommended that the Primary Care Commissioning Committee:
1. Receives the report 2. Approves the Terms of Reference for the Kirklees Primary Care Operational Group (PCOG) 3. Provides recommendations about the TOR so that the group has an effective framework for delivering its responsibilities.
5. Appendices Appendix 1 Draft Terms of Reference for the Primary Care Operational Group
Page 4 of 4
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NHS Kirklees Clinical Commissioning Group
Primary Care Operational Group
Terms of Reference
Version: 0.2
Responsible Officer: Catherine Wormstone
Date issued: April 2021
Review date: March 2022
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Change History
Version No. Changes Applied By Date 0.1 Initial draft prepared ready for PCCC JG 12.04.21 Change wording from quoracy to minimum 0.2 AI 14.04.21 attendees
Contents
1. Purpose 2. Membership 3. Responsibilities and key duties 4. Arrangements for the conduct of business 5. Reporting arrangements 6. Review
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NHS Kirklees Clinical Commissioning Group
Primary Care Operational Group
Terms of Reference
1. Purpose
The purpose of the Primary Care Operational Group (the group) is to manage the Primary Care functions delegated from NHS England and NHS Improvement and to make recommendations which feed into the Primary Care Commissioning Committee (PCCC) for approval as required. The group will ensure that the CCG fulfils its duties in respect of General Practice and Primary Care Networks and that there are effective systems in place to support, monitor and report on the fulfilments of these duties.
The group will provide leadership and strategic direction in relation to quality and development issues within General Practice and make recommendations. They will agree, undertake and monitor specific actions as and where appropriate on behalf of the CCG.
The group will be the link between Primary Care, Quality, Finance, Governance, Transformation, Medicines Management, Contracting & Procurement and Communications and Engagement in relation to Primary Care issues.
2. Membership
2.1 Internal – Kirklees CCG:
Area Role GB Independent Medical Advisors (Chair) Senior Primary Care Managers Primary Care Managers Primary Care Primary Care Officers
Performance Performance Manager Quality Quality Manager
Contracting & Procurement Senior Contracts Manager Primary Care ( or deputy) Finance Senior Finance Manager (or deputy) Medicines Management Medicines Management Advisor ( or deputy) Communications and Engagement Engagement Manager Transformation Leads for Transformation quarterly and as required.
2.2 In Attendance:
Area Role NHS England and NHS Primary Care Manager Improvement Public Health Public Health Manager (or deputy)
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3. Responsibilities and key duties
To review and act upon information from a range of sources To ensure that systems to monitor the quality of services are in place and are functioning appropriately To identify and review any relevant issues for Primary Medical Services and Primary Care Networks and escalate any issues requiring resolution as appropriate To maintain overview of RASCI approach To manage the process of full delegation from NHS England and NHS Improvement including keeping up to date with any subsequent changes and new responsibilities To identify areas of significant and unjustifiable variation and to take appropriate action in line with the CCG’s Quality Assurance Framework. To identify areas of training and support for practices in order to acquire the necessary skills to implement required improvements To identify areas for further discussion with the Patient Reference Group Network, Patient & Public Engagement group, LMC and others as appropriate.
4. Arrangements for the conduct of business
4.1 Chairing meetings
The group will be chaired by the CCG Medical Advisors who will alternate the chair role.
4.2 Minimum Attendees
Minimum requirement is Chair and 1 representative from each of: Primary Care Contracting Quality
4.3 Frequency of meetings
The group will meet monthly.
4.4 Declarations of interest
If any member has an interest, financial or otherwise, in any matter and is present at the meeting at which the matter is under discussion, they will declare that interest as early as possible and act in accordance with the CCG’s Conflicts of Interest Policy and Constitution.
All members receiving documents and participating in discussions for/during this meeting will be made aware that they should remain confidential and should not be shared outside the meeting.
5. Reporting Arrangements
Ratified minutes will be shared with the Primary Care Commissioning Committee and the Quality Committee.
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The group will report by exception to the CCG’s Senior Management Team.
Recommendations will be made to PCCC as appropriate.
6. Review
Review date March 2022.
END
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Kirklees Primary Care th Name of Meeting Meeting Date 28 April 2021 Commissioning Committee
Title of Report Finance Update Agenda Item No. 7 Robert Willis Head of Report Author Financial Reporting and Public / Private Item Public Accounting Clinical Lead Responsible Officer Chief Finance Officer
Executive Summary This report updates the committee on the following financial issues in respect of primary care expenditure: -
Primary care year-end budgets and out-turn positions for the two former CCGS at Month 12 (March 2021) which occurred pre-merger since these were last reported at month 10.
The process and timescales for the 2021-22 financial planning process which is currently taking place.
In line with an internal audit recommendation from their January 2020 Primary Care Co- Commissioning Audit of the former CCGs, this report highlights several late rent reviews for the attention of the committee.
Previous Considerations blank blank blank th Name of meeting Governing Body Meeting Meeting Date 14 April 2021
Finance, Performance and st Name of meeting Meeting Date 31 March 2021 Contracting Meeting
Recommendations It is recommended that the Primary care Commissioning Committee: -
Note the contents of the final budgets and out-turn expenditure for the two formed CCGs
Note the late primary care rent reviews which are overdue.
Note the planning process and timescales.
Decision ☐ Assurance ☒ Discussion ☒ Other:
Implications
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49 Quality and Safety implications (including Kirklees CCG is committed to an equitable and whether a quality impact assessment has consistent approach to funding the core services been completed) expected of all GP practices.
Engagement and Equality Implications N/A (including whether an equality impact assessment has been completed), and health inequalities considerations Resources / Financial Implications (including Outlined in the report Staffing/Workforce considerations)
Sustainability Implications N/A
Has a Data Protection Impact Assessment Yes ☐ No ☐ N/A ☒ (DPIA) been completed?
Strategic Objectives Primary Care Risk (include risk (which of the CCG Delegated Function number and a brief objectives does this Primary Care Strategy description of the GPFV relate to?) risk) Legal / CCG Mandated by NHSE Conflicts of Interest GP Representatives Constitutional Part of delegated (include detail of any Practice Manager Implications function of CCG identified / potential Representative
conflicts)
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50 1. Background
1.1 NHS England became responsible for the direct commissioning of primary medical services on 1 April 2013. Since then, following changes set out in the NHS Five Year Forward View, primary care co-commissioning has seen CCGs invited to take on greater responsibility for general practice commissioning, including full responsibility under delegated commissioning arrangements.
1.2 Where NHS England delegates its functions to CCGs, it still retains overall responsibility and liability for these and is responsible for obtaining assurances that its functions are being discharged effectively.
1.3 NHS Greater Huddersfield CCG entered delegated co-commissioning arrangements on 1 April 2016, whilst NHS North Kirklees CCG entered the same arrangements the following year on 1 April 2017.
1.4 These delegated co-commissioning arrangements have been transferred into the newly formed Kirklees CCG from 1 April 2021.
2. Purpose of the Finance Update in each report
2.1 The purpose of this report is to update the committee on the financial information which the CCG holds in respect of primary care budgets and expenditure.
2.2 The pre-dominant budget held by the CCG in respect of primary care is the ringfenced Delegated Co-Commissioning Budget which is commissioned and supported jointly by NHS England and the CCG. This budget receives a separate and identifiable budget for the funding of GP national contracted services.
2.3 The CCG also holds and reports for a range of other primary care budgets which are separately funded from the CCGs own core allocation.
2.4 This paper will also highlight primary care financial issues in respect of the commissioning and funding of new services, for example, equitable funding.
2.5 In future financial updates to the committee the budgets and expenditure will be reported for the newly formed Kirklees CCG.
3. Introduction
3.1 This report updates the committee on the primary care year-end budgets and out-turn positions for the two former CCGS at Month 12 (March 2021) which occurred pre-merger.
3.2 The last reports to the former Greater Huddersfield CCG and North Kirklees CCG committees were held on 24th February and 10th March respectively and contained financial information at Month 10 (January 2021).
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51 3.3 This report also informs the committee of the process and timescales for the 2021-22 financial planning process which is currently taking place.
3.4 In line with an internal audit recommendation from their January 2020 Primary Care Co- Commissioning Audit of the former CCGs, this report highlights several late rent reviews for the attention of the committee.
4. 2020/21 - Primary Care Budgets at M12 (Final)
4.1 Greater Huddersfield CCG has received budgets for primary care for the year of £45.153m (previously £44.961m) which is an increase of £0.192m since month 10.
4.2 North Kirklees CCG has received budgets for primary care for the year of £36.365m (previously £36.176m) which is an increase of £0.189m since month 10.
4.3 The Primary Care budgets at month 12 (final) are shown in table 1 below: -
Table 1: Primary Care Budgets at month 12 (final)
Greater Huddersfield North Kirklees
Annual Annual Annual Annual Annual Annual Current Previous Budget Current Previous Budget Primary Care Budgets Budget Budget Movement Budget Budget Movement £m £m £m £m £m £m
Primary Care Delegated Co-Commissioning 36.330 36.330 0.000 28.167 28.167 0.000 ARRS 40% 0.364 0.364 0.000 0.460 0.460 0.000 Total Primary Care Co-Commissioning Expenditure36.694 36.694 0.000 28.627 28.627 0.000
Covid 19 - CCG Commissioned Schemes 1.536 1.536 0.000 1.894 1.894 0.000 Covid 19 - CCG GPIT 0.129 0.129 0.000 0.105 0.105 0.000 Total Primary Care Covid Expenditure 1.665 1.665 0.000 1.999 1.999 0.000
CCG Commissioned Schemes 0.303 0.295 0.008 0.642 0.634 0.008 Local Enhanced Services 0.515 0.515 0.000 0.915 0.915 (0.000) Core PCN Funding £1.50 per registered patient 0.384 0.384 0.000 0.299 0.299 0.000 GP Forward View - Extended Access 1.506 1.506 0.000 1.152 1.152 0.000 Primary Care IT 0.971 0.950 0.021 0.750 0.704 0.046 Primary Care Investments 0.163 0.000 0.163 0.135 0.000 0.135
Ophthalmology 0.227 0.227 0.000 0.130 0.130 0.000 Medicines Management - Clinical 0.352 0.352 0.000 0.236 0.236 0.000 Out of Hours 2.064 2.064 0.000 1.327 1.327 0.000 Oxygen 0.309 0.309 0.000 0.288 0.288 0.000
Prior Year impact (0.000) (0.000) 0.000 (0.135) (0.135) 0.000
TOTAL CCG Primary Care (excluding Covid 19) 6.793 6.601 0.192 5.739 5.550 0.189
Total Primary Care Expenditure 45.153 44.961 0.192 36.365 36.176 0.189
4.4 The CCGs have received additional allocations listed in the above table as “Primary Care Investments” which are highlighted in Table 2 below: -
Table 2: Primary Care Network Development Support Funding
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52 PCN Development Support Funding Per PCN GH NK £m £m £m Health Inequalities 0.025 0.125 0.100 Leadership Development 0.003 0.013 0.010 ICS Clinical Engagement 0.025 0.025
0.163 0.135
5. 2020/21 - Primary Care Year-end Out-turn at M12
5.1 At month 12, the Greater Huddersfield CCG has out-turn expenditure of £44.724m which is a favourable variance against budget of (£0.427m) representing a favourable movement since month 10 of (£0.125m).
5.2 At month 12, the North Kirklees CCG has out-turn expenditure of £35.929m which is a favourable variance against budget of (£0.435m) representing a favourable movement since month 10 of (£0.148m).
5.3 The Primary Care budgets, out-turns, and variances at month 12 are shown in table 3 below together with the movement in variance since the numbers were shared with the former committees at month 10: -
Table 3: Primary Care Year-end Out-turn at month 12
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53 Greater Huddersfield North Kirklees
Annual Annual Out-turn Variance Annual Annual Out-turn Variance Current Current Out-turn Variance Movement Out-turn Variance Movement Primary Care Budgets Budget Budget £m £m £m £m £m £m £m £m
Primary Care Delegated Co-Commissioning 36.330 36.174 (0.157) 0.117 28.167 28.193 0.025 0.025 ARRS 40% 0.364 0.364 0.000 0.000 0.460 0.460 0.000 0.000 Total Primary Care Co-Commissioning Expenditure36.694 36.537 (0.157) 0.117 28.627 28.652 0.025 0.025
Covid 19 - CCG Commissioned Schemes 1.536 1.367 (0.169) (0.001) 1.894 1.908 0.014 (0.021) Covid 19 - CCG GPIT 0.129 0.129 0.000 0.000 0.105 0.105 (0.000) 0.000 Total Primary Care Covid Expenditure 1.665 1.496 (0.169) (0.001) 1.999 2.013 0.014 (0.021)
CCG Commissioned Schemes 0.303 0.244 (0.059) (0.138) 0.642 0.671 0.028 (0.018) Local Enhanced Services 0.515 0.622 0.107 0.029 0.915 0.911 (0.004) (0.017) Core PCN Funding £1.50 per registered patient 0.384 0.376 (0.008) (0.008) 0.299 0.293 (0.006) (0.003) GP Forward View - Extended Access 1.506 1.506 0.000 0.016 1.152 1.146 (0.006) (0.006) Primary Care IT 0.971 0.906 (0.065) (0.057) 0.750 0.660 (0.089) (0.100) Primary Care Investments 0.163 0.163 (0.000) (0.000) 0.135 0.135 0.000 0.000
Ophthalmology 0.227 0.225 (0.001) (0.001) 0.130 0.164 0.034 0.024 Medicines Management - Clinical 0.352 0.351 (0.001) (0.025) 0.236 0.241 0.005 (0.002) Out of Hours 2.064 2.058 (0.005) 0.000 1.327 1.327 0.000 0.000 Oxygen 0.309 0.259 (0.049) 0.000 0.288 0.253 (0.035) (0.005)
Prior Year impact (0.000) (0.020) (0.020) (0.056) (0.135) (0.536) (0.401) (0.025)
TOTAL CCG Primary Care (excluding Covid 19) 6.793 6.691 (0.102) (0.241) 5.739 5.264 (0.475) (0.152)
Total Primary Care Expenditure 45.153 44.724 (0.427) (0.125) 36.365 35.929 (0.435) (0.148)
GP VAT Provision Release (0.145) (0.705)
5.4 The primary care delegated co-commissioning variances have moved in Greater Huddersfield by an adverse variance of £0.117m and in North Kirklees by an adverse movement of £0.025m. These are highlighted in a detailed breakdown by expenditure category at Appendix 1 and Appendix 2 of this report.
5.5 The co-commissioning budget includes an expectation of a top-up for Additional Roles funding of in Greater Huddersfield of £0.364m (previously reported as £0.209m) and in North Kirklees of £0.460m (previously reported as £0.489m). The maximum available funding was £0.725m for Greater Huddersfield and £0.559m for North Kirklees however, costs for current roles have been forecast to be lower resulting in receipt of a reduced top- up from NHS England. This is because the CCG can only claim top-up on the costs which are incurred.
5.6 There are small movements in Covid out-turn variance movements which are highlighted in the next section of this report.
5.7 The table also illustrates out-turn variance movements in respect of CCG held primary care budgets across a range of expenditure types.
5.8 The table also includes for information the release of the GP VAT provision which had been incurred as a cost in primary care in recent years, for which a loss is no longer anticipated.
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54 5.9 A detailed primary care co-commissioning table of budgets and forecast out-turn by expenditure type is shown at Appendix 1 and Appendix 2 of this report.
6. 2019/20 – Primary Care Covid 19 Budgets and Claims.
6.1 The primary care Covid budgets for Greater Huddersfield of £1.665m and forecast expenditure of £1.496m are shown in table 4 below: -
Table 4: Greater Huddersfield - Primary Care Covid-19
Total Out-turn M10 Fcast NHS Greater Huddersfield CCG Budget Out-turn Variance Variance mvt Primary Care Covid 19 £m £m £m £m
COVID-19 (22) Practice Excess Sundries Payment 0.138 0.136 (0.002) (0.002) 0.000 COVID-19 (11) Acute Home Visiting Service Extension 0.170 0.167 (0.003) (0.003) 0.000 COVID-19 (12) Meltham Hotspot Flooring (NHSE Reimbursed) 0.015 0.015 0.000 0.000 0.000 COVID-19 (26) Assessment Centre (including PPE) 0.052 0.032 (0.020) (0.020) 0.000 COVID-19 (19) PPE Practices 0.127 0.187 0.060 0.043 0.017 COVID-19 (30) CoHoRT (including PPE) 0.014 0.029 0.015 0.015 0.000 COVID-19 (45) Practice Easter Claims 0.129 0.146 0.017 0.017 0.000 COVID-19 (47) Practice May Claims 0.068 0.068 0.000 0.000 0.000 COVID-19 (68) Reimbursement of Sneeze Screens 0.018 0.017 (0.001) 0.002 (0.003) COVID-19 (66) Care Homes & Care Homes Clinical Lead 0.156 0.156 0.000 0.000 0.000 COVID-19 PCN Clinical Directors Additional Sessions 0.036 0.045 0.009 0.009 0.000 COVID-19 Additional £100 & £150 Payments 0.038 0.038 0.001 0.001 0.000 COVID-19 Elective Care Backlog Review 0.293 0.054 (0.239) (0.239) (0.000) COVID-19 Flu Support 0.080 0.075 (0.005) 0.000 (0.005) COVID-19 Patient Helpline 0.017 0.000 (0.017) (0.000) (0.017) COVID-19 Phlebotomy 0.167 0.167 0.000 (0.055) 0.056 COVID-19 Oximetry 0.010 0.029 0.019 0.069 (0.050) COVID-19 LMC 0.010 0.005 (0.005) (0.005) 0.000 COVID-19 GPIT 0.129 0.129 0.000 0.000 0.000
TOTAL CCG Primary Care Covid-19 Budgets 1.665 1.496 (0.170) (0.168) (0.001)
6.2 The movement overall since month 10 is small at a net favourable movement of (£0.001m).
6.3 The primary care Covid budgets for North Kirklees of £1.999m and forecast expenditure of £2.013m are shown in table 5 below: -
Table 5: North Kirklees - Primary Care Covid-19
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55 Annual Forecast Forecast M10 NHS North Kirklees CCG Current Out-turn Variance Variance mvt Primary Care Covid 19 Budget £m £m £m £m £m
COVID-19 (22) Practice Excess Sundries Payment 0.106 0.122 0.016 0.015 0.000 COVID-19 (11) Acute Home Visiting Service Extension (JUN-20 to SEP-20)0.125 0.125 0.000 0.000 0.000 COVID-19 (17) Assessment Centre (excluding PPE) 0.484 0.521 0.037 (0.001) 0.037 COVID-19 (20) PPE (Assessment Centre, CoHoRT, Practices) 0.288 0.289 0.001 0.000 0.001 COVID-19 (30) CoHoRT (excluding PPE) 0.103 0.103 (0.000) (0.000) 0.000 COVID-19 (45) Practice Easter Claims 0.136 0.136 0.000 0.000 0.000 COVID-19 (47) Practice May Claims 0.065 0.065 0.000 0.000 0.000 COVID-19 (66) Care Homes & Care Homes Clinical Lead 0.116 0.116 0.000 0.000 0.000 COVID-19 PCN Clinical Directors Additional Sessions 0.029 0.036 0.007 0.007 0.000 COVID-19 Additional £100 & £150 Payments 0.036 0.028 (0.008) (0.008) 0.000 COVID-19 ELECTIVE CARE BACKLOG REVIEW 0.286 0.251 (0.036) 0.000 (0.036) COVID-19 (68) Reimbursement of Sneeze Screens 0.005 0.006 0.001 0.001 0.000 Patient Helpline 0.013 0.000 (0.013) 0.000 (0.013) COVID-19 LMC EXPS 0.005 0.005 0.000 0.000 0.000 Flu Support 0.080 0.081 0.001 0.000 0.001 Clinical Leads Oximetry @Home 0.010 0.018 0.008 0.020 (0.012) COVID-19 Wellington House Flooring 0.005 0.005 0.000 0.000 0.000 COVID-19 GPIT 0.105 0.105 (0.000) (0.000) 0.000
TOTAL CCG Primary Care Covid-19 Budgets 1.999 2.013 0.014 0.035 (0.021)
6.4 The movement overall since month 10 is small at a net favourable variance movement of (£0.021m).
7. Late Premises Review
7.1 Although premises rent reviews are the responsibility of NHS England, the CCG should obtain assurance that rent reviews with NHSE and the District Valuations are all up to date or in progress.
7.2 The committee is informed that there are several rent reviews which are overdue, and these are shown in full at Appendix 3. There are 50 premises listed which are awaiting a review and a further 34 not shown which are due for a review in the current financial year.
7.3 The review process relies upon practices and their landlords submitting the required CMR documentation on a timely basis and on them agreeing a date when the district valuer can conduct a valuation visit to the practice’s site(s). The Covid-19 pandemic will have been a significant factor in the delay of a significant number of these reviews being delayed.
7.4 The financial implication of the late reviews is that once these are completed there will be a retrospective charge back to the review date for the revised rent reimbursement. Costs relating to the period prior to the point at which the former CCGs adopted a delegated co- commissioning arrangement will be the responsibility of NHS England, and the responsibility of the CCG thereafter.
8. 2021-22 Financial Plans
8.1 The newly formed Kirklees CCG has been informed of indicative allocations and financial, activity and workforce planning is currently taking place.
8.2 The budgets are being collated as part of a wider ICS footprint across the West Yorkshire and Harrogate ICS. Page 8 of 13
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8.3 The first submission of the plan to NHSE/I is on 6 May 2021 with a second and final submission on 3rd June 2021.
9. Next steps
9.1 Detailed primary care plans will be shared at the next meeting pf the Primary Care Commissioning Committee.
9.2 The committee will be kept informed of primary care budgets and forecast expenditure for the 2021-22 financial year in future finance updates.
10. Implications
10.1 Quality & Safety Implications
None
10.2 Public / Patient / Other Engagement
None
10.3 Resources / Finance Implications
As outlined in the paper.
10.4 Risk
As outlined in the paper.
10.5 Legal / CCG Constitutional Implications
None
10.6 Conflicts of Interest
None identified
11. Recommendations
It is recommended that the Committee: -
Note the contents of the final budgets and out-turn expenditure for the two formed CCGs Note the late primary care rent reviews which are overdue. Note the planning process and timescales
12. Appendices
Appendix 1 – Greater Huddersfield Primary Care Co-Commissioning Budgets and Out-turn and Month 10 (March 2021). Page 9 of 13
57 Appendix 2 – North Kirklees Primary Care Co-Commissioning Budgets and Out-turn and Month 10 (March 2021). Appendix 3 – Primary Care Estates – Late Rent Reviews
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58 Appendix 1 NHS Greater Huddersfield CCG Primary Care Co-commissioning Budgets and Out-turn Expenditure at Month 12 (March 2021)
Annual Variance Expenditure Description Out-turn Variance Budget Movement £m £m £m £m Contract payments C&M-APMS Contract Value 0.717 0.727 0.010 0.009 C&M-APMS OOH Opt Outs (0.013) (0.013) - - C&M-APMS Other Baseline Adjustment - 0.013 0.013 - C&M-GMS Global Sum 7.226 7.235 0.009 - C&M-GMS MPIG Correction Factor 0.025 - (0.025) - C&M-GMS Other Baseline Adjustment - 0.248 0.248 - C&M-PMS Baseline Adjustment 0.155 0.624 0.469 - C&M-PMS Contract Value 15.837 15.413 (0.425) - C&M-PMS List Size Adjustment 0.066 0.075 0.009 0.001 C&M-PMS Out of Hours Opt Outs (0.716) (0.715) 0.001 (0.001) 23.298 23.606 0.308 0.009 QOF C&M-APMS QOF Achievement 0.015 0.017 0.002 - C&M-APMS QOF Aspiration 0.027 0.027 - - C&M-GMS QOF Achievement 0.306 0.368 0.061 - C&M-GMS QOF Aspiration 0.745 0.745 0.000 - C&M-PMS QOF Achievement 0.597 0.720 0.123 - C&M-PMS QOF Aspiration 1.511 1.512 0.001 - 3.201 3.389 0.188 - Premises C&M-APMS Prem Actual Rent 0.013 0.013 - 0.013 C&M-APMS Prem Other - - - (0.079) C&M-APMS Prem Rates 0.010 0.010 - - C&M-GMS Prem Actual Rent 0.604 0.610 0.005 0.005 C&M-GMS Prem Clinical Waste 0.116 0.118 0.002 0.001 C&M-GMS Prem Healthcentre Rates 0.003 0.003 - - C&M-GMS Prem Healthcentre Rent 0.014 0.014 - - C&M-GMS Prem Notional Rent 0.286 0.285 (0.001) 0.000 C&M-GMS Prem Other 0.018 0.018 - - C&M-GMS Prem Rates 0.164 0.162 (0.001) 0.000 C&M-GMS Prem Service Charges (0.001) - 0.001 - C&M-GMS Prem Water Rates 0.014 0.014 - - C&M-PMS Prem Actual Rent 1.239 1.099 (0.140) (0.059) C&M-PMS Prem Clinical Waste 0.001 0.001 - - C&M-PMS Prem Cost Rent 0.037 0.037 - - C&M-PMS Prem Healthcentre Rates 0.040 0.039 (0.001) (0.000) C&M-PMS Prem Healthcentre Rent 0.232 0.318 0.086 0.002 C&M-PMS Prem Notional Rent 0.421 0.484 0.064 0.064 C&M-PMS Prem Other 0.007 0.036 0.029 0.029 C&M-PMS Prem Rates 0.258 0.250 (0.008) - C&M-PMS Prem Water Rates 0.018 0.018 0.000 - Voids and Subsidies 0.090 0.079 (0.010) - 3.583 3.609 0.025 (0.024) Additional Roles C&M- PCN DES CARE COORDINATOR 0.116 0.116 - - C&M-PCN DES DIETICIANS 0.029 0.029 - - C&M-PCN DES HEALTH AND WELLBEING COACH 0.007 0.007 - - C&M-PCN DES PHARMACY TECHNICIANS 0.051 0.051 - - C&M-PMS C&M-APMS PCN DES Physician Assoc 0.022 0.022 - - C&M-PMS PCN DES Clin Pharmacist 0.840 0.840 - - C&M-PMS PCN DES Physiotherapist 0.180 0.180 - - C&M-PMS PCN DES Soc Prescribing 0.165 0.165 - - 1.412 1.412 - - Enhanced Services C&M-APMS PCN DES Participation 0.007 0.007 0.001 - C&M-GMS DES Learn Dsblty Hlth Chk 0.060 0.030 (0.030) - C&M-GMS DES Minor Surgery 0.108 0.093 (0.015) - C&M-GMS PCN DES Invest & impact 0.102 0.102 (0.000) - C&M-GMS PCN DES Participation 0.131 0.143 0.012 - C&M-PCN DES Support Payment 0.066 0.066 (0.000) - C&M-PMS DES Extended Hours Access 0.364 0.364 (0.000) - C&M-PMS DES Learn Dsblty Hlth Chk 0.080 0.087 0.007 - C&M-PMS DES Minor Surgery 0.152 0.119 (0.033) - C&M-PMS DES OOAR in hrs urgentcare 0.033 0.033 - - C&M-PMS Dispensing Quality Sch - 0.007 0.007 (0.001) C&M-PMS PCN DES Clinical Director 0.181 0.181 (0.000) - C&M-PMS PCN DES Participation 0.258 0.281 0.023 - C&M- PCN DES CARE HOME PREMIUM 0.118 0.120 0.002 - 1.659 1.633 (0.027) (0.001)
PMS Premium C&M-PMS LES Primary Care Offer 1.829 1.591 (0.238) 0.099
PCO C&M-APMS PCO Other 0.004 0.004 - - C&M-GMS PCO Doctors Ret Scheme 0.056 0.060 0.004 - C&M-GMS PCO Locum Adop/Pat/Mat 0.060 0.054 (0.007) - C&M-GMS PCO Other 0.054 0.052 (0.001) - C&M-PMS PCO Doctors Ret Scheme 0.030 0.025 (0.005) - C&M-PMS PCO Locum Adop/Pat/Mat 0.032 0.051 0.019 0.008 C&M-PMS PCO Locum Sickness 0.080 0.134 0.054 0.080 C&M-PMS PCO Other 0.106 0.106 (0.000) - 0.422 0.501 0.079 0.102 Other C&M-GMS Prof Fees Prescribing 0.117 0.062 (0.055) - Furniture & Fittings 0.018 - (0.018) - Sterile Products 0.031 0.022 (0.009) (0.002) 0.166 0.083 (0.083) (0.002) Professional C&M-PMS Prof fees Dispensing 0.042 0.061 0.019 - C&M-PMS Prof fees Prescribing 0.024 0.112 0.088 - C&M-PMS Prsc Chrgs Cll&Rmttd by GPs (0.019) (0.020) (0.001) - Prof Serv - Interpreting Services 0.009 0.005 (0.004) - Professional Fees 0.010 0.030 0.020 - legal fees - 0.001 0.001 - 0.066 0.190 0.124 - System Development C&M-PMS Additional Staff Payments 0.813 0.813 - -
Reserves AI-Non Pay General Reserves 0.244 - (0.244) (0.050)
Prior Year Clinical&Medical-Independent Sector - Prior Year - (0.289) (0.289) (0.016) Total: Primary Care Co-Commissioning 36.694 36.537 (0.157) 0.117 Page 11 of 13
59 Appendix 2 NHS North Kirklees CCG Primary Care Co-commissioning Budgets and Forecast Expenditure at Month 12 (March 2021)
Annual Variance Expenditure Description Out-turn Variance Budget Movement £m £m £m £m Contract payments C&M-APMS Contract Value 0.488 0.488 - - C&M-GMS Global Sum 5.485 5.485 - - C&M-GMS Other Baseline Adjustment 0.107 0.188 0.081 0.070 C&M-PMS Baseline Adjustment - 0.026 0.026 0.000 C&M-PMS Contract Value 12.411 12.411 - - C&M-PMS List Size Adjustment 0.044 0.039 (0.005) (0.030) C&M-PMS Out of Hours Opt Outs (0.558) (0.560) (0.002) (0.002) 17.976 18.076 0.100 0.038 QOF C&M-APMS QOF Achievement 0.014 0.017 0.003 - C&M-APMS QOF Aspiration 0.038 0.038 - - C&M-GMS QOF Achievement 0.225 0.271 0.046 - C&M-GMS QOF Aspiration 0.541 0.541 - - C&M-PMS QOF Achievement 0.475 0.555 0.080 - C&M-PMS QOF Aspiration 1.202 1.202 - - 2.495 2.624 0.129 - Premises C&M-GMS Prem Actual Rent 0.177 0.177 - - C&M-GMS Prem Clinical Waste 0.105 0.105 - - C&M-GMS Prem Healthcentre Rates 0.037 0.037 - - C&M-GMS Prem Healthcentre Rent 0.197 0.197 - - C&M-GMS Prem Notional Rent 0.223 0.227 0.004 0.004 C&M-GMS Prem Rates 0.076 0.076 - - C&M-GMS Prem Water Rates 0.006 0.006 - - C&M-PMS Prem Actual Rent 0.603 0.606 0.003 0.003 C&M-PMS Prem Cost Rent 0.026 0.026 - - C&M-PMS Prem Healthcentre Rates 0.084 0.084 - - C&M-PMS Prem Healthcentre Rent 0.492 0.492 - - C&M-PMS Prem Notional Rent 0.454 0.464 0.009 0.009 C&M-PMS Prem Other 0.010 0.045 0.035 0.035 C&M-PMS Prem Rates 0.211 0.211 - - C&M-PMS Prem Water Rates 0.015 0.015 - - C&M-APMS Prem Healthcentre Rates 0.011 0.011 - - C&M-APMS Prem Healthcentre Rent 0.046 0.046 - - Voids and Subsidies 0.672 0.672 - - 3.445 3.498 0.052 0.052 Additional Roles C&M-APMS PCN DES Clin Pharmacist 1.063 1.063 - - C&M-APMS PCN DES Soc Prescribing 0.136 0.136 - - C&M-APMS PCN DES Physiotherapist 0.077 0.077 - - 1.276 1.276 - - Enhanced Services C&M-APMS PCN DES Participation 0.007 0.007 - - C&M-GMS DES Learn Dsblty Hlth Chk 0.024 0.024 - - C&M-GMS DES Minor Surgery 0.107 0.078 (0.029) - C&M-GMS PCN DES Participation 0.108 0.108 - - C&M-PMS DES Learn Dsblty Hlth Chk 0.073 0.073 - - C&M-PMS DES Minor Surgery 0.196 0.150 (0.046) - C&M-PMS DES OOAR in hrs urgentcare 0.026 0.026 - - C&M-PMS PCN DES Participation 0.221 0.221 - - C&M- PCN DES CARE HOME PREMIUM 0.087 0.087 - - C&M-PCN DES IIF PREPARATION PAYMENT 0.080 0.080 - - C&M-APMS DES Extended Hours Access 0.283 0.283 - - C&M-APMS DES Minor Surgery 0.001 0.001 - - C&M-APMS PCN DES Clinical Director 0.141 0.141 - - C&M-PCN DES Support Payment 0.051 0.051 - - 1.404 1.330 (0.075) - PCO C&M-GMS PCO Locum Adop/Pat/Mat 0.047 0.124 0.077 0.077 C&M-GMS PCO Locum Sickness 0.044 0.031 (0.013) (0.013) C&M-GMS PCO Other 0.038 0.039 - - C&M-PMS PCO Locum Adop/Pat/Mat 0.002 - (0.002) (0.002) C&M-PMS PCO Locum Sickness 0.010 0.011 0.002 0.002 C&M-PMS PCO Other 0.086 0.086 - - 0.227 0.292 0.064 0.064 Other C&M-GMS Prof Fees Prescribing 0.035 0.035 - - Clinical&Medical-Othe Public Sector 0.004 0.008 0.004 0.004 Sterile Products 0.005 0.003 (0.002) (0.002) Clinical&Medical-Commercial Sector (0.010) (0.010) - - 0.035 0.037 0.002 0.002 Professional C&M-PMS Prof fees Prescribing 0.077 0.077 - - Prof Serv - Interpreting Services 0.011 0.011 - - Professional Fees 0.001 0.046 0.044 0.044 0.090 0.134 0.044 0.044 System Development C&M-APMS Other Addtl Staff Paymts - 0.008 0.008 - C&M-GMS Other Addtl Staff Paymts - 0.133 0.133 - C&M-PMS Additional Staff Payments 0.633 0.492 (0.141) - C&M-PMS Additional Staff Payments 0.633 0.633 (0.000) -
Reserves AI-Non Pay General Reserves 0.115 - (0.115) -
PMS Premium (QAS Scheme) Clinical&Medical-Independent Sector 0.931 0.931 - -
Prior Year Clinical&Medical-Independent Sector - Prior Year - (0.177) (0.177) (0.177)
Total: Primary Care Co-Commissioning 28.627 28.652 0.024 0.024 Page 12 of 13
60 Kirklees CCG - Primary Care Late Rent Reviews Appendix 3
Former Practice Main / Last Valuation Next Rent Practice name Address CCG Code Branch Date review due Huddersfield Road, Elmwood Health Holmfirth, GH B85006 MAIN 22-May-2010 22-May-2013 Centre Huddersfield, HD9 3TR 60 Thornton Lodge Thornton Lodge Road, Thornton GH B85044 MAIN 5-Feb-2012 5-Feb-2015 Surgery Lodge, Huddersfield, HD1 3SB Healds Road Healds Road, NK B85055 MAIN 14-Feb-2013 14-Feb-2016 Surgery Dewsbury, WF13 4HT 617 Wakefield Road, The Waterloo Waterloo, GH B85024 MAIN 1-Mar-2014 1-Mar-2017 Practice Huddersfield, HD5 9XP 130 Upper Batley Health NK B85008 Commercial Street, MAIN 26-Oct-2014 26-Oct-2017 Centre Batley, WF17 5ED Dewsbury Health Eightlands NK B85020 Centre, Wellington Rd, MAIN 5-May-2018 26-Oct-2017 Surgery Dewsbury, WF13 1HN Park View Road, Dr Mahmood & Netherfield, NK B85650 MAIN 11-Nov-2014 21-Dec-2017 Partners Ravensthorpe, WF13 3JY Netherfield Road, Dr Mahmood & NK B85650 Ravensthorpe, WF13 MAIN 11-Nov-2014 21-Dec-2017 Partners 3JY Netherfield Road, Dr Mahmood & NK B85650 Ravensthorpe, WF13 MAIN 11-Nov-2014 21-Dec-2017 Partners 3JY Cleckheaton Health Centre, Greenside, NK B85001 Parkview Surgery MAIN 22.12.14 22-Dec-2017 Cleckheaton, BD19 5AP Broughton House 20 New Way, Batley, NK B85622 MAIN 25-Jan-2015 25-Jan-2018 Surgery WF17 5QT Town Street, Blackburn Road NK B85025 Birkenshaw, BD11 BRANCH 26-Feb-2015 26-Feb-2018 Medical Centre 2HX Birkhouse Lane, The Junction Moldgreen, GH B85660 MAIN 1-May-2015 1-May-2018 Surgery Huddersfield, HD5 8BE Dewsbury Primary Calder View Care Centre, NK B85004 MAIN 5-May-2018 5-May-2018 Surgery Wellington Road, Dewsbury,WF13 1HN Ravensthorpe Health North Road Suite Centre, Netherfield NK B85009 MAIN 30-Jun-2015 30-Jun-2018 Surgery Rd, Dewsbury, WF13 3JY 1st Floor Cleckheaton Health Centre, 4 The Greenway NK B85030 Greenside, Branch 30-Jun-2015 30-Jun-2018 Medical Practice Cleckheaton, BD19 5AP Cleckheaton Health Centre, Grd Flr. 4 NK B85621 Greenside, MAIN 30-Jun-2015 30-Jun-2018 Cleckheaton, BD19 5AP Meltham Road 9 Meltham Road, GH B85016 MAIN 6-Aug-2015 6-Aug-2018 Surgery Lockwood Highgate Lane, Lepton & GH Lepton, Huddersfield, MAIN 6-Aug-2015 6-Aug-2018 B85031 Kirkheaton HD8 0HH Marsh Gardens, GH B85022 Honley Surgery Honley, Huddersfield, MAIN 6-Oct-2015 6-Oct-2018 HD9 6AG 2 William Street, Windsor Medical NK B85620 Leeds Rd, Dewsbury, MAIN 9-Dec-2015 9-Dec-2018 Centre WF12 7BD 11 Park Road West, Crosland Moor, Crosland Moor (Moorfield Shopping GH Y04266 MAIN 1-Mar-2016 1-Mar-2019 Practice Centre) Hudderdsfield, HD4 5RX 21 New Street, New Street & Milnsbridge, GH B85036 BRANCH 23-Mar-2016 23-Mar-2019 Netherton Huddersfield, HD3 4LB Blackburn Road, Blackburn Road NK B85025 Birstall, Batley, WF17 MAIN 24-Mar-2016 24-Mar-2019 Medical Centre 9PL 1 The Cobbles, Meltham Group GH Meltham, Holmfirth, MAIN 30-Apr-2016 30-Apr-2019 B85032 Practice HD9 5QQ The Albion Mount 47 Albion Street, NK B85646 MAIN 25-May-2016 25-May-2019 Medical Practice Dewsbury, WF13 2AJ The Sidings Brewery Lane, NK B85652 Healthcare Thornhill Lees, MAIN 22-Jun-2016 22-Jun-2019 Centre Dewsbury, WF12 9DU
Heckmondwike Health Brookroyd House Centre, 16 Union St, NK B85014 MAIN 1-Jul-2016 1-Jul-2019 Surgery Heckmondwike, WF16 0HH
71a Woodhouse Hill, Woodhouse Hill GH B85048 Fartown, Huddersfield, MAIN 14-Aug-2016 14-Aug-2019 Surgery HD2 1DH Westgate, The Almondbury Almondbury, GH B85023 MAIN 28-Sep-2016 28-Sep-2019 Surgery Huddersfield, HD5 8XW 140 Slaithwaite Road, Thornhill Lees Thornhill Lees, NK B85606 MAIN 15-Dec-2016 15-Dec-2019 Surgery Dewsbury, WF12 9DW 12 Sand Street, University Health GH Huddersfield, HD1 MAIN 4-Jan-2017 4-Jan-2020 B85062 Centre 3AL 327 Meltham Road, New Street & Netherton, GH B85036 MAIN 2-Jul-2017 7-Feb-2020 Netherton Huddersfield, HD4 7EX 90 Savile Road, Savile Thornhill Lees NK B85606 Town, Dewsbury, BRANCH 1-Mar-2017 1-Mar-2020 Surgery WF12 9LP 5a Shelley Lane, Kirkburton Health GH B85026 Kirkburton, MAIN 3-Oct-2017 10-Mar-2020 Centre Huddersfield, HD8 0SJ Leymoor Road, Fieldhead GH Golcar, Huddersfield, MAIN 2-May-2017 2-May-2020 B85051 Surgery HD7 4QQ Elmwood Health 11 Parkin Lane, GH B85006 BRANCH 4-Jun-2017 4-Jun-2020 Centre Meltham, HD9 4EN 2 Heaton Moor Road, Lepton & Kirkheaton, GH B85031 BRANCH 15-Jun-2017 15-Jun-2020 Kirkheaton Huddersfield, HD5 0ET 8–10 Brook Street, Croft Medical Thornton Lodge, GH B85614 BRANCH 1-Jul-2017 1-Jul-2020 Centre Huddersfield, HD1 3JW 25 Jos Lane, Shepley Health Fieldhead, Shepley, GH B85005 MAIN 8-Jul-2017 8-Jul-2020 Centre Huddersfield, HD8 8DJ Huddersfield Road, Oaklands Health GH B85610 Holmfirth, MAIN 22-Jul-2017 22-Jul-2020 Centre Huddersfeld, HD9 3TP 364A Wakefield Road, Dalton, GH B85010 Dalton Surgery MAIN 8-Oct-2017 10-Aug-2020 Huddersfield, HD5 8DY Cook Lane Cook Lane, NK B85619 (Albion Street) Heckmondwike, WF16 MAIN 6-Oct-2017 6-Oct-2020 Surgery 9JG 313 Wakefield Road, Skelmanthorpe Denby Dale, GH B85061 BRANCH 19-Jan-2018 19-Jan-2021 Family Doctors Huddersfield, HD8 8RX Walnut Lane, Grove House NK B85018 Chickenley, BRANCH 20-Jan-2018 20-Jan-2021 Surgery Dewsbury, WF12 8NJ 62a Acre Street, The Lindley GH Lindley, Huddersfield, MAIN 28-Jan-2018 28-Jan-2021 B85027 Group Practice HD3 3DY The Albion Mount 111 Mountain Road, NK B85646 BRANCH 1-Feb-2018 1-Feb-2021 Medical Practice Thornhill Cross Church Street, Cleckheaton NK B85021 Cleckheaton, BD19 MAIN 1-Mar-2018 1-Mar-2021 Group Practice 3RQ 15 Wentworth Street, Greenhead GH Huddersfield, HD1 MAIN 15-Mar-2018 15-Mar-2021 B85060 Family Doctors 5PX Thomas Street, The Lindley GH B85033 Lindley, Huddersfield, MAIN 22-Mar-2018 22-Mar-2021 Village Surgery HD3 3JD
Page 13 of 13
61 Primary Care Commissioning 28th April 2021 Name of Meeting Committee Meeting Date Primary Care Contracting Title of Report Agenda Item No. 8 Update Report Author Martin Pursey Public / Private Item Public Martin Pursey, Head of Dr Abid Iqbal Clinical Lead Responsible Officer Contracting & Independent GP Adviser Procurement
Executive Summary
This paper provides an update to Primary Care Commissioning Committee in respect of a number of contracting issues where it is felt that the Committee should know or be aware of.
Previous Considerations blank blank blank Name of meeting Meeting Date
Name of meeting Meeting Date
Recommendations The Primary Care Commissioning Committee is asked to receive and note the contents of this report.
Decision ☐ Assurance ☒ Discussion ☐ Other:
Implications Quality and Safety implications (including whether a quality impact assessment has None identified been completed)
Page 1 of 5
62 Engagement and Equality Implications (including whether an equality impact None identified assessment has been completed), and health inequalities considerations Resources / Financial Implications (including Staffing/Workforce considerations) None identified
Sustainability Implications None identified
Has a Data Protection Impact Assessment Yes ☐ No ☐ N/A ☒ (DPIA) been completed?
Strategic Objectives Our patients are at the Risk (include risk (which of the CCG heart of our number and a brief None identified objectives does this commissioning description of the relate to?) decisions risk) Legal / CCG Conflicts of Interest Constitutional None identified (include detail of any None identified Implications identified / potential conflicts)
Page 2 of 5
63
1. Introduction
1.1 This report provides an update to the Committee in respect of a number of contractual issues where it is felt that the Committee should know or be aware of.
Overview of Kirklees CCG Primary Care contracts
1.2 Kirklees CCG has a total of 179 Primary Care contracts made up of Core GP Services contracts, GP Community Services contracts and other Primary Care related contracts.
1.3 There are a total of 64 Core GP Services contracts, made up of 22 General Medical Services (GMS) contracts, 39 Personal Medical Services (PMS) contracts and 3 Alternative Provider Medical Services (APMS) contracts.
1.4 There are a total of 64 GP Community Services contracts consisting of the following local services commissioned from GP practices:
Anticoagulation Telephone by-pass numbers Treatment Room Same Day Access Near Patient Testing Ear Irrigation Zoladex and Prostap 12 Lead CCG Phlebotomy Spirometry Diabetes Injectable Therapies Ring Pessary Wound Care Level 2 Wound Care Level 2 24hr Ambulatory BP Monitoring Quality Access Scheme 1.5 Following confirmation of the intention to continue to commission these services for a period of 6 months, practices have been invited to sign up to the services they can deliver.
1.6 In 2021/22 it is the intention that any agreed Tier 3 and Tier 4 Services will be built into the GP Community Services contracts. Practices have been invited to sign up to the new Kirklees Frailty Scheme and to date 9 practices have confirmed their interest.
1.7 Some of the other Primary Care related contracts include GP Online Consultations, Interpretation Services, Extended Access and Ardens Health Informatics Ltd.
2. General Update
GP Starters/Leavers/Changes April 2021
2.1 The CCG has been advised of the following changes:
2.1.1 The resignation of Dr M Jayashree from the Partnership. CQC and PSCE had been advised.
2.1.2 Dr T C Jones had retired from the Lindley Group Practice, effective from 30 September 2020.
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64 3. National Contract Variations
3.1 There continues to be 1 outstanding National Contract Variations for 2019/20. This practice has been chased in regards to signing their National Variation and has agreed to sign and return as soon as possible.
3.2 The Standard Medical Services Contract Variation Notices for GMS, PMS and APMS contracts were published in December 2020 despite having been dated October 2020. NHS England is in the process of completing the National Variations and had previously advised that these would be uploaded to SharePoint during March; however, they have now advised that they will be uploaded onto SharePoint by the end of April.
4. Incorporations
4.1 There a number of Incorporation requests from GP Practices in progress.
4.2 Croft Surgery has completed their application, and submitted the required documentation. The practice had an initial date for incorporation of 1 February 2021, which was then put back to 1 April 2021. However there are still delays with CQC registration due to COVID therefore this remains outstanding. The solicitors will contact the CCG once they hear back from the CQC.
4.3 Lindley Village Surgery has completed their application and submitted the required documentation. The initial incorporation date was deferred to 1 April 2021 due to COVID related delays in CQC but the registration remains outstanding. CQC has stated that due to the pandemic CQC registration is currently taking 12 to 14 weeks; a new date will be agreed once the practice has had confirmation from CQC.
4.4 Fieldhead Surgery have completed their application and submitted the required documentation including the recently submitted business continuity plan. The practice were hoping to incorporate on 1 April 2021 but delays with CQC registration due to COVID have put back the date; CQC have been contacted by the practice but no registration completion date is currently available.
4.5 Cleckheaton Group Practice has contacted the CCG to restart the incorporation process they originally started in October 2019. An acknowledgement letter and an updated assessment template have been sent to the practice to complete.
5. Branch Closures
5.1 Cherry Tree The branch site at York House has been closed since March 2020 due to COVID and remains closed.
5.2 Wellington House Surgery The branch site at Bond Street has been closed since March 2020 due to COVID, and has been extended to the end of May 2021.
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65 5.3 Brewery Lane Brewery Lane reopened their branch site on 1st March 2021.
5.4 The Grange Group Practice Keldregate branch surgery requested a temporary closure at the end of March 2020, the surgery temporarily reopened in July 2020 but it was felt that a further temporary closure was required. An application for further temporary closure was approved by PCCC at their February meeting for 3 months. The CCG are working with The Grange Group Practice on their intention to apply to close the branch surgery permanently.
7. Recommendations
7.1 The Committee is asked to:
7.1.1 Receive and note the content of the Contracting Update
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66 Primary Care Name of Meeting Meeting Date 28 April 2021 Commissioning Committee
Title of Report Internal Audit Report Agenda Item No. 9 Danielle Hodson, Assistant Public Report Author Audit Manager, Audit Yorkshire Public / Private Item Catherine Wormstone, Mr Ian Currell, Chief Finance Head of Primary Care Clinical Lead Responsible Officer Officer Strategy and Commissioning
Executive Summary In line with the NHS England requirements of delegated CCGs primary medical care commissioning arrangements, an Internal Audit review has been undertaken in line with the framework covering Commissioning and procurement of services. The guidance requires the Committee to have a lead role in discussing and agreeing the internal audit report.
Previous Considerations blank blank blank Name of meeting Meeting Date
Name of meeting none Meeting Date
Recommendations It is recommended that the Committee discuss and agree the Internal Audit report and draft action plan prior to issuing of final report.
Decision ☐ Assurance ☐ Discussion ☒ Other:
Page 1 of 4
67 Implications Quality and Safety implications (including none whether a quality impact assessment has been completed)
Engagement and Equality Implications none (including whether an equality impact assessment has been completed), and health inequalities considerations Resources / Financial Implications (including none Staffing/Workforce considerations)
Sustainability Implications none
Has a Data Protection Impact Assessment Yes ☐ No ☐ N/A ☒ (DPIA) been completed?
Strategic Objectives all Risk (include risk n/a (which of the CCG number and a brief objectives does this description of the relate to?) risk) Legal / CCG none Conflicts of Interest none Constitutional (include detail of any Implications identified / potential conflicts)
Page 2 of 4
68 1. Introduction 1.1 In line with the NHS England requirements of delegated CCGs primary medical care commissioning arrangements, an Internal Audit review has been undertaken in line with the framework covering Commissioning and procurement of services. The guidance requires the Committee to have a lead role in discussing and agreeing the internal audit report.
2. Detail
2.1 NHS England became responsible for the direct commissioning of primary medical care services on 1 April 2013. Since then, following changes set out in the NHS Five Year Forward View, primary care co-commissioning has seen CCGs invited to take on greater responsibility for general practice commissioning, including full responsibility under delegated commissioning arrangements. Where NHS England delegates its functions to CCGs, it still retains overall responsibility and liability for these and is responsible for obtaining assurances that its functions are being discharged effectively.
2.2 In agreement with the NHS England Audit and Risk Assurance Committee, from 2018/19 NHS England requires an internal audit of delegated CCGs primary medical care commissioning arrangements. The purpose of this being to provide information to CCGs that they are discharging NHS England’s statutory primary medical care functions effectively, and in turn use this information to provide aggregate assurance to NHS England and facilitate NHS England’s engagement with CCGs to support improvement.
2.3 To support this, in August 2018 NHS England published the Primary Medical Care Commissioning and Contracting: Internal Audit Framework for delegated Clinical Commissioning Groups. The document provides a framework for delegated CCGs to undertake an internal audit of their primary medical care commissioning.
2.4 The scope of the work has been agreed by both CCGs management to be undertaken over a three year audit plan which covers: a) Commissioning and procurement of services (2020/21 attached) b) Contract Oversight and Management Functions (to be undertaken 2021/22) c) Primary Care Finance (2019/20 – high assurance) d) Governance (common to each of the areas a-c above)
2.5 The guidance requires that the CCG Primary Care Commissioning Committee (or alternative committee with responsibility for the delegated function) should have a lead role in discussing and agreeing the report, therefore propose draft action plan to be presented and agreed prior to issuing of final report.
2.6 The report provides high assurance and recommends one minor in relation to maintaining best practice in review of policies and procedures.
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69 3. Next Steps 3.1 Following approval and comments provided, the Internal Audit report will be finalised and reported to the Audit Committee. Agreed audit recommendations will be followed up to ensure completed.
4. Implications 4.1 Quality and Safety Implications 4.1.1 Not applicable
4.2 Engagement and Equality Implications 4.2.1 Not applicable
4.3 Resources / Finance Implications 4.3.1 Not applicable
4.4 Data Protection Impact Assessment 4.4.1 Not applicable
4.5 Risk 4.5.1 Not applicable
4.6 Legal / CCG Constitutional Implications 4.6.1 Not applicable
4.7 Conflicts of Interest 4.7.1 Not applicable
5. Recommendations It is recommended that the Committee. 1. Discuss and agree the Internal Audit report and draft action plan prior to issuing of final report.
6. Appendices Internal Audit Draft Report – GH03/NK03 2021 Primary Care Co Commissioning
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70
Internal Audit Report
For
NHS Greater Huddersfield and
NHS North Kirklees Clinical Commissioning Groups
Primary Medical Care Commissioning and Contracting: Commissioning and Procurement of Services
GH03/2021 and NK03/2021
71 Contents
Page
Section 1: Executive Summary 1
Section 2: Audit Background, Objectives, Scope and Report Circulation 10
Section 3: Schedule of Findings and Recommendations 14
Section 4: Key to Internal Audit Reports 15
Report Author: Danielle Hodson Report Version: Draft Report Date: 1 April 2021
72 Section 1: Executive Summary
Objective
The overall objective of the review was to provide assurance on the management of delegated primary medical care commissioning arrangements with regards to Primary Medical Care Commissioning and Contracting, and the associated governance arrangements.
NHS Greater Huddersfield CCG
The review established that there is a sound system of internal control in place for delegated primary care commissioning and procurement. There are effective arrangements in place for the commissioning and procurement of primary medical services in the planning and review of provision, commissioning decisions and procurement processes, alongside patient and public involvement. Our testing undertaken confirmed that robust controls and processes were in place and were operating effectively.
The CCG has formally adopted the NHS England & Improvement (NHSE&I) Primary Medical Care Policy and Guidance Manual (PMC PGM) and evidence was provided to support consideration and compliance in commissioning and procurement decisions made. High There was adequate governance and oversight in regard to primary care commissioning and procurement of services by the Primary Care Commissioning Committee (PCCC) and supporting Practice Quality and Contracting Group. Due to the COVID- 19 pandemic, these meetings are now taking place virtually. Urgent decisions which are being considered outside of the Committee are undertaken in line with agreed processes and reported at the next available PCCC. The urgent decisions are communicated and reported through the CCG’s website.
One minor recommendation has been made in regards to the consideration of referencing the PGM in the Procurement Policy.
NHS North Kirklees CCG
The review established that there is a sound system of internal control in place for delegated primary care commissioning and procurement. There are effective arrangements in place for the commissioning and procurement of primary medical services in the planning and review of provision, commissioning decisions and procurement processes, alongside patient and public High involvement. Our testing undertaken confirmed that robust controls and processes were in place and were operating effectively.
The CCG has formally adopted the NHS England & Improvement (NHSE&I) Primary Medical Care Policy and Guidance Manual (PMC PGM) and evidence was provided to support consideration and compliance in commissioning and procurement decisions
73 1 Section 1: Executive Summary
made.
There was adequate governance and oversight in regard to primary care commissioning and procurement of services by the Primary Care Commissioning Committee (PCCC) and supporting Operational Group. Due to the COVID-19 pandemic, these meetings are now taking place virtually. Urgent decisions which are being considered outside of the Committee are undertaken in line with agreed processes and reported at the next available PCCC. The urgent decisions are communicated and reported through the CCG’s website.
One minor recommendation has been made in regards to the consideration of referencing the PGM in the Procurement Policy.
Assurance on Key Control Objectives
Control Objective Review Highlights ( Positive Assurance, ! Action Required) Assurance Level Recommendations (Priority) NHS NHS Major Moderate Minor GHCCG NKCCG There are effective The CCGs have adopted the NHSE&I Primary Medical Care High High 0 0 0 arrangements in place Policy Guidance Manual (PGM) as the primary policy used in for the planning of the the commissioning of primary medical care services. provision of primary The PGM is available on the NHSE&I website for all staff and medical care services evidence was clear from discussion papers and reports to in the area, including both the Greater Huddersfield and North Kirklees Primary carrying out needs Care Commissioning Committees (PCCC) that the PGM is assessments and taken into consideration and followed. consulting with the In November 2019 the PCC committees undertook a 2 hour public and other development workshop to understand the PGM with reference relevant agencies as to contracting mechanisms and patient access. necessary. A review of the minutes of both CCGs’ PCCC, Greater Huddersfield CCG’s Quality and Contracting Group (QCG) and North Kirklees CCG’s Operational Group (PCCOG) established that representatives from NHSE&I attend to
74 2 Section 1: Executive Summary
Control Objective Review Highlights ( Positive Assurance, ! Action Required) Assurance Level Recommendations (Priority) NHS NHS Major Moderate Minor GHCCG NKCCG provide oversight. The Head of Primary Care provides a formal report to each of the PCCC meetings, which reports key projects and initiatives and provides a progress update of primary care activities within Kirklees. The Kirklees Joint Strategic Needs Assessment (KJSNA) held by Kirklees Council is utilised by the CCGs to inform and guide the planning and commissioning of health, well-being and social care services within Kirklees. In February 2020 a paper was presented to the GHCCG PCCC which sought a decision around an application for a practice boundary change from The University Health Centre. The report confirmed and provided assurance that the process that the practice and commissioner had followed were in line with the PGM and the CCG’s boundary change application policy, and included the engagement report, the Quality Impact Assessment and the Equality Impact Assessment relating to the proposed change. Adequate processes The management of the procurement process is documented Significant Significant 0 0 1 are adopted in the within both CCG’s Procurement Policy and Standing Orders. procurement of primary ! Both CCG’s Procurement Policies were due for re-review in medical care services, February 2020 although they are now planned to be reviewed including decisions to as part of the CCG merger and should be reviewed to reflect extend existing the requirements of the PGM. contracts. Each CCGs’ PCCC terms of references enable members to take procurement decisions in respect of primary medical services. These shall be in line with statutory requirements and guidance, the CCG’s Constitution and Standing Orders and the Delegation Agreement between NHS England and the CCG.
75 3 Section 1: Executive Summary
Control Objective Review Highlights ( Positive Assurance, ! Action Required) Assurance Level Recommendations (Priority) NHS NHS Major Moderate Minor GHCCG NKCCG The CCGs’ joint Procurement Team maintain a schedule of contracts which records when contracts are coming up for renewal, and prompts liaison with the Primary Care Team. In the Greater Huddersfield locality there are 22 PMS contracts, 14 GMS contracts and 1 APMS contracts. In the North Kirklees locality there are 18 PMS contracts, 8 GMS contracts and 1 APMS contract. PMS and GMS contracts are perpetual and performance monitored by the Contracts Team and Primary Care Teams. APMS contracts have an agreed contract term and require procurement of services to a competitive marketplace. In NKCCG, the APMS contract commenced in April 2018 and is due for renewal in March 2022. In GHCCG, the APMS was recently renewed in April 2020 with a renewal date agreed for March 2025. Evidence to support the APMS contract renewal was obtained to provide assurance that due process was followed: The development of the APMS contract went through a thorough tender exercise, a series of steps and approval processes, including a detailed public engagement process. A Quality Impact Assessment was undertaken, and an engagement report presented to the PCCC in July 2019. A Consultation Report was presented to the PCCC in November 2019. An Equality Impact Assessment was also undertaken. Letters were sent out to each household registered within the practice area to request their views and then to confirm the outcome of the contract renewal.
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Control Objective Review Highlights ( Positive Assurance, ! Action Required) Assurance Level Recommendations (Priority) NHS NHS Major Moderate Minor GHCCG NKCCG Specific reference was made to the PGM in reports to the PCCCs to confirm compliance with the CCGs statutory duties. It was confirmed that the CCGs provide a monthly report to the Kirklees Local Medical Committee (LMC) interface meeting and the LMC are members of both the PCCC decision making process and therefore an integral part of the discussion. There is evidence of Section 1.3 of the PGM states that one of the general duties of High High 0 0 0 patient and public Commissioners is to ensure there is public involvement where a involvement in decision leads to an impact on the provision of primary care commissioning and services. procurement decisions. Patient and public involvement is a key component of commissioning decisions made by the CCGs. Both CCGs have specific strategic objectives to ensure that engagement and communication is a priority. NKCCG has a specific strategic objective to ensure that “patients are at the heart of our commissioning decisions”. GHCCG’s objective is to “build a collective sense of responsibility, amongst all those involved in health care, for the effective management of resources”. In support of this, the joint Communication and Engagement Strategy 2019 – 2022 details how both CCGs intend to engage, involve and communicate with local people, GP member practices and other stakeholders, in in partnership with a wide range of organisations across Kirklees and West Yorkshire including the Kirklees Local Medical Committee. The Strategy is available on the CCGs’ websites. An annual work plan is produced setting out how the strategy will be implemented. Supporting policies include the Engagement and equality checklist, Media Handling protocol and Paying for Involvement
77 5 Section 1: Executive Summary
Control Objective Review Highlights ( Positive Assurance, ! Action Required) Assurance Level Recommendations (Priority) NHS NHS Major Moderate Minor GHCCG NKCCG Policy. On an annual basis a Communication and Engagement Annual Report is developed and the 2019/20 report was presented at the Governing Body in August 2020 for assurance. This discloses all the patient and public engagement undertaken within the year throughout Kirklees. The CCGs’ websites provide details all the engagement and consultation current activities which can be accessed and viewed by the public. The CCGs approach to public engagement and consultation is to ensure the use of a variety of different mechanisms, methods and approaches to engage with people, including social media, promotional campaigns and pubic engagement events. The CCGs have a joint Patient Engagement Assurance Group (PEAG) which is designed to provide assurance that the CCGs are involving patients, carers and members of the public effectively when planning, developing and commissioning health services. The CCGs hold quarterly engagement events to give the public an opportunity to hear what the CCGs have been doing, priorities and plans for the future. Under the NHS Oversight Framework Patient and Community Engagement Indicator, both CCG received a rating of ‘Green Star’, which was one of the highest ratings in the country. An example of effective patient and public involvement in commissioning decisions was demonstrated through the APMS contract revision. Letters were sent to every household registered at the practice and an eight week consultation took place including drop in
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Control Objective Review Highlights ( Positive Assurance, ! Action Required) Assurance Level Recommendations (Priority) NHS NHS Major Moderate Minor GHCCG NKCCG sessions. Information was also circulated to Kirklees Health and Adult Care Scrutiny Panel, local councillors, MP and Healthwatch Kirklees. There are processes to The Head of Primary Care Strategy and Commissioning High High 0 0 0 commission Directed confirmed that the CCGs do not have any local incentive Enhanced Services schemes. and any Local Directed Enhanced Services (DES) are directed by NHSE&I Incentive Schemes and guidance is provided to the CCGs. (including the design of Primary Care Networks (PCNs) are a Directed Enhanced such schemes). Service implemented from July 2019. Confirmation had been received that all PCNs had signed-up to Network DES 2020- 21. NHSE&I commissions the national DES for the following schemes; Learning Disabilities Health Checks; Minor Surgery level 2, extended hours access and GP Choice Out of Area Registration which have also been confirmed by the CCGs. There are processes to Due to COVID-19 it has been identified that urgent decisions High High 0 0 0 commission a within the scope of the PCCC remit will need to be actioned response to urgent GP outside of the committee. Urgent decisions are required to be practice closures or agreed by the chair or vice-chair of the committee along with disruption to service one of its executive members, in consultation with an provision. Independent GP Advisor and a representative of the Local Medical Committee. Decisions taken in this manner were reported to the wider membership of the committee within one working day and again at the next formal meeting of the committee. The urgent decision process was presented to the committees and approved formally at the GHCCG’s PCCC in April 2020 and NKCCG’s PCCC in May 2020. Evidence was provided of urgent actions requiring approval
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Control Objective Review Highlights ( Positive Assurance, ! Action Required) Assurance Level Recommendations (Priority) NHS NHS Major Moderate Minor GHCCG NKCCG outside of the normal PCCC being made available on the CCGs internet site. A review of the urgent decisions confirmed that these had been appropriately reviewed and presented at the next available PCCC. In particular, there have been temporary closures of branches at both CCGs due to staff requiring to isolate or work from home due to COVID-19. These examples provided assurance that the urgent decisions process was undertaken. Although these closures were temporary, alternative care was considered and provided to patients during that time. There is effective Due to the impracticality of holding meetings in public in the High High 0 0 0 operation and oversight current COVID-19 situation, and in line with national guidance of the Primary Care the Governing Body and other committees have been meeting Commissioning virtually via MS Teams since April 2020 and continue to do so. Committee (or Currently each CCG has its own PCCC who can focus on alternative committee local primary care issues. Following the agreement for the with responsibility for two CCGs to merge in April 2021, a single Kirklees PCCC will the delegated function) be developed. in regard to Primary GHCCG PCCC is supported by a Practice Quality and Care Commissioning Contracting group who meet on a monthly basis. The group and Procurement of take a view on issues and develop recommendations for the Services (but not in PCCC. relation to the NKCCG PCCC is supported by the Primary Care management of Commissioning Committee Operational Group. The minutes Conflicts of Interest). of this group are presented to PCCC. The PCCCs undertake an annual report and self-assessment against the committee to confirm effectiveness an appropriate oversight. This was presented in May 2020 at the NKCCG
80 8 Section 1: Executive Summary
Control Objective Review Highlights ( Positive Assurance, ! Action Required) Assurance Level Recommendations (Priority) NHS NHS Major Moderate Minor GHCCG NKCCG Committee and April 2020 at the GHCCG committee. The Terms of Reference (ToR) for both CCGs’ PCCC were approved by the Governing Body meeting in common in June 2020. Specifically the ToRs confirm that the role of the Committees shall be to carry out the functions relating to the commissioning of primary medical services under Section 83 of the NHS Act statutory requirements and guidance, the CCGs’ Constitution and Standing Orders and the Delegation Agreement between NHS England and the CCGs. Membership quoracy requires the presence of two Lay Members, one who must be the Chair or Vice-Chair, and at least one officer who must be the Chief Officer, Chief Finance Officer or Chief Quality and Nursing Officer. A review of the agendas, papers and minutes from the two most recent public meetings of the GHCCG and NKCCG PCCCs found that the operation of the Committee was in line with the scope in its ToR. Urgent decisions have been made outside a formal committee in line with agreed delegation as approved in the GHCCG’s PCC April 2020 and NKCCG’s PCCC May 2020. These have been made available on the CCG’s internet sites and were presented at the next available PCCC. Overall High High 0 0 1
81 9 Section 2: Audit Background, Objectives, Scope and Report Circulation
Background Information
NHS England became responsible for the direct commissioning of primary medical care services on 1 April 2013. Since then, following changes set out in the NHS Five Year Forward View, primary care co-commissioning has seen CCGs invited to take on greater responsibility for general practice commissioning, including full responsibility under delegated commissioning arrangements. Where NHS England delegates its functions to CCGs, it still retains overall responsibility and liability for these and is responsible for obtaining assurances that its functions are being discharged effectively.
In agreement with the NHS England Audit and Risk Assurance Committee, from 2018/19 NHS England requires an internal audit of delegated CCGs primary medical care commissioning arrangements. The purpose of this being to provide information to CCGs that they are discharging NHS England’s statutory primary medical care functions effectively, and in turn use this information to provide aggregate assurance to NHS England and facilitate NHS England’s engagement with CCGs to support improvement.
To support this, in August 2018 NHS England published the Primary Medical Care Commissioning and Contracting: Internal Audit Framework for delegated Clinical Commissioning Groups. The document provides a framework for delegated CCGs to undertake an internal audit of their primary medical care commissioning.
The scope of the work covers: a) Commissioning and procurement of services b) Contract Oversight and Management Functions c) Primary Care Finance d) Governance (common to each of the areas a-c above)
The audit framework was agreed in 2019/20 to be delivered as a 3 year programme of work to ensure this scope is subject to annual audit in a managed way and within existing internal audit budgets. As Governance is common to each area it was agreed that this is covered in relation to the area of scope under review each year.
Year one 2019/20: Primary Care Finance. Governance of Primary Care Finance.
Year two 2020/21: Commissioning and Procurement of Services. Governance of Commissioning and Procurement of Services.
Year three 2021/22: Contract Oversight and Management Functions.
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Governance of Contract Oversight and Management Functions.
Key Risks
Key risks associated with this area include: The CCGs do not discharge NHS England’s statutory primary medical care functions effectively.
Objectives & Scope
The objective of the audit was to gain assurance that NHS Greater Huddersfield CCG and NHS North Kirklees CCG are discharging NHS England’s statutory functions effectively, and in turn to provide aggregate assurance to NHS England and facilitate improvement.
In order to meet this objective, the audit focused on the following key control objectives: There are effective arrangements in place for the planning of the provision of primary medical care services in the area, including carrying out needs assessments and consulting with the public and other relevant agencies as necessary. Adequate processes are adopted in the procurement of primary medical care services, including decisions to extend existing contracts. There is evidence of patient and public involvement in commissioning and procurement decisions. There are processes to commission Directed Enhanced Services and any Local Incentive Schemes (including the design of such schemes). There are processes to commission a response to urgent GP practice closures or disruption to service provision. There is effective operation and oversight of the Primary Care Commissioning Committee (or alternative committee with responsibility for the delegated function) in regard to Primary Care Commissioning and Procurement of Services (but not in relation to the management of Conflicts of Interest).
Methodology
The objectives of this review were achieved by:
Discussions with key staff; Review of relevant policies, procedures and guidance;
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Assess whether local processes established by the CCGs are aligned to NHS England policies and guidance e.g. Primary Medical Care Policy and Guidance Manual. Roles and responsibilities for activities have been clearly defined. Ensuring that processes are in place to confirm compliance with policies and procedures. Ensuring that documentation is retained, including records of decisions. Reviewing evidence to show decisions were exercised in accordance with NHS England’s statutory duties.
Limitations
The report is based on the review work undertaken and is not necessarily a complete statement of all weaknesses that exist or potential improvements. Whilst every care has been taken to ensure that the information provided in this report is as accurate as possible, no complete guarantee or warranty can be given with regard to the advice and information contained. Our work does not provide absolute assurance that material errors, loss or fraud do not exist.
Responsibility for a sound system of internal controls and the prevention and detection of fraud and other irregularities rests with management and work performed by us should not be relied upon to identify all strengths and weaknesses in internal controls, nor relied upon to identify all circumstances of fraud or irregularity. Effective and timely implementation of our recommendations by management is important for the maintenance of a reliable internal control system.
Where information resulting from audit work is made public or is provided to a third party by the client or by Audit Yorkshire then this must be done on the understanding that any third party will rely on the information at its own risk. Audit Yorkshire will not owe a duty of care or assume any responsibility towards anyone other than the client in relation to the information supplied. Equally, no third party may assert any rights or bring any claims against Audit Yorkshire in connection with the information. Where information is provided to a named third party, the third party will keep the information confidential.
Public Sector Internal Audit Standards
Audit work undertaken by Audit Yorkshire conforms with the International Standards for the Professional Practice of Internal Auditing.
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Report Circulation
Draft Final Recipient Name Recipient Title Catherine Wormstone Head of Primary Care Strategic Commissioning Martin Pursey Head of Contracting and Procurement Alison Needham Head of Finance Ian Currell Chief Finance Officer Laura Ellis Head of Corporate Governance / Data Protection Officer
The guidance requires that the CCG Primary Care Commissioning (or alternative committee with responsibility for the delegated function) should have a lead role in discussing and agreeing the report.
Acknowledgement
The auditor is grateful for the assistance received from management and staff during the course of this review. The following members of the Audit Yorkshire team were involved in the production of this report:
Head of Internal Audit: Helen Kemp-Taylor Audit Manager: Jonathan Hodgson Assistant Audit Manager: Danielle Hodson
Date: 1 April 2021
85 13 Section 3: Schedule of Findings and Recommendations
Management Responsible Finding Risk Recommendation Priority Target Date Response Officer Procurement Policy
The re-review of the Procurement Failure to follow 1. The Procurement Policy Minor Agreed – Procurement Martin Pursey, Head July 2021 Policy for both Greater correct should be updated. The Policy draft has been of Contracting & Huddersfield CCG and North legislation, review should reflect on amended to advise Procurement Kirklees CCG was scheduled for guidance and adding reference to reference to PGM in February 2020. The Policies are practice due to Primary Care Contracts respect of primary due for review as part of the out of date and the requirement to medical services merger of the two organisations in policy. follow the NHSE&I April 2021. Primary Medical Care Policy Guidance Manual. The current Procurement Policy does not refer to Primary Care Contracts and the requirement to follow the NHSE&I Primary Medical Care Policy Guidance Manual.
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Audit Opinion
The following opinions provide management assurance in line with the following definitions:
Opinion Level Opinion Definition Guidance on Consistency
High assurance can be given The system is well designed. The controls in the system are clear and the audit has been able to that there is a strong system of confirm that the system (if followed) would work effectively in practice. There are no significant flaws in internal control which is the design of the system. designed and operating effectively to ensure that the Controls are operating effectively and consistently across the whole system. There are likely to be core High system’s objectives are met. controls fundamental to the effective operation of the system. A High opinion can only be given when (Strong) the controls are working well across all core areas of the system. For example with ‘Debtors’ the controls over identifying income, raising debt, recording debt, managing debt, receiving debt, etc. are all working effectively – there are no serious concerns. Note this does not mean 100% compliance. There could be some minor issues relating to either systems design or operation which need to be addressed (and hence the report may include some recommendations) – however these issues do not have an impact on the overall effectiveness of the control system and the delivery of the system’s objectives.
Significant assurance can be The system is generally well designed - but there may be weaknesses in the design of the system that given that there is a good need to be addressed. system of internal control which Significant is designed and operating In addition most core system controls are operating effectively – but some may not be. effectively to ensure that the (Good) system’s objectives are met and Whilst any weaknesses may be significant they are not thought likely to have a serious impact on the that this is operating in the likelihood that the system’s overall objectives will be delivered. majority of core areas
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Opinion Level Opinion Definition Guidance on Consistency
Limited assurance can be given The system is operating in part but there are notable control weaknesses. as whilst some elements of the system of internal control are There are weaknesses in either design or operation of the system that may mean that core system Limited operating, improvements are objectives are not achieved. (Improvement required in the system’s design In terms of what differentiates a borderline Significant Opinion to a borderline Limited opinion – the main Required) and/or operation in core areas to factors are the scale and potential impact of weaknesses found. Multiple weaknesses across a range of effectively meet the system's core areas would suggest a Limited Opinion level is applicable. However it also true that ONE objectives weakness can suggest a Limited Opinion if it is fundamental enough to mean that a number of core system objectives will not be achieved.
Low assurance can be given as The audit has found that there are serious weaknesses in either design or operation that may mean that there is a weak system of the overall system objectives will not be achieved and there are fundamental control weaknesses that internal control and significant need to be addressed. Low improvement is required in its (Weak) design and/or operation to It should be borne in mind that Low Assurance is not ‘No Assurance.’ The key point here is that there is effectively meet the system's a good chance that the system may not be capable of delivering what it has been set up to deliver – objectives. either through poor systems design or multiple control weaknesses. The report will clearly state if ‘No Assurance’ is actually more applicable than low assurance.
Where limited or no assurance is given the management of both CCGs must consider the impact of this upon their overall assurance framework and their Annual Governance Statement.
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Priorities assigned to individual recommendations
Individual recommendations are graded in accordance with the severity of the risk involved to each CCG. Audit Yorkshire has a standard definition for each level of recommendation priority. This is represented in the table below:
Grading Definition Guidance on Consistency Recommendations which seek to address those findings These are recommendations which aim to address issues which if not addressed which could present a significant risk to the organisation could cause significant damage or loss to the organisation. The expectation is that Major with respect to organisation objectives, legal obligations, these recommendations would need to be taken as a matter of urgency. These (High) significant financial loss, reputation/publicity, recommendations should have a high corporate profile – with a clear implementation regulatory/statutory requirements or service/business tracking process in place, overseen by the Board or a Board level committee. interruption. Recommendations which seek to address those findings These are recommendations which if not addressed could cause problems with the Moderate which could present a risk to the effectiveness, efficiency safe or effective operation of the system being reviewed. The recommendations or proper functioning of the system but do not present a should have appropriate profile within the division or business area in which the (Medium) significant risk in terms of corporate risk. system being considered sits and some profile at Board /Audit Committee level also. These recommendations should be carefully tracked to ensure that action reduces the risks found Minor Recommendations which relate to issues which should be All other recommendations fall into this category. This includes recommendations addressed for completeness or for improvement purposes which further improve an already robust system and housekeeping type issues. (Low) rather than to mitigate significant risks to the organisation. (This includes routine/housekeeping issues)
89 17 Primary Care Name of Meeting Meeting Date 28 April 2021 Commissioning Committee Title of Report Primary Care Dashboard Agenda Item No. 10 Diane Lane, Primary Care Report Author Public / Private Item Public Manager Dr Ibrar Ali, Independent Medical Advisor, Dr Abid Catherine Wormstone, Clinical Lead Responsible Officer Iqbal, Independent Medical Head of Primary Care Advisor
Executive Summary
This paper will seek to provide an overview of the Primary Care Dashboard which was developed in 2017, to support the CCG in carrying out the delegated responsibility from NHS England to support service improvement and respond to quality and performance concerns arising from General Practice, reducing unwarranted variation and supporting member practices. Initially developed by Greater Huddersfield Clinical Commissioning Group, the Dashboard was adopted by North Kirklees Clinical Commissioning Group in 2019, mirroring the process that will be outlined in this paper.
Practices as providers of primary care services are accountable for the quality of services and are required to have their own quality monitoring processes in place.
The Primary Care Dashboard is key to supporting the CCGs developed assurance and surveillance process (February 2019), agreed by Quality Committee and Primary Care Commissioning Committee (PCCC)
Previous Considerations blank blank blank Primary Care Name of meeting Meeting Date 24.2.2021 Commissioning Committee Name of meeting N/A Meeting Date N/A
Recommendations
It is recommended that the Kirklees Primary Care Commissioning Committee: 1.Receive, discuss and approve the dashboard
Decision ☒ Assurance ☒ Discussion ☐ Other:
Implications
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90 Quality and Safety implications (including N/A whether a quality impact assessment has been completed)
Engagement and Equality Implications N/A (including whether an equality impact assessment has been completed), and health inequalities considerations Resources / Financial Implications (including Staff time to produce the data and analysis of the Staffing/Workforce considerations) dashboard. Sustainability Implications None arising from this report
Has a Data Protection Impact Assessment Yes ☐ No ☐ N/A ☒ (DPIA) been completed?
Strategic Objectives All Risk (include risk There is no risk number (which of the CCG number and a brief associated with this objectives does this description of the paper relate to?) risk) Legal / CCG N/A Conflicts of Interest It is possible that some Constitutional (include detail of any Committee members Implications identified / potential will be conflicted. conflicts) Conflict is managed in line with CCGs Conflict of Interest Policy
1. Introduction 1.1 In 2017 the Primary Care Dashboard was first developed by Greater Huddersfield CCG in response to the CCGs taking on delegated responsibilities from NHS England for the commissioning of primary medical services. The dashboard was developed to support service improvement and respond to quality and performance concerns arising from General Practice, reducing unwarranted variation and to support member practices. In 2019, North Kirklees CCG adopted the same Primary Care Dashboard and utilised the same principles and process. 2. Detail 2.1 The Primary Care Dashboard provides an overview of practice performance against identified quality and contractual measures. Appendix 2 shows GHCCG dashboard with no populated data. It is published each month and informs the detail within the performance and contracting reports presented to the Primary Care Operational Group. 2.2 The dashboard is divided into the 5 domains of the NHS Outcomes Framework and all quality, performance and contractual requirements that are presented in the dashboard align to the 5 domains as outlined below:
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2.3 The Primary Care Dashboard is divided into two main data tabs, one includes quality and performance indicators, and the other contractually required indicators, and where there is a national or local measure attached to an indicator, there are rated as Red, Amber or Green (RAG). Separate tabs provide details of the data source, identify national or local measures, and provide a rag rating score key. In addition a performance overview tab provides practice level detail of the number of reds in each domain, and whether this is an improving or declining score from previous dashboard reported position. 2.4 Where RAG risk rating is applied it is defined as follows:
o Green: As determined by the national measured target or locally determined target. o Amber: This has been based on previous NHS England RAG rating processes or has been locally determined o Red: This has been based on previous NHS England RAG rating processes or has been locally determined
Where there are no defined measures (predominantly around domains 2 and 3) statistical process control charts identify practice specific trends, spikes in activity and evidence of improvement/deterioration to inform action. This is provided as the RAG report and trigger sheet and forms part of the quarterly papers that are presented to Primary Care Commissioning Group (PCCC) each quarter.
2.5 In 2019, the Assurance and Surveillance process was signed off by GHCCG and NKCCG Primary Care Commissioning Committees (PCCCs), Appendix 3, details the approach which enables effective assessment, measurement, triangulation and benchmarking of quality indicators and performance metrics from a range of sources. It provides guidance as to what supportive approach and actions will result from the initial trigger and what stage the practice is at in the process. There is also a helpful flowchart of the process.
2.6 NHS England has now launched the Primary Care Network (PCN) Dashboard which provides cumulative data which can be reviewed at ICS, CCG, or PCN level. It includes Page 3 of 4
92 indicative data on performance and achievement for the Investment and Impact Fund (IIF) Indicators as well as PCN service delivery and progress with recruitment. PCN population demographics, population health, performance for general practice indicators and a general practice IT dashboard are accessible.
In comparison the CCGs Primary Care Dashboard focuses on national and local general practice indicators, and provides comparative monthly data at PCN and individual practice level, with the ability to highlight local variation. The two data sources together will provide essential intelligence to focus service improvement, reduce health inequalities and gain insight into geographical variation.
2.7 A review of the indicators within the Primary Care Dashboard will be undertaken over the next few months in line with national and local requirements. Any contractual changes that take effect in 2021/22 will be incorporated into the dashboard.
3 Next Steps 3.1 The dashboard to be presented to this Committee on a quarterly basis. 4. Implications 4.1 Quality and Safety Implications 4.1.1 N/A 4.2 Engagement and Equality Implications 4.2.1 N/A 4.3 Resources / Finance Implications 4.3.1 Staff time to produce the data and dashboard analysis.
4.4 Data Protection Implications 4.4.1 Both former CCGs had comprehensive Data Sharing Agreements in place which are in the process of being reviewed in the light of the creation of a new Kirklees CCG and if applicable, a DPIA will be undertaken. 4.5 Risk 4.5.1 N/A 5. Recommendations 5.1 It is recommended that the Kirklees Primary Care Commissioning Committee: Receive, discuss and approve the dashboard
6 Appendices Appendix 1and 1a – Quality Assurance and Surveillance process Appendix 2 – GHCCG Primary Care Dashboard – blank copy
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93 PRIMARY CARE QUALITY, PERFORMANCE AND CONTRACTING DASHBOARD
GREATER HUDDERSFIELD CCG
April 2021 Publication
Latest data up to March 2021
Notes Friends and Family Test - following a letter from NHS England outlining a number of areas and this included the following suspension of FFT reporting until March 2021.
The two data columns below will be added to future dashboards when data is available Online Access to Full Patient Record At least 25% of appointments available online for booking
94 GHCCG - Primary Care Dashboard Performance Overview - number of red flags by Domain
RAG Performance Total Number of Red's Total number of reds at (D5): Treating and Total number Total number Caring for of reds at of reds at Total number People in a Total number (D2): (D3): Helping of reds at Safe of reds at Enhancing People (D4): Environment (D1): Quality of Recover from Ensuring that and Practice list Preventing Life for Episodes of People have a Protecting size Raw People from People with Ill-Health or Positive them from Practice Figures Mar- Dying Long Term Following Experience of Avoidable GP Practice Code 21 Prematurely Conditions Injury Care Harm Direction of Performance Direction of Performance Direction of Performance Direction of Performance Direction of Performance The Valleys Health & Social Care Network Oaklands Health Centre B85610 Honley Surgery B85022 Elmwood Health Centre B85006 Slaithwaite Health Centre B85059 Meltham Group Practice B85032 Colne Valley Family Doctors B85054 The Mast Healthcare Partnership Dearne Valley Health Centre B85002 Skelmanthorpe Family Doctors B85061 Lepton & Kirkheaton B85031 Kirkburton Health Centre B85026 Shepley Health Centre B85005 Viaduct Health & Care Network New Street & Netherton Group Practice B85036 Meltham Road Surgery B85016 Thornton Lodge Surgery B85044 Fieldhead Surgery B85051 Crosland Moor Practice Y04266 Newsome B85037 Paddock & Longwood B85042 Lockwood Surgery B85641 Greenwood Network The Grange Group Practice B85028 Woodhouse Hill Surgery B85048 Dr Handa & Partners B85611 Croft Medical Centre B85614 Marsh Surgery B85623 Westbourne Surgery B85636 The Lindley Village Surgery B85033 The Lindley Group Practice B85027 Birkby Health Centre B85634 Nook Surgery Y06659 Tolson Care Partnership The Whitehouse Centre B85659 Greenhead Family Doctors B85060 Rose Medical Practice B85058 University Health Centre B85062 Dalton Surgery B85010 The Waterloo Practice B85024 The Junction Surgery B85660 The Almondbury Surgery B85023 Overall CCG Results
Arrows indicate direction of travel from previous months dashboard Increase in metrics rated red No Change in metrics rated red Reduction in metrics rated red
95 PRACTICE DETAIL QUALITY AND PERFORMANCE (D2) Enhancing Quality of (D3) Helping People Recover from Episodes (D5) Treating and Caring for People in a Safe Practice detail (D1) Preventing People from Dying Prematurely Life for People with Long (D4) Ensuring that People have a Positive Experience of Care of Ill-Health or Environment and Protecting them from Term Conditions Following Injury Avoidable Harm Practice B GP PRACTICE NAME Practice list Practice list Practice list Practice Type of GP Practice QOF CQC Latest Cervical Bowel Breast % % Number SMI - % of Learning Disability Unplanned Unplanned Emergency admissions for acute Overall, how Overall experience Support with PPG rep % of patients on % of patients on Health Visitor % of patients Pure Percentage of code size Raw size size Raw Clinical System Contract GMS/ Achievement % Overall Rating Screening Screening Screening Dementia of patients on Healthchecks Hospitalisation for Hospitalisation for conditions that should not would you of making an manging long-term attendance the Palliative Care the Palliative Safeguarding with Atrial Hypertensives Children who have Figures Weighted Figures 65 - EMIS or PMS APMS Rate Rate Rate Diagnostic Dementia SMI Register % Patients that have Chronic Ambulatory Asthma, Diabetes and usually require hospital describe your appointment health conditions at PRGN Register Care register with Attendance at MDT Fibrillation who with no completed Figures and over SystmOne Rate (65 Care Plan with all health completed a health Care Sensitive Epilepsy in under 19s admission experience of coded recorded meetings with are anticoag QRISK/QRISK2 imunisations by and over) Reviews checks check in the last 12 Conditions % your GP discussion about Practice staff 1819 Recorded in recommended ages complete months practice? ACP Last 5 Years
DATA Mar-21 Mar-21 Jan-21 Mar-21 Mar-21 Mar-21 Oct-20 Mar-21 Dec-20 Aug-20 Aug-20 Feb-21 Feb-21 Mar-21 Mar-21 (Dec'19 - Nov20) (Dec'19 - Nov20) (Dec'19 - Nov20) July 20 (Annual) July 20 (Annual) July 20 (Annual) Jan'21 Mar-21 Mar-21 Mar-21 Jul-20 Jul-20 Oct-20 to Dec-20 PERIOD (Quarterly) (Quarterly) (Quarterly) (Quarterly)
SOURCE CCG NHS Digital NHS E NHS Digital CCG NHS E NHS Digital CQC Open Open Open NHS Digital NHS Digital SystmOne & SystmOne & EMIS SUS Portal Children's Monitor SUS Portal IPSOS MORI IPSOS MORI IPSOS MORI CCG SystmOne and SystmOne and Locala Healthy Futures Healthy Futures Immform (Monthly) (Quarterly) (Monthly) (Annually) Exeter Exeter Exeter (QOF) (QOF) EMIS (SUS) EMIS EMIS The Valleys Health & Social Care Network B85610 Oaklands Health Centre B85022 Honley Surgery B85006 Elmwood Health Centre B85059 Slaithwaite Health Centre B85032 Meltham Group Practice B85054 Colne Valley Family Doctors The Mast Healthcare Partnership B85002 Dearne Valley Health Centre B85061 Skelmanthorpe Family Doctors B85031 Lepton & Kirkheaton B85026 Kirkburton Health Centre B85005 Shepley Health Centre Viaduct Health & Care Network B85036 New Street & Netherton Group Practice B85016 Meltham Road Surgery B85044 Thornton Lodge Surgery B85051 Fieldhead Surgery Y04266 Crosland Moor Practice B85037 Newsome B85042 Paddock & Longwood B85641 Lockwood Surgery Greenwood Network B85028 The Grange Group Practice B85048 Woodhouse Hill Surgery B85611 Dr Handa & Partners B85614 Croft Medical Centre B85623 Marsh Surgery B85636 Westbourne Surgery B85033 The Lindley Village Surgery B85027 The Lindley Group Practice B85634 Birkby Health Centre Y06659 Nook Surgery Tolson Care Partnership B85659 The Whitehouse Centre B85060 Greenhead Family Doctors B85058 Rose Medical Practice B85062 University Health Centre B85010 Dalton Surgery B85024 The Waterloo Practice B85660 The Junction Surgery B85023 The Almondbury Surgery ** CCG *** National
** This row shows the position of Greater Huddersfield CCG for the measure indicated in the column heading *** This row shows the national position for the measure indicated in the column heading
96 PRIMARY CARE DASHBOARD - DATA SOURCES AND DEFINITIONS FOR QUALITY AND PERFORMANCE DATA ITEM DATA SOURCE REPORTING DEFINITION OF DATA ITEM TYPE OF MEASURE - CONTRACTUAL REQUIREMENT RAG RATING DEFINITIONS PERIOD NATIONALLY OR LOCALLY DEFINED Practice B code PCSE Monthly The unique organisation code allocated to a practice N/A N/A N/A Practice name PCSE Monthly Name of the practice N/A N/A N/A Practice list size - raw NHS Digital Monthly Number of patients registered at the GP practice N/A N/A N/A Weighted capitation list size based on the Carr-Hill Practice list size Weighted Open Exeter Quarterly formula Nationally defined N/A N/A Number of patients registered at the GP practice that are Practice list size 65 and over NHS Digital Monthly age 65 and over N/A N/A N/A CCG Data Quality Practice Clinical System Team Monthly The clinical system that is used in the GP practice N/A N/A N/A The type of contract that a practice has signed up for: As outlined in the type of contact Type of GP contract NHS England Annually PMS/GMS/APMS N/A PMS/GMS/APMS N/A Practice QOF Achievement % Annually - The % annual achievement of the practice against the NHS Digital published end of Quality and Outcomes Framework Standards taken from October the NHS Digital website Nationally measured target N/A N/A CQC Latest Overall Rating The Care Quality Commission rating awarded to a As per CQC CQC website practice based on the latest inspection. Date represents Dark green - outstanding, green - good, amber - requires schedule the date the last report was issued. Nationally measured target N/A improvement and red - inadequate Cervical Screening % rate % rate for the update of cervical screening for practice Open Exeter Monthly <75% red, 75% to 79.99% amber, 80% and over green registered patients Nationally measured target N/A % rate for the update of bowel screening for practice Bowel Screening % rate Open Exeter Monthly registered patients Nationally measured target N/A <55% red, 55% to 59.99% amber, 60% and Over green Breast Screening % rate % rate for the update of breast screening for practice Open Exeter Monthly <70% red, 70% to 79.99% amber, 80% and over green registered patients Nationally measured target N/A % Dementia Diagnosis Rate (65+) NHS Digital (QOF) Number of patients 65 yrs. + on GP register as % of NHS E Monthly Monthly Below 70% red, 70% to 76.99% amber, 77% and over green number of patients expected to be on the register Workbook Nationally measured target N/A % Actual number of Care Plan Reviews for NHS Digital (QOF) patients diagnosed with Dementia Number of Care Plan Reviews as % of Number of SystemOne & Annual Less than 67% red, 67% and above green Patients on the Dementia Register (any age) EMIS Nationally measured target N/A SMI % rates Measure adopted is the SystemOne & % of patients on SMI register with all health checks target for community mental Monthly 30% and below – red 31-59% - amber 60% and above - green EMIS completed health teams for primary care N/A Learning Disability Health checks % Patients that have completed a health % Patients that have completed a health check in the last Monthly Red below 65% -Amber 65-74.9% - 75% and above green check in the last 12 months 12 months Nationally measured target
% Unplanned Hospitalisation for Chronic Local CCG Determination - national expectation is a year on year Ambulatory Care Sensitive Conditions National expectation is year reduction (Adults) SUS portal Monthly National Definition on year reduction N/A
Local CCG Determination - national expectation is a year on year % Unplanned Hospitalisation for Asthma, National Definition CCG Improvement Assessment National expectation is year reduction Diabetes and Epilepsy in under 19s SUS portal Monthly Framework on year reduction N/A
% Emergency admissions for acute Local CCG Determination - national expectation is a year on year conditions that should not usually require National Definition CCG Improvement Assessment National expectation is year reduction hospital admission SUS portal Monthly Framework on year reduction N/A Practices are measured against the nationally GHCCG average for July 2018 survey results was 87% for this collected data, but the CCG question, so rag rating has been applied as: Dark Green top average from the July 2018 highest 3 practices, green meets CCG average or above, amber NHS England - The % of overall patient experience achieved by the survey for this data field is National measurement around patient is just below CCG average and red is for practices achieving GP Survey - overall patient experience % IPSOS MORI Annually - July practice from the annual GP Survey 87% experience of gp practice 10% or more below the CCG average Practices are measured against the nationally GHCCG average for July 2018 survey results was 70% for this collected data, but the CCG question, so rag rating has been applied as: Dark green top The % gained through the GP annual patient survey of average from the July 2018 National measurement around patient highest 3 practices, green meets CCG average or above, amber GP Survey - % overall experience of NHS England - how patients felt of the ease of getting through to GP on surgery for this data field is experience of making an appointment with is just below CCG average, and red is 10% or more, below the making an appointment IPSOS MORI Annually - July the phone 70% the GP practice CCG average Practices are measured against the nationally GHCCG average for 2018 survey for this indicator was 80% for collected data, but the CCG this question, so rag rating has been applied as: Dark Green top GP Survey - % patients reporting they The % gained through the GP annual patient survey of average from the July 2018 National measurement around patient highest three practices, green meets CCG average or above, receive support with managing long term NHS England - how patients felt of the ease of getting through to GP on surgery for this data field is experience of support from the practice amber is just below CCG average and red is for practices health conditions IPSOS MORI Annually - July the phone 80% with managing long term health conditions achieving 10% or more below the CCG average
Not a contractual requirement, but CCG This column is not rag rated. The data reflects the number of level measurement of engagement with PRGN meetings that a representative from the practice has Patient Rep Group representation at the Whether there was PRG/PPG representation at the CCG patient rep groups and support for attended, against the number of meetings held in the year which CCG Patient Network Reference Group Engagement Team Quarterly Patient Network Reference Group Quarterly meeting Locally defined practices is 4 quarterly meetings for example 2 out of 4 = 2/4. % of patients on the Palliative Care % of patients on the Palliative Care Register Register SystemOne & Monthly Green .5% or above, amber .25% up to .49%, red .24% or below EMIS Nationally measured target N/A % of patients on the Palliative Care Register with coded recorded discussion SystemOne & % of patients on the Palliative Care Registered with Green 50% or above, red below 50% about an Advance Care Plan EMIS Monthly coded recorded discussion about an Advance Care Plan Nationally measured target N/A This data column is not rag rated. The data reflects the number of meetings recorded by the Locala team that have taken place (HV Safeguarding with the GP). The expectation is that these take Health Visitor - Safeguarding - attendances place on a monthly basis and the figure represents for example at the monthly MDT meetings with practice To date , number of months a HV Safeguarding has 3/12 three meetings out of 12 possible monthly meetings in the staff Locala Monthly attended the Monthly MDT meeting with practice staff Locally defined N/A year. % of patients with Atrial Fibrillation who are % of patients with Atrial Fibrillation who are Healthy Futures Quarterly Green 89% and above (STP aspiration), amber 77% to 88% Anticoagulated Anticoagulated Nationally measured target N/A Number of pure hypertensives with no QRISK/QRISK2 recorded in the last five Number of hypertensives with no QRISK2 recorded in years Health Futures Quarterly the last five years Nationally measured target N/A To be agreed September 2018 Nationally collected childhood immunisation uptake % As per national ratings Red Below 90%, Amber 90% to 95% and ImmFORM Quarterly Childhood Immunisations figures for the various ages Nationally measured target N/A Green 95% and above
97 PRACTICE INFORMATION CONTRACTING
Practice B GP PRACTICE NAME Practice Practice list Practice Practice Type of GP PRACTICE QOF Accountable Does the Practice Does the Number of Number of NHS Number of Friends and FFT percentage Online Electronic Electronic Local General Data Security Frailty code list size size patients Clinical contract Achievement % GP practice have meets Core practice GP Led England led Public Health Family non- recommended Access repeat repeat Practitioner's and Protection Raw Weighted age 65 and System GMS/PMS a PPG Hours 8am have a Community Enhanced Schemes 20/21 submission - prescribing dispensing Retention Toolkit Over 65 and over APMS and 6.30pm website Contracts Services 20/21 practices are reminder (EPS) (ERD) Scheme compliance severely frail practices are practices are signed up to letter issued signed up to signed up to (out of a for 20/21 (out of a possible 5) (Out of a possible 3) possible 6)
PERIOD Mar-21 Mar-21 Jan-21 Mar-21 Mar-21 Mar-21 Oct-20 Mar-21 Mar-21 Dec-19 Mar-21 20/21 20/21 20/21 Feb-20 Feb-20 Jan-21 Jan-21 Jan-21 April-18 As at April Mar-21 onwards 2019
SOURCE CCG NHS Digital NHS E NHS Digital CCG NHS E NHS Digital SystmOne CCG EDeC CCG CCG NHSE Public Health NHSE NHSE NHS Digital ePACT2 ePACT2 NHSE NHS Digital Data Quality (Annually) and EMIS Dec'2018 England The Valleys Health & Social Care Network B85610 Oaklands Health Centre B85022 Honley Surgery B85006 Elmwood Health Centre B85059 Slaithwaite Health Centre B85032 Meltham Group Practice B85054 Colne Valley Family Doctors The Mast Healthcare Partnership B85002 Dearne Valley Health Centre B85061 Skelmanthorpe Family Doctors B85031 Lepton & Kirkheaton B85026 Kirkburton Health Centre B85005 Shepley Health Centre Viaduct Health & Care Network B85036 New Street & Netherton Group Practice B85016 Meltham Road Surgery B85044 Thornton Lodge Surgery B85051 Fieldhead Surgery Y04266 Crosland Moor Practice B85037 Newsome B85042 Paddock & Longwood B85641 Lockwood Surgery Greenwood Network B85028 The Grange Group Practice B85048 Woodhouse Hill Surgery B85611 Dr Handa & Partners B85614 Croft Medical Centre B85623 Marsh Surgery B85636 Westbourne Surgery B85033 The Lindley Village Surgery B85027 The Lindley Group Practice B85634 Birkby Health Centre Y06659 Nook Surgery Tolson Care Partnership B85659 The Whitehouse Centre B85060 Greenhead Family Doctors B85058 Rose Medical Practice B85062 University Health Centre B85010 Dalton Surgery B85024 The Waterloo Practice B85660 The Junction Surgery B85023 The Almondbury Surgery CCG National
98 PRIMARY CARE DASHBOARD - DATA SOURCE AND DEFINITIONS FOR CONTRACTING TYPE OF MEASURE - DATA ITEM DATA SOURCE REPORTING PERIOD DEFINITION OF DATA ITEM NATIONALLY OR LOCALLY CONTRACTUAL REQUIREMENT DEFINED RAG RATING APPLIED - Red, Amber Green Accountable GP 7.7B.1. A Contractor must ensure that for each of its registered patients (including those patients under the age of 16) there % of patients that have been allocated a named accountable GP on is assigned an accountable GP. Accountable GP SystemOne & EMIS Monthly the practice clinical system at the time of reporting Nationally defined requirement Green - 100%, Amber 90% -99%, 89% and below Red 40A.1 A Contractor which provides Essential Services must establish a “Patient Participation Group” comprising of some of its Registered Patients for the purposes of: 40A.1.1 obtaining the views of Patients who have attended the Practice about the services delivered by the Contractor; and 40A.1.2 enabling the Practice has a Patient The practice has a functioning Patient Participating Group in the Contractor to obtain feedback from its Registered Patients about Participation Group (PPG) GP Practice Monthly practice. If it is a virtual group this will be identified with a V Nationally defined requirement those services. Green - Yes, Red - No 7.2 The Contractor must provide Essential Services and such other Services that it is required to provide under this Agreement to those Patients, at such time, within Core E Declaration submission Nationally defined requirement as Hours, as are appropriate to meet the reasonable needs of its Green for meeting the contractual requirement. TBC where Practice meets Core Hours December 2016/ Practice The requirement within the GMS/PMS contract is for practices to per contract/EDeC submission Patients. Core hours being between 8 - 6.30pm excluding EDeC information is not clear and needs clarification by 8am -6.30pm Websites Annually provide essential services within the core hours “0800-1830”. data. weekends & bank holidays. practices.
37.1 Where the Contractor has a website, the Contractor must publish on that website details of the Practice Area, including the Practice has a website CCG Bi-annually Practice has a functioning informative website Nationally defined requirement area known as the outer boundary area Green - Yes, Red - No Number of GP Led Services other than Essential Services, Additional Services Community Contracts or Out of Hours Services. practices are signed up to for 19/20 (Out of a possible Number of GP Led Community Contracts practices are signed up to 5) CCG Annually in 19/20 out of a possible 5 schemes Local measure N/A Services other than Essential Services, Additional Services Number of NHS England or Out of Hours Services. led Enhanced Services 19/20 practices are signed Number of NHS England led Enhanced Services practices are signed Nationally defined for participating up to (out of a possible 4) NHS E Annually up to in 19/20 out of a possible 4 schemes practices N/A Number of Public Health Services other than Essential Services, Additional Services Schemes 19/20 practices or Out of Hours Services. are signed up to (out of a Number of Public Health Schemes 2019/20 practices are signed up possible 5) Public Health, Local team Annually to out of a possible 5 schemes Local measure N/A
36.1 A Contractor which provides Essential Services must give all Patients who use the Contractor's Practice the opportunity to provide feedback about the service received from the Practice Friends and Family non- through the Friends and Family Test. submission reminder letter Where a practice has NOT submitted FFT data on three consecutive 36.2 The Contractor must: report the results of completed Friends Green - no breach, Red is a breach in the month of issued NHS England Monthly months they will receive a reminder letter from NHS E Nationally defined measure and Family Tests to the Board; reporting
Green - 80% - 100% recommended, 50% - 79% FFT percentage of patient % of those patients who returned FFT questionnaire, are recommended Amber, 49% and below, or no data recommendations NHS England Monthly recommending the practice in the reporting month return Nationally defined measure N/A submitted - Red Contractual requirement for practices to achieve minimum 10% with a National drive to achieve 30% of their patient The % of patients registered to be using one or more services online - population to be using one or % online Access NHS Digital Monthly National definition - CCG Improvement Assessment Framework more on line services. Contractual requirement minimum of 10% Green 10% and over. Red below 10% Electronic repeat Number of items supplied through EPS as a percentage of all items prescribing (EPS) ePact Monthly prescribed and dispensed N/A N/A N/A Electronic repeat Number of items prescribed and dispensed as erD as a percentage of dispensing (ERD) ePact Monthly all items prescribed and dispensed N/A N/A N/A
No further sign up is Sign up to the Retained applicable to this scheme, Doctor Scheme - valid new scheme is now in Practices who have retained a GP in practice under the terms of this March 2017 - June 2019 NHS England place. scheme National Scheme N/A No rag rating, Yes or No answer applies The contractor shall comply with the NHS Information Governance Toolkit (as such term is understood in the NHS Green - the CCG has been informed by IG Governance from time to time, and to the extent that it applies to the that the practice has completed the toolkit, Red - the CCG Data Security and IG Governance Team Whether a practice has completed the annual IG Toolkit, (Data Contractor); has been informed by IG Governance that the practice has Protection Toolkit (EMBED) Annually Security and Protection Toolkit) and meets compliance Nationally defined requirement NOT completed the toolkit The contractual requirements are for the practice to maintain a register of these patients, have a medication review with the severely Practice to maintain a register of these patients, have a medication frail and also discuss additional Summary Care Record with both review with the severely frail and also discuss additional Summary less than 2% red, 2% to 2.99% amber and 3% and above Frailty SystemOne & EMIS Monthly cohorts. Nationally defined requirement Care Record with both cohorts. green
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Primary Care
Quality Assurance and Surveillance Process
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Review and Amendment Log/Control Sheet
Responsible Officer: Head of Primary Care Strategy and Commissioning
Clinical Lead: Chair, Kirklees Primary Care Operational Group
Author: Primary Care Manager/ Quality Manager
Date approved: tbc
Committee: Kirklees Primary Care Commissioning Committee
Version: 0.1
Review date: Six months from date of approval
Version History
Version No. Date Author Description Circulation February 2019 Quality Manager Originating document, approved in Greater Huddersfield and North Kirklees CCGs 0.1 April 2021 Primary Care Updated Kirklees Primary manager/Quality following merger Care Manager for new Kirklees Operational CCG, committee Group (for references; approval) renumbering and paragraphs
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1. INTRODUCTION
1.1 The CCG has a responsibility under delegated responsibility from NHS England for improving and developing the quality and performance of primary care general practice. This should include a process for responding to and managing quality, performance, and contractual concerns effectively in a safe and timely manner in accordance with a NHS England Quality Concerns Process. This paper sets out a new Primary Care Quality Assurance and Surveillance Process.
2. PURPOSE
2.1 Under delegated responsibility from NHS England Kirklees CCG needs to support improvement and respond to quality and performance concerns arising from General Practice, reducing unwarranted variation and supporting member practices. Practices as providers of primary care services are accountable for the quality of services and are required to have their own quality monitoring processes in place. CCGs are required to be supportive whilst monitoring and enhancing quality and preventing harm to patients. Through the duty of candour and the contractual relationship with commissioners, practices are required to provide information and assurance to commissioners and engage in system wide approaches to improving quality and performance.
2.2 NHS Kirklees CCG is committed to monitoring and improving the quality of care and performance of practices for our patients. Therefore the Quality Assurance and Surveillance Process describes the proposed approach which enables effective assessment, measurement, triangulation and benchmarking of quality indicators and performance metrics from a range of sources through a dashboard across all general practice providers. It then provides guidance as to what supportive approach and actions will result from the initial trigger and what stage the provider is at in the process. This should be a clear and transparent process which is done through collaboration between the CCG and provider.
2.3 This process will clearly define:
How the dashboard will support data analysis and monitoring. This should define the different quality and performance data used. This will also include their source, acceptable range, target and where required, the CCG average How a GP practice triggers the informal or formal stages of the process, and what actions will result from this trigger involving the Provider, CCG and NHS England. The different stages in the process and how this interfaces with the NHS Quality Concerns Trigger tool. Each stage will articulate what the CCG’s responses/options and actions are for each stage. The stages will also articulate how the CCG will offer early and effective intervention and support when quality and or performance appears to be deteriorating, to safeguard and support practices to deliver high standards of safe quality care.
3. THE PRIMARY CARE DASHBOARD
3.1. The Primary Care Dashboard provides an overview of practice performance against identified quality measures. It is reviewed monthly and informs the integrated quality performance and contracting report which reports to Kirklees Primary Care Operational Group (KPCOG).
3.2. The dashboard is divided into the 5 domains of the NHS Outcomes Framework; quality, performance and contractual requirements will be aligned to the domains.
102 Quality will continue to be defined by the Darzi (2008) definition: Patient Safety, Clinical Effectiveness, and Experience of patients. Therefore all three domains of quality are represented within the five domains.
3.3. Dashboard RAG rating (Red, Amber, Green rating)
3.3.1. Current RAG rated measures are based on the nationally measured and defined targets there are however the following 3 broad definitions:
Nationally measured target or expectation (17 metrics with 1 national measure with no target). National basis but measured against CCG achievement (4 metrics not RAG rated). Locally defined (2 metrics not RAG rated).
3.3.2. Where RAG risk rating is applied it is defined as:
Green: As determined by the national measured target or locally determined target. Amber: This has been based on previous NHS England RAG rating processes or has been locally determined as defined in Appendix A Red: This has been based on previous NHS England RAG rating processes or has been locally determined as defined in Appendix A
3.3.3. Where there are no defined measures (predominantly around domains 2 and 3) the KPCOG will create run lines and statistical process control charts to identify practice specific trends, spikes in activity and evidence of improvement/deterioration to inform action.
103 3.3.4. The data collected under each domain are as follows:
•Screening rates for: cervical, bowel and breast •Dementia diagnostic rates Domain 1 •% number of care plan reviews for those on dementia register •SMI: % of patients registered with all health checks complete
• % Unplanned hospitalisation for Chronic Ambulatory Care Sensitive Conditions Domain 2 • % Unplanned hospitalisation for Asthma, Diabetes and Epilepsy in under 19s
•Emergency re-admissions within 30 days of discharge •Emergency admissions for acute conditions that should not usually require hospital admission. Domain 3
•E Referrals •Online Access •GP Survey: Overall patient experience of their GP practice , Overall experence of making an appointment, Support with managing long-term health conditions, Patient Reference Group (PRG) rep attendance at PRG Network Domain 4 •Palliative Care: % of patients on the palliative care register, % of patients on the palliiative care register with coded discussion about Advance Care Plan (ACP)
•Health Visitor Safeguarding attendance at MDT meeting with the practice staff •% of patients with Atrial Fibrillation (AF) who are anti-coagulated •Childhood imms : Imms rate for childern aged 1, who have been immunised for diptheria, tetanus, Polio, Pertussis, Domain 5 Haemophilus influenzae type B (Hib)
4. PRIMARY CARE QUALITY ASSURANCE AND SURVEILLANCE STAGES
4.1 The process will have four stages. The flowchart in Appendix B provides a detailed summary of the stages.
Stage 4B Formal Action Risk Summit
Stage 4A: Formal Action: Single Item QSG with Qualiity Risk Profile
Stage 3A&B: Formal Enhanced Survillence: (Aligned to NHS England process) Quality Review Meeting & Quality/Monitoring Assurance Visit. Escalation to Stage 3B: Enhanced Qualiity Review Meeting with Quality Risk Profile)
Stage 2: Informal Enhanced Survillence: Practice Visit to determine risks to Quality, Safety, Performance and Contractual concerns
Stage 1: Routine Survillence: Reviewing monthly dashboard for any Practice the Trigger Stage 2
104 4.2 Stage 1: Routine Quality Assurance Monitoring
4.2.1. There is a quality, performance and contracting dashboard that is populated through the business intelligence team and performance manager using a range of resources on a monthly basis. The performance team will RAG rate the indicators as defined in 3.3 which provides risk stratification. It is important to note that any outlying RAG rating does not necessarily mean that there is a concern but it does indicate that the quality and or performance in the area identified needs further examination.
4.2.2. It has been agreed by the CCG that only 12/ 15 indicators (in domains 1-5) that are RAG rated will contribute to the trigger criteria. These 12 indicators are * in Appendix A. These indicators have been identified as a priority for the CCG in regards to quality of patient care and where quality improvement is actively encouraged. These may change on a yearly basis as part of the annual review of this process.
4.2.3. This process is intended to be an ‘early warning’ to identify practices that may require advanced diagnostics to address concerns regarding unwarranted variation or identify ‘vulnerable’ practices that may require signposting to additional support/resources. This ‘early warning’ is first and foremost a supportive measure to encourage insight into practice quality issues and or concerns and signpost, guide and support the practice where required.
4.2.4. The Kirklees Primary Care Operational Group (KPCOG) Pre-Meet will review the dashboard and the highlighted practices on a monthly basis which have triggered one of the criteria (which are listed below). The Pre-Meet group will provide KPCOG with a full summary of the discussion of all the Practices that have triggered and a recommendation as to which should be escalated to Stage 2 Informal Enhanced Surveillance. KPCOG will review the findings of the Pre-Meet and have a further discussion prior to making a final decision which Practices will be escalated.
4.2.5. The Trigger criteria:
Total of 10 from either RED or AMBER indicators across Quality, Performance and Contracting Total of 6 REDs. A CQC report that assesses the ‘SAFE’ and or ‘WELL-LED’ KLOEs as Requires Improvement. A serious incident identified in the practice. Any new intelligence/ significant complaint or whistleblowing issue of significant importance. Concerns raised from the routine quarterly practice visit. A CQC report which provides an overall assessment of Requires Improvement A CQC report which provides an overall assessment of Inadequate (Consideration may be given to escalate to stage 3 or 4 dependent on the patient safety risk).
4.2.6. KPCOG will undertake a more in-depth review and triangulating of the dashboard data, intelligence and knowledge of the practice from multiple sources. This discussion will determine if there is evidence or intelligence of a quality, performance or contracting concern/s which is either not resolving or is deteriorating. If a concern is identified and agreed within the meeting, KPCOG will initiate Stage 2 Informal Enhanced Surveillance.
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4.3 Stage 2: Informal Enhanced Surveillance
4.3.1. A Practice Visit will be arranged with 2-3 members of the CCG compiled from the appropriate members of the Primary Care, Quality and Contracting teams. The initial visit and any potential subsequent visits will be led by an appropriate member of the Primary Care or Quality Team dependent on the area (s) of concern such as, but not exclusively, unwarranted clinical variation, workforce, safeguarding, performance or contractual concerns.
4.3.2. The practice visit is intended to be an informal way for the CCG to have an open discussion with practices about the dashboard data which may identify them as outliers for good, deteriorating or underperforming practice or care. There will be key lines of enquiry and scope agreed for this visit to ensure everyone is fully sighted on the purpose and outcomes expected.
4.3.3. The overall purpose of the visit: Supportive process to provide a deep dive analysis and understanding of the data/ intelligence with the practice into the concerns the dashboard/incident/CQC report may have highlighted. It is important to identify whether the practice was sighted on these concerns and what actions have been already taken to address this. Improving patient outcomes by offering appropriate support, guidance and managing quality issues. Discuss Quality Improvement support needs Enabling the sharing and development of good practice and action plans as required.
4.3.4. Following the visit a letter will be provided to the practice to summarise the key discussion points, actions and next steps. This would include any contractual information or concerns noted from quality, performance, contracting and CQC findings.
4.3.5. All the findings and evidence will be reviewed by KPCOG (whose membership includes NHS England) with three options available:
a) If there are no improvements noted or concerns are identified: The practice will be required to then provide a detailed action plan with clear timeframes using the SMART principles. Progress against the action plan will be reviewed monthly by KPCOG and reported to PCCC. A clear timescale for sustained improvement will agreed and where concerns are not addressed in a timely manner the KPCOG can determine to escalate the process to stage 3A.
b) If patient safety concerns are significant with minimal or no assurance, KPCOG can recommend escalation to Stage 3A or Stage 4A dependent on the risk identified and status of assurance. This would start the formal process as described in the Commissioners Quality Concerns Trigger Tool by NHS England.
c) Improvements were already in progress by the practice: KPCOG can recommend that they remain in monitoring for three months to ensure sustained improvement occurs, or the Practice could be deescalated from enhanced monitoring if robust and clear sustained improvements and assurance were noted at the visit and agreed at KPCOG.
4.3.6 At any time during the Stage 2, if there is an increasing risk to patient safety and an urgent response is required, the CCG can escalate immediately to stage 4A or 4B, dependent on the risk.
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4.3.7 Governance arrangements for Stage 2: The reporting of Practices at Informal Enhanced Surveillance will occur through KPCOG with overall reporting to PCCC. The CCG may choose to formally inform NHS England of any concerns and may request further support or guidance from the NHS England Contracting team.
4.4 Stage 3 (A & B): Formal Enhanced Surveillance (Investigation/ Quality Review Meeting). This follows the NHS Trigger Tool process ‘Enhanced Quality Assurance Process’.
4.4.1. This is the formal reactive element of the quality assurance/surveillance process and manages persistent and/or increasing quality/performance concerns. The provider is escalated to this level where increasing risk is identified. The Formal Enhanced Surveillance process mirrors the enhanced quality assurance process as detailed in the NHS England Quality Concerns trigger tool.
4.4.2. At any time during Stage 3, if there is an increasing risk to patient safety and an urgent response is required, the CCG can escalate immediately to stage 4A or 4B, dependent on the risk.
4.4.3. Stage 3A: It is expected that as soon as Stage 3A is triggered that the following three meetings/ visit must be planned as a matter of urgency:
1. An Investigation / Quality Review Meeting (QRM) should be arranged within 5 working days. This meeting should include all relevant CCG teams (Primary Care, Quality, Performance, and Contracting) with consideration as to whether invite NHS England, CQC and other relevant parties. The designated Chair will be dependent on the concern/concerns raised.
The purpose of the meeting is to initiate a formal investigation including further conversations with the practice to share wider intelligence, with further analysis of the situation. Furthermore to discuss whether the risk associated with the substantiate concerns. Actions that may come from this meeting include: Details of all Quality, Performance and Contracting concerns should be clearly noted with new timescales considered dependent on the risk. Review the existing action plan and consider further formal contractual actions or support strategies that may be implemented. Agree key lines of enquiry and scope for the Targeted Quality/Monitoring Assurance Visit. Consider initiating the NHS England Quality Risk Profile to support any decision making. Consider formal discussions with NHS England and CQC surrounding performance, quality and safety and contractual concerns. Consider any remedial and breach notifications. Consider escalation to stage 4A or 4B depending on risk and concern to patient safety. Arrange follow up QRMs as required, reviewing progress against the action plan as well as reviewing the outcome of Targeted Quality/Monitoring Assurance Visit/s.
2. A Targeted Quality/Monitoring Assurance Visit must be arranged within 10 working days of this Stage 3A being triggered with the relevant team agreed. The purpose of the visit is to: Provide further quality assurance based on key lines of enquiry agreed at the Investigation/ Quality Review Meeting. To provide further guidance or support sign posting for quality improvement.
107 Ensure that the practice is fully sighted on all the concerns and has a robust action plan with clear SMART objectives with timescales that is agreed by the CCG. Provide a clear report to a follow up QRM and the Practice of the outcome of the visit.
3. Formal Meetings with the Practice should be arranged to discuss the outcome of the initial and subsequent Stage 3A Investigation / Quality Review Meetings. These meeting should include: Agree actions, with SMART objectives and evidence required with clear timescales agreed with the CCG and all relevant parties. Agree further meeting dates during this monitoring period to ensure effective communication and escalation of concerns. If the concerns are contractual, for close monitoring to occur with appropriate formal letters. Any feedback on current evidence on actions submitted to the CCG. Discuss any further support arrangements if required.
4.5 Stage 3B: The Formal Enhanced Quality Review Meeting.
4.5.1. The evidence and intelligence supporting the outcomes in the Action Plan should be reviewed alongside current Quality, Performance and Contracting data and intelligence at a Formal Enhanced Quality Review Meeting (Stage 3B). There are 3 options available as an outcome of this meeting:
a) If assurance has been evidenced with changes embedded and sustained: The outcome could be that this practice is recommended to KPCOG to be de- escalated to Stage 2 Informal Enhanced Surveillance for monitoring for a further 3 months. At that point a decision can be made to escalate further or remain on Formal Enhanced Surveillance depending on the long term progress and performance. b) If assurance is evidenced due to significant changes to the contract holder status or substantial changes in the practices which eradicates or significantly reduces the concern, a recommendation to KPCOG could be that it is deescalated to Stage 1. However this would require clear and robust documentation and risk assessment on the decision made. c) The final option reflects where there is little assurance or evidence to indicate that the improvement in performance and or patient safety concerns have been addressed in a robust and sustained manner. The Formal Enhanced Quality Review Meeting can recommend to KPCOG that this practice is escalated to stage 4A or 4B dependent on the risk. If this practice is being escalated to Stage 4A or 4B the following should occur: KPCOG will approve the recommendation of the Practice moving to stage 4A or 4B. A Quality Risk Profile should be developed to support and inform decision making. The purpose of the risk profile is to systematically assess the risks to quality of provision at a point in time. The profile should be used where persistent/increasing quality concerns have been identified. This will give focus to where further exploration is required. There is an acknowledgment that relevant stakeholders will be actively involved in the development of the profile. The profile can be re‐run at any time to demonstrate an increasing or decreasing level of assurance. A meeting between Commissioners and Regulators to determine next steps should be convened within 5 working days of this decision to escalate.
4.5.2. The practice will be formally informed of the outcome, expectations of the practice and next steps to ensure they are fully informed of the decision and rationale for this.
108 4.5.3. Governance arrangements Stage 3A & 3B: The reporting of practices at Formal Enhanced Surveillance will occur through KPCOG with overall reporting to PCCC and the private section of Quality Committee. The CCG may choose to formally inform NHS England via letter of any concerns and may request further support or guidance from the NHS England Contracting team.
4.6 Stage 4A: Formal Action: Single Item QSG (Quality Surveillance Group)
4.6.1. Formal communication to the practice should occur surrounding the increased surveillance to stage 4A: Single Item QSG. The Quality Risk Profile should be shared with the provider. A Single Item QSG meeting should be convened within 5-7 working days and should involve all relevant CCG team members and Heads of Service as well as all relevant Regulators and parties.
4.6.2. This Single Item QSG should:
Review all the evidence, data and intelligence from all QSG members alongside the Quality Risk Profile. Provide a summary of the practice timeline of events, actions, mitigation, and assurance so far, evidence of sustained and embedded change. The summary should also include a timeline of all interventions by the CCG and support mechanisms from external resources. The Single Item QSG should provide an overall summary of the current concern and risk to quality and patient safety, risk to the practice sustainability, and should summarise the concern and risks to the practice, patients and staff, mitigation in place and system risk to surrounding GP Practices. The Single Item QSG members are required to determine the level of assurance they have currently surrounding quality, patient safety, staff safety, performance at the Practice.
4.6.3. Actions from the Single Item QSG:
The members of the Single Item QSG should determine and agree on next steps surrounding an additional review period given to the practice to provide evidence of improvement or whether escalation straight to a Risk Summit is required (Stage 4B). If a review and improvement period is decided then clear aims, objectives and timescales through an action plan and any contractual notices should be formally presented to the practice by letter and by a visit from the CCG team. Also it should determine the frequency of any more Quality Assurance Visits. A further Formal Enhanced Quality Review meeting date should be set to review progress at the end of the review period to determine whether the risk is improving or deteriorating. If a review period is granted to give the practice time to improve, a series of monitoring mechanisms needs to be agreed and implemented including regular written and verbal contact, visits and monitoring by the Primary Care Team as well as planned or unplanned Quality Assurance Visits. A formal Enhanced Quality Review meeting at the end of the review period will determine whether the practice can be deescalated to stage 3A for a period of 3 months of monitoring or whether a further monitoring period for sustainability of improvement is decided at Stage 4A.
4.6.4. Should the identified risk remain or increase at any point of Stage 4A a Risk Summit will be convened.
109 4.7 Stage 4B: Formal Action: Risk Summit
4.7.1. The organisation raising the concern should immediately arrange an intelligence- sharing teleconference with relevant parts of the system to determine whether a risk summit should be held. Usually this should be within 24 hours of the concern being identified which matches one or more of the trigger mechanisms. If a decision is made to recommend a Risk Summit there must be certainty that there is a serious quality failure that cannot be resolved through established and routine operational systems. This Summit should be convened in a matter of days.
4.7.2. A Risk Summit is a significant event that requires statutory organisations across the health and care system to come together to give specific, focussed consideration to the concerns raised. This should facilitate rapid, collective judgements to be taken about the specific risk to quality.
4.7.3. The National Quality Board (NQB) (2017) stated that a Risk Summit should be considered when: Serious quality failings are identified by any organisation or part of the system, and The organisation or part of the system believes that there is a need to act rapidly to protect patients and or staff.
4.7.4. Serious quality concerns may be identified through a range of routes (NQB 2017): Individual organisations’ routine quality and operational performance monitoring systems; Quality Surveillance Groups; Completion of the Quality Risk Profile Tool CQC Chief Inspectors Information sharing meetings; or A single material event.
4.7.5. A Risk Summit enables the organisations which make up the health and care system to: Give specific, focused consideration to the concern raised, sharing information and intelligence, including with the service provider where the quality risk has been identified; Facilitate rapid, collective judgements to be taken about quality within the provider organisation in question; and Agree any actions needed as a result of the risk identified. As above, it should be emphasised that action is likely to be needed across the system, not only by a particular provider where the risk has manifested ( NQB, 2017)
4.7.6. The Risk Summit should follow National Quality Board Guidance (NQB, 3rd Edition July 2017). This guidance provides a clear and consistent framework for all NHS bodies across England to assist in the management of serious quality risks and failures. It describes the purpose and potential triggers for calling a Risk Summit; the roles and responsibilities of the different participants; the governance arrangements for Risk Summits and practical advice in preparing for and conducting a Risk Summit.
4.7.7. The guidance provides templates for the agenda, letters, checklists and a document for formal recording of the details discussed and follows up actions at the Risk Summit.
4.7.8. The Risk Summit membership (discussed below) should discuss the concerns and risks and review this in light of the provider and the wider GP system. This Summit
110 can be chaired by NHS England and NHS Improvement, or potentially the CCG as co-commissioners. This will be determined as part of the teleconference.
4.7.9. Membership varies but can include any of the following (*minimum attendance): * NHSE DCO Team (Director, Medical and Nurse Directors) * NHS Improvement (delivery and improvement director and a clinical lead) * Care Quality Commission Public Health England * Relevant CCG (accountable officer or nominated Director level representation) * Local Authority (joint commissioned services) * Relevant Provider (GP Partners and contract holders) * General Medical Council * Nursing and Midwifery Council * Health Education England Local HealthWatch ( as appropriate) * Secretariat (to be provided by a senior manager within the ‘chair’ organisation’ *Communications support from the chair organisation, if necessary. Other commissioners with an interest Other local government agencies Local supervising authority midwifery officer Police Safeguarding boards Expert witnesses; and Other professional regulators
4.7.10. Governance arrangements Stage 4A & 4B: The reporting of Practices at Formal Action stages will occur through KPCOG with overall reporting to PCCC and the Private section of Quality Committee and Governing Body.
5. REVIEW OF THE PROCESS
5.1 During the first year of this process being initiated the Process and its trigger criteria will be reviewed at the 6 month period to ensure this is working effectively for both practices and CCG. This Process will then be reviewed routinely on a yearly basis as part of an annual review to ensure it is in line with national and local policy as well as CCG priorities.
6. IMPLICATIONS
6.1. Quality & Safety Implications: This Process will provide a clear and transparent effective process for assessing, monitoring and managing quality and performance.
6.2. Engagement & Equality Implication: Engagement has been through the LMC interface.
6.3. Legal / CCG Constitutional Implications: To support the CCG to be able to discharge its responsibility under delegated responsibility for Primary Care Commissioning from NHS England.
7. APPENDICES Appendix A: Dashboard data: Sources and ranges.
Appendix B: Flowchart
111 Appendix A
* indicates which indicators contribute to the trigger criteria for Informal Enhanced Surveillance
DATA ITEM DATA DEFINITION OF DATA TYPE OF RAG RATING DEFINITIONS SOURCE ITEM MEASURE - NATIONALLY OR LOCALLY DEFINED Practice B code The unique PCSE organisation code allocated to a practice N/A N/A Practice name PCSE Name of the practice N/A N/A Number of patients Practice list NHS registered at the GP size - raw Digital practice N/A N/A Weighted capitation list Practice list Open size based on the Carr- Nationally size Weighted Exeter Hill formula defined N/A CCG Data The clinical system that Practice Quality is used in the GP Clinical System Team practice N/A N/A The type of contract that a practice has Type of GP NHS signed up for: contract England PMS/GMS/APMS N/A N/A Practice QOF The % annual Achievement % achievement of the NHS practice against the Digital Quality and Outcomes Nationally Framework Standards measured target N/A CQC Latest The Care Quality Overall Rating Commission rating Dark green - outstanding, CQC awarded to a practice green - good, amber - requires website based on the latest Nationally improvement and red - inspection measured target inadequate Cervical % rate for the update of Screening % Open cervical screening for <70% red, 70% to 79.99% rate * Exeter practice registered Nationally amber, 80% and over green patients measured target % rate for the update of Bowel bowel screening for Screening % Open practice registered Nationally <60% red, 60% and Over rate* Exeter patients measured target green Breast % rate for the update of Screening % Open breast screening for <70% red, 70% to 79.99% rate* Exeter practice registered Nationally amber, 80% and over green patients measured target Dementia NHS Number of patients on Diagnosis % Digital GP register as % of Below 66% red, 66% to Rate (QOF) number of patients 70.99% amber, 71% and over NHS E expected to be on the green Monthly National target register Workbook 67%
112 % Actual NHS number of Care Number of Care Plan Digital Less than 74% red, 74% to Plan Reviews Reviews as % of (QOF) 78.99% amber, 79% and for patients Number of Patients on SystmOn above green diagnosed with the Dementia Register National target e & EMIS Dementia * 67% SMI % rates* based upon the target for % of patients on SMI SystmOn community 30% and below – red 31-59% - register with all health e & EMIS mental health amber 60% and above - green checks completed teams for primary care % Unplanned Hospitalisation for Chronic Local CCG Determination - Ambulatory National national expectation is a year Care Sensitive expectation is on year reduction Conditions SUS year on year (Adults) portal National Definition reduction % Unplanned Hospitalisation Local CCG Determination - for Asthma, National Definition CCG National national expectation is a year Diabetes and Improvement expectation is on year reduction Epilepsy in SUS Assessment year on year under 19s portal Framework reduction % Emergency National Definition CCG National Local CCG Determination - re-admissions Improvement expectation is national expectation is a year within 30 days SUS Assessment year on year on year reduction of discharge portal Framework reduction % Emergency admissions for acute Local CCG Determination - conditions that national expectation is a year should not National Definition CCG National on year reduction usually require Improvement expectation is hospital SUS Assessment year on year admission portal Framework reduction The % of electronic referrals by the practice Nationally 90% achievement - green. % of E- NHS - National definition - measured and 85% to 89.9% is amber and referrals Digital CCG Improvement the target is an 84.9% and below is red Assessment aim of Framework Nationally The % of patients driven aim for registered to be using practices to one or more services achieve 30% of online - National patients to be definition - CCG using one or Improvement more on line 30% achievement - green, % online NHS Assessment services by end 10% to 19.9% amber, and services Digital Framework of March 2019 9.9% and below red
113 Practices are measured against the nationally GHCCG average was 88% so collected data, rag rating has been set against but the CCG this figure which was higher NHS The % of overall patient average within than the national average. GP Survey - England - experience achieved by the survey for 88% and above - Green, 80- overall patient IPSOS the practice from the this data field is 87.9% Amber, 79.9% and experience % * MORI annual GP Survey 88% below - Red. Practices are measured against the nationally GP Survey - % The % gained through collected data, of how patients the GP annual patient but the CCG GHCCG average was 72% so felt of the ease NHS survey of how patients average from rag rating set against this of getting England - felt of the ease of the July 2017 figure. 72% and above - through to GP IPSOS getting through to GP surgery for this Green, 60-71.9%, Amber, on the phone:* MORI on the phone data field is 72% 59.9% and below - Red. Practices are measured against the nationally GP Survey - % The % gained through collected data, patients the GP annual patient but the CCG GHCCG average was 86% so reporting they NHS survey of how patients average from rag rating set against this are able to see England - felt of the ease of the July 2017 figure. 86% and above - a GP within 2 IPSOS getting through to GP surgery for this Green, 75% to 85.9% is working days* MORI on the phone data field is 86% Amber, 75% and below - Red. This column is not rag rated. Patient Rep The data reflects the number Group of PRGN meetings that a representation Whether there was representative from the at the CCG PRG/PPG practice has attended, against Patient representation at the the number of meetings held in Network CCG Patient Network the year which is 4 quarterly Reference Engagem Reference Group meetings for example 2 out of Group ent Team Quarterly meeting Locally defined 4 = 2/4. % of patients % of patients on the Green .5% or above, amber on the Palliative Care Register .25% up to .49%, red .24% or Palliative Care SystmOn Nationally below Register* e & EMIS measured target % of patients on the Palliative Care Register with % of patients on the Green 50% or above, red coded recorded Palliative Care below 50% discussion Registered with coded about an recorded discussion Advance Care SystmOn about an Advance Care Nationally Plan* e & EMIS Plan measured target % of patients with Atrial Healthy green 89% and above (STP Fibrillation who % of patients with Atrial Futures aspiration), amber 77% to 88% are Fibrillation who are Nationally Anticoagulated* Anticoagulated measured target
114 This data column is not rag rated. The data reflects the number of meetings recorded by the Locala team that have taken place (HV Safeguarding Health Visitor - with the GP). The expectation Safeguarding - To date , number of is that these take place on a attendances at months a HV monthly basis and the figure the monthly Safeguarding has represents for example 3/12 MDT meetings attended the Monthly three meetings out of 12 with practice MDT meeting with possible monthly meetings in staff Locala practice staff Locally defined the year.
As per national ratings Red Nationally collected ImmFOR Below 90%, Amber 90% to childhood immunisation M 95% and Green 95% and Childhood uptake % figures for the Nationally above Immunisations* various ages measured target
115 Appendix 3 Kirklees CCG Primary Care Quality Assurance/Surveillance Flowchart
Routine Surveillance Return to Routine Surveillance Dashboard populated and RAG applied to each indicator for each practice
Do any practices trigger Stage 1? ie. One or more of the following: Total of 10 or more RED or AMBER indicators (mixed or otherwise) ≥6 REDs No CQC reports Requires Improvement for Safe and/or Well Led domains, or for overall CQC reports Inadequate for overall Serious incident identified New intelligence eg. complaint/whistleblowing re: risk to patient care or safety Concerns raised from quarterly practice visit
if significantif patient concernssafety Yes concerns
PQC assess each practice re: eligibility for Informal Enhanced Surveillance considering: Existing service improvement/action plans Practice has sight of issues and provides assurance of improvements Atypical practice populations affecting indicators at any point thein process
4 3 or
s Is PQC assured that actions/improvements have been made and are sustainable? Yes
No
Practice enters Informal Enhanced Surveillance (Stage 2) – monitored by PQC CCG practice visit (consider evidence, action plans, CQC reports, contracts etc.) any point thein process significant if patient safety Determine whether to alert CQC and whether specific action plan required Assess whether escalation to Stage 3 required
Consider rapid escalationStage to Review monthly for 3 months (normally) from entering Stage 2 Stages 3 Stages or 4 at Yes Is PQC assured that concerns addressed or resolved?
No
Practice enters Formal Enhanced Surveillance (Stage 3) – monitored by PQC
Formal Investigation/Quality Review meeting within 5 days from entering Stage 3 Consider rapid escalation to Identify all concerns with actions, timeframes and review period Maintain effective written communication between practice and CCG throughout Arrange targeted Quality Monitoring Assurance visits within 10 days of entering Stage 3 Monthly monitoring by PQC (and reported to PCCC and Quality Committee) Enhanced Quality Review meeting at end of review period (usually 3 months)
Are PCCC and QC assured that improvements made and sustained? Yes
No
Practice enters Formal Action Single Item QSG (Stage 4) – monitored by PCCC, QC and GB Formal communication with practice Arrange single item QSG (commissioners + regulators) within 5-7 days of entering Stage 4 Complete Quality Risk Profile and share with practice Consider Risk Summit Action plan monitored monthly by PQC and reported to PCCC, QC and GB
Yes Are PCCC, QC and GB assured that improvements made and sustained?
No
Risk Summit following National Quality Board Guidance
116 Primary Care Name of Meeting Meeting Date 28/04/2021 Commissioning Committee Review of Temporary Title of Report Branch Closures due to Agenda Item No. 11 Covid-19 Pandemic Joanne Davis Senior Primary Care Manager Report Author Public / Private Item Public Jan Giles Senior Primary Care Manager Catherine Wormstone Dr Ibrar Ali / Dr Abid Iqbal Head of Primary Care Clinical Lead Independent Medical Responsible Officer Strategy and Advisors Commissioning
Executive Summary
As a result of the Covid 19 pandemic situation the Primary Care Commissioning Committees (PCCCs) of North Kirklees and Greater Huddersfield Clinical Commissioning Committees received requests from a small number of practices for temporary closure of their branch sites. The requests for temporary branch closure started to be received at the end of March 2020 and further requests for the extension of temporary closure were received and reviewed by the PCCCs on a regular (three monthly) basis.
At 28th April 2021, the following Kirklees practices currently have approval for temporary closure of their branch sites due to Covid-19:
Keldregate - branch surgery of B85028 – The Grange Group Practice Bond Street – branch surgery of B85015 - Wellington House Surgery York House - branch surgery of B85655 - Cherry Tree Surgery
This paper:
1) Sets out the current issues regarding temporary branch closures for the Kirklees Primary Care Commissioning Committee (PCCC) 2) Seeks approval from the PCCC for the continuation of the temporary closure of these three branch surgeries until 21st June 202
The continued temporary closures are requested due to the premises being unsuitable for use due to COVID 19 restrictions and guidance still in place at this time. Kirklees CCG expects that all branch surgeries will re-open on 21st June 2021, if the key dates of the government’s roadmap are achieved.
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117 Previous Considerations blank blank blank North Kirklees Primary 10/03/2021 Care Commissioning 13/01/2021 Committee for: 19/11/2020 1) Bond Street – branch 11/11/2020 surgery of B85015 - 09/09/2020 Name of meeting Wellington House Surgery Meeting Date 30/07/2020 2) York House - branch 04/06/2020 surgery of B85655 - Cherry 05/05/2020 Tree Surgery 02/04/2020
Greater Huddersfield 24/02/2021 Primary Care 28/10/2020 Commissioning Committee 30/07/2020 for Keldregate - branch Name of meeting Meeting Date 04/06/2020 surgery of B85028 – The 05/05/2020 Grange Group Practice 02/04/2020
Recommendations It is recommended that the Primary Care Commissioning Committee
1) Review the updates for the continued temporary closure of the following branch sites: Keldregate – branch surgery of B85028 – The Grange Group Practice Bond Street – branch surgery of B85015 - Wellington House Surgery York House - branch surgery of B85655 - Cherry Tree Surgery
2) Support the continuation of the temporary branch closure of Keldregate – branch surgery of B85028 – The Grange Group Practice due to the limitations of the Keldregate premises during the Covid-19 pandemic
3) Support the continuation of the temporary branch closure of Bond Street – branch surgery of B85015 – Wellington House Surgery due to the limitations of the Bond Street premises during the Covid-19 pandemic
4) Support the continuation of the temporary branch closure of York House – branch surgery of B85655 Cherry Tree Surgery due to the limitations of the York House premises during the Covid-19 pandemic
5) Agree that all Kirklees branch surgeries will be expected to open from 21st June 2021, if key dates are achieved on the government’s roadmap out of lockdown.
Decision ☒ Assurance ☐ Discussion ☒ Other:
Implications Quality and Safety implications (including The implications are identified in the Rapid Impact whether a quality impact assessment has Assessments that have been completed in been completed) relation to these branch closures
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118 Engagement and Equality Implications The implications are identified in the Rapid Impact (including whether an equality impact Assessments that have been completed in assessment has been completed), and health relation to these branch closures inequalities considerations Resources / Financial Implications (including Supportive of staff wellbeing and safety during the Staffing/Workforce considerations) Covid 19 pandemic
Sustainability Implications None arising from this report
Has a Data Protection Impact Assessment Yes ☐ No ☐ N/A ☒ (DPIA) been completed?
Strategic Objectives All Risk (include risk Not currently included (which of the CCG number and a brief on the CCG’s risk objectives does this description of the register relate to?) risk) Legal / CCG None identified Conflicts of Interest GP members will have Constitutional (include detail of any an interest Implications identified / potential conflicts)
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1. Introduction 1.1 As a result of the current Covid 19 pandemic situation three Kirklees practices currently have approval to temporarily close their branch surgeries due to their premises limitations under the current Covid restrictions. The three branch surgeries currently closed temporarily are:
Keldregate Surgery, 268 Keldregate, Deighton, Huddersfield, HD2 1LE. Keldregate Surgery is the branch of B85028 – The Grange Group Practice Bond Street, Birstall, WF17 9EX. Bond Street is the branch of B85015 – Wellington House Surgery York House Surgery, 284A Oxford Road, Gomersal, Cleckheaton, WF17 5DH. York House Surgery is the branch of B85655 Cherry Tree Surgery
1.2 The decision to approve the temporary closure of Keldregate and Bond Street branch sites was taken by urgent meetings of the Greater Huddersfield and North Kirklees Primary Care Commissioning Committees held on 2nd April 2020. The agreement for the temporary closure of Keldregate was a retrospective approval to 31st March 2020. The agreement for the temporary closure of Bond Street was a retrospective approval to 27th March 2020.
1.3 North Kirklees Clinical Commissioning Group (CCG) became aware in March 2021 that the branch surgery of Cherry Tree Surgery – York House has been closed since March 2020. The decision to temporarily close York House was taken by the practice, without the knowledge or agreement of the CCG. The practice advise that this is due to staff being unable to fully implement national social distancing guidance at this site currently.
1.4 The Primary Care Commissioning Committee (PCCC) is now asked to consider the continuation of the temporary closure of these three branch surgeries until 21st June 2021.The continued temporary closures are requested due to the premises being unsuitable for use due to COVID 19 restrictions and guidance still in place at this time. Kirklees CCG expects that all branch surgeries will re-open on 21st June 2021, if the key dates of the government’s roadmap are achieved.
2. Detail 2.1 During the COVID-19 pandemic, pressure on GP practice services has increased considerably through a combination of additional workload relating to patient needs, the requirement for practices to rapidly adopt and adapt to new ways of working and maintaining practice staff cover when there were increased staff absences due to being unwell, self-isolating or shielding.
2.2 In recent months practice staff have also being asked to contribute to staffing local Primary Care Network (PCN) Covid vaccination centres, leading to additional practice staff workforce pressures.
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2.3 Some Kirklees practices have looked to manage their workload and delivery of clinical services in different ways, including the concentration of service delivery at one practice venue or co-locating at another practice venue. National guidance encouraged practices to introduce remote triage models and to rapidly increase the uptake of video, telephone and online consultations. 2.4 In addition, as social distancing and Covid security measures were put in place, some very small practice premises were not able to meet the requirements. 2.5 Applications from practices for the temporary closure of their branch sites have focussed on both premises and staffing issues. 2.6 The timeline in Table One, below, sets out the decisions taken by the Greater Huddersfield and North Kirklees PCCCs in relation to the temporary closures of Keldregate, Bond Street and York House Surgery 2.7 Table One – Decision Timeline for the Temporary Closure of Keldregate, Bond Street and York House Surgery GP Decision Approved Date of 1st Current Status practice Decision Approved B85028 Retrospective approval from the 2 April 2020 Remains closed The 31/03/20 for The Grange Group Grange Practice to temporarily close its Group branch surgery, Keldregate Practice B85015 Retrospective approval from the 2 April 2020 Remains Closed Wellington 27/03/20 for Wellington House Surgery Surgery to temporarily close its House branch surgery, Bond Street B85655 Retrospective approval for Cherry Retrospective Currently closed Cherry Tree Surgery to temporarily close decision Tree its branch site, York House obtained from Surgery Surgery 10 March 2021 PCCC meeting
2.8 Following the initial approvals for temporary branch closure, regular reviews took place. These were initially monthly and subsequently every two to three months, to determine whether the position had changed sufficiently to enable the branch sites to re-open 2.9 Table two, below, provides feedback from the three practices whose branch sites are currently temporarily closed 2.10 Table Two – Feedback from the Grange Group Practice, Wellington House and Cherry Tree Surgery Regarding Temporary Branch Closure GP Practice Comments from practice B85028 The Grange Group The partners do not feel that Keldregate is a clinically safe site Practice in relation to the current ongoing Pandemic to be opened in an unrestricted manner. The practice advise that they have taken a number of actions
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121 to support access for patients who previously used the Keldregate branch surgery. These are as follows:
The practice introduced its eConsult service, allowing patients to access advice from their GP quickly and easily online.
Electronic prescribing was increased to prevent patients needing to collect prescriptions from the practice (allowing them to collect from local pharmacies).
Access to online ordering via online services has been promoted.
Restrictions preventing patients ordering over the phone have been relaxed during the pandemic for any patients unable to use online services.
Extended access appointments were extended from 2 days per week to 4 days per week at the main site in order to further improve access to services. The Fartown site is now open 8am- 8pm Monday-Thursday, and 8am- 6:30pm on Fridays.
B85015 Wellington House The Partners continue to have serious concerns about re- Surgery opening Bond Street safely.
Given the current guidance, we are of the view that it would not be in the best interests of our clinicians, support staff or patients, to re-open the Birstall branch surgery.
Furthermore, it is our opinion that with our own extensive experience of working in this building, the risk assessment undertaken (update attached) confirms a severe risk, which given the current guidance cannot justify the small number of face to face consultations which would be held at Birstall, particularly when patients are more than willing to visit the Batley surgery if F2F is necessary.
It remains our responsibility to act in the best interests of our patients and re-opening Birstall would expose them & ourselves to avoidable risk. Measures to mitigate such risk would be significantly inefficient and detrimental to our service as a whole.
All of our staff resources are being fully deployed at the Batley surgery, providing telephone, video & e consultations, allowing for the two staff members who are home working as they fall into a high risk category.
When the guidance from NHS England & the British Medical Page 6 of 12
122 Association changes we will review the situation and will be able to re-open the Birstall branch with 48 hours’ notice B85655 Cherry Tree Patients and staff are unable to follow social distancing Surgery guidelines at York House Surgery, due to limited space available within the building to utilise.
Batley Health Centre also utilises York House as a branch surgery, therefore due to social distancing guidelines having to be followed at this time there isn’t the room in the reception area for two reception staff from different practices to work at the same time.
One of the clinical rooms available is upstairs, there is no space to social distance on the stair way.
There are now 4 phone lines at Cherry Tree Surgery instead of 2, therefore patients are getting through to the practice with ease for enquires to be answered.
Telephone and video consultations are offered at this time as well as face to face appointments. The practice has received positive feedback from patients in relation to accessing telephone consultations.
The practice hasn’t received any negative feedback from patients in relation to travelling to Cherry Tree Surgery for a face to face appointment.
2.11 Site visits were undertaken to Bond Street and Keldregate premises by CCG staff in July 2020 to better understand the limitations of the sites. The issues identified are presented below. 2.12 Visits to Keldregate Branch of the Grange Group Practice 28th July 2020 2.12.1 A site visit was undertaken to the Keldregate branch of The Grange Group Practice by the CCG’s Independent Medical Advisor and Senior Primary are Manager on 28 July 2020. The practice was represented by the Senior GP partner. 2.12.2 The key findings were as follows: a) The practice operates from a building which poses significant challenges in the physical environment to the operation of safe and efficient services during the COVID-19 response.
b) There is only one point of entry which makes patient and staff access and egress difficult and does not allow for social distancing, safe patient flow or a consistent in and out flow.
c) Ventilation in the building is poor.
d) The waiting area is very small and therefore appropriate social distancing is not possible
e) There is only one toilet which is used for both staff and visitors so currently out of use
f) All additional capacity from the branch site has been fully redeployed into provision of services either at the main site or through working remotely. Page 7 of 12
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g) The vast majority of consultations are still being delivered remotely in line with the national Standard Operating Procedure.
h) Those present at the visit, including the LMC representative and GB practice representative were supportive of the branch remaining temporarily closed.
2.13 Visit to Bond Street Branch of Wellington House 23 July 2020
2.13.1 A site visit was undertaken to the Bond Street branch of Wellington House by a Governing Body Practice Representative and the CCG’s Head of Primary Care Strategy & Commissioning on 23 July 2020. The practice was represented by the Practice Manager and a GP partner and they were supported by the LMC in attendance. There were some key points to note from the visit.
2.13.2 Physical Environment
The practice operates from a building (photographs below) which pose significant challenges in the physical environment to the operation of safe and efficient services during the COVID-19 response.
2.13.3 It was noted at the visit that:
a) There is only one point of entry which makes patient and staff access and egress difficult and does not allow for social distancing, safe patient flow or a consistent in and out flow. b) The access from the street opens into a small single room (waiting room and reception access) which would need to be used for entry and exit but is also the
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124 waiting room. The waiting room would not allow safe social distancing with people walking through. c) Ventilation in the building is poor. d) The ground floor has a reception area, one consulting room with adjacent treatment room and access to the second floor where further consulting rooms are situated. e) The staircase access to the second floor is very steep and narrow and could not accommodate patients passing, accessing/waiting safely or at distance. Therefore the second floor consulting rooms would be effectively deemed out of use by the practice. f) The practice is not unwilling to re-open the branch but has real reservations about doing this safely and efficiently. The only model which would allow for safe consultation is essentially for one patient, one receptionist and one GP at any one time. The practice is willing to implement this model but stress that is not an efficient one, particularly where the advice to practices is to maintain and offer remote triage in the first instance. g) If elderly or immobile patients who live in the Birstall area and who need face to face consultation (after triage) cannot travel to the main site, additional home visits are being accommodated. This has applied to shielding patients too. h) All additional capacity from the branch site (which would ordinarily include two clinicians plus one nurse and one receptionist) has been fully redeployed into provision of services either at the main site or through working remotely. i) Public transport links between the branch at Birstall and the main site in Batley are very good. Frequent bus services are in operation and a taxi costs approximately £2.50. j) The Practice Manager reported that patients with a disability would ordinarily attend the main Wellington House site anyway as this building is easier to navigate than the Bond Street site. k) The vast majority of consultations are still being delivered remotely in line with the national Standard Operating Procedure. l) Closure notices are displayed on the window of the branch site. m) The practice website has the following narrative displayed “****Our Birstall Branch will be closed from today due to the extraordinary circumstances surrounding the pandemic. All usual services can be requested from Batley Branch 01924 669960 **** n) Those present at the visit, including the LMC representative and GB practice representative were supportive of the branch remaining temporarily closed.
2.14 Cherry Tree Surgery, Branch Surgery - York House
2.14.1 York House surgery is utilised by two North Kirklees practices as a branch surgery (Cherry Tree Surgery and Batley Health Centre). Historically on Cherry Tree Surgery’s practice website it is noted that 1 x pm session a week is provided at York House surgery for patients registered at Cherry Tree Surgery.
2.14.2 Batley Health Centre has confirmed to the CCG that they are stilling providing primary care medical services to their registered patients at this venue.
2.14.3 The York House Surgery building poses significant challenges in the physical environment (photographs below) to the operation of safe and efficient primary care services for two practices as branch surgeries during the COVID-19 response:
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2.14.4 To note:
a) The building has limited administration and clinical space available. b) The waiting area is very small. c) The stairwell is narrow, which does not allow for social distancing. d) Registered patients have the option of having a telephone / video consultation or a face to face appointment at Cherry Tree Surgery. e) All additional capacity from the branch site (which would ordinarily include one clinician and one receptionist) has been fully redeployed into provision of services either at the main site or through working remotely. f) The practice has updated their patients in relation to the branch closure via their patient communication routes. g) The practice is planning to restart deliver of the one pm session a week at York House surgery in May/ June 21.
2.15 A letter was submitted to North Kirklees CCG from Cherry Tree Surgery on the 26th January 2021, stating that: “Our branch surgery at Gomersal has been closed since the start of the pandemic in March 2020. We have provided full service to all our patients who are registered there at Cherry Tree Surgery”
2.15.1 Following the submission of this letter a meeting was held with Cherry Tree Surgery Practice management staff on the 23rd February 2021 to discuss the York House branch closure. At this meeting the practice staff noted that it was unable to operate safely at the York House surgery building at this moment in time as social distancing guidelines could not be followed (due to the limited space available and Batley Health Centre also operating sessions at this building).
2.15.2 At this meeting it was noted by the CCG that the practice should have informed the CCG of their intention to temporary close the branch surgery in March 2020 and the practice were made aware of the processes that needed to be followed in relation to branch surgery closures.
2.15.3 At the meeting with Cherry Tree Surgery practice staff it was confirmed that the practice was aiming to re-open their branch surgery (York House) in May / June 21.
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126 2.15.4 A rapid impact assessment review has been carried out in relation to the retrospective York House temporary branch closure, it is worth noting the following points:
Patients registered at Cherry Tree Surgery have been informed of the branch closure via text message; however there is no sign on the door at York House surgery informing patients of the branch closure and the website has not been updated to reflect the closure either. The practice has been asked by the CCG to update their website and the information displayed on the branch surgery door.
Patients requiring face to face appointments will need to travel to the Cherry Tree practice in Batley. As York House Surgery is 2 miles away from Cherry Tree Surgery this may make it harder for some patients to access face to face appointments at this time. However Cherry Tree Surgery have not had received any complaints from their patients in relation to this.
2.16 As part of the government’s current roadmap out of lockdown a key date of the 21st June is proposed when potentially social distancing and remaining Covid restriction measures may not be in place, therefore the 21st June 2021 is seen as a date when the three branch surgeries could be in a position to fully re-open.
3 Next Steps
3.1 To advise the Grange Group Practice, Wellington House Surgery and Cherry Tree Surgery of the outcomes of this review process.
3.2 To advise the three practices that, if the government’s current roadmap out of lockdown continues to be in place, the branch surgeries should re-open on 21st June 2021.
4 Implications a. Quality & Safety Implications
Revised rapid impact assessments have been completed for the three branch closures. CQC has rated all three practices as Good overall when last reviewed. b. Engagement & Equality Implications
All three practices have undertaken a brief patient survey. Patients have not reported any difficulty in accessing services from the main practice sites.
5 Recommendations It is recommended that the Primary Care Commissioning Committee
1) Review the updates for the continued temporary closure of the following branch sites:
Keldregate – branch surgery of B85028 – The Grange Group Practice Bond Street – branch surgery of B85015 - Wellington House Surgery York House - branch surgery of B85655 - Cherry Tree Surgery
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2) Support the continuation of the temporary branch closure of Keldregate – branch surgery of B85028 – The Grange Group Practice due to the limitations of the Keldregate premises during the Covid-19 pandemic
3) Support the continuation of the temporary branch closure of Bond Street – branch surgery of B85015 – Wellington House Surgery due to the limitations of the Bond Street premises during the Covid-19 pandemic
4) Support the continuation of the temporary branch closure of York House – branch surgery of B85655 Cherry Tree Surgery due to the limitations of the York House premises during the Covid-19 pandemic
5) Agree that all Kirklees branch surgeries will be expected to open from 21st June 2021, if key dates are achieved on the government’s roadmap out of lockdown.
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128 NHS KIRKLEES CCG PRIMARY CARE COMMISSIONING COMMITTEE WORK PLAN – APRIL 2021 TO MARCH 2022
No. Agenda Item Apr 21 Jun 21 Aug 21 Oct 21 Dec 21 Feb 22 Comments
Routine Reports – for assurance 1 Finance Report x x x x x x - 2 Contracting Report x x x x x x - 3 Primary Care Dashboard Update x - x - x - Bi-monthly 4 Primary Care Networks Update - x - - x - Including progress on ARRS 5 Estates and ETTF Update - x - - x - - 6 National GP Patient Survey Results - - x - - - Annual 7 Patient Story - x x x x x For discussion / reflection Items for Decision To include: 8 Kirklees Equitable Funding Review - - x - x - - Assurance on progress - Review of implementation 9 Health Inequalities Scheme - - x - x - - 10 University QOF - - - x - - - 11 Special Allocation Scheme - x - - - - - NHSE guidance expected 12 Extended Access Service Update - - - x - x Summer 2021 13 Practice Quality Issues (e.g. CQC, ------As required Healthwatch, complaints) Practice Issues – Boundary 14 Changes; List Closures; Mergers; ------As required End of Time Limited Contracts; Incorporation Requests Covid and Covid Vaccination 15 - - x - - - - Update
129 Governance
No. Agenda Item Apr 21 Jun 21 Aug 21 Oct 21 Dec 21 Feb 22 Comments 16 Committee Annual Report - - - - - x - 17 Committee Self-Assessment - - - - - x - Findings 18 Committee Work Plan x x x x x x - 19 Committee Terms of Reference x ------Practice Care Operational Group – 20 x ------Terms of Reference Governing Body Assurance Review Primary Care risks 21 - x - - x - Framework Dec / June each year 22 Notification of Urgent Decisions x - - - - - As required Internal Audit Report Findings and 23 x ------Recommendations
130 Primary Care Name of Meeting Meeting Date 28 April 2021 Commissioning Committee Notification of urgent Title of Report Agenda Item No. 13 decisions Laura Ellis, Head of Report Author Public / Private Item Public Corporate Governance Beth Hewitt, Lay Member: Catherine Wormstone, Clinical Lead Responsible Officer PPI Head of Primary Care
Executive Summary The current COVID-19 situation means that urgent decisions may be required by the CCG in relation to matters which are within the delegated scope of the Primary Care Commissioning Committee. These are matters of such urgency, and relate to the management of COVID-19, that they will not wait until the next scheduled meeting of the Committee and warrant the use of urgent decision processes set out within terms of reference (TOR), constitution and utilising good governance approaches. An urgent decision process has been put in place, which is detailed within the report, and this requires the notification of all decisions taken under such a process to be brought to the next routine meeting of the Committee.
Previous Considerations blank blank blank Name of meeting Meeting Date
Name of meeting Meeting Date
Recommendations That the Committee NOTE the urgent decisions taken under the urgent decision procedure, by Greater Huddersfield and North Kirklees Primary Care Commissioning Committees.
Decision ☐ Assurance ☒ Discussion ☐ Other:
Implications Quality and Safety implications (including As set out in each decision notice. whether a quality impact assessment has been completed)
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131 Engagement and Equality Implications As set out in each decision notice. (including whether an equality impact assessment has been completed), and health inequalities considerations Resources / Financial Implications (including As set out in each decision notice. Staffing/Workforce considerations)
Sustainability Implications As set out in each decision notice.
Has a Data Protection Impact Assessment Yes ☐ No ☐ N/A ☒ (DPIA) been completed?
Strategic Objectives All Risk (include risk No specific risks (which of the CCG number and a brief objectives does this description of the relate to?) risk) Legal / CCG None identified Conflicts of Interest None identified Constitutional (include detail of any Implications identified / potential conflicts)
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132 1. Introduction 1.1 The current COVID-19 situation means that urgent decisions may be required by the CCG in relation to matters which are within the delegated scope of the Primary Care Commissioning Committee. These are matters of such urgency, and relate to the management of COVID-19, that they will not wait until the next scheduled meeting of the Committee and warrant the use of urgent decision processes set out within terms of reference (TOR), constitution and utilising good governance approaches.
2. Detail 2.1 The following process had been agreed for the GH Primary Care Commissioning Committee:
Decisions were made by: The Chair (Beth Hewitt) or Vice Chair (Hilary Thompson) And an executive member of the committee – Carol McKenna, Ian Currell, or Penny Woodhead
This was done in consultation with: LMC representative (Dr Bert Jindal) Independent GP Advisor (Dr Ibrar Ali)
Meetings were initially scheduled in diaries from 2.00pm – 2.30pm every Tuesday and Thursday, with effect from Thursday 2 April through to 4 June 2020. They recommenced on 3 November 2020. The meetings were run virtually.
Briefing papers were sent out 24 hours in advance of the meeting; and the meeting was also stood down with 24 hours’ notice if there was no business.
The decisions were recorded on an urgent decision template, which was sent out to all members of the Committee within one working day of the decision.
As from 30 November 2020 meetings were no longer being routinely scheduled, but were arranged in line with the criteria above should the need for an urgent decision have arisen.
2.2 Since the last meeting of the Greater Huddersfield PCCC, the urgent decisions process had been used on three occasions:
10 March 2021 - Additional Roles 2019/20 Underspend Proposal (decision notice appended). 17 March 2021 - Primary Care Income Protection – COVID-19 2021/22 (decision notice appended).
23 March 2021 - Phase 2 of the COVID Vaccination Programme and role of the PCN Local Vaccination Sites (LVS) in Kirklees (decision notice appended).
2.3 The following process had been agreed for the North Kirklees Primary Care Commissioning Committee:
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Decisions were made by: The Chair (Hilary Thompson) or Vice Chair (Beth Hewitt) And an executive member of the committee – Carol McKenna, Ian Currell, or Penny Woodhead Independent GP Advisor (Dr Oliver Hirst or Dr Abid Iqbal)
This was done in consultation with: LMC representative (Dr N Chandra or nominated deputy) Council of Members Chair (Dr Mohammed Hussain) CCG Clinical Chair (Dr Khalid Naeem)
All other arrangements were identical to those listed in 2.1 above.
2.4 Since the last meeting of the North Kirklees PCCC, the urgent decisions process had been used on two occasions:
17 March 2021 - Primary Care Income Protection – COVID-19 2021/22 (decision notice appended).
23 March 2021 - Phase 2 of the COVID Vaccination Programme and role of the PCN Local Vaccination Sites (LVS) in Kirklees (decision notice appended).
3. Next Steps 3.1 The urgent decisions process will remain available to the new Kirklees CCG Primary Care Commissioning Committee, although meetings are no longer being routinely scheduled. Notification of any future decisions taken will continue to be reported to the Committee, and also be published on the CCG’s website.
4. Implications As set out on cover page.
5. Recommendations That the Committee NOTE the urgent decisions taken under the urgent decision procedure.
6. Appendices Appendix 1 - Additional Roles 2019/20 Underspend Proposal - decision notice Appendix 2 – (GH) Primary Care Income Protection – COVID-19 2021/22 - decision notice Appendix 3 – (GH) Phase 2 of the COVID Vaccination Programme and role of the PCN Local Vaccination Sites (LVS) in Kirklees - decision notice Appendix 4 – (NK) Primary Care Income Protection – COVID-19 2021/22 - decision notice Appendix 5 – (NK) Phase 2 of the COVID Vaccination Programme and role of the PCN Local Vaccination Sites (LVS) in Kirklees - decision notice.
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Record of Urgent Decision
Committee/Body on behalf of Greater Huddersfield Primary Care Commissioning Committee which decision made:
Decision Maker(s): Name Role Hilary Thompson Lay Member: Finance and Remuneration (Chair of meeting) Beth Hewitt Lay Member: PPI Ian Currell Chief Finance Officer Carol McKenna Chief Officer
Consultee(s) Present: Name Role Dr Ibrar Ali Independent Medical Advisor Dr Bert Jindal LMC Representative
Others Present: Name Role Laura Ellis Head of Corporate Governance Jan Giles Senior Primary Care Support Manager Catherine Wormstone Head of Primary Care Strategic Commissioning Helen Robinson Governance Officer
Clinical/GB Lead: Dr Ibrar Ali Lead Officer: Catherine Wormstone
Subject: Additional Roles 2019/20 Underspend Proposal
Decision: 1) Approved the proposals for utilisation of the underspend of 2019/20 ARRS for the GH PCNs subject to the agreement of a Memorandum of Understanding between the CCG and each PCN. 2) Agreed that an appropriate timescale for evaluation of the approved proposals was the end of Quarter 1 (end of June 2021)
Details and Rationale: As set out in report.
Any Relevant Implications As set out in report. (Quality/Safety, Engagement/Equality, Resources/Finance, Data Protection, Risk, Legal/Constitutional, Conflicts of Interest etc):
Report attached? Yes/No (delete as appropriate) Public/Private? Public/Private (delete as appropriate) If private, give reason(s):
Time and Date of Decision: 1.00 – 1.30 pm, 10 March 2021. Decision Recorded by: Name Role Helen Robinson Governance Officer
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Record of Urgent Decision
Committee/Body on behalf of Greater Huddersfield Primary Care Commissioning Committee which decision made: (held in parallel with North Kirklees Primary Care Commissioning Committee)
Decision Maker(s): Name Role Hilary Thompson Lay Member: Finance and Remuneration (Chair of meeting) Penny Woodhead Chief Quality and Nursing Officer Carol McKenna Chief Officer
Consultee(s) Present: Name Role Dr Ibrar Ali Independent Medical Advisor
Others Present: Name Role Laura Ellis Head of Corporate Governance Alison Needham Head of Finance Catherine Wormstone Head of Primary Care Strategic Commissioning Helen Robinson Governance Officer
Clinical/GB Lead: Dr Steve Ollerton/Ian Currell Lead Officer: Catherine Wormstone/Alison Needham
Subject: Primary Care Income Protection – COVID-19 2021/22
Decision: 1) Income Protection is extended for the first quarter of 2021/22 and only offered to practices who have signed up to the new Enhanced Service DES. 2) Income for practices is based on option 3. 3) Uplift is applied retrospectively once agreed and not included as part of the income protection. 4) QOF Protection income protection is not provided by the CCG. 5) Minor Surgery DES income protection is not provided by the CCG. 6) Public Health Schemes are not provided income protection by the CCG.
Details and Rationale: As set out in report.
Written comments taken into account from Dr Bert Jindal and Dr N Chandra (LMC Representatives), and Dr Mohammed Hussain (Chair – NK Council of Members).
AN clarified that the income protection in Decision 1 would apply to all practices that had signed up to the enhanced service, to deliver first and 2nd vaccinations for cohorts 1-9.
The LMC’s disappointment regarding the response from Public Health in relation to income protection was noted.
Any Relevant Implications As set out in report. (Quality/Safety, Engagement/Equality, Those working in local practices declared a direct financial interest Resources/Finance, Data in this item, and it was agreed that this would be managed by Protection, Risk, holding a short conflicted discussion during which time they could Legal/Constitutional, Conflicts make comments, and then switching off their cameras and playing of Interest etc): no further part in the remaining non-conflicted discussion and
136 decision. Conflicted members were permitted to remain on the call as observers.
Report attached? Yes/No (delete as appropriate) Public/Private? Public/Private (delete as appropriate) If private, give reason(s):
Time and Date of Decision: 9.00 – 9.30 am, 17 March 2021. Decision Recorded by: Name Role Helen Robinson Governance Officer
137
Record of Urgent Decision
Committee/Body on behalf of Greater Huddersfield Primary Care Commissioning Committee which decision made: (held in parallel with North Kirklees Primary Care Commissioning Committee)
Decision Maker(s): Name Role Beth Hewitt Lay Member: Patient and Public Involvement (Chair of meeting) Hilary Thompson Lay Member: Finance and Remuneration Ian Currell Chief Finance Officer Carol McKenna Chief Officer
Consultee(s) Present: Name Role Dr Ibrar Ali Independent Medical Advisor Dr Bert Jindal LMC Representative
Others Present: Name Role Laura Ellis Head of Corporate Governance Alison Needham Head of Finance Catherine Wormstone Head of Primary Care Strategic Commissioning Lindsay Greenhalgh Head of Medicines Management Helen Robinson Governance Officer
Clinical/GB Lead: Dr Ibrar Ali Lead Officer: Catherine Wormstone
Subject: Phase 2 of the COVID Vaccination Programme and role of the PCN Local Vaccination Sites (LVS) in Kirklees
Decision: 1) Supported the continuation of the three PCN Local Vaccination Service sites to progress to phase 2 of the COVID-19 vaccination Programme. These are Cathedral House, Holme Valley Memorial Hospital and Dewsbury HealthCentre (3 Centres PCN only).
2) Noted the stated intentions of the remaining PCNs to withdraw from the Enhanced Service. This includes all constituent practices of SHAWN PCN, Batley and Birstall PCN, Dewsbury and Thornhill PCN in North Kirklees and the Mast PCN in Greater Huddersfield.
Details and Rationale: As set out in report.
Written comments taken into account from John Laville (Patient Representative NK).
It was acknowledged that the individual PCN decisions had been based on capacity and sustainability, rather than finances.
It was agreed that further efforts should be made to recruit additional vaccinators, such as St John’s staff, locum GPs and retired professionals.
It was acknowledged that practices returning to ‘business as usual’ was a positive step for patients.
Any Relevant Implications As set out in report.
138 (Quality/Safety, Engagement/Equality, Those working in local practices declared a direct financial interest Resources/Finance, Data in this item, and it was agreed that this would be managed by Protection, Risk, allowing them to comment, but then playing no part in the Legal/Constitutional, Conflicts decision. of Interest etc):
Report attached? Yes/No (delete as appropriate) Public/Private? Public/Private (delete as appropriate) If private, give reason(s):
Time and Date of Decision: 9.00 – 9.45 am, 23 March 2021. Decision Recorded by: Name Role Helen Robinson Governance Officer
139
Record of Urgent Decision
Committee/Body on behalf of North Kirklees Primary Care Commissioning Committee (held in which decision made: parallel with Greater Huddersfield Primary Care Commissioning Committee)
Decision Maker(s): Name Role Hilary Thompson Lay Member: Finance and Remuneration (Chair of meeting) Penny Woodhead Chief Quality and Nursing Officer Carol McKenna Chief Officer Dr Abid Iqbal Independent Medical Advisor
Consultee(s) Present: Name Role Dr Khalid Naeem Clinical Chair Dr Chandra LMC Representative Dr Mohammed Hussain Chair – Council of Members
Others Present: Name Role Laura Ellis Head of Corporate Governance Alison Needham Head of Finance Catherine Wormstone Head of Primary Care Strategic Commissioning Helen Robinson Governance Officer
Clinical/GB Lead: Dr Khalid Naeem/Ian Currell Lead Officer: Catherine Wormstone/Alison Needham
Subject: Primary Care Income Protection – COVID-19 2021/22
Decision: 1) Income Protection is extended for the first quarter of 2021/22 and only offered to practices who have signed up to the new Enhanced Service DES. 2) Income for practices is based on option 3. 3) Uplift is applied retrospectively once agreed and not included as part of the income protection. 4) QOF Protection income protection is not provided by the CCG. 5) Minor Surgery DES income protection is not provided by the CCG. 6) Public Health Schemes are not provided income protection by the CCG.
Details and Rationale: As set out in report.
Written comments taken into account from Dr Bert Jindal and Dr N Chandra (LMC Representatives), and Dr Mohammed Hussain (Chair – Council of Members).
AN clarified that the income protection in Decision 1 would apply to all practices that had signed up to the enhanced service, to deliver first and 2nd vaccinations for cohorts 1-9.
The LMC’s disappointment regarding the response from Public Health in relation to income protection was noted.
Any Relevant Implications As set out in report. (Quality/Safety, Engagement/Equality, Those working in local practices declared a direct financial interest
140
Resources/Finance, Data in this item, and it was agreed that this would be managed by Protection, Risk, holding a short conflicted discussion during which time they could Legal/Constitutional, Conflicts make comments, and then switching off their cameras and playing of Interest etc): no further part in the remaining non-conflicted discussion and decision. Conflicted members were permitted to remain on the call as observers.
Report attached? Yes/No (delete as appropriate) Public/Private? Public/Private (delete as appropriate) If private, give reason(s):
Time and Date of Decision: 9.00 – 9.30 am, 17 March 2021. Decision Recorded by: Name Role Helen Robinson Governance Officer
141
Record of Urgent Decision
Committee/Body on behalf of North Kirklees Primary Care Commissioning Committee (held in which decision made: parallel with Greater Huddersfield Primary Care Commissioning Committee)
Decision Maker(s): Name Role Beth Hewitt Lay Member: Patient and Public Involvement (Chair of meeting) Hilary Thompson Lay Member: Finance and Remuneration Ian Currell Chief Finance Officer Carol McKenna Chief Officer Dr Abid Iqbal Independent GP Advisor
Consultee(s) Present: Name Role Dr Khalid Naeem Clinical Chair Dr Chandra LMC Representative
Others Present: Name Role Laura Ellis Head of Corporate Governance Alison Needham Head of Finance Catherine Wormstone Head of Primary Care Strategic Commissioning Lindsay Greenhalgh Head of Medicines Management Helen Robinson Governance Officer
Clinical/GB Lead: Dr Abid Iqbal Lead Officer: Catherine Wormstone
Subject: Phase 2 of the COVID Vaccination Programme and role of the PCN Local Vaccination Sites (LVS) in Kirklees
Decision: 1) Supported the continuation of the three PCN Local Vaccination Service sites to progress to phase 2 of the COVID-19 vaccination Programme. These are Cathedral House, Holme Valley Memorial Hospital and Dewsbury HealthCentre (3 Centres PCN only).
2) Noted the stated intentions of the remaining PCNs to withdraw from the Enhanced Service. This includes all constituent practices of SHAWN PCN, Batley and Birstall PCN, Dewsbury and Thornhill PCN in North Kirklees and the Mast PCN in Greater Huddersfield.
Details and Rationale: As set out in report.
Written comments taken into account from John Laville (Patient Representative NK).
It was acknowledged that the individual PCN decisions had been based on capacity and sustainability, rather than finances.
It was agreed that further efforts should be made to recruit additional vaccinators, such as St John’s staff, locum GPs and retired professionals.
It was acknowledged that practices returning to ‘business as usual’ was a positive step for patients.
142 Any Relevant Implications As set out in report. (Quality/Safety, Engagement/Equality, Those working in local practices declared a direct financial interest Resources/Finance, Data in this item, and it was agreed that this would be managed by Protection, Risk, allowing them to comment, but then playing no part in the Legal/Constitutional, Conflicts decision. of Interest etc):
Report attached? Yes/No (delete as appropriate) Public/Private? Public/Private (delete as appropriate) If private, give reason(s):
Time and Date of Decision: 9.00 – 9.45 am, 23 March 2021. Decision Recorded by: Name Role Helen Robinson Governance Officer
143