NHS WEST CLINICAL COMMISSIONING GROUP

PRIMARY CARE COMMISSIONING COMMITTEE

11 July 2017, 2.00 – 3.30 pm

Boardroom, Hilldale, Wigan Road, , L39 2JW

Paper / Item Time Agenda item Action Presenter Verbal 1. 2.00 Welcome and apologies Chair

2. 2.05 Declaration of Interests V I All

3. 2.10 Minutes from the previous meeting Paper DR Chair

4 2.20 Update on actions from the previous meeting Paper D Chair

STRATEGIC ISSUES 5. 2.30 Primary Care Strategy/ working in V I / D Jan Charnock / neighbourhoods Jackie Moran 6. 2.35 Draft options for a Enhanced V I / D Claire Care Home Scheme Heneghan 7. 2.45 Finance update Paper I Paul Jones 8. 2.50 Pharmacy update • Minor ailment scheme V I Nic Baxter OPERATIONAL ISSUES 9. 2.55 NHS England update Paper I Sheena Wood 10. 3.00 Primary Care Practice Update • Practice Issues by exception V I Jan Charnock • Viran Medical Centre update V I Jan Charnock • Cyber-attack and business continuity plans V I Jan Charnock 11. 3.05 Quality and safety by exception Alison Lumley • Assurance framework Paper I / Jan Charnock 12. 3.10 Workforce • Primary care tool V I Jan Charnock / • Wider workforce development work V I Jackie Moran / • Practice Nurse Annual Report Paper I Alison Lumley 13. 3.20 Practice Visits Update V I Jan Charnock / Claire Heneghan FOR INFORMATION 14. 3.25 Notes from the Primary care operation Group Paper I Jan Charnock 15. 3.30 Any other business V I Chair

Date and Time of Next Meeting – 12 September 2017, 1.30 – 2.30 pm, Boardroom, Hilldale

I – Information D-Discussion DR – Decision Required

Minutes

Primary Care Commissioning Committee

Venue: Boardroom, Hilldale, Ormskirk Date & Time: Tuesday 9 May 2017 at 1.30 – 3.00pm Attendees: In attendance: Mr S Gross – Chair Miss C Ashcroft – Executive assistant Mr D Soper – Lay member Mrs J Moran – Head of Quality, Performance and Mrs C Heneghan – Chief Nurse Contracting Mr P Kingan – Chief Finance Officer Mrs J Charnock – Primary Care Development Manager Mr M Maguire – Chief Officer Mrs S Wood, Clinical Leadership Manager, NHS England North (Lancashire) Apologies: Mrs J Harrison – NHS England (in attendance) Dr A Robinson – Secondary Care Consultant Mr P Jones – Head of Finance

Agenda Summary of Discussion Lead Item

1. Welcome and apologies for absence Steve Gross introduced himself and welcomed the members of the Primary Care Commissioning Committee to the first formal meeting of the committee. The apologies above were relayed. One member of the public was present.

2. Declaration of interest Steve Gross reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of West Lancashire CCG.

Declarations declared by governing body members are listed in the CCG’s Register of Interests. The register is available either via the secretary to the governing body or the CCG website at the following link: http://www.westlancashireccg.nhs.uk/wp-content/uploads/Register-of- interests-Governing-Body-and-committee-members-March-2017.pdf

John Caine declared a general interest as he is employed by another GP, but is a non-voting member. The chair considered the declaration of interest and deemed this to be significant and not fundamental and confirmed that John Caine should remain in the meeting.

3. Update on actions from previous meeting The action sheet, from the informal meeting held in shadow form on 28 March was updated.

4. Draft options for West Lancashire Enhanced Care Home Scheme The paper, produced by Charlotte McAllister the urgent care commissioning lead, addresses care home residents with both physical and mental health issues and the difficulty in accessing GP services with homes having residents registered with a range of practices. The NHS framework for Enhanced Health in Care Homes summarises the findings from six National Vanguards for care home support and sets out a guide for other CCGs to adopt locally. The framework consolidates evidence from interventions which are shown to make Primary Care Commissioning Committee – 9 May 2017 Page 1 of 4

Agenda Summary of Discussion Lead Item

a difference to care home residents and those in the community and sets out seven care elements and principles underpinning how to access the home care resource.

Considering what services are already in place and the work undertaken by Ernst Young to identify how homes impact on services, it is clear that specialist advice and pharmacy review is needed. This will require multi-disciplinary teams and additional support for GP practices with £1 of the £5 per head being used for backfill and associated practices costs.

Three case studies of enhanced care home schemes which could be adopted include: • South Manchester – three geriatricians, two advanced nurse practitioners, a GP, nurse case manager to look after 300 beds in nine care homes. This has proved successful but would require GPs’ patients to transfer to the team. • Sheffield – each care home was assigned to a GP practice with named GPs providing proactive care. • South Sefton – the patient’s GP and a team of community matrons have access to a geriatrician for advice via a video link. Care plans are in place.

All models achieved a reduction in the number of emergency medical admissions.

Proposed options for the West Lancashire model include: 1. A LES with GP practices to deliver the service, with care homes allocated to each GP practice. 2. As with option one, but practices work together in their neighbourhood. The GP Federation could be commissioned to provide the services for homes where no practice express an interest to deliver the LES. 3. CCG commissions a separate team to provide the service including geriatric support, pharmacy, nursing and a GP(s). This would be considered if GPs do not express an interest in option 1 and 2.

Discussion ensued on the options available highlighting that more detail and costings would be required for each model before decisions could be reached. Current training in care homes will continue as a priority. Some of the work expected from GPs is already being paid for under GPS. Options 1 and 2 build on the existing relationship between patient and GP, whereas option 3 will incur higher costs. Work to align care homes with GP practices is already taking place in Ormskirk and GPs are open to this option. John Caine has carried out work looking at other areas and how they have priced their models and their success rate. The need for expert elderly mentally infirm (EMI) and geriatrician input is essential, with possible telephone contact with GPs was suggested. The different needs and subsequent work required in residential and care homes was highlighted, including the size of the home requiring more NHS services.

The average cost of a multi-disciplinary team is approximately £5.5 thousand, with £400 thousand allocated to a LES. It is expected that between £300-400 thousand per year to cover this. However, there are different models available eg a pharmacist works between neighbourhoods. A specification should be written to outline what services are required.

Primary Care Commissioning Committee – 9 May 2017 Page 2 of 4

Agenda Summary of Discussion Lead Item

An additional contribution to the current £5 per head was suggested to ensure employing a geriatrician. Capacity issues within homes was discussed in terms of requirements of staff ratio to patients and the benefits of neighbourhood working with cover across homes.

This situation could change over the next 18 months as and Ormskirk Hospital NHS Trust (the Trust) have a care home model to try to provide more services out of the hospital and Virgin Care could introduce a model. A DES to carry out ward rounds, expected to commence by April 2017, has not taken place.

The Primary Care Commissioning Committee: recommended the scheme should be a LES with options for practices to: Do - provide the service for their own patients; Share - with other neighbourhood practices or; Buy - the service from another organisation. The scheme will require an appropriate governance framework.

It was agreed that John Caine cannot present the scheme to the Membership Council given his involvement. It is anticipated that the decision will be made by the end of June and a further Primary Care Commissioning Committee meeting may be required to allow final discussion.

5. Primary Care Strategy The primary care strategy is expected by the end of June. Work on neighbourhoods will take place at the next Membership Council meeting and the strategy needs to include how the funding will be used over the next two years to meet the requirements. The primary care strategy and the operational plan including the next two years planning will return to the next committee JCh meeting in July. NHS England will also issue details of what elements of the plan will be monitored centrally.

6. Quality monitoring process in primary care Claire Heneghan circulated the Quality Concerns Trigger Tool. The tool was trialled and used on the Trust by the CCG. This was a good task as the process led to a Risk Summit. The tool has since been refined and as a level 3 co-commissioner the CCG will use the tool for care homes, GP practices etc. It will require significant work to put this in place and monitor. A quarterly quality report will go to the Quality and Safety Committee and NHS England. There is a need to be mindful of who will escalate this in the organisation and, once agreed, the tool will go to the Membership Council to inform them that their CH requirements will change.

Other practices in Lancashire use datix to record internal complaints about practices. Sheena Wood will ask Alison Cole who can discuss practice SW complaints with the Membership Council.

It was confirmed that NHS England will record GP issues and forward them to the CCG to resolve. For example, one issue received by NHS England relates to a GP practice which closes for one afternoon each week with no cover provided. The CCG investigated to find that all practices are covered or a skeleton staff is provided in the practice to distribute prescriptions.

A governance framework will return to the next committee meeting. CH/JCh

Primary Care Commissioning Committee – 9 May 2017 Page 3 of 4

Agenda Summary of Discussion Lead Item

7. NHS England update Sheena Wood provided an update for NHS England, highlighting the following: • The memorandum of understanding, which covers the task and function list, is in draft form. The document should be circulated on 11 May by Sarah Bloy. • A development programme achieved a high attendance from practice managers and a lower attendance from practice nurses, which supports upskilling back office staff. • Resilience fund • The pharmacy scheme has now finished and clinical pharmacists are working in two GP practices in West Lancashire. The demand on the clinical pharmacists time to study during the first few years in practice was raised as an issue. Sheena Wood will feedback this comment. SW • GP career plus • Workforce demand management pilot • GP contractual changes, which has already gone to the Membership Council. • An invitation to become a pilot test site for the primary care home model is based on 30-50 thousand population (GPs can work collaboratively across an area). The CCG did not bid, but is already undertaking the work. The NAPC is running a test site, where the next wave of primary care home models are available. • A programme board is working with LMC to see how they work differently across the patch and a meeting will take place to look at links across our strategy. • Sustainability Transformation Plan – there is currently no update available.

8. Dr Hindle update Further to Dr Hindle’s resignation an invitation for practices to bid to provide a caretaker GP service for his patients has been sent out. The bids will need to be tested and mobilised. Other options are being considered should a suitable bidder not be found. The public will be kept informed. A private company is handling the engagement and a portacabin will be in place in by mid- June.

9. Any other business Angela Manning is looking for primary care clinicians with an interest in right JC care. John Caine will consider this.

PDS medical won a bid for a zero-tolerance scheme, which starts on 1 June across the pan-Lancashire area.

Helen Fogg, the new federation manager, will be working closely with Sheena Wood going forward.

Date and time of the next meeting – The next meeting of the committee will take place on Tuesday 11 July at 1.30 pm, Boardroom, Hilldale.

Primary Care Commissioning Committee – 9 May 2017 Page 4 of 4

West Lancashire CCG Primary Care Commissioning Committee Action sheet

9 May 2016 Action Lead Date required by Action completed 5. Primary Care Janet Charnock 11 July 2017 The primary care strategy and the operational plan including the next two years planning will return to the next committee meeting in July. 6. Quality monitoring process in primary care Claire Heneghan 11 July 2017 There is a need to be mindful of who will escalate this in the organisation and, once agreed, the tool will go to the Membership Council to inform them that their requirements will change.

6. Quality monitoring process in primary care Sheena Wood 11 July 2017 Other practices in Lancashire use datix to record internal complaints about practices. Sheena Wood will ask Alison Cole who can discuss practice complaints with the Membership Council.

6. Quality monitoring process in primary care Janet Charnock / 11 July 2017 A governance framework will return to the next Claire Heneghan committee meeting.

7. NHS England update Sheena Wood 11 July 2017 The pharmacy scheme has now finished and clinical pharmacists are working in two GP practices in West

Lancashire. The demand on the clinical pharmacists time to study during the first few years in practice was raised as an issue. Sheena Wood will feedback this Page 1 of 2

comment. 9. Any other business John Caine 11 July 2017 Angela Manning is looking for primary care clinicians with an interest in right care. John Caine will consider this.

28 March 2017 Action Lead Date required by Action completed 5. Practice overview (including current issues) Jackie Moran 11 July 2017 The dashboard is close to completion A new dashboard is being produced and will develop and will be brought to the next meeting. to ensure current information is recorded. This will Q3 data will be shared with Membership return to the next meeting. Council and can be sorted by practice or neighbourhood. It will be available in hardcopy and on sharepoint for GPs. 6. Financial plan Paul Jones Ongoing Sheena Wood will enquire if the CCG A regular financial update will come to future will be picking up finances from meetings and the data received will be included in the pharmacies. Some funding is ring- future CCG integrated business reports. fenced for primary care. A summary will be produced for the next meeting.

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West Lancashire CCG : Primary Care Co-Commissioning June 17

Annual Budget YTD Budget YTD Spend Variance Forecast Forecast Description £000 £000 £000 £000 £000 Variance £000 Narrative GMS / PMS Contract Payments 10,045 2,474 2,474 (0) 10,045 (0) GMS Mpig Correction Factor 8 2 2 (0) 8 (0) GMS Funding Differential 4 1 1 (0) 4 - GMS Baseline Adjustment 1 0 0 - 1 - General Practice GMS / PMS 10,058 2,478 2,478 (0) 10,058 (0) Quality Achievement 405 - - - 466 60 Budget was set based on 15/16 QOF data. Actuals for 16/17 exceeded this and so forecast for 17/18 is based on 16/17 outturn plus an uplift for list growth. Quality Aspiration 1,118 280 280 (0) 1,118 0 QOF 1,524 280 280 (0) 1,584 60 DES Learning Disability Hlth Chk 37 - - - 37 - Payments are made on a quarterly basis Q1 in August, Q2 in November, Q3 in February. DES Minor Surgery 165 41 43 1 166 2 Monthly payments based on claims made via Exeter DES Avoiding Unplanned Admissions ------Scheme ended 31/3/17. Payments made in 17/18 charged back to NHSE to match accrual DES Violent Patients 9 2 2 (1) 2 (8) No further payments in 17/18. Service now provided under an NHSE contract. DES Extended Hours Access 100 25 22 (2) 94 (5) Monthly payments based on list size. P81674 opted out of service. Enhanced Services 310 68 67 (2) 299 (11) Seniority 151 38 41 3 160 9 Q1 payments made in June. Locum Adoption/Paternity/Maternity 58 14 26 11 69 11 YTD overspend due to 3 ongoing maternity leave cases. Locum Sickness ------CQC / Indemnity Fees 103 12 12 (0) 103 - Prof Fees Prescribing 81 7 15 8 81 - Other 393 71 93 22 414 20 - Premises Rent 394 108 108 (0) 394 0 Premises Rates 78 28 23 (5) 75 (3) Reduction in rateable values in 2017/18 Premises Water Rates 14 4 2 (2) 14 - Premises Other - - 3 3 3 3 NHSPS Healthcentre Charges 246 - - - 246 - Forecast = budget until information received from NHSPS re payments due to GP's Voids & Subsidies 342 86 86 - 342 - Accrued to budget - invoices due from NHSPS to CCG Contract - Refuse & Clinical Waste 37 9 9 - 37 - Premises 1,112 235 231 (4) 1,112 0 Contingency 68 - (0) (0) 68 - 1% Non-Recurrent 137 - - - 137 - Reserves / Contingency 72 - - - - (72) Surplus identified at budget setting offsets pressure on QOF. Reserves / Contingency 278 - (0) (0) 205 (72) Grand Total 13,675 3,131 3,148 17 13,672 (3)

Meeting Delegated Commissioning Committee

Date of Meeting 11 July 2017 Beacon Primary Care (P81112) and North Medical Report Title Centre (P81772) Practice Merger Author West Lancashire CCG / NHS England – Sheena Wood

Presented By West Lancashire CCG/NHS England - Sheena Wood

The purpose of this report is to present to the Primary Care Co- commissioning Joint Committee the application received from two Purpose of Paper practices to merge with effect from 1 September 2017.

This report details the enablers to achieve the desired outcome.

Summary / Background

The purpose of this report is to present the application received from:

• Beacon Primary Care - P81112 • North Meols Medical Centre – P81772 to merge and terminate P81772 following the inclusion of all of the GPs onto each of the respective contracts. The process of the addition of partners onto the respective contracts is an administrative merger with no formal approval required.

Practice P Code Contract List Size Number of Type as at GP partners March 2017

Beacon Primary Care P81112 GMS 12,463 2 partners North Meols Medical P81772 GMS 3,126 2 partners Centre (same partners as above)

The practices are located at Beacon Primary Care, Sandy Lane Health Centre, Sandy Lane, Skelmersdale, WN8 8LA and North Meols Medical Centre, Church Road, Banks, Southport, PR9 8ET. Both hold GMS contracts.

Beacon Primary Care operates from three sites:

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• Sandy Lane Health Centre, Sandy Lane, Skelmersdale, WN8 8LA • Hillside Health Centre, Tanhouse Road, Skelmersdale, WN8 6DS • 9-11 Railway Road, Ormskirk, L39 2DN

The reasons outlined in the application are: • Better access • More continuity • Access to a wider team of clinicians • More services available.

The clinical database merger date has been agreed with EMIS for end August / beginning September 2017 weekend.

Benefits to Patients

• Wider range of services, for example joint injections, coil fittings.

• Prescription ordering run by the medicines management team who have particular expertise and knowledge to manage requests quickly and efficiently.

• A larger number of doctors, nurse clinicians, nurses and health care assistants to consult with across the week.

• Better able to cover staff sickness and holidays to maintain appointments.

• Better access to telephone consulting, as we can use clinicians from any site to support patients at North Meols MC.

• Specialised facilities at our other sites, for example minor surgery, will be accessible to North Meols MC patients.

• Long term viability of the North Meols MC assured.

Hours and Boundary Hours The current hours are:

Beacon Primary Care (over three sites) Monday - Friday: 8.00 am – 6.30 pm Wednesday evening 6.30pm-8.30pm late night surgery

North Meols Medical Centre Monday - Friday: 8.00 am – 6.30 pm Monday evening 6.30pm-8.00pm

The practices have confirmed that they have no current plans to alter core opening hours.

Telephones All North Meols Medical Centre telephone lines will be kept. Two of the lines will be 2

made part of Beacon Primary Care’s call queueing system. The number that North Meols patients will ring will remain the same local call number but will divert into the Beacon Primary Care call queueing system within the call centre. The telephone engineers have said they need a minimum of two weeks’ notice. It is the applicant’s intention to notify them as soon as the merger is approved.

Clinical Data Transfer Emis Web has confirmed that a provisional date cannot be booked until an order from the CCG or an email of intent comes through. They have stated that once that comes through, they can arrange a date.

Boundary The practices confirmed that there will be no change to current boundaries. Benefits to the Practice • Smoother processes in place.

• Time efficiency.

• Able to cover sickness and absence of clinicians better by remote working and the ability to move a larger skill set of clinicians around to absorb this.

• Less utilisation of locums where possible.

• Fall in line with the GP Forward View.

• Vital clinical support.

• Administration staff part of a bigger, better supported system.

• Regular training sessions in the bigger team.

• More efficient administrative systems.

• One clinical system, which will stop staff having to log out of one and into another in order to deal with patients.

Consultation Five hundred consultation letters and questionnaires were made available in the surgery, local pharmacy, local shop and published on website for all patients. Of these letters, 73 responses were received, handed into surgery.

1 Do you give us your support to combine the clinical and administrative teams?

• Yes – 65 (89%) • No – 4 (5.5%) • No Response – 4 (5.5%)

2 Do you have any particular worries about combining the teams?

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• Yes – 17 (23%) • No – 54 (74%) • No Response – 2 (3%)

Patients were invited to a consultation meeting on 8 June 2017. Twenty-four patients attended the meeting which discussed the pros and cons and answered any concerns / worries that they had.

Discussion with the PPG prior to the consultation meeting on 8 June 2017 also took place and they fully support the merge.

Patients initially thought that by merging there would be a removal of services from North Meols Medical Centre. Following on from the meeting last night and discussions within the surgery, patients are now aware that this is not the case and support the move to a merged service.

Following the consultation document, the practice received the following patient comments and have added its responses: • As long as no skills are lost – totally the opposite more skills will be gained. • Will there be an expectation to travel to other sites – not at all but if the patient feels it would be of their benefit to travel they are welcome at any site. • Demand: will there be enough staff – demand is not changing by the merge. The surgeries will still be staffed to the level they are currently. • Lack of knowledge and input into specialist conditions – absolutely not; a bigger skill mix means more knowledge in specialised areas. • Could you change the telephone system to a queueing system – this will be the first job should the merge be approved. • North Meols MMC must stay open – This is absolutely the case we will not be closing North Meols MC. • More direct consultations with a Doctor – There will be more availability across the practices.

Should the merger be approved, the intention is to hold regular PPG meetings.

Jan Charnock and Jackie Moran at West Lancashire CCG have both been informed about the decision and request to merge.

The LMC supports the application.

Financial Implications As they are both GMS contracts, there are no financial implications in relation to the merger of the two contracts and clinical systems. There are no MPIG or PMS premium implications with these two practices. Risks • Inefficiencies in running separate contracts if P Code termination is not approved. • May impact on benefits to patients noted above.

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Policies

Contract Variations • Chapter 6 – Contract Variations of the Policy Book for Primary Medical Services

The underlying principle for the CCG to consider when any such proposal is made to them is what the benefit is for the patients and what the financial implications for the CCG are. This policy describes the process to determine any contract variation, whether by mutual agreement or required by regulatory amendments, to ensure that any changes reflect and comply with national regulations so as to maintain robust contracts. The policy focuses on primary medical care contracts in their various forms and has been developed in line with national legislation and regulations.

General Medical Services (GMS) arrangements are governed by the GMS Contract Regulations (SI No.2004/291, as amended from time to time).

Variations to contracts fall broadly within three categories: changes to the detail of the contracting parties/organisational structure, alterations in the service provision covered and/or changes to the payment mechanisms. In determining all variations the following guidance, legislation and regulations are considered:

• GMS regulations.

• PMS regulations and guidance.

• APMS directions.

• Statement of Financial Entitlements.

• NHS Act(s).

• EU procurement legislation.

• The public contracts regulations.

• Department of Health procurement guide.

• Principle and rules of co-operation and competition (issued by the

• Department of Health). There are three ways in which practices can propose to merge contracts:

1. each contractor becoming a party to the other contractor's contract (through variations of the contracting parties); or 2. terminating one existing contract, continuing the other contract but varying it to include the other contractor as a party to the contract; or 3. by terminating the two existing contracts and creating a single organisation or partnership which will enter into one new contract;

In the case of the two practices concerned, they will proceed with option 2, becoming parties to each other’s contracts, then requesting a formal merger and termination of 5

one P code, as indicated above, to operate under one single contract.

Approve the application to merge contracts, terminating P81772 and Option 1 operate both practices under one GMS contract P81112.

Option 2 Do not approve the application to merge or terminate P81772.

Recommendation

The Committee is requested to Approve the application to merge contracts, terminating P81772 and operate both practices under one GMS contract P81112.

The application meets all relevant regulatory requirements and is consistent with the Policy Book for Primary Medical Services which requires consideration in relation to the benefits to patients and the financial consequences.

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Quality Assurance & Monitoring Framework

Executive Governing Body Committee

Quality & Safety Committee

Annual Work Plan

Primary Care Acute Trusts Third Sector Community & Urgent

Primary Care Transition & Various Contract & CCG Quality Monitoring Commissioning Transformation Board & Quality Meetings with Process Committee Providers sub-groups

Report quarterly by Report quarterly by Report quarterly by exception exception Report by exception exception

Infection Prevention & Control / Safeguarding Adults & Children / Serious Incidents / Integrated Business Report

June 2017

Primary Care Non-Medical Clinical Nursing Workforce April 2016 – March 2017

Introduction The non-medical clinical workforce in primary care is key to support skill mix development to help address the plethora of workforce issues impacting on primary care and the wider health service. The historical development of the practice nurse role means that the experienced practice nurse workforce is reducing due to retirement. A significant number of nurses age 50 and above can retire aged 55 years. Lack of student exposure to primary care, lack of formal educational routes and differing workforce terms and conditions have resulted in a lack of experienced or trained nurses to recruit into primary care. Therefore, it is essential that we understand our current workforce profile within West Lancashire. The workforce information below is based on information provided by practices and the existing nursing workforce. However, practices are under no obligation to update the CCG when they have leavers / starters. Therefore, the following is based on the information available.

Recruitment & Retention Over the last 12 months there has been a decrease in the number of nurse posts by 2 although hours have increased by 126 hours. That is the equivalent of just under 3.5 whole time equivalent (wte) posts. There are at least four current vacancies. Healthcare assistants’ posts have increased by 2 but this only equates to 2 hours. Overall, headcount has increased by 1 registered nurse and 2 for healthcare assistants. Please note there are 2 nurses who work in 2 posts in West Lancashire and 2 HCAs who work in 2 posts within West Lancashire.

Actual April 2016 March 2017 % Increase Increase Registered Nurse Posts 47 45 -2 -4 Registered Nurse Headcount 42 43 1 2 Registered Nurse Hours 1019.5 1145.75 126.25 12

Healthcare Assistant Posts 27 29 2 7 Healthcare Assistant Headcount 26 28 2 8 Healthcare Assistant Hours 581.5 590.5 9 2

The nurse hours equate to 1 whole time equivalent (wte) per 3666 population of West Lancashire which is an increase from 4254 last year. There is no recommended figure for non-medical clinical workforce in primary care.

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Over the 12-month period ➢ 11 registered nurses were recruited by 7 practices. Recruited from: o Hospital x 4 o Walk in Centre x 2 o Community x 2 o Primary Care x 2 o Unknown x 1 ➢ 13 registered nurses left their post across 10 practices. Reasons for leaving: o More hours x 4 o Retired x 2 o Another post x 3 (1 within West Lancashire) o No reason x 1 o Post lost as part of practice merger x 1 o Career change x 2 ➢ 4 healthcare assistants were recruited by 4 practices. ➢ 2 healthcare assistants left their post across 2 practices Overall, 13 practices were involved in the movement of staff

Age Profile Headcount by Age

➢ 51% of the RN workforce are 50 years ➢ 43% of the HCA workforce are 50 years ➢ 67% of the RN workforce are 45 years or over and 61% of the HCA workforce ➢ 5% RN workforce are under 35 years and 14% of the HCA workforce are under this age. Last year the figures were 0% and 15% respectively. ➢ If all nurses aged 55 plus retired it would result in a loss of 16 posts across 9 practices ➢ 5 of those practices would lose their entire nurse workforce

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Posts by Age

Hours by Age

➢ 46% of the RN hours are delivered by those aged 50 years or above with 40% of HCA hours within this age group ➢ 64% of the RN hours are delivered by individuals aged 45 years. This is an improvement on last year when it was 70%. ➢ 57% of the HCA hours are delivered by individuals aged 45 years. Again, this is an improvement on last year when it was 62%.

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Number of Posts by Hours

➢ Overall 64% of posts of nurse posts are 21 hours or above. This is an increase from 49% last year ➢ HCA posts of 21 hours or above is 48%. This is a decrease from 52% last year.

Average Age by Hours

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Continuing Professional Development (CPD) Three funding streams were available in 2016/17 for supporting the non-medical clinical workforce in primary care:

• CPD Apply • CPD Flexible Cash Allocation • Public Health Allocation Details of uptake / spend are outlined below.

CPD Apply (Non-medical registered clinicians only) These monies are embedded with Higher Education Institutes (HEIs) within the North West and modules / short courses applied for via web based system. If all allocated monies are not utilised they cannot be reallocated. Courses commonly accessed via this route include non-medical prescribing, clinical examinations.

In 2016/17 the allocation was 1,197.76. This was a significant reduction from the previous year’s allocation of 12,007.01 The entire allocation part funded one non-medical prescribing module.

CPD Flexible Cash Allocation (All non-medical patient facing clinical workforce) The allocation was 10,729.61. Spend 10,747.00. The spend is to support skills development.

Provider Course Cost Places

Edge Hill University Supporting Learning and Assessment in Practice 800.00 1 Edge Hill University Advanced Respiratory Care Practice 800.00 1 Edge Hill University Partial Funding Non-Medical Prescribing 402.24 1 Edge Hill University Non-Medical Prescribing 3200.00 2 Edge Hill University Clinical Examination 620.00 1 Edge Hill University Negotiated Work Based Learning 800.00 1 Edge Hill University Clinical Assessment & Diagnostics 1240.00 2 M&K Update Phlebotomy 170.00 1 Primary Care Respiratory The Complete Respiratory Course 420.00 1 University of Central Lancashire Care of the Adult with Diabetes 760.00 1 University of Central Lancashire General Practice Nursing 380.00 1 University of Central Lancashire Identifying the sick child 90.00 1 University of Cumbria Chronic Kidney Disease 935.00 20 University of Liverpool Introduction to Contraception & Sexual Health 130.00 1

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Public Health An allocation of 3,823.90 was given to provide training in the areas of cervical cytology, immunisation and vaccination (updates excluded) and motivational interviewing. The monies were spent as detailed below: In addition, an annual immunisation and vaccination training was arranged on behalf of the practices for the both registered nurses and healthcare assistants.

Subject Cost Places

Cervical Sample Takers Course 750.00 3

Smear mentor update 45.00 1 Motivational Interviewing 1500.00 20 Introduction to Immunisation for Health Care Support Workers 770.00 3 Introduction to Childhood Immunisation Course 750.00 3

Practice Nurse Meetings Meetings were introduced for practice nurses in March 2015. Over the last 12 months the agendas have continued to be developed. Speakers are asked to attend and subjects covered within the last year have included:

• Rehabilitation Services • Walking Away from Diabetes • e-Referrals • Respiratory Services • Rally Round • Virgin Care • Active West Lancs • McMillan • Quit Squad • Care Quality Commission • Level 3 Co-commissioning • Medicines Optimisation Team Unfortunately, attendance remains extremely variable and poor at times. Known factors affecting attendance include: • Working in practice • Practice meeting • In-house training • Training • Working in another post • Personal appointment

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PN meeting attendance

Revalidation The Nursing & Midwifery Council introduced revalidation in April 2016. To date, 10 nurses have successfully revalidated. Support for nurses and practices continues to be available in respect of this.

Non-Medical Prescribers (NMP) As at March 2017 there are 17 nurses employed who are qualified non-medical prescribers. 16 are employed to prescribe. Over the last 12 months 6 NMP started in post and 4 left. No increase was due to completion of training. However, there are currently 3 nurses undertaking the non-medical prescribing course. This is an extremely positive improvement over last year when no applications were received. Prescribers are provided with their own prescribing data on a quarterly basis.

Student Placements Historically no pre-registration student placements have been available in primary care in West Lancashire. In 15.16 significant progress was made in opening placements and at March 2016 the area has 3 placements taking pre-registration nursing students. Within the last 12 months a further 2 practices have opened placements with a further 2 in progress. All placements have evaluated extremely well and student nurses have accessed training and attended practice nurse meetings when on their placement.

SharePoint Site The SharePoint site continues to be well utilised as a form of communication.

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NHS West Lancashire CCG Primary Care Operational Group Meeting Wednesday, 6 July 2017 2.00-3.30pm

Members Present: Jackie Moran (JMO), Paul Jones (PJ), Jan Charnock (JCH), John Caine (JC), Nicola Baxter (NB), Alison Lumley (AL), Matt Greene (MG), Joanna Rimmer (JR), Charlotte McAllister (CMc), Claire Heneghan (CH), Chris Russ (CR)

In Attendance: Anne-Marie Bridge (AMB) – Note Taker

Item 2 – Minutes of last meeting and actions

The minutes will be reviewed at the next Operational Group Meeting.

Item 3 – Operational Issues a. Practices by Exception JCH gave an update on the practice issues – House Surgery are encouraging some difficulties with the surgery property and George Hurst is looking into how this can be resolved. This may also be alleviated through further discussions with the other practices and partnership working. AL is also working with the practice to help with their nursing staff. b. CQC Ratings JCH informed the group that the CQC inspections for the area are now complete with all surgeries being rated Good and a couple rated Outstanding. Lathom House Surgery still needs to have their registration changed to portray the current practice name. The CQC have announced that they will reinspect 10% of surgeries in West Lancashire and this will mean that 2 practices will be reinspected. They have not announced which 2 yet. c. Viran Medical Practice JCH updated the group on the status of Viran Medical Practice. Beacon Primary Care took over temporary running of the practice from Monday 3 July 2017 and the surgery will be run from a temporary building at Tarleton Health Centre. All patients have received the relevant communication and there are signs up around village. It was reported that there were some DNAs on the first day and the telephone system was quiet. Positive feedback had also been received from patients. d. Beacon & North Meols Merger Beacon Primary Care have applied formally to merge the North Meols Practice and this will be presented at the Primary Care Committee next week, for formal approval.

Item 4 – Initial Feedback from Practice Visits

Practice visits have been carried out during the last couple of weeks and JMO asked for any initial feedback from the group members. This feedback focused mainly on the volume of care home visits and the plans use of £5 per head. Other issues raised were around resilience. There was discussion around NHS England (NHSE) using the LMC to work with practices around their future work plans. JCH will pull together all the feedback from the visits and compile a report.

Item 5 – Finance

PJ informed the group that there are still unanswered queries around QOF payments on the finance plan issued by NHSE. There was discussion around NHSE issuing money direct to practices with regards to neighbourhood working and money available for transformation work. MG will represent finance at future meetings.

Item 6 - Primary Care Strategy a. OD Plan i. JCH has written the Primary Care Strategy. She gave an update on the extended hours service and how this is hoping to develop towards neighbourhood working. It is hoped that the service will also be offered in all 3 neighbourhoods within West Lancashire. It was highlighted that West Lancashire were leading the rest of Lancashire with the implementation of this service. The Enhanced Care Home model will be presented in a paper at the Primary Care Committee next week. JC gave an overview of the scheme and how he would like the Quality Contract to feed in to this model in the future to include further incentives for the GPs. This will encourage further neighbourhood working and help with Quality, Innovation, Productivity & Prevention (QIPP), and hospital admissions. ii. Chris Russ presented the IT strategy and explained how the use of artificial intelligence will play a part in this in the future. iii. JMO b. Workforce Plans i. Nursing Report - The nursing report will be presented to the Primary Care Committee next week. ii. Workforce Tool - JCH explained how the workforce tool is currently being used by 6 practices, this collates data on practice process and looks at future practice workforce needs. It is hoped that this tool will be rolled out to other interested practices by the end of July 2017, but it was suggested that a letter be drafted to NHSE to encourage all practices be given access. ACTION: Draft letter to NHSE – JCH. iii. International GPs - All practices were asked for expression of interest in hosting the training of international GP’S in their practice. There was very little interest raised and it was decided that this should be added to the membership agenda for the meeting to be held on 12 July 2017. ACTION: Add to membership agenda – AMB. iv. Grow Your Own GP - No update at this time. v. Physician Associates - No update at this time. vi. Clinical Pharmacists – NB gave an outline of will submit a bid for this in September 2017.

Item 7 – Pharmacy Strategy

NB has written the strategy and it is currently in draft form. She highlighted the main priorities within the strategy. The document will be discussed at the Primary Care Group next week and then presented to the Governing Body for final approval. The minor ailments scheme was discussed as the funding from NHSE for this will cease. A letter will be drafted for distribution to the pharmacies to inform them of the change. ACTION: Draft letter to be sent to pharmacies – NB

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Item 8 – Estates Strategy

George Hurst is currently working on the estates strategy for West Lancashire and there are several projects he is involved with around health and leisure facilities in the area.

Item 9 – Agenda and papers for Primary Care Committee

The agenda and papers were reviewed. The Enhanced Care Home paper will be presented in its current form and quality contract will filter into this at a later date. The finance paper will be tabled on the day as still awaiting information.

Next Meeting: Wednesday 6 September 2017

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