WIGAN BOROUGH CLINICAL COMMISSIONING GROUP GOVERNING BODY - OPEN MEETING
Tuesday, 26 June 2018 1.30 pm Wigan Borough CCG Boardroom - Wigan Life Centre
AGENDA
Agenda Item Time Presenter Pages/ Action Verbal Required 1. Chairman's Welcome 1.30 pm Tim Dalton
2. Apologies for Absence Tim Dalton Record
3. Declarations of Interest All Record
Individuals will declare any interest that they have, in relation to a decision to be made in the exercise of the commissioning functions of Wigan Borough Clinical Commissioning Group, in writing to the governing body, as soon as they are aware of it and in any event no later than 28 days after becoming aware. 4. Minutes of Previous Wigan Borough Tim Dalton 1 - 14 Approve Clinical Commissioning Group Governing Body Meeting held on 22 May 2018
5. Actions/Decisions Log from Previous Tim Dalton 15 - 18 Approve Wigan Borough Clinical Commissioning Group Governing Body Meeting
6. Questions from Members of the Public
7. Key Messages 1.40 pm
Verbal 7.1 Chair's Key Messages Tim Dalton Information Report Caroline Verbal 7.2 Chief Officer's Key Messages Kurzeja Information Report
8. New Business Items 1.55 pm
Sally 8.1 Quality Annual Report 2017/18 19 - 46 Receive Forshaw Medicine Optimisation Annual Report 8.2 Linda Scott 47 - 74 Receive 2017/18 CCG Annual Report and Accounts Caroline 8.3 75 - 204 Receive 2017/18 Kurzeja 9. Current Business Items
Paul 205 - 9.1 Finance Report Receive McKevitt 214 Caroline 215 - 9.2 Performance Report Receive Kurzeja 224 Greater Manchester Health & Social 9.3 Care Strategic Partnership Board Tim Dalton No Meeting Minutes 10. Governing Body Committee Updates
Chairperson's Report - Audit 225 - 10.1 Peter Armer Approve Committee 228 Chairperson's Report - Clinical 229 - 10.2 Ashok Atrey Approve Governance Committee 234 Chairperson's Report - Corporate Maurice 10.3 No Meeting Governance Committee Smith Chairperson's Report - Finance and Mohan 235 - 10.4 Approve Performance Committee Kumar 238 Chairperson's Report - Service Peter 10.5 Design and Implementation No Meeting Marwick Committee Minutes - Primary Care 10.6 Gary Cook No Meeting Commissioning Committee 11. Service Delivery Footprint Primary Care 239 - Highlight Reports 240
241 - 11.1 Leigh Gen Wong Receive 246 Sanjay 247 - 11.2 LIGA North Receive Wahie 252 11.3 LIGA South Neeta 253 - Receive James 256 Mohan 257 - 11.4 SWAN Receive Kumar 264 265 - 11.5 TABA+ Ashok Atrey Receive 270 Jayne 271 - 11.6 Wigan Central and North Wigan Receive Davies 278 12. Any Other Business - To be accepted at the Chairman's discretion
13. Date and time of next meeting Tuesday 24 July 2018 at 13.30 in Room 17, Wigan Life Centre This page is intentionally left blank OPEN MEETING (Unratified)
Meeting of Wigan Borough Clinical Commissioning Group (WBCCG) Governing Body Held on Tuesday 22 May 2018 at 3.30pm in Meeting room 17, Wigan Life Centre
Present: Dr Tim Dalton, Chair (TD) Caroline Kurzeja, Deputy Chief Officer (CK) Frank Costello, Lay Member – Deputy Chair (FC) Mike Tate, Chief Finance Officer (MT) Dr Sanjay Wahie, Clinical Executive LIGA North SDF (SW) Dr Jayne Davies, Clinical Executive Wigan Central SDF (JD) Dr Neeta James, Clinical Executive LIGA South SDF (NJ) Dr Gen Wong, Clinical Executive Leigh SDF (GW) Maurice Smith, Lay Member Governance and Conflicts of Interest (MS) Dr Ashok Atrey, Clinical Executive, TABA+ SDF (AA) Peter Armer, Lay Member, Audit and Financial Management (PA) Catherine Jackson, Governing Body Nurse Member (CJ)
In Attendance: Jane Clucas, PA to Chair – Minute Taker (JCl) Tim Collins, Assistant Director Governance (TC) Julie Crossley, Director Commissioned Services, item 9.2 (JC) Sally Forshaw, Director Nursing and Quality, item 9.4 (SF) Margaret Hughes, PPG representative (MH)
ACTION 1. Chairman’s Welcome The Chairman opened the meeting at 3:30pm formally welcoming all Governing Body members and members of the public.
2. Apologies for Absence Apologies for absence were received from:
Trish Anderson Dr Gary Cook Dr Mohan Kumar Dr Pete Marwick 3. Declarations of Interest
Other than the previously recorded declarations of interest there were no additional declarations of interest for any items on this agenda.
The Chairman reminded Governing Body members that apart from the
Page 1 standing declarations of interest individuals must declare any interest that they have, in relation to a decision to be made in the exercise of the commissioning functions of Wigan Borough Clinical Commissioning Group (WBCCG) in writing to the Governing Body, as soon as they are aware of it and in any event no later than 28 days after becoming aware.
Where an individual is unable to provide a declaration in writing, for ALL example, if a conflict becomes apparent in the course of a meeting, they will make an oral declaration before witnesses, and provide a written declaration as soon as possible thereafter.
4. Minutes from the Previous Wigan Borough Clinical Commissioning Group governing Body Meeting held on the 24 April 2018
The minutes of the meeting held on the 24 April 2018 were agreed as a true and accurate account of the meetings.
Resolved: 1. The Governing Body members received the minutes.
5. Actions/Decisions Log from Previous Wigan Borough Clinical Commissioning Group Governing Body Meetings
24.10.17 Item 8.2 – Draft Operating Model for the SCF – June agenda
27.2.18 Item 9.2 – HWP Alliance Agreement – June agenda
27.3.18 Item 10.2 – Performance Report – June agenda
24.4.18 Item 9.1- Update on QIPP and Contracts – Agenda item
6. Questions from Members of the Public There was one member of the public present and one Patient Forum Representative. There were no questions from members of the public.
7. Key Messages 7.1 Chair’s Key Messages
TD highlighted the meetings attended over the past month and particularly highlighted a meeting which discussed the work being carried out at a Greater Manchester level around the GP Excellence Programme which will bring on line the Quality 2 Page 2 Innovation Productivity and Prevention (QIPP) work. This shows how to demonstrate quality and improvement by live day by day management.
Resolved: The Governing Body members received the update.
7.2 Chief Officer’s Key Messages
CK gave an update on the work she has undertaken in the last month particularly focussing her approach locally on the delivery of QIPP, the Local Care Organisation and creating the right relationships and culture to move towards a Single Commissioning Function. She is also focusing on ensuring that performance does not slip and that systems are in place to respond when issues arise.
Resolved: The Governing Body members received the report.
8. Service Delivery Footprint Primary Care Highlight Reports 8.1 Leigh
The monthly highlight report from Leigh SDF was received by the Governing Body members.
Resolved: The Governing Body members received the report.
8.2 LIGA North
The monthly highlight report from LIGA North SDF was received by the Governing Body members.
Resolved: The Governing Body members received the report.
8.3 LIGA South
The monthly highlight report from LIGA South SDF was received by the Governing Body members.
Resolved: The Governing Body members received the report.
3 Page 3 8.4 North Wigan
The monthly highlight report from North Wigan SDF was received by the Governing Body members.
Resolved: The Governing Body members received the report.
8.5 SWAN
The monthly highlight report from SWAN SDF was received by the Governing Body members.
Resolved: The Governing Body Members received the report. 8.6 TABA+
This item was taken before item 8.
AA gave a presentation on behalf of TABA+ SDF and highlighted the following points:
Profile
The SDF has the best correlation between registered population and resident population with over 95% matching.
However, 4,810 patients registered with GPs in this SDF, reside outside the Borough - the highest of all 7 SDFs.
2,246 SDF residents are registered with an out of area GP.
This creates an issue between health and the social care service especially as one full care home is registered but not resident.
TABA+ has the lowest Out of Hours attendance rate. The average Borough attendance rate per 1000 registered patients is 87.5. The average SDF attendance rate per 1000 registered patients is 59.8.
TABA+ patients are more likely to attend A&E out of the Borough due to the location of the SDF.
Projects
Extended Team working including Health and Social Care 4 Page 4 team, staff in Homes and Patient’s Carers with improved communication between various team members.
Best qualified person to deal with the issue is called in first and avoid waste of resources.
Reduce attendances at A&E, Ambulance call out from nursing homes, residential homes and housebound patients.
CK referred to the high number of small practices in the SDF and enquired whether help is required with primary care resilience. AA replied that they are now moving away from silo working which is helping.
SW asked whether the CCG is having reciprocal conversations with neighbouring CCGs regarding the issue of patients from the Wigan borough boundary receiving out of area treatment. CK suggested this is discussed at North West Sector commissioning. CK suggested local discussions take place with patients around this issue.
AA highlighted that the GP workload created by caring for patients from nursing homes is significant compared to caring for the rest of the practice population and does not feel they are remunerated sufficiently. CK replied that there are new models being discussed and these need to be fast paced and extended out to primary care.
Resolved: The Governing Body Members received the report. CK to raise the issue of cross boundary patient treatments at North West Sector Commissioning CK meeting A piece of work to be undertaken on how the CCG engages with the patients who choose to receive CK treatment out of area.
8.7 Wigan Central
The monthly highlight report from Wigan Central SDF was received by the Governing Body members.
Resolved: The Governing Body Members received the report.
9. New Business Items
5 Page 5 9.1 Patient Engagement Briefing and Patient Forum Attendance
This item taken after item 6.
FC presented the Patient Forum briefing on public engagement activity between January 2018 and May 2018 and highlighted the following points:
Patients’ Forum
The topics discussed at the Patients’ Forum meetings were: o End of Life Strategy o Implementation of Healthier Together o Review of Dermatology services o New Terms of Reference to extend membership beyond Patient Participation Group (PPGs) o Planning for the PPG Conference on the 10 July 2018 during Wellfest week. Jon Rouse, Chief Officer of the Greater Manchester Health and Social Care Partnership will attend to talk about the “Devolution Difference”.
Patient Participation Group (PPG) Development
Working with PPG members on the implementation of the PPG strategy and have run training sessions with further sessions planned.
Cluster Patient Participation Groups (PPGs)
Helped Leigh Cluster PPG to plan and deliver a workshop on the 9 May 2018. Helping LIGA Cluster PPG to produce a video or a poster to publicise the PPG. Shows they wish to be principle players within the footprint.
Wigan Borough Engagement Group
The group have focussed on: o Working with Healthier Wigan Partnership to design an animation for the public and identifying areas for further involvement. o Reviewing the list of Locality Plan projects. o Attending the Healthier Wigan Alliance event in April.
6 Page 6 Outpatient Service Redesign
Working on a document to summarise the work completed around service redesign.
Urgent Primary Care Patient Reference Group
The group is working on the review of Urgent Primary Care Services.
Medicines Management
Feedback from a session has been included in a response to NHS England’s consultation on over the counter items.
Maternity Voices Partnership (MVP)
Launch event of the partnership was held on the 11 May 2018.
Orrell and Billinge Engagement Work
Engagement work in Orrell and Billinge to understand their views on healthcare services.
Reference was made to the survey undertaken to understand what residents think of healthcare services in Orrell and Billinge and highlighted the poor responses received for Billinge Medical Practice. This practice is under the control of St Helens CCG but there are 5,700 Wigan residents registered with the surgery. He asked the Chair to raise the issue with St Helens CCG.
Dr Chan Practice Engagement
Assisting Dr Chan and his practice team to engage with their patients around a proposed merger of the Elmfield Surgery and Seven Brooks.
FC added that both the End of Life Strategy and the North West Sector papers have been through patient consultation which recognises the important role patients play.
MH added that all workshops have been well attended, especially the dying matters topic and the social media training.
MH also wished to congratulate the engagement team without 7 Page 7 whose help they would be unable to make these achievements and raised concerns that in the changes ahead this help will be lost. The Wigan Patient Advisory Group Model is also being used in Manchester.
CK agreed to address their concerns around the lack of capacity in the practice run by St Helens CCG by writing to their Chief Officer asking for an urgent meeting with the Accountable Chief Officer. CK said she would encourage patients to also write to St Helens CCG.
CK said she would like to engage the PPG members in discussions on how to encourage Wigan patients to spend the “Wigan pound” in Wigan and dissuade patients from going out of Wigan for treatment.
TD reminded the Governing Body members that the survey is one snapshot and more data is also required against other local practices. He suggested that the matter is taken as an action and taken forward depending on evidence.
JD expressed a conflict of interest in this discussion as she is a registered patient with the practice. She did not complete the patient survey.
JD asked whether there are plans to engage young people and adults with the PPGs. AM advised that they have worked with Winstanley College and the Deanery High School but have encountered problems due to fitting in with the school timetable.
Resolved: CK The Governing Body members received the report. CK to write to the Chief Officer of St Helens CCG regarding the issues raised by the Patient Survey CK around the Billinge Medical Practice. Further data collection is required to compare against other practices. 9.2 End of Life Strategy
JC presented the Wigan Borough End of Life Strategy 2018 – 2023 which was commissioned by the Health and Wellbeing Board. This is the first draft of the document which has been designed to deliver a vision of high quality services that support families and care.
TD advised that the Strategy has been taken through all relevant committees and shared with providers. The strategy is intended 8 Page 8 to address patients dying in hospital against their wishes.
PA suggested there should also be reference to tissue donation.
TD advised that this is a strategy of end of life from young to old and suggested that tissue donation is included with family engagement.
The Governing Body members received the Strategy and approved its submission to the Health and Wellbeing Board.
Resolved: The Governing Body members received the Strategy and approved its submission to the Health and Wellbeing Board.
9.3 Governing Body Assurance Framework Quarter 4 2017/18
TC presented the Governing Body Assurance Framework for quarter 4 (2017/18) (GBAF).
The framework has been drafted with directors separately, reviewed at the Senior Leadership Team and presented to the Corporate Governance Committee in April 2018. The GBAF is applicable as at the 31 March 2018.
There are three risks rated extreme at the end of 2017/18:
If Bridgewater Community Healthcare FT (BCHFT) does not improve its ability to evidence quality assurance there is a risk that the service is not delivering the appropriate quality of patient care. This may in turn jeopardise achievement of the Transformation agenda.
If ambulance response times continue to be breached, patients will continue to experience delays in receiving treatment.
If demand exceeds capacity the urgent care system will not deliver planned performance levels.
The QIPP programme will be included in quarter 1 and will be brought to the July Governing Body meeting.
Resolved: The Governing Body members approved the report.
9 Page 9 9.4 Quality, Safety and Safeguarding Report Quarter 4 2017/18
SF presented the Quality, Safety and Safeguarding Report for quarter 4 2017/18 and highlighted the following points:
Bridgewater Community Healthcare NHS Foundation Trust (BCHFT) Bridgewater issue in context of quality review risk profile. Action plan has been provided and will be reviewed at next commissioning collaborative. A decision has been taken to move the Trust’s current level of surveillance from routine to enhanced in line with the Cheshire and Merseyside CCGs.
Wrightington Wigan and Leigh NHS Foundation Trust (WWL) The Trust’s Care Quality Commission (CQC) inspection was rated as “good”. Maternity services were rated as “requires improvement”. This will be monitored at the Quality Safeguarding and Safety Group (QSSG).
Primary Care – General Medical Practice The “Fellowship for General Practice Nursing (GPN) Scheme” scheme aims to improve the local recruitment and retention of GPNs. Twelve local practice nurses where nominated for the GM Practice Nurse Awards and four were successful in receiving awards.
CK wished it to be noted and commend WWL’s performance which is good and suggested it would be helpful to compare the ratings of other hospitals in the footprint in order to highlight the Trust’s good performance to patients. Overall the Borough has good and outstanding primary care services and good and excellent services in hospitals.
FC raised the continuing issue around mortality which is highlighted in the Governing Body Assurance Framework report. He also referred to Bedford Nursing Home which continues to require improvement.
SF advised that there has been a significant amount of work undertaken around mortality through a summit and joint audits. Joint work is being undertaken with the CCG’s Medicine Management team and the Council to assist Bedford Nursing Home. A new service manager is now in place and is hopeful improvements will be made.
10 Page 10 SW asked whether the step-up beds are located in the right place as we need to be assured that they are leading to improvements. CK suggested that this question is raised at the Quality Safety and Safeguarding group.
PA queried what improvement programme is in place for maternity services. SF advised that an action plan has been submitted to the CQC, the CCG has visited the hospital and monitoring is being carried out by the Quality Safety and Safeguarding Group.
TD recognised the work undertaken with the practices’ nurses which has been recognised in Greater Manchester and invited the award winners to present to the Governing Body. SF advised that they are presenting to the July Clinical Governance Committee and would invite them to also attend the Governing Body meeting.
Resolved: The Governing Body members received the report. Quality Safety and Safeguarding Group to look into whether step-up beds are in the right place. SF 10 Current Business Items 10.1 Material Conditions Transformation Funding (2)
MT presented a paper which gave an updated position on both Transformation Fund 1 and 2 (TF1 TF2) and concludes that the material conditions have been met. The paper looks for support from the CCG, Local Authority and Health and Wellbeing Board prior to formal discussion with Greater Manchester Health and Social Care Partnership on the release of resources.
The CCG and Local Authority officers believe that the material conditions for TF1 and TF2 have been met and will ask for the remaining funds for to be released.
The Governing Body members are asked to approve the paper for onward discussion at the Locality Plan Portfolio Group, Health and Wellbeing Board and Greater Manchester Health and Social Care Partnership.
Resolved: The Governing Body members received and approved the report.
10.2 QIPP Update
11 Page 11 MT presented an update on the CCG’s Quality Innovation Productivity and Prevention (QIPP) position and actions required for 2018/19.
The CCG has made significant progress in developing creditable transformational plans based around the SDFs in a short period of time. The CCG still needs to identify additional schemes to mitigate for potential in year non-delivery. The mitigation on QIPP delivery should be achieved by setting stretch targets for SDFs.
The Governing Body members are asked to fully support the continued approach outlined in this paper. They are also asked to fully support additional schemes to mitigate any in-year non- delivery supported by stretch targets for the SDF areas as set out in Appendix B of the report.
MT added that they have also adopted the Council’s approach to have a fundamental budget review throughout June to identify any further savings in the corporate arena.
It was suggested that more QIPP reporting is brought through the Finance Committee and Governing Body.
It was highlighted that there is a serious risk of non-delivery as noted at the March Governing Body meeting. Discussions are taking place with Greater Manchester Health and Social Care Partnership.
CK wished the Governing Body members to note that the Officers cannot provide assurance against the £7.8m. It was suggested that the Patient Participation groups are also engaged in these discussions especially around how we spend the “Wigan pound”. It was agreed that AM would arrange for CK to meet with the PPG.
FC referred to paragraph 3.4 Variation, Referral and Demand Management and suggested it would be beneficial to explicitly mention the Rightcare comparators as it is important to demonstrate that we are looking at all areas of referral. MT agreed to action.
Resolved: The Governing Body members received the report. The Governing Body members agreed to continue to fully support the continued approach outlined in this paper. The Governing Body members agreed to fully support 12 Page 12 additional schemes to mitigate any in-year non- delivery supported by stretch targets for the SDF areas as set out in Appendix B of the report. AM to arrange for CK to meet with the PPGs to discuss their input on spend priorities. AM Rightcare comparators to be included under variation, referral and demand management. MT 10.3 Greater Manchester Health & Care Board Minutes
TD presented the minutes of the Greater Manchester Health and Care Board from the meeting held on the 16 March 2018 and asked the Governing Body members to receive them.
Resolved: The Governing Body members received the minutes. 11 Governing Body Committee Updates . 11.1/1 Chairpersons’ reports were circulated as below: 1.6 11.1 – Healthier Together Joint Committee – no meeting 11.2 – Audit Committee – no meeting 11.3 – Clinical Governance Committee – (6.5.18) 11.4 – Corporate Governance Committee – (17.4.18) MS referenced the CCG’s gender pay gap which had been raised at the meeting and wished to raise with the Governing Body members.
It was agreed to clarify equal pay for equal value work and decide what actions to be taken to rectify.
Subject to this additionality the report was received and it was noted that the Corporate Governance Committee would monitor actions.
11.5 – Finance and Performance Committee – (23.4.18) 11.6 – Service Design and Implementation Committee – (no meeting) 11.7 – Primary Care Commissioning Committee Minutes – (1.5.18) Advised that they are in the process of recruiting a GP to replace the member who had resigned.
Resolved: The Governing Body received and approved the Chairpersons’ reports.
13 Page 13 12 Any Other Business – to be accepted at the Chairman’s discretion There being no other business the Chairman closed the meeting at 17:05.
13 Date and time of next meeting . Tuesday 26 June 2018 at 1:30pm in Room 17, Wigan Life Centre
Signed ………………………………………………….. Date …26.6.18………. Dr Tim Dalton, Chair
14 Page 14 ACTIONS FROM WIGAN BOROUGH CLINICAL COMMISSIONING GROUP GOVERNING BODY OPEN MEETINGS 2018/19
Meeting Agenda Agreed actions from meeting Action Deadline Update Date Item By 24.10.17 8.2 Draft Operating Model for the SCF
The model was approved subject to the following conditions being applied to the final version: It should be made clear in diagrams CK March 2018 These actions will now and narrative that the Primary Care form part of the initial work Commissioning Committee can only of the Joint Commissioning be a committee of the CCG and Committee which shall primary care commissioning cannot report back to governing be delegated further body in September 2018
Page 15 Page There should be further clarity on with proposals on the CCG’s Governing Body terms of implementation. reference through changes to its constitution eg meeting frequency, business plan etc. Patient involvement in the process of decision making in the new model should be clearly described The patient voice should be drawn from the existing apparatus established by the CCG and not from other sources The two senior positions within the SCF of Accountable Chief Officer and Director of Strategic Commissioning/Chief Operating Officer should be comprised from the Council and CCG (one from
w:corporate office:corporate office:wbccg:board:board meetings:2016:master action log – open meeting KEY: RED-Incomplete, AMBER-In progress, GREEN-complete ACTIONS FROM WIGAN BOROUGH CLINICAL COMMISSIONING GROUP GOVERNING BODY OPEN MEETINGS 2018/19
Meeting Agenda Agreed actions from meeting Action Deadline Update Date Item By each) not from a single organisation There should be clarity around the role of the proposed Quality Oversight Committee and more generally around the committee structure beneath the Joint Commissioning Committee Further detail is required around the Outcomes Framework, the KPIs are welcomed but they are too high level; the national requirements should be adopted but local Page 16 Page objective indicators also set The diagrams and narrative within the model should be corrected to provide consistent language and descriptions The CCG’s constitution will require amendment and approval to include the proposed changes The final version of the model subject to the above changes should be returned to the governing body for scrutiny and approval in quarter 4, 2017/18
w:corporate office:corporate office:wbccg:board:board meetings:2016:master action log – open meeting KEY: RED-Incomplete, AMBER-In progress, GREEN-complete ACTIONS FROM WIGAN BOROUGH CLINICAL COMMISSIONING GROUP GOVERNING BODY OPEN MEETINGS 2018/19
Meeting Agenda Agreed actions from meeting Action Deadline Update Date Item By 27.02.18 9.2 HWP Alliance Agreement
Further clarification is needed CH June 2018 To be agreed at HWP around potential risk share of all the Board in June then signatories which should be the subsequent CCG outcome from a future Governing Body workshop/event to be convened 27.03.18 10.2 Performance Report
Improvement trajectory for CK June 2018 Agenda item Ambulance performance to be
Page 17 Page included in future reports 22.05.18 8.6 TABA+ SDF Presentation
Raise the issue of cross boundary CK June 2018 Oral update patient treatments at North West Sector Commissioning meeting Exercise to be undertaken on how the CCG engages with patients who CK July 2018 choose to receive treatment out of area 22.05.18 9.1 Patient Engagement Briefing Write to the Chief Officer of St CK June 2018 Complete Helens CCG regarding the issues raised by the Patient Survey around the Orrell/Billinge Medical Practice.
w:corporate office:corporate office:wbccg:board:board meetings:2016:master action log – open meeting KEY: RED-Incomplete, AMBER-In progress, GREEN-complete ACTIONS FROM WIGAN BOROUGH CLINICAL COMMISSIONING GROUP GOVERNING BODY OPEN MEETINGS 2018/19
Meeting Agenda Agreed actions from meeting Action Deadline Update Date Item By Patient Engagement Briefing (Cont.)
Further data collection is required to CK July 2018 compare against other practices. 22.05.18 9.4 Quality, Safety & Safeguarding Report Quarter 4 - 2017/18 Quality Safety and Safeguarding SF July 2018 Group to look into whether step-up beds are in the right place. 22.05.18 10.2 QIPP Update AM to arrange for CK to meet with AM July 2018
Page 18 Page the PPGs to obtain their input on spend priorities NHS Rightcare comparators to be CK July 2018 included under variation, referral and demand management.
w:corporate office:corporate office:wbccg:board:board meetings:2016:master action log – open meeting KEY: RED-Incomplete, AMBER-In progress, GREEN-complete MEETING: Governing Body Item Number: 8.1 DATE: 26 June 2018
REPORT TITLE: QUALITY ANNUAL REPORT 2017 / 18
2. Commissioning high quality services, which reflect the CORPORATE OBJECTIVE population's needs, delivering good clinical outcomes ADDRESSED: and patient experience within the resources allocated and available to the Borough. 3. Functioning as an effective strategic commissioning organisation that puts the patient first. 4: Developing a collaborative and integrated system with partners and stakeholders to implement the outcomes of the Greater Manchester Commissioning Review in order to improve the health and care of the Borough's citizens. 5: Functioning as an organisation that consistently delivers its statutory duties and participates fully in the Greater Manchester Health and Social Care Partnership. Senior Assistant Director for Nursing & Quality REPORT AUTHOR: Wigan Borough CCG
Director of Nursing & Quality PRESENTED BY: Wigan Borough CCG
RECOMMENDATIONS/DECISION The Governing Body is requested to review and approve the REQUIRED: Quality Annual Report 2017 / 18.
EXECUTIVE SUMMARY Wigan Borough Clinical Commissioning Group must ensure that it is competent and capable to deliver quality along the whole commissioning cycle as part of its core business functions, in combination with effective systems of governance. The work undertaken collectively by the CCG Quality Team provides assurance to the Governing Body through the Clinical Governance Committee. To this end the Quality Annual Report provides a retrospective view of the year 2017/ 18. The report details the innovative approach that the CCG has adopted to respond to how quality has and is continuing to influence the commissioning of safer healthcare locally. This is undertaken whilst ensuring the best possible use is being made of the available finances.
FURTHER ACTION REQUIRED: As captured within the report
EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.
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QUALITY ANNUAL REPORT
2017 / 18
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Quality In Focus
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A FOCUS ON QUALITY 2017 / 18
Foreword:
Wigan Borough Clinical Commissioning Group (‘the CCG’) must ensure that it is both competent and capable to deliver quality along the whole commissioning cycle as part of its core business functions, in combination with effective systems of governance.
The work activities undertaken by the CCG Quality Team during 2017 / 18 has already been comprehensively documented within the quarterly Quality Safety and Safeguarding assurance reports received by both the CCG Clinical Governance Committee and Governing Body.
The purpose of this annual report is to provide a retrospective overview on Quality. In doing so the report will seek to highlight the innovative approaches that the Quality Team has adopted to respond to how quality has and is continuing to influence the commissioning of safer; clinically effective healthcare locally.
The information contained within this report is not intended to be wholly comprehensive of all the work undertaken by the Quality Team; however it does provide a ‘snap shot’ of some of the areas of work that have been undertaken in year.
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CONTENT Page
Foreword - A Focus On Quality 2017 / 18 2
What do we mean when we talk about ‘Quality’? 5
1 Wigan Borough CCG - Strategy for Quality & Safety 2017 / 20 5
2 Quality Accounts 6
3 Care Quality Commission (CQC) - Quality Reports 6
4 Quality Safety & Safeguarding Groups (QSSGs) 7
5 Commissioning for Quality and Innovation (CQUIN) 2017 / 18 8
6 Infection Prevention & Control - Inclusive of Healthcare Associated Infection 10
7 Learning from Serious Incidents and Never Events 12
8 Commissioner Quality Improvement Visits 13
9 Experiences of Healthcare Services 14
10 Quality Initiatives in Primary Care 15
11 Quality Drivers in Care Homes 17
12 Reporting Process 2017 / 18 18
13 CCG Quality Strategy Priorities for 2017 / 20 18
14 The Year Ahead 2018 / 19 20
15 Reporting 21
16 Conclusion and Recommendations 21
Appendix 1: CQC Ratings for Nursing and Residential Homes at 31 March 2018 Appendix 2: A Collaborative Celebration of General Practice Nursing Awards 2018
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What do we mean when we talk about ‘Quality’?
This would seem to be a relatively simple question, and yet it is not always so easy to answer. In brief; the 2008 Darzi NHS Next Stage Review (Department of Health 2008c) defined quality in the NHS in terms of three core areas: (1) Safety (2) Effectiveness and (3) Experience.
Until that time, performance was defined by policy-makers primarily as the achievement of productivity targets, activity volumes and waiting time targets (Raleigh and Foot 2010). This definition is now enshrined within the Health and Social Care Act (2012) placing quality firmly at the heart of everything that we do.
1. Wigan Borough CCG - Strategy for Quality & Safety 2017 / 20
1.1 Local people and the care that they receive in the health and care system have remained at the heart of all the work that we do at the CCG. Our ambition is clear we have and will continue to seek to commission high quality health and care services and deliver excellent primary care that enables local people to live longer, healthier lives.
1.2 An action in year as reported within the Quality Annual Report for 2016 / 17 was the planned review of the current CCG strategy for quality. This action was completed and the revised ‘Strategy for Quality and Safety 2017 / 20’ was approved by the CCG Governing Body on 23 May 2017.
1.3 The Strategy identifies the clear shift in activity as we deliver against the; Wigan Borough Locality Plan – Further faster towards 2020 and identifies the key areas of focus and the methodologies that will be used to drive this work.
1.4 Importantly the Strategy remains true to the CCGs initial pledge to commission high quality, safe care and details the context which will shape and drive the CCG Quality Teams Delivery Plan for the next two years.
1.5 The CCG Quality Team has a strong track record of collaboration with its partner organisations and we recognise and appreciate their commitment in working with us to improve the quality and safety of local services. In delivering the Strategy for Quality & Safety (2017 / 20) we will seek to reinforce our collaboration and engagement activities with our providers to secure the required quality improvement whilst holding them to account for standards of quality and safety.
1.6 Through the provision of the Annual and the Quarterly Quality Safety and Safeguarding Reports and other supporting reports / papers to the CCG Governing Body and Clinical Governance Committee; the Quality Team have remained true to the tenants of the Strategy and as a minimum requirement has provided robust evidence in respect of the outcomes noted in the high level view at figure 1.
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1.7 The Quality Team fully recognises the need to maintain our proven track record in respect of provider quality assurance and improvement. Going forward, first and foremost we will need to be able to demonstrate that we are making a credible difference by driving the agenda for quality and safety improvement.
2. Quality Accounts
2.1 The NHS Foundation Trusts locally publish their Quality Accounts annually to track progress against their quality improvements and to outline their quality priorities for the year ahead.
2.2 The Quality Accounts provide an open and honest description of the quality of the services for which the respective Trust Boards are accountable.
2.3 The Quality Account is designed to assure commissioners, patients and the local resident population that, the provider is delivering the highest level of clinical care and continually seeks to improve what they do.
2.4 The Quality Team has reviewed each of the providers draft Quality Accounts and has provided a commentary for inclusion in their final reports.
3. Care Quality Commission (CQC) - Quality Reports
3.1 The CQC monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety.
3.2 The CCG has systems in place to ensure that we receive and review the CQC reports relating to our local service providers; and where it is required the monitoring of the provider quality improvement plans.
3.3 Overall in year we can report a very positve picture in respect of the outcomes of the CQC inspections that have been undertaken across all service providers across the health and care economy. Whilst we recognise there are some areas that require further focused attention to drive the required quality improvements there are systems and processes in place that will support the delivery of the provider improvement plans.
3.4 A high level overview of the position at 31 March 2018 is captured below:
Wrightington Wigan and Leigh NHS Foundation Trust • CQC have rated the Trust overall as GOOD North West Boroughs Healthcare NHS Foundation Trust • CQC have rated the Trust overall as GOOD Bridgewater Community Healthcare NHS Foundation Trust • CQC have rated the Trust overall as REQUIRES IMPROVEMENT Primary Care - General Practice • There are 62 General Practices located within the Wigan Borough At 31 March 2018 the CQC overall ratings for the Practices are as follows:
• Outstanding = 2 • Good = 58 • Requires Improvement = 0 • Inadequate = 0 • Not yet inspected = 2
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NHS Foundation Trusts:
3.5 Wrightington Wigan and Leigh NHS Foundation Trust: The CQC inspected the Trust in November 2017 and subsequently published the quality report in March 2018. The Trust received an overall rating of ‘Good’; and all of the Trust sites are now rated as ‘Good’ or ‘Outstanding’.
3.6 In relation to the Trust Services; the Maternity Service was rated as ‘Requires Improvement’. An Improvement Plan has been drafted and will be shared with the CQC ahead of the April 2018 deadline. Once approved by the CQC progress against the plan will be monitored via the QSSG.
3.7 North West Boroughs Healthcare NHS Foundation Trust (NWBHFT): The Trust has maintained a CQC rating of ‘Good’ overall, with ‘Good’ achieved in all five domains of ‘Safe, Effective, Caring, Responsive and Well-led’. There was also a good response from the Trust in year to the CQC focussed inspection of Atherleigh Park.
3.8 Bridgewater Community Healthcare NHS Foundation Trust (BCHFT): The Trust continues to be rated as ‘Requires Improvement’. Progress with implementation of the Trusts CQC Improvement Plan has and continues to be monitored via the QSSG.
Primary Care - General Practice
3.9 At the year end (2017 / 18) a very positive position can be reported with all General Practices in Borough rated as Good overall with the exception of two Practices rated as Outstanding and two Practices that as yet have not been inspected.
Nursing and Residential Care Homes
3.10 Improvement has been seen across the sector with 29 out of 31 Residential Homes in Borough and 14 out 22 Nursing Homes rated overall as Good.
3.11 This is a positive shift from the previous status in respect of the CQC ratings; as reflected within the dashboards included at appendix1. For all the Care Homes rated as Requires Improvement; or Inadequate service improvement plans and monitoring systems are in place.
3.12 Wigan Borough’s Residential Care Homes have been ranked as the third most improved in the United Kingdom (UK) over the last 12 months. Wigan was ranked out of 151 local authorities.
4. Quality Safety & Safeguarding Groups (QSSGs)
4.1 The QSSGs evidence assurances on the quality and safety of commissioned services in line with the jointly agreed provider quality oversight schedules. The role and function of the QSSG in brief is to:
. Provide assurance that commissioning incorporates and upholds the tenets of Clinical Governance.
. Promote and assure quality so that patients receive clinically effective, safer care with a positive experience of the care provided.
. Oversee the execution of the QSSG duties in relation to the safeguarding of children and adults.
. Provide systematic assurance to the CCG ClGC on the quality and safety of all services commissioned on behalf of and for the population of the Wigan Borough.
4.2 The information included at figure 2 below summarises a number of examples of the specific areas of focus that have been reported in briefing papers and within the Quality, Safety and Safeguarding reports to the CCG Clinical Governance Committee in year.
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Figure 2
. Wigan Assessment Team Performance . Child & Adolescent Mental Health Service - Patient Safety; staffing and capacity North West review Boroughs . Mental Health - Homicide Review . Healthcare Revision of the Serious Incident process . CQC Service Improvement Plans - Monitoring & Review NHS FT . Annual Quality Accounts & Priorities . Compliance with CPA policy . Safeguarding Training Compliance
. NHS England Enhanced Surveillance / QRP . CQC Trust rated as Requires Improvement / SIP in place . Trusts Internal Governance arrangements Bridgewater . Safeguarding training mandatory compliance Community . Workforce capacity and demand management Healthcare . Medicines Management and medicines safety NHS FT . Serious Incident Reporting and Management . Organisational Development Plan 2018 / 2023 . Intermediate Care Services commissioner by BCHFT
. Mortality - assurance activity & reports to CCG Clinical Governance Committee and Governing Body . Implementation of the Health Information System (HIS) Wrightington . Safer Staffing Reviews Wigan & Leigh . Discharge / Transfer – Quality Improvement activity NHS FT . CQC Service Improvement Plans - Monitoring & Review . Quality Strategy - assurance on delivery . Sepsis – identification and treatment . VTE risk assessment
Quality Assurance & Improvement Framework
4.3 In year the CCG Quality Team developed and implemented an enhanced Provider Quality Assurance and Improvement Framework. A site visit was undertaken to each of the NHS Foundation Trusts and a comprehensive quality assurance review focusing on compliance against a wide range of service areas was undertaken. Any areas that were rated as Amber or Red have been followed up in year via the QSSG meetings to gain the required assurances.
4.4 A revised Quality Assurance and Improvement Framework has been produced for 2017 / 18 which will be approved in collaboration with the providers via the QSSGs.
5. Commissioning for Quality and Innovation (CQUIN) 2017 / 18
5.1 The CQUIN payment framework enables commissioners to reward excellence by linking a proportion of providers’ income to the achievement of local quality improvement goals.
5.2 The framework aims to embed quality within commissioner-provider discussions and to create a culture of continuous quality improvement, with stretching goals agreed in contracts on an annual basis.
5.3 A number of the CQUIN schemes performed well all year; examples of the areas where quality achievements have been made have been summarised at figure 3 below.
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Figure 3
Preventing ill health by risky behaviours Improving services for people with mental Alcohol and Tobacco health needs who present to A&E
NWBHFT has been fully engaged with this scheme in This CQUIN was designed to encourage collaboration 2017/ 18. Successes include: between providers across the care pathway • Bespoke face to face Smoke free Level 2 training delivered to clinical ward staff WWLFT and NWBHFT have worked together during • Ratification of Trust smoke free policy and procedure in 2017 / 18 to deliver a 55% reduction in A&E attendances December 2017 for a selected cohort of frequent attenders (the top 10) • 89% of clinical ward staff have received Dual Diagnosis training
Improving staff health and wellbeing: Improving physical healthcare to reduce Healthy food for NHS staff, visitors and patients premature mortality in people with serious
WWLFT and NWBHFT have been successful in delivering the mental illness: Collaboration with Primary healthy food component of this scheme during 2017/18. Care Clinicians
Successes include: The aim of this component of the CQUIN was to improve • The banning of price promotions on sugary drinks and collaboration and communication between primary and foods high in fat, sugar or salt secondary care.
• The banning of advertisements of sugary drinks and During 2017/18 NWBHFT has undertaken a piece of work foods high in fat, sugar or salt to align its CPA registers with SMI QOF registers • Healthier catering provision to staff
Supporting Proactive and Safe Discharge Improving the Assessment of Wounds
WWLFT and BCHFT have worked closely to deliver this The Community Trust has standardised both paper and CQUIN. The CQUIN has delivered: electronic documents to ensure all risk factors are
considered and recorded. Joint working and • A 6% increase in the number of patients aged over 65 communication between both clinical and performance (admitted via a non-elective route) discharged to their teams has been effective with Q4 Results showing a usual place of residence within 7 days. notable success with 67% improvement.
Personalised Care & Support Planning
Systems and processes are now in place to identify the relevant patient population.
There is early evidence of the positive impact of an asset based approach.
The figures reported in Q4 2017 / 18 show an increase of 33% in the provision of integrated personalised care and support planning.
5.4 Sepsis: The Acute Trust (WWLFT) has failed to achieve agreed targets for the Reducing the Impact of Serious Infection (sepsis) scheme. A particular concern was the administration of IV antibiotics within one hour. A Sepsis Improvement Plan has been shared with the CCG. Progress will continue to be monitored via the CQUIN which will continue in 2018/19.
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6. Infection Prevention & Control - Inclusive of Healthcare Associated Infection (HCAI)
Strategy for the Managemant of HCAI
RCA / PIR Reduction of Healthcare Infection PROCESS Associated Prevention C.diff / MRSA / Infections Programmes GNBSI (HCAI)
Collaborative Working
6.1 The management of HCAI has been captured in year and reported through the monthly HCAI Dashboards and the quarterly Quality Safety and Safeguarding reports to the CCG Governing Body and Clinical Governance Committee.
6.2 The main areas of activity are highlighted below.
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Strategy for the Management of HCAI 2016 / 2018
6.3 In the Strategy we said we would ….. Ensure that processes to support the prevention of HCAI were embedded across the health and care economy…
Quality Outcome: Whole Health Economy wide engagement with the HCAI RCA / PIR Process, in line with National guidance, has been achieved, with all Care Providers involved with the patients care journey for all reported cases.
The CCG managed approach has enabled a positive collaborative response from local Health and Social Care and Out of Borough Providers to enable the review of all the confirmed cases and the sharing of all identified learning.
Learning opportunities have developed from the RCA / PIR Review process, with the CCG IPC Lead promoting shared learning and collaborative working.
Proactive leadership by the CCG Quality Team via the IPC lead has:
Promoted the zero tolerance approach to avoidable infections. This has been through a collaborative approach, locally, regionally and nationally. The CCG IPC Lead has engaged with National and Regional Leaders to develop local initiatives and shared learning opportunities within the Borough.
Ensured the prevention of HCAI has maintained a high profile throughout the local health economy with recognition, monitoring and reporting processes within all provider organisations structures to Board level to drive clinically effective, safe care for local residents/ patients. Compliance with the Health and Social Care Act 2008 (2015) has been consistently monitored through the CCG Quality, Safety and Safeguarding Groups to achieve responsibility and shared ownership of compliant care.
Promoted a quality approach, adopting improvement methodology to sharing and learning. This has been achieved with the delivery and engagement with the General Practice: Preventing Infection Together (GP PIT) Programme. Interactive, working groups and educational updates have engaged General Practice staff throughout the Borough to share learning and develop skills and knowledge of General Practice staff. Excellent, positive feedback has been received for the provided programme.
Adopted a collaborative approach to the reduction of E.coli, with the development of a local E.coli Improvement Plan to be actioned across the local health Economy in line with the National Ambition to reduce E.coli cases by 50% by 2021. The plan has seen the engagement at Organisational Board and Director level and the development of a local E.coli Improvement Group, engaging and collaborating with local health and social care provider organisations. This work will continue to develop over the following years.
In line with the National E.coli reduction ambition, has delivered local initiatives to raise the E.coli and antimicrobial resistance agenda. This has been in collaboration with Medicines Management colleagues, shared with GP and CCG colleagues and through the GP PIT Education Programme and the CCG Medicines Management GP Peer Review Programme. The focus areas have included: New Antimicrobial prescribing guidance; appropriate antibiotic prescribing, Medicines Optimisation QIPP Plan, “Antibiotic Guardian” pledging and TARGET resources to assist Urinary Tract Infection management
E.coli:
6.4 In 2017 NHS Improvement announced the Ambition to halve healthcare associated Gram- negative blood stream infections (GNBSI) by March 2021. This group of infections includes E.coli, Pseudomonas aeruginosa and Klebsiella spp.
6.5 Executive Leads at both the CCG and WWLFT have been identified and agreed to support the high level agreement from the Directors of Infection Prevention and Control at both organisations, with agreement from local care providers to support the required reduction.
6.6 A Wigan Health Economy approved Gram negative BSI: E.coli - Improvement Plan has been approved and implemented in year and is monitored through respective organisations internal governance arrangements for the CCG this is the Clinical Governance Committee. Page 32 11
6.7 The Wigan Health Economy had an initial ambition of a 10% reduction in E.coli for (2017/18) which was recognised as a significant challenge. Across the Borough whilst the whole Health Economy reduction was not reached by the end of year however; a reduction of 2.45% was achieved compared to the 2016 / 17 data. In light of this we anticipate that the CCG will be positively recognised as a ‘low outlier’ for community onset E.coli on publication of the Public Health England data for quarter 4 2017/18. The local Acute Trust did achieve a 10% reduction in cases compared to the 2016 data.
IPC Education and Support
6.8 The General Practice: Preventing Infection Together (GP PIT) Programme has continued to be delivered. The reduction of all HCAI/GNBSI, including an E.coli and Antimicrobial Resistance focus, is included within the GP PIT Working / Support Group and the Education Programme and has been made available to all General Practice staff.
6.9 In year 185 Practice staff have attended the programme. The evaluations from each session has demonstrates extremely positive feedback from participants. The programme will therefore continue to be run during 2018 / 19.
NHS Mersey Internal Audit Agency (MIAA)
6.10 During the summer of 2017 the CCG Quality Team were audited by MIAA in respect of the Management of HCAI. The audit findings were very positive and MIAA awarded the CCG High Assurance’.
7 Learning from Serious Incidents and Never Events
7.1 The CCG holds the responsibility for the performance management of the Serious Incidents (SIs) and Never Events (NEs) reported by the Acute and Community NHS Foundation Trusts. The Quality Team also liaises with the Lead Commissioner for Mental Health Services (NHS Knowsley CCG) in respect of SIs involving Wigan Patients and or Wigan based services.
7.2 SIs and NE’s are integral to the QSSG agendas and have been reported through the monthly SINE Dashboard and the quarterly Quality Safety and Safeguarding Reports.
7.3 We seek to ensure that lessons are learned from all incidents and that findings are shared wherever practicable to do so; to mitigate the risk of future recurrences. Detailed below are some examples of the actions taken by the Trusts as a result of the wider learning.
BridgewaterNorth West BoroughsCommunity Healthcare Healthcare NHS NHS Foundation Foundation Trust Trust Lynn
Joint Improvements to Refresh of the Commissioner / Borough Lessons Internal Patient Trusts Standard 72 hour review NHSE review of SI Learned Forums Safety Alerts Operating reports process Procedures
Bridgewater Community Healthcare NHS Foundation Trust
Renewed focus Introduction Joint Care Plan Patient Safety Pressure Ulcers on improvement Trust Wide piloted in Care huddles identifing Grade 3/4 of Case Note Newsletter Homes high risk patients Reviews 'Shared Learning'
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Wrightington Wigan and Leigh NHS Foundation Trust
Themed Themed 'Duty of Themed ‘Hospital Internal Patient 'Diagnotsic Weekly Executive Candour' SIRI Acquired Pressure Safety Alerts Incidents' SIRI Scrutiny Pledges Panel Ulcers' SIRI Panel Panel
8. Commissioner Quality Improvement Visits
8.1 The visits have provided an opportunity for commissioners to fulfil their duty to patients and the public for the quality of commissioned services by:
. Connecting with patients and staff at the point of care.
. Further developing the relationships and understanding between clinical commissioners, providers and patients / service users.
. Developing a better understanding and experience of the care environment that has been commissioned.
8.2 In year the Quality Team have visited a number of commissioned services for example:
Child and Adult Mental Health Service (CAMHS)
The CCG has undertaken 2 Unannounced Commissioner Visits to the Wigan CAMHS during 2017/18. Issues highlighted by the visit included:
• Timeliness of therapeutic interventions • Utilisation of clinic appointment slots • Cancelled appointments • Waiting times • Consistency of the personalisation of safety advice given to children, young people and their families
Outcomes: The Trust has worked with the CCG and Wigan Council to deliver the CAMHS Improvement Plan. Improvements include increased staffing and progress with recruitment; enhanced communication within the service; improved clinical and management supervision; induction for all new staff and skill set analysis and training.
Maternity Services – Inpatient Unit
The CCG undertook an unannounced Commissioner Visit to the Inpatient Maternity Service in February
2018. Issues highlighted during the visit included:
• Coordinators not being supernumerary • The provision of postnatal analgesia • Medical staffing vacancies • Environmental issues • Communication • Staff attitude
Outcomes: The visit identified several issues that were also highlighted in the CQC Inspection Report (March 2018). At the QSSG (March 2018) the Trust agreed that they would produce one action plan to address the findings highlighted by both the CCG and CQC site / service visits
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General Practice Visits
Supportive visits have been undertaken to four CCG Practices in response to: CQC ratings and self-reported incidents.
In each case a development programme that is bespoke to the individual Practice has been formulated and agreed. The content is dependent on the outcomes highlighted at the initial meeting. All Practices do not have the same requirements therefore a standard format is not deemed to be appropriate. Self-reported incidents in regard to patient records have been highlighted in two practices.
Outcomes: The principal objective is to support the Practice staff to deliver the quality improvement programme to ensure the delivery of high quality, safer care for local people and to actively seek to reduce any unwarranted variation in the provision of care across the Borough.
Additional visits have also been undertaken to the following services: Intermediate Care Services delivered across 2 sites in Borough Integrated Community Services - Single Point of Access Care Home Quality Visits
9. Experiences of Healthcare Services
9.1 Service User Experience of Care Friends and Family Test
BCHFT Assessment Team Delay in SALT WWLFT Overall performance issues assessments Highest A&E Score identified and fed addressed via CCG in Greater Patient Satisfaction into QSSG to agree QSSG & Contract Manchester Rate 95.9% improvements Meetings 90.53%
Community Primary Care NWBHFT HIS Incident Physiotherapy Overall Satisfaction Improved Position relating to discharge Waiting Times Average Rate 92% Overall 93% letters identified and addressed via Consitently higher of Service Users reported as an CCG QSSG & than GM & England would recommend Serious Incident Contract Meetings Average the Trust
9.2 Complaints, Concerns & Compliments: Quarterly reports have been included on the QSSG quality schedules for the three main NHS providers of Acute; Community and Mental Health Services. Compliance has been monitored via the QSSG meetings.
9.3 Parliamentary and Health Service Ombudsman (PHSO) letters have also been included on the quality schedules for the providers and compliance monitored via the QSSG with each provider respectively.
9.4 Coroner’s Regulation 28 Reports (Prevention of Future Death Reports - PFD): the Trusts have shared the PFDs letters and their responses to the HM Coroner which included details of the actions taken and to reassure the Coroner that their concerns have been addressed to prevent future deaths. Compliance has been monitored via the QSSG in this report period.
9.5 In respect of the above areas any significant concerns have been escalated through the QSSG Chairpersons report to the CCG Clinical Governance Committee.
9.6 A CCG Complaints Report has also been provided to the Corporate Governance Committee bi-monthly in year. Any areas of concern have been escalated to the CCG Governing Body. Further information is captured within the CCG Complaints Annual Report for 2017 / 18.
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10. Quality Initiatives in Primary Care
10.1 The Primary Care quality work-streams have been reported on consistently in year through the Quality Safety and Safeguarding reports (quarterly).
10.2 Areas of focus have included:
. Quality Peer Reviews 2017 / 18: The review of professional practice by a peer is a valuable and important part of the maintenance and enhancement of a health practitioner’s clinical and professional skills. Peer review is a well-established part of the informal, voluntary, collaborative activities used by clinicians to review and support improvement in their professional and clinical practice and to maintain and improve the quality of patient care.
The CCG Quality Peer Review process has provided an informal learning opportunity to allow Primary Care colleagues of all disciplines to share good practice. For the 2017 / 18 Peer Reviews all Practices in Borough were required to submit a Quality Improvement Project (QIP) of their choice. The quality improvement area selected by the Practice was required to be appropriate and relevant to the Practice’s priorities to drive improvement. The meetings provided an opportunity to share good practice and assist to improve the quality of patient care from the sharing of learning.
. Locality Nurse Champions Group: The Locality Nurse Champions (LNCs) collectively consider and triangulate information and intelligence to contribute to the delivery of safe, clinically effective quality care in General Practice Nursing across the Borough. In particular the Champions Group have and will continue to consider:
- Patient experience and Compassion in General Practice vision and strategy. - Promote the Professional Development of the General Practice Nursing Team. - Promote and further develop Clinical Supervision in General Practice Nursing. - Reporting of incidents / concerns in General Practice Nursing. - Deliver quality care to patients by educating and supporting GPNs.
The Nurse Champions and their designated deputies have been significantly involved in delivering a large proportion of work to develop Practice Nursing locally to ensure they are able to meet the current and future demands facing primary care. The group are also recognised for the key role they play in delivering the wider strategy for Primary Care transformation and the key part they play in local workforce planning.
. Primary Care Education Group: The Education Group brings together representatives from both Primary Care and the CCG to assist with ensuring the development of the Primary Care General Practice Workforce across the Wigan Borough. The aim of the group is to promote education and training and assure consistency of approach to improve the Quality and Safety of Primary Care services.
Examples of initiatives that have been undertaken in year are highlighted below.
Review of CQC Quality Primary Care Reports Student Nurse Training & to identify the Placement Education areas for improvement
Quality Improvement Fellowship for Primary Care support for General Quality & Practices Engagement Rated by CQC Practice Schemes Nursing as Requires Improvement
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The annual work plan for 2017 / 18 has been reviewed and refreshed to ensure that projects have and are achieving projected deadline dates and any new initiatives are identified and established.
. Practice Nurse Fellowship Scheme: The General Practice Forward View (2016) and the Chief Nursing Officer for England’s ‘Ten Point Plan for General Practice Nursing (2017) highlighted the need to build the primary care workforce. Importantly there is a recognition that General Practice Nurses will be at the forefront of leading the transformational change by delivering better outcomes in Primary Care and making Primary Care the place to be for ambitious nurses who deliver world class care and support our local population to live well.
The development of the Fellowship for General Practice Nursing is an opportunity to develop a local solution to enable a consistent approach to ensuring the whole general practice nursing team are equipped to deliver health outcomes now and in the future
In year 11 Nurse Fellows have joined the programme including two newly qualified nurses who actively sought a position in general practice following on from their undergraduate nursing placements within Wigan Locality Practices.
The Scheme has been positively recognised by the Greater Manchester Health and Social Care Partnership General Practice Nursing (GPN) Collaborative. The concepts of the Wigan Borough Nurse Fellowship Model have also been shared with the NHS England Cheshire and Mersey GPN Collaborative. Feedback on progress made to date has been sought from local Practice Managers, Nurse Fellows; Nurse Mentors and from Training Providers and the early anecdotal feedback is very positive. A formal method of evaluation is currently in development.
There are currently two nurses on the fellowship that have chosen Primary care as their first career choice. This is an exciting opportunity for both the Practices and the Borough as this will facilitate General Practice to support a new generation of Nurses to Primary Care and promote General Practice Nursing as a career opportunity.
10.3 Greater Manchester Health and Social Care (GM H&SCP) – A Celebration of Practice Nursing Awards - February 2018: The awards event was collaboratively supported by both GM H&SCP and the local NHS CCGs. The event was the first of its kind, designed by the GM H&SCP Practice Nurse Forum as a platform to celebrate the achievements of General Practice Nursing from each CCG, and to support delivery of the NHSE 10 Point Plan for General Practice Nursing.
10.4 Wigan Borough CCG Practices were nominated for 12 awards in recognition of their outstanding work and went onto receive the following awards:
Transforming Services Award - ‘Winners’
Education & Training Practice of the Year - ‘Runners Up’
General Practice Nurse of the Year - ‘Runners Up’
General Practice Nurse Innovator of the Year - ‘Runners up’
10.5 The information circulated to all CCG Member Practices to recognise the successful outcomes has been included at appendix 2 for information.
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11. Quality Drivers in Care Homes
11.1 The CCGs vision for Care Homes is that local people living in Care Homes will have equitable access to high quality, safe, health and care services. Quality in Care Homes is currently driven by the following factors:
Leglislation Quality Assurance (e.g. Care Act 2014) Frameworks & Strategies Care Homes Quality Drivers
Regulatory Body NICE Best Practice Guidance (CQC) & Standards of Care
11.2 The CCG has continued to work collaboratively with its partners Wigan Council to support quality improvement within the Wigan Borough Care Homes. Communication and working relationships with professionals and groups external to the CCG and Wigan Council continues to grow.
11.3 Joint Care Home Reform Board: The Board was established in January 2017 and consists of Senior Leadership representation from Wigan Council, the CCG and local Providers. Throughout 2017 / 18 the Board has ensured a continued system wide approach in supporting and developing the care homes within an integrated health and social care economy. Initiatives undertaken by the Care Home Reform Board in year have included:
. Revised review of services currently providing support to Care Homes. . Development of the Care Home Ethical Framework. . Workforce development across Care Homes.
11.4 In year we have also seen relationships enhanced between the Acute and Community Trusts and the local Independent Care Home Providers with joint working undertaken to avoid unnecessary Hospital admissions and provide care closer to the patient’s own home. Early results are positive and importantly it is seeking to enhance the patient’s; carers and families overall experience of care.
11.5 During autumn of 2017 the CCG Quality Team were audited by NHS Mersey Internal Audit Agency (MIAA) in respect of the quality support provided by the CCG to the local Care Home Market. The audit findings were very positive and MIAA awarded the CCG ‘High Assurance’.
Quality Improvement Initiatives
11.6 React to Red (R2R): The CCG Quality Team launched the ‘React to Red’ campaign at the Wigan Council Care Home Forum back in October 2016. The resource packs included:
Training Book and DVD User Guide Staff Pocket Guides Patient Guide Posters Competency Forms
11.7 All Nursing Homes within the Borough have taken receipt of this resource. Essential support from Bridgewater Community Healthcare NHS Foundation Trust (BCHFT) in year has enabled us to improve from approximately 50% to 100% access to the resource for all Residential Homes in Borough. The BCHFT Community Team is now liaising with the Domiciliary Care providers in Borough that are signed up to the Ethical Framework to rollout this next stage during 2018 / 19.
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11.8 Red Bag Scheme (Hospital Transfer Pathway): The Pathway was developed by the Sutton Homes of Care Vanguard Site who participated in the development of the Enhanced Health in Care Homes Framework (September 2016). The Pathway ensures improvement in communication between Care Homes and Acute Hospitals during times of patient transfers and a reduction in delayed discharges.
The Project was presented to the Wigan Council Care Home Forum on 10 April 2018 and was well received with ‘10’ Care Homes (6 Nursing Homes and 2 Residential Homes) identified to participate in the project at the time of reporting. Agreement on the transfer of care documentation is currently pending and the formal launch of the project is planned for June 2018.
11.9 Greater Manchester Health & Social Care Partnership - Best Practice in Care Home Group: The inaugural meeting in January 2018 with the remit to support organisations across Greater Manchester in facilitating the delivery of a programme of quality improvement initiatives within the Care Home sector. Key themes identified by the Group with developing work streams for 2018 / 19 include; Quality of Care, Service User Experience and Developing Partnerships.
12. Reporting Process 2017 / 18
12.1 In year the Wigan Borough CCG Governing Body and Clinical Governance Committee have received detailed periodic updates on a quarterly basis.
Quality, Safety and Safeguarding Report Quarter 1: 1 April to 30 June 2017
Quality, Safety and Safeguarding Report Quarter 2: 1 July to 30 September 2017
Quality Safety & Safeguarding Report Quarter 3: 1 October to 31 December 2017
Quality, Safety and Safeguarding Report Quarter 4: 1 January to 31 March 2018
12.2 The purpose of the quarterly reports was to provide the Governing Body and Clinical Governance Committee with a view on the Quality, Safety and Safeguarding activities in the specified reporting periods.
12.3 The quarterly reports were structured to highlight the areas of concern relating to our Providers and sought to evidence the actions that were being taken to drive the required improvements in quality and safety.
12.4 This final overview report will also be included on the Wigan Borough CCG Governing Body and Clinical Governance Committee agendas at July 2017 for completeness.
13. CCG Quality Strategy Priorities for 2017 to 2020
13.1 Success Factors - Quality Outcomes: A number of challenging quality outcomes were identified within the Wigan Borough CCG Strategy for Quality and Safety 2017 / 20 and remain key areas of focus for the Quality Team.
13.2 There are a number of areas in which progress has been made in the first twelve months post implementation; examples have been summarised below.
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. Care Quality Commission - Ratings for Wigan Borough Health and Care Services All NHS Foundation Trusts (NHS FTs) to be rated no less than ‘Good Overall’. As captured within the previous sections both the Acute and the Mental Health service providers are rated as Good overall. The Community services provider (BCHFT) has a rating of ‘Requires Improvement’ a service improvement plan and monitoring programme is in place. A CQC reinspection is now awaited.
. Primary Care - Quality Outcomes CQC Status: At 31 March 2018 all GP Services in Borough were rated no less than ‘Good Overall’. Two of the local Practices have been rated as ‘Outstanding’.
Primary Care Standards: subject to the publication of the findings and achievements in year this will be reported to the CCG Primary Care Committee.
Elimination of any unwarranted variation in the provision of Primary Care Medical Services: As detailed within the report there have been many activities that have supported the drive to reduce unwarranted variations in care:
- CQC Inspections - Workforce Development - Education & Training - Peer Reviews - IPC / Management of HCAI
. New roles in Primary Care: Areas of work in year have included: - The development and implementation of the Fellowship for General Practice Nursing - Enhancements to the Health Care Support Worker role. - The development of the Clinical Pharmacist role. Positions have been recruited to and the role will be implemented within local Practices during 2018 / 19.
. Gram-negative bloodstream infections: E.coli: The ambition is that by 2020 / 21 the infections will have fallen by an anticipated 50%. This will be challenging and will only be achieved by a system-wide approach in collaboration with Health and Care providers and commissioners. Progress to date is as follows:
- The CCG is following the NHSI guidance and had developed tools to support local teams to prevent Gram-negative bloodstream infections.
- Ensuring that Escherichia coli (E-coli) infections are attributed the same level of priority as MRSA and C.difficile.
. Mortality: To reduce overall rates for both HSMR and SHMI to 1.00 or below.
The most up to date HSMR figure for 2017 / 18 is 101.9 to December 2017. The SHMI rate reported at March 2018 was 1.2028. Actions to reduce SHMI and SHMI rates in year have included:
The monitoring of the implementation of the SHMI improvement plan developed post the joint WWLFT / CCG review of SHMI.
NHS Improvement Sub-regional team are working closely with the Trust on the mortality improvement work.
The Trust is working with partners to understand the drivers for Mortality and is engaged with Salford to share
best practice.
Wigan Borough CCG is represented and contributes to the Trusts Mortality Review Committee.
A Wigan Borough Mortality Summit was jointly hosted by the CCG and Wigan Council on 10 January 2018; an action from the ‘Summit’ is to undertake a review of Sepsis coding with support from Public Health.
A further joint WWLFT / CCG review of patients who died within 30 days of discharge is currently in progress.
Mortality continues to be discussed with the Trust and is a standing item on the QSSG agenda. Further actions
to reduce the SHMI are in plan for 2018 / 19.
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Hospital Standardised Mortality Ratio (HSMR): In respect of HSMR this has reduced from 107.3 (year to date at August 2017) to 101.7 (year to date at November 2017).
SHMI is reported to remain higher because the time period tracked is much earlier than HSMR and there is an expectation that it may fall once it reflects the same time period as HSMR. However this is not a certainty and NHSI and partners are currently seeking further understanding on when these changes are likely to affect published SHMI and HSMR scores in relation to outlier status.
Learning from Deaths: As part of the implementation of the CQC report ‘Learning, Candour and Accountability’, all Trusts will be expected to have proper arrangements for learning from deaths of patients in their care. Trusts will be asked to publish their data on; ‘all deaths judged as likely to have been caused by problems in care’; along with the actions taken to learn and prevent such deaths in future. This information will be provided to the CCG and then summarised in each Trusts Quality Account. Alongside this we will also challenge providers to specifically evidence:
- Improvements in support to and communication with bereaved families and carers.
- Improvements in the standards and understanding of data on harm and mortality.
- Those services for people with learning disabilities and mental health problems are a core part of this learning.
. Mental Health: this will include measures to bring about the integration of; primary and specialist hospital care and also physical and mental health services. Outcomes included:
- Defined new relationships with local community and mental health providers as well as health and mental health providers and social services.
- Evidence of improvements in Mental Health care for New and Expectant Mothers for specialist perinatal mental health teams.
- Evidence a reduction in suspected self-inflicted harm meeting SI criteria.
. NHS Smoke Free Estate: as captured within the previous report the local Mental Health Trust was smoke-free. In line with the ‘Next Steps on the Five Year Forward View’ (March 2017); this was to be expanded to the local Acute Trust in 2018 / 19, leading to implementation across the wider NHS estate locally by 2019 / 20. We can confirm that at 31 March 2018 all NWBHFT and WWLFT sites were ‘Smoke Free’
13.3 In addition as part of the whole systems approach the CCG Quality Team has further developed quality assurance; improvement and outcome measures for NHS and other care services across the health and care system.
13.4 It is important to again highlight that the quality outcomes as captured in the CCG Strategy for Quality and Safety 2017 / 20 were a ‘point in time view ‘of the estimated and anticipated future deliverables based on the agreed priorities at 2017.
14 The Year Ahead:
14.1 The CCG Quality Team recognises that 2018 / 19 will bring increased challenges in respect of the current economic and financial climate. In addition a particular area of focus nationally and locally is the capacity and resilience of the workforce to ensure that the health and care system can deliver high quality, safe care that is clinically effective for local people both today and importantly to support the delivery of new models of care that will ensure that health and care services are future fit.
14.2 These challenges also provide excellent opportunities for doing things differently as we continue to integrate health and social care with ‘people and place’ being at the heart of the delivery of services closer to home.
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14.3 The CCG Quality Team will continue to:
. Strive to ensure that we apply quality oversight and scrutiny across commissioned services to provide the required level of quality assurance whilst simultaneously driving Quality Improvement.
. Act as professional ambassadors for quality and patient safety as we represent the Wigan Borough across Greater Manchester; regional and national forums.
15 Reporting
15.1 This Quality Annual Report for 2017 / 18 will be included on the agendas for both the CCG Clinical Governance Committee and the Governing Body for their approval in June 2018.
16 Conclusion
16.1 This report provides describes the quality workstreams and provides a wide range of examples of the achievement in year. This enables the CCG maintain it drive for continuous quality improvement across all health and care commissioned services. This process is evolutionary and continues to be strengthened.
16.2 Acknowledgements: the CCG Quality Team recognises the work that we do is supported by many other colleagues both within and external to the CCG and we feel that it is important to recognise this. Particular recognition must be given to the volunteers from our local Patient Participation Groups (PPGs) and Healthwatch who have continued to support the work of the Quality Team particularly in respect of the commissioner quality visits.
16.3 The NHS Wigan Borough Clinical Commissioning Group - Governing Body is asked to note the content of the report and accept assurances that systems and processes are in place which monitor the quality, safety and effectiveness of services commissioned on behalf of the resident population of the Wigan Borough.
Report produced by: Senior Assistant Director for Nursing & Quality (WBCCG) On behalf of the WBCCG Quality Team
Received by: Clinical Governance Committee (WBCCG) Date: 6 June 2018
Approved by: Governing Body (WBCCG) Date: 26 June 2018
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Appendix 1 (a) CARE QUALITY COMMISSION (CQC) STATUS - NURSING HOMES 31 March 2018
Page 43 Page
22 Appendix 1(b) CARE QUALITY COMMISSION (CQC) STATUS – RESIDENTIAL HOMES 31 March 2018
Page 44 Page
23
Appendix 2
24 Page 45 This page is intentionally left blank MEETING: Governing Body Item Number: 8.2
DATE: 26 June 2018
REPORT TITLE: Medicines Optimisation Annual Report 2017/18
CORPORATE OBJECTIVE 1,2,3, 4 & 5 ADDRESSED:
Anna Swift – Senior Assistant Director of Medicines REPORT AUTHOR: Management
PRESENTED BY: Anna Swift – Senior Assistant Director of Medicines Management
RECOMMENDATIONS/DECISION Approval of annual report REQUIRED:
EXECUTIVE SUMMARY
This report provides an overview of the activity of the Medicines Management Team and the work completed over the financial year 2017/18 to ensure the CCG meets the financial, best practice and statutory requirements in relation to medicines optimisation and prescribing.
The report focuses on the work of the CCG Medicines Management Team. The success of this team requires the full engagement of the GP Practices across the CCG.
The achievements detailed within this report have required significant input from our GP Practices and reflects the good working relationships between Practices and the Medicines Management Team.
FURTHER ACTION REQUIRED: N/A
EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.
Page 47 This page is intentionally left blank Medicines Optimisation Annual Report 2017/18
0 Page 49
DOCUMENT CONTROL PAGE
Medicines Optimisation Annual Report 2017/18
Title
Medicines Optimisation Annual Report 2016/17
Supersedes
N/A
Minor Minor
Amendments
Anna Swift
Author
Medicines Management Group 18/4/18
Ratification
N/A
Application
All GP Practices Senior Leadership Team Healthier Wigan Partnership
Circulation
Annual report produced each year
Review
Date Placed on the EqIA Registration Number Intranet/Sharepoint:
Following Approval
1 Page 50 Contents
Executive Summary 3 Introduction 3 Purpose 4 Medicines Optimisation Strategy Objectives 4 Medicines Optimisation QIPP Plan 5 Medicines Optimisation Peer Review Programme 6 Table 1 - Selected prescribing QIPP topics at CCG level 7 Service Delivery Footprint (SDF) working 8 GP Practice Based Support 8 Care Home Support 10 Antimicrobial Stewardship 11 GMMMG Support 12 Spreading the key messages of medicines optimisation both within and external to the organisation 12 Joint working with Main Providers 12 Patients and the public 13 Local Authority 14 Wigan and Leigh Hospice 14 Local Area Team (LAT) 15 Controlled Drugs Local Intelligence Network (CD LIN) 15 CCG Teams 15 Improving Medicines Safety 16 Reducing Waste Medication 16 Clinical Briefing 17 Community Pharmacy 17 Oxygen 18 Non-Medical Prescribing 19 Financial Achievements 19 Equality and Diversity 20 Future developments 20 Appendix 1 - How the Medicines Optimisation objectives support the CCG objectives and ambitions 22 Appendix 2 - How the Medicines Management work supports our Medicines Optimisation objectives 24 Appendix 3 Medicines Management QIPP savings 2017/18 25
2 Page 51 Executive Summary
1. This report provides an overview of the activity of the Medicines Management Team and the work completed during the financial year 2017/18 to ensure the Clinical Commissioning Group meets the financial, best practice and statutory requirements in relation to medicines optimisation and prescribing.
2. The report focuses on the work of the CCG Medicines Management Team. The success of this team requires the full engagement of the GP Practices across the CCG.
3. The achievements detailed within this report have required significant input from our GP Practices and reflects the good working relationships between Practices and the Medicines Management Team.
Introduction
4. The Wigan Borough Clinical Commissioning Group (WBCCG) vision for medicines optimisation is:
WBCCG patients and their carers will be supported by knowledgeable clinicians to make decisions about which medications to take to help them to feel better and/or live longer. Where medication is taken by a patient the clinician will ensure medication is used in a safe way that is evidence-based and value for money for the NHS.
5. Medicines play a crucial role in maintaining health, preventing illness, managing chronic conditions and curing disease. In an era of significant economic, demographic and technological challenge it is crucial that patients get the best quality outcomes from medicines.
6. Medicines optimisation is a person-centred approach to safe and effective medicines use, enabling people to obtain the best possible outcomes from their medicines.
7. Medicines optimisation is about ensuring that the right patients get the right choice of medicine, at the right time. By focusing on patients and their experiences, the goal is to help patients to: Improve their outcomes. Take their medicines correctly. Avoid taking unnecessary medicines. Reduce wastage of medicines. Improve medicines safety.
8. The medicines optimisation approach requires a multidisciplinary team with healthcare professionals working together to individualise care, monitor outcomes more carefully, review medicines more frequently and support patients when needed.
3 Page 52 9. Good medicines optimisation will support the CCG in achieving our vision, ambitions, and objectives, in turn delivering the NHS outcomes.
10. The Medicines Management Team (MMT) provides support and advice to Practices, Prescribers and other Healthcare Professionals on medicines optimisation to improve patient outcomes as part of the multidisciplinary team. This involves: promoting evidence based choice of medicines ensuring treatments of limited clinical value are not used ensuring medicines no longer required are stopped ensuring medicines use is as safe as possible reducing incidents of avoidable harm improving adherence to treatment reducing waste medicines Purpose 11. The purpose of this report is to provide an overview of the activity of the MMT and the work completed over the last year to ensure the CCG meets the financial, best practice and statutory requirements in relation to medicines optimisation and prescribing.
12. This report focuses on the work of the CCG MMT. The success of the MMT requires the full engagement of the GP Practices across the CCG. The achievements detailed within this report have required significant input from our GP Practices and reflects the good working relationships between Practices and the MMT.
Medicines Optimisation Strategy Objectives 13. The Medicines Optimisation Strategy for 2015-2020 identifies 8 key objectives to ensure delivery of the medicines optimisation vision for the CCG and which the MMT have continued to work towards in 2017/18.
4 Page 53 14. The Medicines optimisation objectives are: Patients and Clinicians are supported to implement shared decision making on a. the use of medication All Clinicians implement current evidence based prescribing ensuring cost- b. effective use of resources. All medication is used safely c. Medicines optimisation is included within all commissioning and service re- design arrangements to deliver assurance of safe, high quality and cost- d. effective use of medicines across providers and to promote seamless care across health economy interfaces Contribute to Greater Manchester Medicines Management Group (GMMMG) e. work streams to ensure that effective arrangements are in place for local decision making in line with the NHS Constitution and national guidance Deliver challenging medicines optimisation quality, innovation, productivity and f. prevention (QIPP) initiatives each year promoting quality and innovation as well as productivity and prevention in pathways of care involving medicines Work with all stakeholders/commissioned providers e.g. patients, primary care g. based contractors, community providers, secondary care, care homes, local authority to ensure medicines optimisation is part of routine practice Develop and use metrics that demonstrate the benefits of investing in medicine h. optimisation both to patients and health economies 15. See appendix 1 for details of how these objectives support the CCG ambitions, quality ambitions, corporate objectives, NHS outcomes framework and medicines optimisation principles.
16. See appendix 2 for details of how the work undertaken by the Team relates to these objectives.
Medicines Optimisation QIPP Plan 23. The Medicines Optimisation QIPP plan is an integral part of the CCG's Medicines Optimisation Strategy and is designed to focus the work of the Practice-based team by identifying the key work streams for the year.
24. Annually the Senior MMT reviews NICE guidance and key therapeutic topics, reviews local guidance, analyses prescribing data, evaluates current work streams and seeks feedback from GP Practices to identify opportunities to improve efficiency, effectiveness and quality of prescribing across the CCG.
25. The Senior Pharmacists work collaboratively with the GP Clinical Director for Medicines Management and GP Medicines Management Champions developing a QIPP plan focused on areas where patient safety and/or quality can be improved and efficiency savings achieved.
26. Savings targets are set based on the previous year’s spend and the expected level of achievement and quality areas are selected where either national guidance exists or prescribing data indicates there may be room for improvement.
5 Page 54 27. The key work streams identified within the annual Medicines Optimisation QIPP plan for 2017/18 were: Generic Prescribing Specials Greater Manchester Do Not Prescribe List and Red Drugs Individual Prescribing Reviews Scriptswitch Drugs for Urinary Frequency, Enuresis and Incontinence Nutrition Review Quetiapine MR Antidepressants and Venlafaxine MR Pain Management Respiratory Review Care Home and Integrated Care medication review Wound care, incontinence and stoma appliances
35. In addition quality areas identified were: Antibiotics – ensure only prescribed where indicated, reduce the use of co-amoxiclav, cephalosporins and quinolones and reduce inappropriate prescribing of antibiotics for UTI’s Atrial Fibrillation – improving use of anticoagulants Bisphosphonates – increase primary prevention Hypnotics – reduce overall use Low Dose Antipsychotics for the management of BPSD and in people with learning difficulties - reduce use PPIs – reduce overall use Reduce inappropriate polypharmacy especially in multimorbidity Prevention of acute kidney injury through appropriate use of sick day guidance
Medicines Optimisation Peer Review Programme 36. The Medicines Optimisation Peer Review programme is an innovative, multi- disciplinary way of influencing prescribing in all GP Practices across the CCG.
37. The peer reviews promote person-centred, evidence-based, safe, cost-effective prescribing in-line with NICE guidance leading to improved quality of prescribing and patient outcomes. The Peer Reviews ensure Prescriber engagement with the Medicines Optimisation QIPP plan and are a crucial part of the overall delivery of the Medicines Optimisation Strategy.
38. The WBCCG Medicines Optimisation Peer Review Programme has been published on the NICE Shared Learning website as an example of good practice in the implementation of the NICE Medicines Optimisation guidance (NG5): https://www.nice.org.uk/sharedlearning/medicines-optimisation-peer-review- programme-engaging-gp-practices-to-deliver-medicines-optimisation-and- implement-nice-guidance
6 Page 55 39. A NICE quality and productivity case study based on the WBCCG Medicines Optimisation Peer Review Programme has been published: https://www.nice.org.uk/savingsandproductivityandlocalpracticeresource?ci=htt p%3a%2f%2farms.evidence.nhs.uk%2fresources%2fQIPP%2f1055014%2fatta chment%3fniceorg%3dtrue
40. Peer Reviews were held this year from June to August to allow Practices time within the financial year to work on their selected areas.
48. Topics selected for the 2017/18 Peer Reviews were: Hypnotics Antibiotics – total prescribing Urinary Tract Infection (UTI) - Trimethoprim All Analgesics Gabapentin and pregabalin NSAIDs First Choice Antidepressants Venlafaxine MR Quetiapine MR
49. In addition to the clinical areas, the availability of generic pregabalin for neuropathic pain, the NHSE consultation on low values medicines and the CCG waste campaign were discussed.
50. 61 out of 62 Practices attended and selected 3 areas to work on over the financial year. See table 1 below.
51. A full report on the 2017/18 Peer Review Programme has been produced.
Table 1 - Selected prescribing QIPP topics at CCG level
Practice Practice Prescribing Topic Prescribing Topic Numbers Numbers
Hypnotics 26 NSAIDs 13 First Choice All Antibiotics 17 11 Antidepressants UTI - Trimethoprim 28 Venlafaxine MR 34
All Analgesics 17 Quetiapine MR 19
Gabapentin and Pregabalin 18
7 Page 56 Service Delivery Footprint (SDF) working 52. At the start of 2017/18 the GP Practice groupings changed from localities to service delivery footprints (SDFs). This change allowed GPs within the same geographical area to work together to shape services around the needs of their patients.
53. In order to support SDFs the Medicines Management Clinical Champion roles were reviewed and a clinical champion from each SDF was appointed.
54. This has meant that several new GPs have started to work more closely with the Medicines Management Team building on the existing input.
55. Training and support have been provided and the GPs are currently developing their role both with the CCG Team and with the SDF acting as a conduit between the two to support delivery of the medicines optimisation agenda.
56. Further support will be provided in 2018/19 particularly with regards to the Peer Review process. GP Practice Based Support 57. The MMT supports all GP Practices across the Borough.
54. The Medicines Management Technicians work with all Practices across the CCG. They target their efforts carefully and design tailored Practice action plans based on different levels of potential impact and ability and willingness to change within the QIPP plan.
55. The Practice based support focuses on improving the quality and safety of prescribing as well as supporting delivery of the Medicines Optimisation QIPP agenda and GM and Local Primary Care Standards.
56. From a patient safety perspective, work has continued to ensure the safe management of Shared Care Protocols which are now available for the majority of Amber drugs as defined by Greater Manchester Medicines Management Group (GMMMG).
57. The Practice-based team have been working with GP Practices to develop procedures and policies to ensure prescribing of these drugs is taken over in a safe way i.e. only when the patient has been stabilised on the treatment and a shared care protocol has been provided and then to ensure appropriate on- going monitoring.
58. A frequently asked questions (FAQ) document has been developed to support Practices in this area.
8 Page 57 59. From a quality and safety perspective work has commenced on reviewing the use of opioids for the management of chronic pain within primary care. This has been highlighted as a national issue with guidance produced by Public Health England in conjunction with the Faculty of Pain Management.
60. The team have supported practices to identify areas where prescribing could be improved and the review of patients. This will continue to be a priority area in 2018/19.
61. Work continues with regards to the effective and safe management of repeat prescriptions. Guidance has been produced to support effective use of electronic Repeat Dispensing and work is on-going with Pharmacies who support patient ordering of medication.
62. The Medicines Management Dietician has worked with 29 of our GP Practices to review patients. These reviews have predominantly been patients prescribed SIP feeds but additional areas include orlistat, vitamin supplements, infant milks and gluten free foods. A full report is currently being produced.
63. The Medicines Management Nurse has been reviewing patient’s prescribed stoma and catheter appliances. Links have been developed with both Bridgwater and Wrightington, Wigan and Leigh teams to develop local processes and procedures. Pathways for primary care prescribers are currently being developed to support safe and effective prescribing of appliances.
64. The Team continues to develop the Scriptswitch profile with review of all recommendations on-going on a British National Formulary (BNF) chapter by chapter basis. This has supported the on-going savings achieved by this software and the delivery of a number of key prescribing safety messages.
65. Two of our Medicines Management Technicians have commenced clinical diplomas this year to further develop their clinical knowledge.
66. Recruitment for the Leigh cluster Practice-based Pharmacists has commenced with conditional offers made to 5 pharmacists and further interviews booked.
67. The key outcome of this new service will be improved care and health outcomes for patients with improved access to care in General Practice.
9 Page 58 68. This will be achieved by:
Reducing GP workload to free up GP capacity to enable development of the primary care service e.g. improved access, increased appointment times, continuity of care Supporting patients to self-manage their wellbeing and long term conditions Improving medicines adherence through shared decision making Optimising medicines ensuring evidence based prescribing and cost- effective use of resources. Improving communication and medicines reconciliation across care interfaces Improving medicines safety Reducing medicines related hospital admissions and re-admissions Reducing medicines waste
69. In addition to the Leigh cluster business case we also have a group of GP Practices who have submitted a bid to take part in the NHS England pilot of Practice-based Pharmacists. We expect to hear the outcome of this bid in April 2018 and should the Practices be successful the CCG Team will provide support as needed.
Care Home Support 70. The Medicines Management Care Home Team have provided medication review to Care Home residents and support to Care Home staff to ensure the safe use of medicines. This has led to both improved patient outcomes and the safer use of medicines for care home residents.
71. Medication reviews have led to reduced inappropriate polypharmacy and pill burden and improvements in a number of key quality outcomes including reduced use of hypnotics and reduced use of antipsychotics used for challenging behaviour associated with dementia.
72. The Wigan borough model supports care home staff as well as prescribers; focusing on improving processes within the care home as well as the individual review of patients. This approach has improved medicines optimisation over and above medicines review allowing the team to take a more holistic approach.
73. The support provided to care home staff to improve the safe use of medicines has supported both the Local Authority and CQC inspection processes and has contributed to an improvement in CQC ratings for the homes supported. Wigan is currently the third fastest improving area in the country for Care Home CQC ratings.
74. The Team works closely with the Local Authority and takes the lead in developing and monitoring medicines-related aspects included within service improvement plans (SIPs).
10 Page 59 75. This year the WBCCG Care Home work has been published on the NICE Shared Learning website as an example of good practice in the implementation of the NICE guidance on managing medicines in care homes (SC1): https://www.nice.org.uk/sharedlearning/improving-medicines-optimisation-for- care-home-residents-and-providing-medicines-management-support-to-care- homes-the-wigan-borough-ccg-approach
76. The NICE shared learning has been shortlisted for the award associated with this work and a poster will be displayed at the NICE conference in Manchester in June 2018.
77. We have also published an article in The Pharmaceutical Journal in order to share our work further so that others can learn from our experience: https://www.pharmaceutical-journal.com/research/research-article/improving- medicines-optimisation-for-care-home-residents-wigan-borough-ccgs- approach/20204291.article
78. Best practice guidance is currently in development in a number of areas e.g. covert administration, hydration and management of malnutrition.
79. A full report is currently being produced.
Antimicrobial Stewardship 80. The two main areas of concern for the CCG with regards to antibiotic use are antimicrobial resistance and healthcare associated infections.
81. A delicate balance must be struck between discouraging indiscriminate use of antibiotics and promoting the timely and appropriate treatment of probable bacterial infections.
82. Appropriate use of antimicrobials forms a key part of the CCG Medicines Optimisation Work Plan delivered by the MMT.
83. This year the appropriate management of urinary tract infections has been a priority area to help support a reduction in E. coli blood stream infections.
84. GP Practices have been provided with copies of the Urinary tract infection (UTI) information leaflet to provide to patients to support a no-antibiotic approach in addition to the generic ‘Treating your Infection’ leaflet.
85. This work has caused a change in prescribing habits with an increased use of the first choice antibiotic. In terms of improved patient outcomes this means patients are more likely to receive the most effective antibiotic for this condition.
86. We have supported the production and review of Greater Manchester Antimicrobial guidelines which replace the previous Wigan guidance, ensuring it meets the needs of the Clinicians within Wigan.
87. We have promoted healthcare professionals to become antibiotic guardians.
11 Page 60 88. We have supported all CDI root cause analysis meetings ensuring that learning is shared across our GP Practices to reduce the risks for future patients
89. A full report will be produced when prescribing data for the year becomes available and at this stage we expect that the CCG will achieve the NHS England quality premium associated with this work.
GMMMG Support 90. GMMMG is the co-ordinating group for decision making around medicines and in particular high cost medicines for Greater Manchester (GM). It also has a role in performance monitoring of health economies prescribing.
91. The decisions of this group and its sub-groups impact on the CCGs ability to manage prescribing in clinical and/or financial terms.
92. There are a number of work streams under the GMMMG remit which have been reviewed during 2017/18 with a re-organisation of the GMMMG sub- groups.
93. We have continued to support the GMMMG processes this year and have representatives on the GMMMG overarching group, the Pathways and Guidelines Development Subgroup and the Formulary and Managed Entries Subgroup. The High Cost Drugs group is supported by the Pharmacy Team from Wrightington, Wigan and Leigh NHS Trust as the main focus of this group is hospital prescribing.
94. We have supported both the website redesign and antimicrobial guidance task and finish groups.
95. We ensure we review and comment on all formulary chapters and other GM document reviews and actively encourage our main providers to comment on all GMMMG documents which we circulate for review.
Spreading the key messages of medicines optimisation both within and external to the organisation
Joint working with Main Providers 96. We have strong working relationships with the Medicines Management Teams of Bridgewater Community Healthcare NHS Foundation Trust (Bridgewater), North West Borough Healthcare NHS Foundation Trust (NWMH, formerly 5 Boroughs Partnership NHS Foundation Trust) and Wrightington, Wigan and Leigh NHS Foundation Trust (WWL).
97. We attend regular interface meetings with each of these provider organisations working together closely on medicines optimisation issues to ensure a consistent message is provided to patients by all providers.
12 Page 61 98. In particular we are working with our main providers to ensure that the GMMMG shared care protocols are implemented and that requests for GPs to prescribe these medications are made in a way that meets the needs of both primary and secondary care.
99. This includes ensuring patients meet the stability criteria before transfer of prescribing; supporting GPs to enable them to take over prescribing and working to improve the communication between primary and secondary care where shared care protocols are used.
100. We have started work on a pathway for the prevention of aspiration pneumonia in primary care working with GPs, WWL, Bridgewater and the Local Authority. Guidance in this area will be approved and published in 2018/19.
101. From May 2018 representatives from Bridgewater, NWMH and WWL will attend the CCG Medicines Management Group to support a borough-wide approach to medicines optimisation. Reports from the Medicines Management Group will be submitted to the Healthier Wigan Partnership (HWP) board.
102. As the prescribing of medicines is one of the most common health interventions the medicines optimisation agenda will form an integral part of any health and social care transformation. During 2018/19 the Medicines Management Team will develop ways of working with the HWP to ensure our residents achieve the best outcomes from their medicines.
Patients and the public 103. We have held two patient engagement events this year related to the NHS England consultations on drugs of limited clinical value and conditions for which over the counter items should not routinely be prescribed in primary care.
104. These engagement events have informed the CCG response to both of these NHS England consultations.
105. Final guidance in both areas has now been published and further patient engagement and consultation will be carried out in 2018/19 related to conditions for which over the counter items should not routinely be prescribed in primary care as the CCG works with GM to implement this guidance.
106. We have worked closely with the Patient and Public Engagement Team to develop links with patients and the public.
107. We have attended a variety of meetings to talk about medicines optimisation and prescribing issues e.g. Patient Participation Networks.
108. We have worked with this group to develop a waste campaign aimed at reducing wasted medications through appropriate ordering practices.
109. This campaign was launched in September 2017 following a training programme with Patient Participation Networks to enable members of these groups to provide information to patients at their GP Practices.
13 Page 62 Local Authority 110. We have continued to support the review of service specifications for all council locally commissioned pharmacy services.
111. Support has been provided for the Healthy Living Pharmacy service. This year the local service was replaced with a national arrangement with support required to ensure that as many of our Community Pharmacies as possible were able to meet the national requirements.
112. Support has been provided for the newly awarded contract for sexual health services with a significant input into ensuring the patient group directions to be used are fit for purpose ensuring a high quality service.
113. Support has recently commenced relating to substance misuse services with the provider changing in April 2018. Work will continue in this area over the coming months.
114. We have provided significant support during the influenza outbreak from December 2017 to March 2018, including an out of season period. We worked closely with the Council, Public Health England, GP Practices and Community Pharmacy to ensure timely access to treatment and prophylaxis for residents of our affected Care Homes which resulted in the commissioning of a new Locally Commissioned Service from the GP Alliance to ensure a timely, co-ordinated response.
115. We have worked closely with Wigan Council on the production of the Pharmaceutical Needs Assessment (PNA) which was published in March 2018.
116. To support production of this document the Medicines Management Team collated and analyses all information on Pharmacy services provided across the Borough, co-ordinated the patient satisfaction survey and drafted the Pharmacy section of the PNA to ensure all legal requirements were met. This represents a significant amount of work
117. See Care Home support section
Wigan and Leigh Hospice 118. We have worked with the Hospice, WWL and Bridgewater to support the implementation of the Greater Manchester Strategic Clinical Network Pain & Symptom Control Guidelines - Palliative Care and the development of local guidance to support Primary Care prescribing and administration of end of life medication.
119. New end of life guidance was approved and published this year with a significant input into GP education and training.
14 Page 63 Local Area Team (LAT) 120. We liaise closely with the LAT where issues with contractors are identified.
121. We liaise closely with the Controlled Drugs Accountable Officer (CDAO) where issues with controlled drugs are identified.
122. We currently support the Greater Manchester Health and Social Care Partnership Medicines Optimisation Group to develop the use of pharmacy skills within the NHS, the Greater Manchester Pharmacy Local Professional Network and the Greater Manchester Patient Safety Group.
Controlled Drugs Local Intelligence Network (CD LIN) 123. We have reviewed controlled drug outlier reports provided by the LAT and worked with Practices as necessary to review prescribing in this area.
124. We are an active member of the CD LIN and have shared our work at the CD LIN meetings as an example of good practice.
CCG Teams 125. We have supported finance, commissioning, contracts, safeguarding, corporate office and the primary care teams as required.
126. We have built good working relationships with the Project Management Office and Commissioned Services in the re-design and pathway work.
127. We have supported the review of service specifications for GP Locally Commissioned Services including the development of the Influenza Outbreak Management Service (see section 114).
128. We have supported the Primary Care Team where issues with service provision have been identified and in the APMS re-procurement process.
129. We are supporting the cluster work as this develops.
130. Significant support has been provided to Leigh Cluster in their bid to employ Practice-based Pharmacists (see section 66-68).
131. We have agreed that the CCG will host this Team on behalf of the Leigh Cluster Practices and the Medicines Management Team will provide professional oversight of this work. The Clinical Pharmacist recruitment has been complete with staff coming into post from June 2018.
132. This work supports our primary care transformation and work force development in GP Practices. This will be a new work stream during 2018-19.
15 Page 64 133. We are working with both Wigan and TABA+ clusters as they develop their support to Care Homes. Pharmacist support for all medication reviews carried out as part of the Wigan cluster approach has been provided and has been found to be essential in this delivery model with the TABA+ model requiring ad- hoc advice and support. Work is on-going to further develop effective ways of working.
134. We have responded promptly to all Freedom of Information requests, have supported the complaints process, have provided support for medicines optimisation queries and supported in the review of CCG policies.
Improving Medicines Safety 135. This year we have continued to focus on shared care protocols and have started to focus on the appropriate use of opioids for chronic pain.
136. We are working closely with the quality team to try to improve the communications between primary and secondary care with regards to medicines.
137. We continue to promote the reporting of medication errors and their investigation to allow learning. Where appropriate we share learning between GP Practices and Community Pharmacies via our clinical briefing (see clinical briefing section).
138. We have reviewed processes in all GP Practices to ensure implementation of the Patient Safety Alert issued in April 2017 relating to the use of sodium valproate in women of childbearing age.
Reducing Waste Medication 139. Waste medication is estimated to cost the NHS £300million each year of which half is thought to be avoidable. It is therefore important that we minimise waste medication across the CCG.
140. With regards to medicines, this means not only reducing the amount of medicines that are sent away to be incinerated, but also improving repeat prescribing and dispensing systems and encouraging rational cost effective prescribing to minimise the reduced health outcomes that result from people not taking their medicines as intended.
141. The Practice-based team have worked closely with GP Practices to review systems for repeat medication training staff as required. They have worked with Practices and Pharmacies to review the systems in place for Pharmacies ordering on behalf of patients.
142. Practices have implemented the guidance within the CCG Guidelines for Prescribing and Repeat Prescribing.
16 Page 65 143. Where Pharmacies have been identified by Practices as contributing to waste this has been raised with individual contractors and they have worked with us to improve their process to both reduce waste and improve patient safety.
144. The Care Home Technicians review the ordering procedures of each Home they visit. Where systems which contribute to waste are identified they work with Care Home staff and the dispensing Community Pharmacy to improve systems to reduce waste.
145. See points 93 and 94 for information on the waste campaign aimed at patients.
Clinical Briefing 146. The MMT produces a clinical briefing periodically throughout the year. The briefing is sent to GP Practices, Community Pharmacies, Non-Medical Prescribers and the Medicines Management departments of our main providers.
147. The briefing aims to update Prescribers on any changes to local guidance, share safety messages, answer commonly asked questions and provide updates on evidence based prescribing.
148. Clinical briefings have been circulated quarterly this year.
149. Topics that have been included are: Antimicrobial stewardship – relevant local and national guidance, antibiotic awareness week, antibiotic guardian campaign Prescribing guidance – shared decision making, GMMMG guidance, shared care, patients with learning disabilities, inhaler technique Safe use of controlled drugs – fentanyl, buprenorphine, CQC guidance, lost/stolen prescriptions International dysphagia diet standardisation initiative Reducing medicines waste Community Pharmacy 150. We have started contract monitoring and post payment verification of the Pharmacy Monitored Dosage System (MDS) Scheme and this will continue in 2018/19.
151. This process has highlighted a significant lack of knowledge amongst Pharmacy staff relating to the Disability Discrimination Act, appropriate adjustments to support compliance and the requirements of the community pharmacy contract.
152. All Pharmacies visited have been provided with a number of supporting documents to ensure that where adjustments are made to meet a patients needs these are effective and safe for the patient, for example, few pharmacies have been found to check compliance with MDS after initiating the patient on this device.
17 Page 66 153. This process has also highlighted that a number of Pharmacies have been claiming incorrectly for this service and savings have been identified from this work in the 2018/19 medicines optimisation QIPP Plan.
154. Following completion of the contract monitoring process the service specification will be updated to incorporate the learning from this process. A full report will be produced following completion of the process.
155. We have reviewed the palliative care formulary in conjunction with the updated end of life guidance to ensure access to a wide range of medications that may be used at the end of life. Contract monitoring has been carried out to ensure the appropriate changes to stocks have been implemented. A full report is currently being produced. 156. Working with Mersey Internal Audit Agency (MIAA) we have carried out review of the minor ailment scheme. A report is currently being produced by MIAA.
157. We have commissioned pharmacy services to provide extended hours opening on the public holidays of Easter and Christmas.
Oxygen 158. During 2018/19 the new initial home oxygen risk mitigation form (IHORM) has been launched with the aim of improving the safe use of home oxygen therapy.
159. We have worked with our providers to ensure adoption of this paperwork by all prescribers and to address issues as they have arisen.
160. We continue to work with our main Home Oxygen Service (HOS) providers (WWL and Bridgewater) to ensure the safe use of Oxygen and to resolve issues occurring across the interface.
161. We work with the North West Oxygen Lead to review data provided by Air Liquide and address patient safety issues.
162. We have supported the paediatric team at Bridgewater to develop a robust process for the shared care of oxygen in paediatric patients where a variety of tertiary providers may be involved.
163. We are currently working with Bridgewater through the contracting process to ensure they have a Clinical Lead for Oxygen in post.
164. The CCG policy for risk management of the home oxygen patient will be reviewed during 2018/19 to ensure it reflects current service provision and the split of the commissioner and clinical HOS lead roles.
18 Page 67 Non-Medical Prescribing 165. Non-medical prescribing is the term used to describe any prescribing by a healthcare professional other than a doctor or dentist.
166. The principles that underpin Non-Medical Prescribing are: Improve patient care without compromising patient safety Make it easier for patients to get the medicines they need Increase patient choice in accessing medicine Make better use of the skills of healthcare professionals Contribute to the introduction of more flexible teams working within GP practices or commissioned services.
167. This year the CCG NMP Policy has been updated with this document due for approval at the April 2018 meeting of the Medicines Management Group. This will ensure that systems are in place to guide NMP’s, their employers and the CCG to ensure safe and effective processes are in place to protect patients and professionals alike.
168. We have completed the annual assurance process for 2017/18 and work is underway to collate the required information for 2018/19.
169. We continue to support the processes for staff to undertake NMP training and qualification and to allow qualified NMPs to prescribe within the CCG.
170. We regularly supply prescribing data to all NMPs working within our area to facilitate the review of their prescribing.
Financial Achievements 171. Medicines Management QIPP savings for 2017/18 were £3.88million which is £100k above the target of £3.78million. For a full breakdown see appendix 3.
172. Example of savings: Work reviewing pain management achieved £2.6million in savings against a target of £1.6million. This saving was largely as a result of the Lyrica patent expiry allowing the use of generic pregabalin for the management of neuropathic pain. This has been the priority work area for the team since July 2017 due to the significant savings associated with this change. Do not prescribe and red drugs achieved £72k against a target of £50k Scriptswitch achieved savings of £252k against a target of £300k.
173. All of the work is based upon improving medicines optimisation and patient safety.
174. The work delivers against fair, person-centred, safe and effective care in addition to ensuring equality, improved outcomes and best patient experience. As a result of this there are secondary savings that we are unable to cost e.g. reduced admissions due to falls as patients are removed from medication which
19 Page 68 can cause falls, improved recovery from ill health as patients nutrition status is improved.
Equality and Diversity 175. Equality and diversity impact assessments have been completed throughout the year as required.
176. Steps have been taken to minimise any negative impacts which have been identified.
Future developments 177. A Medicines Optimisation QIPP plan has been developed for 2018/19 detailing potential savings of £3million and a number of quality areas that we will work on with Practices. This will be approved at the April 2018 Medicines Management Group.
178. From May 2018 the Medicines Management Group will be developed to include representation from our main provider organisations and to report in to the HWP Board to ensure a consistent medicines optimisation message across the Borough and to support the health and social care transformation.
179. We will continue to ensure our medicines optimisation strategy and delivery plans support achievement of the aspirations within the GM Taking Charge of our Health and Social Care Plan.
180. The Peer Review Programme will be run over June and July to secure engagement and a commitment from Practices to work on selected areas and supporting tools are currently being developed.
181. Employment of the Practice-based Pharmacists for the Leigh business case will commence in June 2018. This will form a significant new work stream for the Medicines Management Team as we work with the Leigh Practices to develop this role and demonstrate the impact that can be achieved on the quality and safety of prescribing, GP workload and the development of the primary care workforce.
182. We will continue to work with all SDFs to develop medicines management support further, particularly in relation to care homes.
183. NHS England has recently announced plans to develop pharmacy support to Care Homes. We aim to become involved in this project to both develop our own service and to support others to learn from our experience and expertise in this area.
184. Patient engagement and consultation will continue related to the NHS England guidance on conditions for which over the counter items should not routinely be prescribed in primary care. We will work with GM to ensure a consistent asset based approach whilst delivering the self-care agenda with local implementation expected towards the end of 2018/19.
20 Page 69 185. We will continue to develop engagement opportunities with patients and the public to investigate how we can work together to improve Medicines Optimisation.
186. Contract monitoring and post payment verification will be completed on the locally commissioned Monitored Dosage System service and will inform an update of the service specification.
187. We will develop our work with the Local Authority particularly looking at ways in which we can work together to prevent ill health building on the principles within the GM Taking Charge of our Health and Social Care Plan.
21 Page 70 Appendix 1 - How the Medicines Optimisation objectives support the CCG objectives and ambitions
nts
-
designarrangeme
-
Implement decision shared making costEvidence based effective prescribing medicationAll is used safely Medicines is optimisation included in all commissioning and service re Contribute GMMMG to work streams Deliver medicines optimisation QIPP initiatives with allWork stakeholders to ensure medicines optimisationof is part routinepractice. Develop/use metrics benefits the demonstrating of optimisation medicine Address the wider determinants of health Target patients with higher dependence on health services Shift the delivery of
services from in-hospital to out of
itions hospital Improve the quality and efficiency of seamless care
CCG amb CCG services Patient Safety Clinical Effectiveness Patient; Service User or Carer Experience
CCG qualityCCG objectives of Care Supporting our population to stay healthy and live
longer Commissioning high quality services, within the resources available Function as an effective commissioning organisation that puts patients first CCG corporateCCG objectives Function as an organisation that
22 Page 71
nts
-
designarrangeme
-
Implement decision shared making costEvidence based effective prescribing medicationAll is used safely Medicines is optimisation included in all commissioning and service re Contribute GMMMG to work streams Deliver medicines optimisation QIPP initiatives with allWork stakeholders to ensure medicines optimisationof is part routinepractice. Develop/use metrics benefits the demonstrating of optimisation medicine consistently delivers its statutory duties Preventing people from dying prematurely Enhancing quality of life for people with
long-term conditions Helping people to recover from episodes of ill health or following injury Ensuring people have a positive experience of care Treating and caring for people in a safe
NHS outcomesNHS framework environment and protecting them from avoidable harm Aim to understand the patients experience Evidence based choice of medicines
Ensure medicines use is as safe as possible Make medicines optimisation part of Medicines optimisation principles routine practice
23 Page 72 Appendix 2 - How the Medicines Management work supports our Medicines Optimisation objectives
commissioned providers commissioned
design
-
Shared Decision Making CostEvidence Based, effective Prescribing Medication Is Safely Used Commissioning and Service Re SupportGMMMG QIPP Medicines Optimisation with allWork stakeholders and Use Of Metrics Medicines Optimisation QIPP Plan Medicines Optimisation Peer Review Programme GP Practice based support Care Home support Antimicrobial stewardship GMMMG support Spreading key messages of medicines optimisation internally and externally Improving medicines safety Reducing waste medication Clinical briefing Community pharmacy Oxygen Non-Medical Prescribing Financial achievements Equality and diversity
24 Page 73 Appendix 3 Medicines Management QIPP savings 2017/18
P r e Total Year Workstream v Apr 2017 May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Dec 2017 Jan 2018 Feb 2018 Mar 2018 To Date Generic Prescribing £5,345 £6,612 £12,423 £1,146 £792 £3,664 £1,197 £10,093 £6,864 £2,641 £3,651 £ 54,427 Specials £27,281 £3,248 £17,274 £13,765 £5,794 £12,618 £14,237 £19,144 £12,122 £ 125,483 GM Do Not Prescribe List and Red Drugs £10,230 £10,883 £2,071 £14,347 £1,570 £16,656 £79 £8,640 £3,678 £3,300 £678 £ 72,133 Individual Prescribing Reviews £49,144 £41,362 £27,647 £44,388 £10,277 £9,016 £19,407 £13,562 £7,160 £16,922 £6,295 £18,954 £ 264,135 Scriptswitch £20,227 £29,852 £27,379 £24,174 £25,349 £21,497 £21,063 £16,093 £14,385 £17,609 £16,563 £17,627 £ 251,818 Urinary Frequency, Enuresis and Incontinence £1,440 £2,646 £2,297 £11,176 £983 £1,987 £1,238 £ 21,766 Nutrition Review £14,472 £11,557 £11,752 £8,472 £3,690 £4,468 £6,712 £23,780 £11,501 £17,275 £2,161 £3,908 £ 119,748 Quetiapine MR £5,081 £2,568 £7,116 £859 £2,193 £14,995 £ 32,812 Antidepressants and Venlafaxine MR £4,549 £365 £27,248 £11,505 £0 £4,983 £897 £154 £46 £5,944 £421 £1,060 £ 57,172 Pain Management £40,275 £40,166 £36,625 £199,312 £919,953 £763,699 £252,110 £161,560 £130,987 £23,323 £8,684 £33,743 £ 2,610,438 Respiratory Review £5,314 £6,929 £3,191 £6,676 £17,145 £9,221 £25,752 £19,336 £2,893 £2,933 £2,785 £1,182 £ 103,356 Page 74 Page Care Home and Integrated Care Medication £15,817 £11,745 £7,028 £10,575 £15,719 £9,928 £21,146 £32,033 £30,091 £405 £ 154,487 ReviewWoundcare, Incontinence and Stoma £3,012 £433 £3,174 £1,036 £1,337 £755 £1,384 £2,138 £1,357 £1,975 £209 £ 16,812 Appliances Total £ 202,188 £ 165,798 £ 178,111 £ 346,570 £ 995,833 £ 850,662 £ 366,921 £ 308,743 £ 228,966 £ 95,758 £ 53,569 £ 91,468 £ 3,884,587 Cumulative Month Total £ 202,188 £ 367,986 £ 546,098 £ 892,668 £ 1,888,501 £ 2,739,163 £ 3,106,084 £ 3,414,827 £ 3,643,793 £ 3,739,551 £ 3,793,119 £ 3,884,587 Cumulative Month Target £ 315,000 £ 630,000 £ 945,000 £ 1,260,000 £ 1,575,000 £ 1,890,000 £ 2,205,000 £ 2,520,000 £ 2,835,000 £ 3,150,000 £ 3,465,000 £ 3,780,000 % of Target Achieved
25 MEETING: Governing Body Item Number: 8.3
DATE: 26th June 2018
REPORT TITLE: CCG Annual Report & Accounts 2017/18
CORPORATE 5. Functioning as an organisation that consistently OBJECTIVES delivers its statutory duties and participates fully in ADDRESSED: Greater Manchester Devolution.
CCG Communications, Finance, Governance and REPORT AUTHOR: Performance Teams
PRESENTED BY: Caroline Kurzeja, Deputy Chief Officer
RECOMMENDATIONS/ Receive DECISION REQUIRED:
EXECUTIVE SUMMARY:
The CCG’s Audit Committee approved the audited annual report and accounts (ARA) at its meeting on 23 May 2018 but at that time Grant Thornton had not finalised the Independent Auditor’s Report to Members of the Governing Body. That report appears at the beginning of Section 3 in the attached final edition of the ARA. As required the document was submitted to NHS England before 29 May 2018 and can be accessed on the CCG’s website. It will also be presented in summary at the CCG’s Annual General Meeting.
FURTHER ACTION None REQUIRED:
EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.
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Annual Report and Accounts 2017/18
0 Page 77 SECTION 1: PERFORMANCE REPORT
CONTENTS
SECTION 1: Performance Report Overview Statement from Chief Officer 3 Purpose and Activities 3 Issues and Risks 7 Greater Manchester Partnership 8 Performance Summary 8
Performance Analysis Measuring Outcomes & Performance 10 Sustainability 20 Improving Quality 23 Patient & Public Involvement 25 Reducing Health Inequalities 27 Health and Wellbeing Strategy 28
SECTION 2: Accountability Report Corporate Governance Report Members Report 31 Statement of Accountable Officer’s Responsibilities 36 Governance Statement 38
Remuneration and Staff Report Remuneration Report 61 Staff Report 70
Parliamentary Accountability and Audit Report 74 SECTION 3: FINANCIAL STATEMENTS Independent Auditors Report 76 Financial Statements 80
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SECTION 1 PERFORMANCE REPORT
Trish Anderson Accountable Officer 24 May 2018
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Overview
1. Welcome to the Annual Report and Accounts for 2017/18. This overview gives you our highlights from the year from the pperspective of Trish Anderson,, our Accountable Officerr.
2. It sets out briefly what we are working to achieve, what might stop us from achieving this and a summary of our performance for the year.
Statement from Trish Anderson, our Accountable Officer
3. This year, as in previous years, I am pproud of what we have achieved at Wigan Borough CCG to support the delivery of high quality, sustainable NHS services.
4. Throughout the annual report you will see evidence of a well governed, disciplined organisation that focuses on improving the quality of care our patients receive and meeting our financial commitments.
5. We cannot do this without the involvement and support of our GP member practices and also the many patients and members of the public who work so closely with us in such a positive way.
Purpose and Activities
6. The CCG’s objectives are:
Supporting our population to sstay healthy and live longer in all areas of the Borough; Commissioning high quality services, which reflect the poopulation's needs, delivering good clinical outcomes and patient experience witthin the resources allocated and available; Functioning as an effective strategic commissioning organisation that puts the patient first; Developing a collaborative and integrated system witth partners and Updated for stakeholders to implement the outcomes of the Greaater Manchester 2017/18 Commissioning Review in order to improve the health and care of the Borough’s citizens. Functioning as an organisation that consistently delivers its statutory duties and participates fully in the Greater Manchester Health and Social Care Partnership.
7. We set about delivering these by:
Treating physical and mental wellbeing as equally important;
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Understanding that factors like debt, housing and lonelineess can make a difference to a person’s health, how well they recover and how much help they need from the NHS; Focusing on those patients who are the most vulnerable and seek the most help from services; Improving the quality of out of hospital care with a focus on creating an integrated health and care service, working in partnership with providers and Council commissioners; Improving the quality of in hospital care with an emphasis on creating a high quality, sustainable hospital; Working closely with our partners and providers to create a joined-up, sustainable service that supports people to be well.
8. On thee next pages are just a few of ouur achievements that I want to highlight.
Partnership Working
9. Working closely with our partners at the hospital, local council,, community and mental health providers is essential to delivering high quality local services.
10. We are an active partner in the Healthier Wigan Partnership whicch brings together local health and social care organisations to support the integration of services, including signing the Alliance Agreement in March 2018.
11. With the Council we have been invoolved in ongoing conversations about how we might best integrate the commissioning of local services as well as ttheir provision.
12. This partnership on transformation enables us to join up health and social care services, improve patient experience and save money.
13. We have also taken an active role in the Greater Manchester Health and Social Care Partnership (GMHSCP) and are commmitted to continuing to do so to ensure the best care for local residents.
Image: Our Annual General Meeting held in Leigh Market, September 2017
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HIGHLIGHTS FROM THE YEAR!
Recognised nationally by NICE for our work in care homes Set up a new GP service at the improving medicines hospital to support A&E. managemment and improving lives for patients.
The Medicines Management team have saved £3.8million We are the best performing whilst also improving care and Borough in Greater Manchester medicines. on canceer waiting times.
Actively encouraged new apprentices to join the Rated as ‘Outstanding’ by organisation and supported all NHS England for our apprentices from 2016/17 to Diabetes services. secure employment with us or partnner organisations.
Engaged wwith local residents in Supporrted patients in Neuro- Orrell and Billinge on the quality rehabilitation to be safely of local services. transfeerred to a new location.
Awarded the highest level of Engaged with local residents on assurance by internal auditors, the Healthier Wigan Partnership MIAA, for our work with local and whaat integrated services care homes. should look like in the area.
Succeessfully delivered a leadership and management programme over six months for Practice Managers and CCG staff.
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Offer more appointments on evenings and weekends through GP Exxtended Hours – one group of practices is piloting a same day access hub.
Worked with GP members to create new geographically based groups of practices that . can offer more services locally – one is piloting a service for housebound patients.
Introducedd the practice nurse Developed the Integrated fellowship to promote the Discharge Team with local Undertakken commissioner visits recruitment of practice nurses partners to ensure patients are to assess quality of services, into the Borough to support the discharged from hospital quickly with paatient representatives primary care workforce – and safely with the necessary being involved in the visits. recognised as best practice support. across GM.
Rolled out a big programme of Are performing above the learning development for national standards for all the practices to help them improve mental health service targets. local services.
Held our Annual General Meeting in Leigh Market to engage with over 700 local residents on what the CCG does and how we can improve local services.
Engaged with local residents and staff on a new End of Life
Strategy on what is important to them.
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Financial Stability
14. The CCG received an allocation of £530.8m. Due to national reporting guidance this have been reduced to £521.4m to remove the prior year surplus of £9.4m that the CCG has been reporting throughout the financial year. The reporting of a higher level of surplus allocation, had previously been agreed with both GM Health and Social Care Partnership, and NHS England and was maintained through all of the financial year.
15. In accordance with the financial rules set by NHS England the CCG has spent £518.5m so generating the required ‘surplus’ of £2.9m. The required surplus includes £0.05m of statutory surplus notified to the CCG at the start of the financial year; plus the release of the 0.5% funding the CCG was required to withhold for the national system reserve totalling £2.3m; and a further release of £0.6m relating to savings made as a result of the national changes applied to non-branded drug pricing.
Issues and Risks
16. The Governing Body normally receives and reviews on a quarterly basis the Assurance Framework which contains all risks rated ‘high’ or ‘extreme’ that the CCG is managing. These risks cut across all corporate objectives of the CCG covering the delivery of quality improvement; performance against national and local indicators and standards; and financial duties.
17. The Assurance Framework is also scrutinised by the Audit Committee and Corporate Governance Committee which both meet four times per year.
18. Our Annual Governance Statement found later in this report goes into greater detail describing how we have managed risk throughout the year. There have been three areas of concern reported regularly to our governing body:
Urgent and Emergency Care – performance has been below the national standard of 95% of patients being admitted, transferred or discharged within four hours of arrival – the borough health system led by the CCG will continue to work together to support the department at the Royal Albert Edward Infirmary and Leigh Walk-in-Centre to effectively manage admissions and discharges;
Ambulance performance - none of the six new performance standards was met between August 2017 and March 2018 - the CCG has been proactively working with GMHSCP throughout the year to highlight its concerns;
Financial position – the CCG has faced a number of financial pressures during the year along with many other parts of the NHS but by year-end we are able to report that we have met the financial rules set by NHS England for CCGs.
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Greater Manchester Devolution and Partnership
19. In April 2016 Greater Manchester took charge of its health and care system as one Partnership spanning NHS and local government, commissioners and providers of both physical and mental health. In doing so, we embarked upon the most radical health and care transformation programme in the country.
20. We are now approaching the third year of the delivery of our strategy, Taking Charge. Two years into our journey, we can see a health and care landscape in Greater Manchester that looks fundamentally different.
21. Our approach to this change has been guided by a core principle: identifying who contributes to health creation and how they can be better connected.
22. Through our programme of reform and investment we now see our way to the system architecture in GM that will be in place as a legacy of Taking Charge. This will comprise these recognisable and consistent features:
The establishment of 10 Local Care Organisations (LCOs) integrating provision; Pooled health and social care resources into a single budget, managed through an integrated Single Commissioning Function in all ten localities; New models of hospital provision seeing hospitals working together in Greater Manchester at a much greater scale than ever before to a set of consistent quality standards; A Greater Manchester-wide architecture where it makes sense to do things at greater scale – including the GM Commissioning Hub, Health Innovation Manchester, a Digital Collaborative, a Workforce Collaborative and a ‘one public service estate’ strategy.
Performance Summary
23. We are required to measure our performance against a number of national and local indicators. The Governing body receives monthly reports about our performance and looks to drive continual improvement.
24. The operational standards that underpin the NHS Constitution relate to:
Waiting times for elective (planned) care Non-elective (unplanned/emergency) care Treatment of cancer
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Standards around same-sex accommodation Timely access to mental health services.
25. The CCG measures and monitors performance against a number of non-financial key performance indicators (KPIs). These KPIs provide assurance in relation to the achievement of operational standards and plans, as well as the progress against delivery of improved health outcomes.
26. The CCG Performance Report is based around the NHS Operational Planning and Contracting Guidance, issued by NHS England and NHS Improvement, and includes a number of performance indicators grouped into themes: Acute Urgent Care, Acute Planned Care, Cancer, Mental Health, and Quality of Care.
27. The operational standards monitored are defined in the NHS Constitution. The NHS Constitution brings together details of what staff, patients and the public can expect from the National Health Service.
28. It is underpinned by The Health Act 2009, which includes provisions related to the NHS Constitution and came into force on 19 January 2010.
29. The Health and Social Care Act 2012 also includes provisions related to the NHS Constitution. These provisions came into force on 1 October 2012 and, in the case of the NHS Commissioning Board and CCGs, 1 April 2013.
30. Wider information about the quality of health services commissioned by CCGs and the associated health outcomes is provided by the CCG Outcomes Indicator Set (CCGOIS).
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PERFORMANCE ANALYSIS
Measuring CCG Outcomes & Performance Acute Urgent Care 31. Wigan Borough CCG aims to ensure that all patients are seen in a timely manner at our local A&E department. However, the 4 hour 95% standard has not been achieved throughout 2017/18. Winter pressures have placed a significant strain on the availability of beds in which to care for emergency patients presenting in A&E since November. The full year position at March 2018 is below standard, at 80.97%.
32. GMHSCP has worked with all localities including Wigan to develop an improvement plan to allow GM as a whole to meet the national standard by June 2018. The Wigan improvement plan has been developed collaboratively with all local NHS partners and Wigan Council to provide additional capacity and take pressure out of the system.
Full Year Performance A&E Waits Within 4 Hours at WWL 80.97%
100% 95% 90% 85% 80% 75% 70% 65% 60% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2017/18 Performance Standard
33. To reflect the changing demands on the ambulance service, the Ambulance Response Programme was commissioned in 2015 to test new ways of working for the service. As part of this, new measurement systems were introduced from August 2017. There are six standards for ambulance response times:
Category 1 (Life Threatening) calls responded to in an average time of 7 minutes; 90% of Category 1 calls responded to before 15 minutes; Category 2 (Emergency) calls responded to in an average time of 18 minutes; 90% of Category 2 calls responded to before 40 minutes;
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90% of Category 3 (Urgent) calls responded to before 2 hours; and 90% of Category 4 (Less Urgent) calls responded to before 3 hours.
34. Across the North West Ambulance Service area, the August 2017 to March 2018 position reveals that none of the six standards has been achieved.
35. GMHSCP is progressing a significant urgent and emergency care improvement and reform programme in GM, which will help systems to develop more integrated out of hospital urgent care services and enable North West Ambulance Service to manage the lower acuity calls more directly thus reducing conveyances to hospital. The Partnership is working closely with the regional ambulance commissioners, NHS Improvement and NHS England to agree an improvement plan which will include better call trajectories across all categories.
Acute Planned Care
36. The Referral to Treatment (RTT) operational standard states that 92% of patients on incomplete pathways should have been waiting no more than 18 weeks from referral to start their treatment. The full year position at March 2018 is that the CCG is above the standard at 94.34%.
Full Year Performance 18 Wks RTT: Incomplete Pathways 94.34%
96% 95% 94% 93% 92% 91% 90% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2017/18 Performance Standard
37. Operational standards for key diagnostic tests are in place and require that a maximum of 1% of patients wait more than 6 weeks for their test. The full year position at March 2018 is higher (worse than) standard at 1.39%.
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38. This under-performance is not with our local acute services provider, Wrightington, Wigan & Leigh NHS Foundation Trust (WWL), but the issues are with other providers where our patients are treated. This performance is being managed through the Directors of Commissioning in the North West Sector of GM and Improvement Plans are in place.
Full Year Performance Diagnostics 6+ Week Waits 1.39%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2017/18 Performance Standard
Cancer
39. The NHS Constitution details a number of cancer waiting times standards, which cover the various stages of cancer referral pathways.
40. The full year position at March 2018 is that the CCG has achieved the standard for both of the two Seen Within 14 Days indicators.
Full Year Monthly Cancer: 2 Week Wait Standard Performance Trend
Seen Within 14 Days of GP Referral 93.00% 96.72%
Breast Symptoms Seen In 14 Days 93.00% 93.89%
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41. The full year position at March 2018 is that the CCG has achieved the standard for each of the four Diagnosis-To-Treatment Within 31 Days indicators.
Full Year Monthly Cancer: 31 Day Wait Standard Performance Trend
Treatment Within 31 Days of Diagnosis 96.00% 98.63%
Subsequent Surgery in 31 Days 94.00% 98.28%
Subsequent Drug in 31 Days 98.00% 100.00%
Subsequent Radiotherapy in 31 Days 94.00% 100.00%
42. The full year position at March 2018 is that the CCG has achieved the standard for both of the Referral-To-Treatment Within 62 Days indicators. The Consultant Upgrade indicator does not have a national standard.
Full Year Monthly Cancer: 62 Day Wait Standard Performance Trend
GP Referral To Treatment In 62 Days 85.00% 92.00%
NHS Screening Referral To Treatment In 62 Days 90.00% 91.06%
Mental Health
43. The Improving Access to Psychological Therapies (IAPT) programme expects CCGs to commission services that will achieve a minimum of 16.8% of adults with relevant disorders to access IAPT services during 2017/18.
44. The IAPT programme additionally expects services to deliver a minimum 50% recovery rate. IAPT waiting times are also measured to ensure that 75% of patients referred to IAPT will enter a course of treatment within 6 weeks of referral and 95% within 18 weeks.
45. At the present time, published data is only available to January 2018. The data shows that the CCG had achieved or was on track to achieve the full year target for all IAPT indicators.
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YTD (Apr-Jan) Monthly Improving Access To Psychological Therapies Standard Performance Trend
IAPT Access Rate 14.00% 15.80%
IAPT Recovery Rate 50.00% 53.86%
IAPT 6 Week Waits 75.00% 99.78%
IAPT 18 Week Waits 95.00% 100.00%
46. In addition to the IAPT indicators, the CCG is required to meet a number of other Mental Health standards during 2017/18. These include the standard to maintain a Dementia Diagnosis Rate of 66.7% or greater, to ensure that at least 50% of people referred with Psychosis are treated within two weeks and that 95% of patients on the Care Programme Approach are followed up within seven days of discharge from inpatient care.
47. The first two of these standards are reported on a quarterly basis, while the CPA measure is reported on a quarterly basis. All three indicators achieved the full year standard.
Full Year Monthly Mental Health Standard Performance Trend
Dementia Diagnosis Rate 66.70% 72.14%
Psychosis First Treated <2 Weeks 50.00% 93.97%
Full Year Quarterly Mental Health Standard Performance Trend
Care Programme Approach 7 Day Follow Up 95.00% 96.87%
Quality of Care
48. The NHS Constitution and Operating Plans require CCGs to ensure the quality of care, in addition to the performance of services. The standards and plans relate to infection prevention and control, as well as the elimination of mixed sex accommodation.
49. The CCG continues to work closely with healthcare providers to reduce the number of healthcare associated infections (HCAI) for our patients. As at March 2018, five
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patients had tested positive with MRSA in the 2017/18 year. The full year (April 2017 to March 2018) number of Clostridium Difficile infections is reported as 95.
50. All providers of NHS funded care are expected to eliminate mixed-sex accommodation (MSA), except where it is in the overall best interest of the patient. In the April 2017 to March 2018 period, a total of 22 CCG patients experienced breaches of the Department of Health policy on eliminating mixed sex accommodation.
51. The CCG continues to work proactively across providers where small numbers of breaches occur. The most persistent issues have been at Royal Bolton Hospital where the design and layout of some departments such as the High Dependency Unit have not allowed ready transition to a zero breach position. Patient experience views are sought in each case and none has yet reported negatively. The CCG will continue to challenge providers where breaches occur.
Full Year Full Year Monthly Quality Of Care Plan/Standard Performance Trend
Health Care Associated Infection: MRSA 0 5
Health Care Associated Infection: C-Diff 81 95
Mixed Sex Accommodation 0 22
Financial Performance 2017/18
52. The CCG was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006.
53. The accounts for the year ended 31 March 2018, as presented within the financial statements, have been prepared by the CCG under section 17 of schedule 1A of the National Health Service Act 2006 (as amended) in the form which the Secretary of State has, with the approval of the Treasury, directed.
54. The accounts have been prepared on the going concern basis. Details can be found in Note 1.1 of the financial statements.
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2017/18 performance against the CCG’s primary financial indicators
55. CCGs have a number of financial duties under the National Health Service Act 2006 (as amended). Note 40 of the financial statements refers to the financial performance of the CCG in relation to its statutory duties.
56. The CCG has met all of its statutory financial duties in 2017/18, and its financial control total as set by NHS England/GMHSCP.
57. As the local leader of NHS services in Wigan Borough, the CCG has:
Achieved the control total of £2.967m; The achievement includes £2.913m additional surplus as required by NHS England as further detailed in section 59 & 60; Also includes a planned surplus of £0.054m. Due to reporting guidance the planned surplus of £9.494m has been offset by the previous years surplus of £9.440m, leaving a recalculated surplus of £0.054m; Achieved its cash target; Maintained the costs of CCG administration below its budget £7.106m – 1.3% of total spend; and Spent £518.463m in the year on healthcare services for the population of Wigan Borough.
58. As set out in the 2017/18 NHS Planning Guidance, CCGs were required to hold a 0.5% reserve uncommitted from the start of the year, created by setting aside the monies that CCGs were otherwise required to spend non-recurrently. This was intended to be released for investment in the Five Year Forward View transformation priorities.
59. However, the national position across the provider sector has been such that NHS England has been unable to allow CCGs to spend the non-recurrent monies set aside. Therefore, to comply with this requirement, the CCG has released its 0.5% reserve providing an additional surplus for the year of £2.267m. This additional surplus has been used nationally to offset other national cost pressures from the current financial year.
60. A national price reduction on non-branded (Category M) drugs was agreed from August 2017. NHS England has instructed CCGs not to spend the savings achieved from Category M drugs. This has resulted in an additional surplus of £0.646m. This additional surplus has been used nationally to offset other national cost pressures from the current financial year.
61. The areas of total CCG expenditure are shown in the following graphic:
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62. Secondary care hospital costs represent over half of the CCG’s expenditure. These include services such as Accident and Emergency, Maternity, General Medicine and Surgery. The cost of ambulance services to convey people to hospital is also included.
63. The CCG has managed the contracct with its main secondary care provider, WWL, within its available financial resourcee. This was achieved by the introduction of a block contract for two years.
64. The CCG continues to face increasing demand for secondary caree services year on year. To maintain overall financial baalance in 2018/19, the second year of the two year block contract will be essential, with its focus on collaborative working and on cost base reduction.
65. The CCG is also responsible for commissioning £46.1 million of primary care services from NHS England delegated budgets. This includes payments to local GP (General Practitioner) practices for General Medical Services, Personal Medical Services and Alternative Provider Medical Services contracts, Qualiity and Outcomes Framework and enhanced services commissioned for Wigan Borough patients.
66. In addition, the CCG has invested £5.3m in GP Primary Care Standards to improve standaards and reduce variability across GP primary care.
67. The cost of prescribing in 2017/18 was £61.9m. This includes tthe cost of drugs prescribed by primary care professionals. Within the expenditure for 2017/18 is a pressure of £1.9m relating to non-branded drugs under the No Cheaper Stock Obtainable (NCSO) category. This pressure has been offset by a rigorous effficiency programmme, including resulting cost savings of £1.5m against the drug Pregabalin.
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68. Community Health Services include the cost of the services provided in a community setting or in patients’ own homes, such as District Nurses, Therapists and Community Clinics. The cost of the contract for the Out of Hours service and Walk- in Centre is also included here.
69. Mental Health services include the costs of our main contract to provide Mental Health and Learning Disability support within the Borough. This includes Psychological Therapies (counselling services) and Inpatient Medical Care for patients with Mental Health conditions.
70. The CCG has continued to invest in Mental Health services to ensure the GM Mental Health Investment Standard is achieved, aimed at giving parity to mental and physical health services.
71. Continuing Health Care is a package of medical care arranged and funded solely by the NHS for our most vulnerable patients. It can be delivered in any setting and can include the full cost of a place in a nursing home if the needs of the patient meet a rigorous set of criteria. The CCG has residents who meet these criteria, and have been assessed as eligible for fully funded NHS care, which the CCG pays for and monitors.
72. The CCG is also responsible for Funded Nursing Care for patients who do not meet the Continuing Healthcare criteria but still require nursing care when in a care home environment.
73. The CCG has invested £22.9m in conjunction with Wigan Council to the nationally mandated Better Care Fund in 2017/18. This investment will continue in 2018/19 as stated in national guidance to support work around health and social care services.
74. Other programme services include the costs of paying for clinical premises, and the NHS 111 service.
75. The CCG in 2017/18 became a member of the Healthier Wigan Partnership. An alliance agreement was signed with partners to work together from 2018/19 on innovative ways to improve the delivery of clinical services at a lower cost.
Financial planning and risks (2018/19)
76. The CCG has delivered its statutory financial duties in 2017/18. However, in keeping with the wider NHS it is still faced with significant financial challenges over the coming years.
77. The biggest risk to the financial sustainability of the CCG over the coming years continues to be the CCG’s ability to reduce the demand and costs for hospital services. One of the best ways of improving services and at the same time remaining
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in financial balance is to treat more patients, where it is appropriate, in an alternative out of hospital setting, in the community or by GP led primary care.
78. To meet the significant financial challenges, the CCG in conjunction with its locality partners has developed a detailed plan to reduce unwarranted variation, reduce inefficiencies and duplication and where possible remove non-clinical overheads.
79. This is designed to ensure quality of services going forward, whilst maintaining financial sustainability over the longer term.
80. The CCG believes that the plans that are being developed and implemented will change the delivery of healthcare services to the extent required to achieve long term financial sustainability. Failure of organisations to work together to deliver this outcome represents a significant financial risk.
81. Central to financial balance is the CCG/locality five-year plan covering 2015/16 through to 2020/21.
82. The CCG was required to refresh its detailed operational plans for 2018/19. The refreshed plans show an initial financial gap in 2018/19 of £29.6m. Work is ongoing to update the plans to ensure a balanced overall five-year plan and schemes continue to be developed to bridge the current aggregate financial gap for the health economy.
83. The plan is monitored by the GMHSCP Team and underpins our transformation work.
84. Given the financial challenges that face the locality from 2018/19 onwards, GMHSCP has asked the locality to revise its five year financial plan in order to ensure financial challenges are fully met.
85. The CCG and Wigan Council are leading on the production of this revised plan and working with provider partners. Central to this approach will be the Healthier Wigan Partnership and its alliance agreement in 2018/19.
86. It is envisaged that the work undertaken to model sustainable quality clinical services will be completed in June 2018, in order to allow reporting back to partner Governing Bodies/Boards and the Locality Health and Wellbeing Board.
87. It is hoped that proposals for the revised clinical model agreed will be agreed in time to allow efficiencies to be achieved in financial year 2018/19.
88. The full financial statements included within this document give more detail on the numbers reported within this financial review.
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Sustainability Report
89. As an NHS organisation, and as a spender of public funds, we have an obligation to work in a way that has a positive effect on the communities for which we commission and procure healthcare services. Sustainability means spending public money well, the smart and efficient use of natural resources and building healthy, resilient communities. By making the most of social, environmental and economic assets we can improve health both in the immediate and long term even in the context of the rising cost of natural resources.
90. As a part of the NHS it is our duty to contribute towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS, public health and social care system by 34% (from a 1990 baseline) equivalent to a 28% reduction from a 2013 baseline by 2020. It is our aim to supersede this target by reducing our carbon emissions by 10% in 2018/19 using 2011/12 as the baseline year.
91. The CCG’s modelled carbon footprint in 2017/18 was 116,624 tonnes of carbon dioxide equivalent emissions (tCO₂e). The majority of this impact is from the services we commission. The NHS standard contract requires providers to report performance against their carbon reduction management plans.
140,000 120,000 100,000 (tCO2e)
80,000 Community 60,000 Supply chain Emission
40,000 Commissioning 20,000 Core Carbon 0
92. As a commissioning and contracting organisation, we need effective contract mechanisms to deliver our ambitions for sustainable healthcare delivery. The NHS policy framework already sets the scene for commissioners and providers to operate in a sustainable manner. Crucially for us as a CCG, evidence of this commitment will need to be provided in part through contracting mechanisms.
93. The following table provides a sustainability comparator for the main providers that we commission services from.
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On track for Healthy SD Organisation Name SDMP 34% GCC travel Adaptation Reporting reduction plan score Wrightington, Wigan And Leigh 3. No target Yes included in No No Yes Minimum NHS Foundation plan Trust Bridgewater Community 1. On track to Yes No Yes Yes Minimum Healthcare NHS meet target Foundation Trust North West Boroughs 1. On track to Yes No Yes No Good Healthcare NHS meet target Foundation Trust 4. No Salford Royal NHS Sustainable No Development No Yes No Excellent Foundation Trust Management Plan Bolton NHS 1. On track to Yes No No No Minimum Foundation Trust meet target North West 1. On track to Ambulance Yes Yes No Yes Excellent meet target Service NHS Trust
More information on these measures is available here: www.sduhealth.org.uk/policy-strategy/reporting/organisational-summaries.aspx
94. We can improve local air quality and improve the health of our community by promoting active travel – to our staff, through our providers and to the patients and public that use the services we commission.
Category Mode 2014/15 2015/16 2016/17 2017/18 miles 131,605 154,659 164,331 179,635 Staff commute tCO2e 48.36 55.93 59.39 64.01 miles 89,438 106,837 91,033 68,853 Business Travel tCO2e 32.86 38.94 34.56 24.53 miles 267,987 197,327 114,753 15,420 Active and public transport tCO2e 24.17 16.90 10.64 1.39 Owned Electric and PHEV miles 0 0 0 0 mileage tCO2e 0.00 0.00 0.00 0.00 Total cost of travel Not Not Not £ modelled modelled modelled £78,811
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95. We have reduced staff business travel year on year and aim to continue WBCCG have reviewed travel plans to ensure staff wellbeing and a C02 reduction. Travel surveys are taken annually to review staff commute and to look at initiatives that will help reduce C02. Car sharing and cycle schemes are promoted and have been well received along with on-site loan bikes for use.
96. The CCG has spent £32,974 on energy in 2017/18, which is a 3.8% decrease on energy spend from last year.
Carbon Emissions ‐ Energy Use 250
e) 200 2 150 (tCO
100
Carbon 50 0 2014/15 2015/16 2016/17 2017/18
Gas Oil Coal Electricity Green Electricity
97. Our performance on waste reduction and recycling is improving and we are looking into further methods to implement more recycling.
Waste Breakdown
20 Recycling/ reuse 15 (tonnes)
10 Other 5 Weight 0 Landfill
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Improving Quality
98. The CCG has continued to support and drive quality improvement within the health and care services that have been commissioned on behalf of local people and has summarised this within the quarterly reports to the Governing Body during 2017/18.
99. These reports were based on a number of information / data sources such as:
Provider Care Quality Commission (CQC) Quality Reports; Commissioner and Provider reports presented at the Quality, Safety and Safeguarding Groups; Quality Indicators identified through the Contract Monitoring and Performance Groups; Serious Incidents and Never Events reported via the Strategic Executive Information System (StEIS). GMHSCP Quality Board and Quality Collaborative and related sub groups i.e. HCAI, Care Home and the Practice Nursing collaborative, NHS England (NHSE) and NHS Improvement (NHSI) guidance and reports.
100. The CCG has effective systems and processes in place for monitoring and acting on a range of information about the quality of commissioned services; examples include: An established Quality Oversight Framework for 2017/18; CCG Serious Incidents and Never Events (SINE) Panel; Commissioner Quality Visits to Providers i.e. North West Boroughs Healthcare NHS Foundation Trust (NWBHFT) Child and Adolescent Mental Health Service and WWL Maternity Service. Patient / family / carer interviews form part of every visit and Healthwatch/Patient Participation Group (PPG) members are key partners in this process; Commissioning for Quality and Innovation (CQUIN) Schemes are in place with each of the NHS Foundation Trusts locally and are monitored on a quarterly basis. One of the schemes in year focused on reducing the impact of serious infections (Antimicrobial Resistance and Sepsis) and resulted in WWL implementing a sepsis improvement plan. Systems and processes that support the effective management of Healthcare Associated Infections (HCAI) are in place for example: The CCG hosts the Wigan Locality Root Cause Analysis / Post Infection Review (RCA/PIR) Group; An E.coli (Gram Negative Bloodstream Infections) Improvement Plan has been approved and is being implemented, The CCG IPC Surveillance and Audit Lead attends and contributes to the following groups: GMHSCP - E.coli Task and Finish Group
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GMHSCP - Infection Preveention and Control Collaborative Public Health England / NHS North - PIR Case Review Process (MRSA)
101. Where we identify any lapses in care the CCG embraces a cultture of open and honest co-operation where individuaals and organisations are transparent about the quality of care being provided to patients by partnership organisationns.
102. WWL continues to be an ‘outlier’ for the Summary Hospital-level Mortality Indicator (SHMI). This is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patientss treated. This has led to a number of actions being initiated in partnership with the; CCG, WWL and Wigan Council. The Trust has establlished a Mortality Group whichh is developing an action plan based on recommendaations of the Joint Mortality Review. A Wigan Borough Mortality Summit was also held in January 2018.
103. In respect of Primary Care quality the General Practices locally are all currently rated as good or outstanding by the CQC. The CCG has developed an assurance framework for Primary Care which is monitored and reviewed by tthe CCG Primary Care Commissioning Committee. A number of quality improvemeent activities have also been undertaken in year for example the; Quality Peer Reviews and the introduction of the Nurse Fellowship scheme for new-to-post nurses. The Practice Nurses were also recognised for their quality improvement work at the GMH&SCP Practice Nursing awards.
104. The CCG also effectively utilises ‘Service User Experience of Care’’ data reported by the local GP Practices to inform the overall quality assurance and improvement processs. Post analysis of the data information is fed back to local providers to ensure changes are made to drive the required improvements in quality. A focus in year has been improvements to discharge letters to local GPs.
105. There are 53 Care Homes providing a range of care services including nursing and residential care in Borough. In year we have seen an improved position in respect of the CQC Care Home ratings. A summarised position is captured in the following charts.
106. The Residential Care Homes have alsso been assessed as the third most improved in the UK over the last 12 months. 24 Page 101 SECTION 1: PERFORMANCE REPORT
107. The CCG’s Quality, Medicines Management and Safeguarding Vulnerable Adults Leads continue to provide clinical support and advice to both the Wigan Council Quality Oversight Team and the Care Home Providers. Care Home specific quality improvement schemes implemented in Borough have included:
React 2 Red Pressure Ulcer Prevention: This training pack has been produced for care homes and other care providers and is an essential resource for anyone caring for those at risk of developing pressure ulcers. Red Bag Scheme: This is a Hospital Discharge Pathway Tool that is being implemented across a pilot group of six care homes in Borough, the aim being to assist residents to achieve a smooth transition between the Hospital and the Care Home. Future plans are to roll out this wider following the evaluation of the pilot.
Engaging People and Communities
108. We are committed to involving patients and residents in the work we do.
109. This includes involving them in the development of strategies, service design and the review of the quality of local services.
110. It is important that we understand the needs, challenges and concerns of the people who use our services so we can commission high quality, efficient services that meet the needs of the people who use them.
111. We have a dedicated group of patients, our Patient Forum, who meet with us regularly to challenge us to get this right. They act as advisors and critical friends on our approach to engagement, as well as helping us to deliver it.
112. Our Patient Forum reports in to our Governing Body on a quarterly basis to give them an honest appraisal of how well we have delivered against our commitment to engage.
113. We are constantly aware of the commitment they give as volunteers and are grateful for their support and advice.
114. This is only a small part of our engagement activity.
115. We engage closely with our network of 62 GP Practice Patient Participation Groups and have this year engaged with them on a twelve month development programme. This includes delivering a series of training sessions for them and their members on diverse topics from dementia friends training, meeting skills, involving other patients and social media.
116. We bring together our 62 PPGs in to 7 geographically based groupings, that match our Governing Body structure and the local Service Delivery Footprints (SDFs). This
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allows local patients to get directly involved in the design of services for their specific communities.
117. We hold Equality Impact Assessment workshops with the local voluntary sector organisations to understand and assess the impact our work has on the protected characteristics and host an Equality Delivery System 2 event to evaluate with our community and voluntary sector delivery of our equality duties.
118. We also attend voluntary sector and community groups to engage directly with their members on specific topics. For example, this year we have atttended the Deaf Society, BYOU+ (LGBTQ+), Autism Wigan and Leigh and local residential home groups.
119. Wider public discussion, “Spotlight Sessions”, are held regularly to engage with patients and residents on topics such as the Integrated Care, Fair Processing and Primarry Care Reform.
120. This year, our Annual General Meeting was held in the local thriving market on a busy market day. We stayed in the market to talk to local residentts about the CCG for three days and involved over 700 people.
121. On specific service redesigns we also hold more formal engagement and consultation activities. For example, we have held a consultation on the future of a branch practice and undertaken engagement exercises to support the design of our End of Life Strategy and the delivery of local services in Orrell and Billinge.
Image: Trish Anderson, Chief Officer, and Donna Hall, Chief Executive off Wigan Council, at Wigan Pride 2017 which we support in both organising, delivering and engaging with the LGBTQ+ community on the day.
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Reducing Health Inequality
122. The CCG’s Commissioning Intentions Plan for 2017/18 extended the roll-out of primary care standards across all 62 of our GP practices and should result in a reduction in variation in outcomes across a number of indicators including long term condition management, proactive care and targeted support for population groups experiencing health inequalities. All our practices are rated good or outstanding by the Care Quality Commission.
123. NHS England has highlighted that residents in care homes often experience difficulties accessing the right care at the right time. Improving the clinical input into a home and tailoring care around the diverse needs of individual residents can improve the quality of care and quality of life for this group. The CCG Care Home Team reduces the inequalities faced by this vulnerable group of patients.
124. In November 2017 the following was published on the National Institute for Health and Care Excellence (NICE) website:
Wigan Borough CCG has employed a team of pharmacists and pharmacy technicians since 2014 to work with GP practices, residential and nursing homes to carry out structured medication reviews for care home residents. Reviews promote person-centred, evidence-based, safe, cost-effective prescribing in-line with NICE guidance on medicines optimisation (NICE NG5, Recommendations 1.4.1 to 1.4.3) and have led to a reduction in pill-burden and inappropriate polypharmacy.
The team works collaboratively with colleagues from the Local Authority Market Oversight Team and in addition to ensuring the safer use of medicines, has resulted in improved CQC ratings in a number of homes within the Borough.
125. During 2017/18 the CCG has incentivised its Mental Health and Community Providers to deliver improved health outcomes for patients who smoke and/or consume excess alcohol through the ‘Preventing ill health by risky behaviours – alcohol and tobacco CQUIN’.
126. This Commissioning for Quality and Innovation (CQUIN) indicator seeks to help deliver on the objectives set out in the NHS England Five Year Forward View (5YFV), particularly around the need for a ’…radical upgrade in prevention…’ and to ‘…incentivising and supporting healthier behaviour’ by increasing screening, the provision of brief advice and referral to specialist support, where needed, for patients who smoke and / or consume excess alcohol.
127. The CCG has been assured by NHS England as providing ‘Outstanding’ care for patients with Diabetes. This includes encouraging patients to go through a formal education programme to help them manage their condition and making sure patients are treated in line with NICE guidance.
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128. The CCG is committed to extending its offer of personal health budgets (PHB) to include a wider cohort of people. There is an ever-growing shift to personalisation in healthcare to improve health outcomes for people. PHBs are one way to give people with long term health conditions and disabilities more choice and control over the money spent on meeting their health and wellbeing needs. PHBs can transform people’s lives, enabling the development of a package of care that more effectively responds to them as an individual.
129. Community Link Workers are based in all our GP Practices with the aim of improving the health and wellbeing of local people through better connections to appropriate sources of support in the community. This delivers help that is easily accessible, responsive, supportive and practical to patients and residents across the borough.
130. One of our practice clusters is piloting the development and delivery of a same day access hub. By introducing same day access the cluster aims to improve access to general practice through the creation of an in-hours Acute Primary Care Access Hub which will be delivered on a collaborative basis via a multi-disciplinary team. It creates a new model of primary care where primary care access means more than just a GP appointment – it will enhance patient flow by creating a space for GPs, Nurses, Physiotherapists, and social care to interact with patients directly without multiple handovers.
131. Another of our practice clusters is piloting a service for residential care and housebound patients. Patients within this cohort receive a multidisciplinary assessment on a two weekly basis to provide proactive case management and support them to remain in their usual place of residence.
Health and Wellbeing Strategy 132. We are active members of the Wigan Borough Health and Wellbeing Board with our Chair, Dr Dalton, also co-chairing the Health and Wellbeing Board with a key Council Cabinet Member. The CCG has six voting members on the Board including the Chair - two GP Clinical Leads, the Secondary Care Clinical Lead, the Chief Officer and Chief Finance Officer. 133. The Board, with the support of the CCG, is committed to: Improving population health and reducing health inequalities Reforming the way the health and care system works Protecting the health of residents 134. It is a central part of our local partnership working and governance arrangements. 135. The Board oversees the delivery of our joint Health and Wellbeing Strategy and the Wigan Borough Locality Plan, which sets out how collectively we will transform local services and make them sustainable.
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136. The Health and Wellbeing Strategy for 2016-2018 is built on the Robert Wood Johnson Foundation methodology to ‘Create a Culture of Health’ across Wigan and generate a sense of ownership across stakeholders to ensure that health is the business of all stakeholders. The strategy sets out the four action areas that need to be applied to create such a culture, these being: To make health a shared value To foster cross sector collaboration to improve wellbeing To create healthier, more equitable communities To strengthen integration of the health service and systems
137. The creation of such a culture will translate into significant improvements in health and wellbeing and will contribute to the realisation of the vision for The Deal for Health and Wellbeing, creating stronger communities and addressing the wider determinants of health through growth and reform. The investment and the strength of the applications and innovations at the community level will support the realisation of our vision and impact on our priority areas.
138. Wigan’s four Health and Wellbeing Priorities for 2016-2018 are:
Creating a Culture of Health & Well-being Delivering Further Faster Towards 2020 Creating & Sustaining Resilient Communities Addressing Wider Determinants through Maximising the Potential of Growth & Reform
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SECTION 2 ACCOUNTABILITY REPORT
Trish Anderson Accountable Officer 24 May 2018
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CORPORATE GOVERNANCE REPORT
Members Report
Member Practices
1. Wigan Borough CCG has 62 member practices that work together on Service Delivery Footprints (SDFs) of 30,000 – 50,000 patients. The main sites of the 62 practices are listed below:
Leigh Service Delivery Footprint Brookmill Medical Centre, College Street, Leigh Dr Esa (The Avenue Surgery), Leigh Health Centre, The Avenue, Leigh Dr Gupta, Bridgewater Medical Centre, Henry Street, Leigh Dr Khaing, Leigh Health Centre, The Avenue, Leigh Dr Wong & Partners, Old Henry Street Medical Centre, Henry Street, Leigh Foxleigh Surgery, Bridgewater Medical Centre, Henry Street, Leigh Grasmere Surgery, Leigh Health Centre, The Avenue, Leigh Intrahealth Leigh Sports Village, Leigh Sports Village, Leigh Intrahealth Leigh Sports Village (Older Persons), Leigh Sports Village, Leigh Leigh Family Practice (Integral), Bridgewater Medical Centre, Henry Street, Leigh Lilford Park Surgery, Leigh Health Centre, The Avenue, Leigh Premier Health, Bridgewater Medical Centre, Henry Street, Leigh Westleigh Medical Centre, 4-12 Westleigh Lane, Westleigh, Leigh
LIGA North Service Delivery Footprint Dr Ahmed & Partners, Alexander House Surgery, Platt Bridge Health Centre, Rivington Avenue, Platt Bridge, Wigan Dr Tun & Partners, Hindley Health Centre, 17 Liverpool Road, Hindley, Wigan Dr Ullah’s Practice, Platt Bridge Health Centre, Rivington Avenue, Platt Bridge, Wigan Higher Ince Surgery (SSP Ltd), Manchester Road, Ince-in-Makerfield, Wigan Intrahealth Platt Bridge, Platt Bridge Health Centre, Rivington Avenue, Platt Bridge, Wigan Lower Ince Surgery (SSP Ltd), Claire House, Lower Ince Health Centre, Phoenix Way, Lower Ince, Wigan Pennygate Medical Centre, 109 Ladies Lane, Hindley, Wigan
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LIGA South Service Delivery Footprint Ashton Medical Centre (Pitalia – SSP), 120 Wigan Road, Ashton-in-Makerfield, Wigan Braithwaite Road Surgery (Kadiyala SSP), 36 Braithwaite Road, Lowton, Warrington Dr Anis & Partner, Kidglove House, Golborne Health Centre, Kidglove Road, Golborne Dr Pal, Kidglove House, Golborne Health Centre, Kidglove Road, Golborne Dr Shahbazi Family Medical Practice, Kidglove House, Golborne Health Centre, Kidglove Road, Golborne Dr Xavier, 647 Liverpool Road, Platt Bridge, Wigan Slag Lane Medical Centre, 216 Slag Lane, Lowton, Warrington
North Wigan Service Delivery Footprint Aspull Surgery, Haigh Road, Aspull, Wigan Beech Hill Medical Practice, 278a Gidlow Lane, Beech Hill, Wigan Shevington Surgery, Houghton Lane, Shevington, Wigan Standish Medical Practice, 49 High Street, Standish, Wigan
SWAN Service Delivery Footprint Bryn Cross Surgery, 246 Wigan Road, Ashton-in-Makerfield, Wigan Dr Alistair Ashton, Ashton Clinic, Queens Road, Ashton-in-Makerfield, Wigan Dr Mohan Kumar & Partner, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Dr Zaman & Partner, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Hawkley Brook Medical Practice, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Marus Bridge Practice, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Medicentre, 185 Wigan Road, Ashton-in-Makerfield, Wigan Shakespeare Surgery, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Winstanley Medical Centre, Holmes House Avenue, Winstanley, Wigan
TABA+ Service Delivery Footprint 7 Brooks Medical Practice, Seven Brooks Medical Centre, 21 Church Street, Atherton
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Astley General Practice (Pitalia SSP), 391a Manchester Road, Astley Bee Fold Lane Surgery, Bee Fold Lane, Atherton Boothstown Medical Centre, 239 Mosley Common Road, Boothstown Coldalhurst Lane Surgery, The Surgery, 1 Coldalhurst Lane, Astley Dr Atrey & Partner, Atherton Health Centre, Nelson Street, Athertonn Dr K.K. Chan, & Partners, Seven Brooks Medical Centre, 21 Church Street, Atherton Dr Vasanth & Partner, Bag Lane Surgery, Atherton Health Centre, Nelson Street, Atherton Elliott Street Surgery, 145 Elliott Street, Tyldesley Elmfield Surgery, Atherton Health Centre, Nelson Street, Atherton Intrahealth Tyldesley, Tyldesley Health Centre, Poplar Street, Tyldesley The Surgery, Astley, 10 Higher Green Lane, Astley The Surgery, Tyldesley, High Street, Tyldesley
Wigan Central Service Delivery Footprint Bradshaw Medical Practice, Bradshaw Street, Wigan Intrahealth Marsh Green, Harrow Road, Marsh Green, Wigan Longshoot Medical Practice, Scholes, Wigan Mesnees View Surgery, Mesnes Streeet, Wigan Newtown Medical Practice, Sherwood Drive, Wigan Pemberton Surgery, Sherwood Drive, Wigan Sullivan Way Surgery, Sullivan Way, Scholes, Wigan Dicconson Group Practice, Boston House, Wigan Health Centre, Froog Lane, Wigan Wrightiington Street Surgery, Wrightington Street, Wigan
Our Governing Body
2. The CCG’s Governing Body membership this year is detailed below.
3. One Clinical Exective Governing Boddy member retired on 30th June 2017 and two new Clinical Executives were elected in August 2017 following a change in the compoosition of the membership. The Governing Body had approved a change from six “Localities” to seven SDFs in March 2017, and a third Laay Member was appointed in September 2017.
4. Governing Body Members:
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Mrs Trish Anderson, Chief Officer (Accountable Officer) Mr Mike Tate, Chief Finance Officer Ms Julie Southworth, Director of Quality & Safety Dr Sanjay Wahie, Clinical Executive for LIGA North SDF Other Responsibility: Clinical Lead for Medicines Management Dr Tim Dalton, our Chair Dr Mohan Kumar, Clinical Executive for SWAN SDF Other Responsibility: Chair of Finance and Performance Committee Dr Ashok Atrey, Clinical Executive for TABA+ SDF Other Responsibility: Chair of Clinical Governance Committee Dr Gen Wong, Clinical Executive for Leigh SDF Other Responsibility: Member of Wigan Health and Wellbeing Board Dr Pete Marwick, Clinical Executive for North Wigan SDF Other Responsibility: Chair of Service Design and Implementation Committee Dr Tony Ellis, Clinical Executive for Wigan Central SDF (retired June 2017) Other Responsibility: Chair of Corporate Governance Committee Dr Jayne Davies, Clinical Executive for Wigan Central SDF (Sept 2017) Dr Neeta James, Clinical Executive for LIGA South SDF (Sept 2017) Mr Frank Costello, Lay Member (Deputy Chair) Other Responsibility: Lay Member with responsibility for Patient and Public Engagement Canon Maurice Smith, Lay Member with responsibility for Governance and Conflicts of Interest Mr Peter Armer, Lay Member with responsibility for Audit and Remuneration Dr Gary Cook, Secondary Care Consultant Governing Body Member Other Responsibility: Chair of Primary Care Commissioning Committee Mrs Catherine Jackson, Nurse Governing Body Member
5. The Audit Committee members throughout the year were: Canon Maurice Smith (Chair, April 2017 – Sept 2017, Lay Member Oct 2017 – March 2018)) Mr Peter Armer (Chair, Oct 2017 – March 2018) Mr Frank Costello (Lay Member, April 2017 – Dec 2017) Dr Tony Ellis (GP Member and also Chair of Corporate Governance Committee, retired 30 June 2017) Mrs Catherine Jackson (Nurse Member, July 2017 – March 2018)
6. Details of all other committees of the Governing Body including key responsibilities, membership, attendance and highlights of their work can be seen in the governance statement section of this report.
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Register of Interests
7. For up-to-date information on the Governing Body Members’ and GP Practice declarations of interest, please see our website:
http://www.wiganboroughccg.nhs.uk/your-ccg/our-governing-body
Personal Data Related Incidents
8. There were no serious incidents relating to data security breaches at the CCG and therefore none was reported to the Information Commissioner in the year ending 31 March 2018.
Statement of Disclosure to Auditors
9. Each individual who is a member of the CCG Governing Body at the time the Members’ Report is approved confirms:
so far as the member is aware, there is no relevant audit information of which the CCG’s auditor is unaware that would be relevant for the purposes of their audit report
the member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish that the CCG’s auditor is aware of it.
Modern Slavery Act
10. Wigan Borough CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking. Our Slavery and Trafficking Statement for the financial year ending 31st March 2018 appears on our website at
http://www.wiganboroughccg.nhs.uk/here-to-help/safeguarding
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Statement of Accountable Officer’s Responsibilities
11. The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Officer, Trish Anderson, to be the Accountable Officer of NHS Wigan Borough CCG.
12. The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for:
The propriety and regularity of the public finances for which the Accountable Officer is answerable, For keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction), For safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities). The relevant responsibilities of accounting officers under Managing Public Money, Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)), Ensuring that the CCG complies with its financial duties under Sections 223Hto 223J of the National Health Service Act 2006 (as amended).
13. Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction.
14. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year.
15. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Group Accounting Manual issued by the Department of Health and in particular to:
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Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; Make judgements and estimates on a reasonable basis; State whether applicable accounting standards as set out in the Group Accounting Manual issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and, Prepare the financial statements on a going concern basis.
16. To the best of my knowledge and belief I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter.
17. I also confirm that:
as far as I am aware, there is no relevant audit information of which the CCG’s auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information. that the annual report and accounts as a whole is fair, balanced and understandable and that I take personal responsibility for the annual report and accounts and the judgments required for determining that it is fair, balanced and understandable.
Trish Anderson
Accountable Officer
24 May 2018
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Governance Statement
Introduction and context
18. Wigan Borough Clinical Commissioning Group (the CCG) is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended).
19. The CCG’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population.
20. As at 1 April 2017, the CCG is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.
Scope of responsibility
21. As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the CCG’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my CCG Accountable Officer Appointment Letter.
22. I am responsible for ensuring that the CCG is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the CCG as set out in this governance statement.
Governance arrangements and effectiveness
23. The main function of the governing body is to ensure that the CCG has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it.
24. The CCG has adhered to the Nolan principles of standards in public life. We have also complied with the principles below contained in our published constitution:
Inclusivity: of clinicians and patients, local residents, stakeholders and partners.
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Subsidiarity: by delegation to service delivery footprints (SDFs); Locality: by commitment to reflecting the SDF requirements; Accessibility: by listening to and responding to the SDFs.
25. The membership of the CCG established a Governing Body in order to undertake the business of the CCG and to discharge its statutory functions. Membership of the Governing Body is in line with statute and in addition is representative of the membership through the elected SDF clinical executive membership.
26. Under the scheme of delegation there can be no provision to allow any SDF, practice or grouping of practices to delegate any CCG responsibilities or functions to the governing body of the CCG as the CCG is the corporate and statutory body and not the SDF or other practice grouping.
27. Each member of the governing body shares corporate responsibility as part of a team to ensure that the CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of its constitution.
28. The Governing Body has 16 voting members including the Chair. The Governing Body is clinically led and has a majority of clinicians as members. The SDF clinical executive members are practising GPs within the CCG area and GP members are on the performers list of Wigan Borough or the subsequent arrangements. The Governing Body membership comprised:
a) the Chair; b) seven SDF clinical executives elected by, and representing each SDF group of member practices; c) three lay members: one leading on audit and remuneration, one leading on governance and conflicts of interest, one leading on patient and public participation; d) one lay registered nurse; e) one lay secondary care specialist doctor; f) the Accountable Officer; g) the Chief Finance Officer h) the Director of Quality & Safety
29. The Governing Body has met in public each month between April 2017 and March 2018 except August and December. The Governing Body also meets in closed session, generally to scrutinise documents in draft before they are published. A minimum of two thirds (67%) of members and at least four of the seven SDF clinical executives must attend for meetings to be quorate.
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30. This has been achieved on each occasion except the January meeting and attendance has ranged between 69% in one month to 100% on two occasions.
See Appendix 1 for the attendance record of each member.
31. It is crucial that an interest and involvement in the local healthcare system does not also involve a vested interest in terms of financial or professional bias toward or against particular solutions or decisions. For this reason the CCG demands that members, governing body members, officers and those wishing to provide services to the CCG declare any conflict or potential conflict in relation to a decision to be made by the Group, and record them in published registers.
32. During its meeting in July 2017, the Governing Body approved the CCG’s updated Conflicts of Interest Policy following the release of the NHS England mandatory guidance earlier in the previous month. There is a request at the start of each meeting that members highlight any interests not previously declared and which may be pertinent to any agenda item or decision.
33. The Governing Body receives and reviews at its meetings:
New business items such as quality strategies and assurance reports; Current business items such as the Performance and Finance Reports which evidence how the CCG is performing against local priorities, and NHS England’s Improvement and Assessment Framework; Governing Body Committee Chairperson reports; SDF Executive Meeting Chairperson reports.
34. In addition to the above and the work of the committees, the Governing Body reviewed its effectiveness through a number of development sessions and formal meetings.
35. In 2017 the GM Commissioning Review was completed which resulted in a requirement to deliver integrated healthcare provision and commissioning locally. As a result we established the Healthier Wigan Partnership (HWP), as a partnership of health and social care providers working together to develop an integrated approach to health and social care for Wigan and to set out our journey to an Integrated Care System. 36. The jointly developed operating model for a Strategic Commissioning Function (SCF) was conditionally approved by the Governing Body in October 2017 as the governance template for a Wigan place based commissioning function.
37. There was also recognition that the governing body would benefit from the recruitment of an additional lay member with the requisite qualifications to express informed views about financial management and audit matters so this was
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completed in September 2017 when the current Chair of Audit Committee joined the governing body.
38. There are eight committees reporting into the Governing Body and their terms of reference and achievements this year are summarised as follows:
Clinical Governance Committee (9 meetings)
It is the role of the committee to Membership Members Meetings demonstrate that there is an effective Category attended and consistent process in respect of Dr Ashok 7 commissioning for quality across the Atrey (Chair) SDF Clinical CCG, also ensuring that any areas of Dr Sanjay Executives 8 concern and under-performance are Wahie identified and high standards of care Dr Gen Wong 6 and treatment are delivered. Clinician Dr Gary Cook 7 The committee provides assurance to Governing Catherine the Governing Body with regard to Body Lay 4 Clinical Governance activities in the Members Jackson appropriate areas of accountability and GP Member Dr Tankard 6 in line with its terms of reference. It Governing Julie receives reports from the Quality, Safety Body Officer 1 Southworth and Safeguarding Group meetings held Member to monitor the quality of healthcare at Sally the three large local NHS providers, Forshaw 8 Wrightington, Wigan & Leigh NHS Linda Scott / Foundation Trust, 5 Boroughs 9 Deputy Partnership NHS Foundation Trust (Mental Health) and Bridgewater CCG Officers Julie Community Healthcare NHS Foundation Crossley / 8 Trust. Deputy Debbie The committee also provides oversight 3 on: Szwandt Intermediate Care and Community Tim Dalton 0 Bed Providers Trish Open 1 Primary Care – General Practice Anderson Care Homes in the Borough Mike Tate 0 Serious Incidents and Never Events Healthcare Associated Infections Service User Experience of Care Patient Opinion Commissioner Quality Improvement Visits Safeguarding Children and Vulnerable Adults
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Corporate Governance Committee (4 meetings)
The committee provides assurance to Membership Members Meetings the Governing Body with regard to all Category Attended corporate governance issues in the Governing Maurice 4 appropriate areas of accountability Body Lay Smith (Chair) covering mostly non-clinical controls Member and regulations. The committee meets (Chair since every two months, is chaired by a Jan 2018) governing body member and provides a SDF Clinical Dr Tony Ellis 0 Chairperson’s report to the Governing Executive (retired 30 Body in the month following each (Chair for June 2017) meeting. April 2017 – June 2017) The committee received quarterly Governing 4 presentations of the Governing Body Body Lay Assurance Framework (GBAF) with the Member Frank purpose of scrutinising corporate risks, (Acting Chair Costello controls and action plans. July 2017 – Dec 2017) Progress reports were received by the Governing Julie 3 committee at each meeting covering the Body Officer Southworth CCG’s responsibilities in the areas of: Members Mike Tate/ 4 Communications Deputy Human Resources Sally 4 CCG Officer Information Management Forshaw Members Information Governance Tim Collins 4 Equality & Diversity Dr Tim - Emergency Preparedness, Open Dalton Resilience & Response (including Members Trish 2 business continuity arrangements) Anderson Health & Safety Incident Reporting Risk Management & Assurance Patient Response (enquiries, complaints, freedom of information enquiries, Member of Parliament correspondence) Sustainability
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Finance & Performance Committee (10 meetings)
The committee has implemented and Membership Members Meetings monitored the CCG arrangements category attended around Finance, Contracting and Dr Mohan SDF Clinical Performance, including nationally driven Kumar 8 Executive initiatives. (Chair) Dr Justin SDF Clinical 9 The key responsibilities of the Tankard Represent- committee are: Dr Nikesh atives (GPs) 9 Vallabh Agree the annual planning Trish timetable; Anderson / 6 Oversee the annual planning Governing Deputy process to ensure the delivery of Body Officer Mike Tate 7 the following milestones: Members Julie o Commissioning intentions; Southworth/ 8 o Financial plan; Deputy o Contracts with NHS and Non- Governing Frank NHS partners; Body Lay Costello 10 o Agree annual budget book; Member Overview the annual planning cycle Craig Hall 10 for performance targets; CCG Officer Review on behalf of the governing Julie Members body the monthly finance, QIPP and Crossley / 10 performance reports; Deputy Transformation Fund reports; Review and approve Quality, Innovation, Productivity and Prevention (QIPP) business cases; and link with the audit committee to ensure the CCG produces timely and accurate annual accounts in accordance with reporting guidance.
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Service Design & Implementation Committee (8 meetings)
The committee provides assurance to Membership Members Meetings the governing body with regard to Category Attended service strategy, design, development and implementation, driven by the Dr Peter SDF Clinical priorities of the CCG. The committee Marwick 8 Executives facilitates the planning and coordination (Chair) of initiatives, service redesign and policy development. Dr Hari 8 Sukhavasi GP Leads Dr Syed The committee built on its work from the 8 previous year and continued to receive Shah regular reports on the integration of Governing Frank community services being led by the Body Lay Costello 8 Healthier Wigan Partnership and the Member Trish Outpatient Redesign. 2 Anderson Governing Mike Tate/ Body Officer 5 The committee also provided oversight Deputy Members on progress with a number of other Julie 1 programmes: Southworth CCG Officer Jennie Transformation Fund 3 Members Gammack Wigan Locality Plan Julie Alternative Provider Medical 2 Crossley Services (APMS) contract John 7 procurement Marshall Transfer of neurological rehabilitation service GP Streaming at the acute hospital site Nursing home reform
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Audit Committee (4 meetings)
The committee reviews the Membership Members Meetings establishment and maintenance of an Category Attended effective system of integrated Maurice governance, financial oversight, internal Smith (Chair 4 control and risk management across the April 2017 – whole of the CCG’s activities (both Sept 2017) clinical and non-clinical) that support the Governing Peter Armer achievement of the objectives. Body Lay (Chair Oct 1 Members 2017 – The main responsibilities of the Audit March 2018) Committee are to: Frank Review and adopt the CCG’s Costello 3 financial statements and annual (April – Dec) report; SDF Clinical Dr Tony Ellis Review the work and the findings of Executive (retired 30 0 the CCG’s External Auditors; June 2017) Monitor the work and effectiveness Governing of the CCG’s Internal Auditors and Body Nurse Catherine Local Counter Fraud Services; Member 2 Jackson Review the effectiveness of internal (from July controls, the Governing Body 2017) Assurance Framework and risk management systems; Review any findings of Internal Audit and Local Counter Fraud Services, and ensure that action plans are in place and completed; Monitor any losses and compensation payments; Review the CCG’s gifts and hospitality register and declarations of interest
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Remuneration Committee
39. The committee makes recommendations to the governing body on determinations about pay and remuneration for employees of the CCG and people who provide services to the CCG, in line with the CCG’s procedure, and evidence based review as outlined in the scheme of delegation. Members are:
Chair of Governing Body Governing Body Lay Members and SDF Clinical Executives
40. The table below summarises the required members for various membership decisions.
Decision about: Who will be invited to attend VSM (Accountable Officer, Chief All members Finance Officer and Director of Quality and Safety) CCG Chair All members except CCG Chair Clinical Governing Body Members All members except 7 Clinical Governing Body Members Lay Members (3 lay members, All members except the 5 Lay secondary care lay member and Members nursing lay member) Clinical Directors, Clinical All members except members who Champions, Lead Practice Managers are Clinical Champions and other clinical engagement payments
41. The Remuneration Committee met three times in 2017/18. There are 13 members of this committee which is formed of all the Governing Body members except the three executive officers. The meetings were attended by 11, 10 and 12 members respectively. The Accountable Officer and Chief Finance Officer attended each meeting and a Human Resources representative was also present at each meeting.
42. The Committee is responsible for setting pay rates and uplifts for all staff not subject to national Agenda for Change pay scales. This includes Governing Body Members, Clinical Directors, Clinical Champions and Practice Nurse representatives. Rates have been set for 2017/18 and agreed for 2018/19. The Committee has also monitored the process for evaluation of Governing Body Members’ Performance.
43. Finally, the Remuneration Committee has responsibility for setting policies that relate to expenses and benefits payments, which have included the CCG Travel, Subsistence and Expenses Policy and the Patient Participation Expenses Policy.
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Greater Manchester CCGs Healthier Together Joint Committee
44. The Healthier Together Committee operated as a committee in common through 2015 until its meeting in December when it began to operate as a Shadow Joint Committee (HTSJC). It then transitioned to the Healthier Together Joint Committee in June 2016 when it decided that its future business would focus on the hospitals programme within Healthier Together and the Greater Manchester Health & Social Care Partnership’s Joint Commissioning Executive would cover the primary and integrated care elements of Healthier Together.
45. The meeting of the committee in September 2017 approved the full business case for Healthier Together. It confirmed to the committee the consistency of the model of care with the decision made in 2015; the robustness of the implementation plan, including the financial plan; and the risks associated with the programme and how they are being managed.
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Primary Care Commissioning Committee (7 meetings)
The Committee has been established in Membership Members Meetings accordance with statutory provisions to Category Attended enable the members to make collective Clinician decisions on the review, planning and Governing Dr Gary Cook 7 procurement of primary care services in Body Lay (Chair) the borough of Wigan, under delegated Member authority from NHS England. The Governing Frank majority of members are drawn from Body Lay 6 Costello existing lay members and executive Member officers of the Governing Body. Trish 6 Anderson The committee is chaired by the lay Governing Mike Tate/ 7 secondary care specialist doctor and has Body Officer Deputy a majority of lay members and officers Members Julie as members. The committee met seven Southworth/ 7 times in the year and was quorate at Deputy every meeting. A primary care GP Member Dr James operational group was established to Weems (until 6 oversee the service delivered for the Dec 2017) CCG by the NHS England Greater John 6 Manchester Primary Care Team. The CCG Officer Marshall focus for the committee was: Members Debbie 4 Szwandt Primary Care Quality Wigan Stuart Improvement Programme Council Cowley/ 3 Transformation Programme Deputy Alternative Provider Medical Healthwatch Dave Nunns 1 Services (APMS) Contracts Patient Ernie 6 Procurement Forum Rothwell Primary Care Reform Investment Members Gary Young / 3 Agreement Margaret Collaboration with Healthier Hughes Wigan Partnership GP Practice 7 day access
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UK Corporate Governance Code
46. We are not required to comply with the UK Corporate Governance Code. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the CCG and best practice.
Discharge of Statutory Functions
47. In light of recommendations of the 1983 Harris Review, the CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions.
48. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the CCG’s statutory duties.
Risk management arrangements and effectiveness
49. The key elements of the risk management framework are:
Governing Body Governing Body Committees CCG Senior Leadership Team Governance and Quality Teams Risk Management Strategy & Policy Governing Body Assurance Framework (GBAF) Directorate/department risk registers
50. The GBAF is a means of identifying and quantifying strategic risks within the organisation and is the means by which the Governing Body monitors and controls the risks which may impact on the organisation’s capacity to achieve its objectives.
51. The GBAF identifies the corporate objectives of the organisation and the principal risks related to the delivery of these objectives. Key controls are made explicit together with the assurances on these controls. In addition, the GBAF identifies linkages with inter-related areas of assurance.
52. The GBAF together with the monthly Performance Report are the two primary tools used by the Governing Body to measure and monitor the CCG’s performance. The content of NHS England’s Improvement and Assessment Framework was drawn upon to populate the GBAF as the CCG is assessed on its delivery against the framework. 49 Page 126 SECTION 2: ACCOUNTABILITY REPORT
53. The GBAF was presented to the Governing Body twice in the year and is submitted following presentation at Corporate Governance Committee which fulfils its role by focusing on risks, controls, gaps in control and resultant action plans. The Audit Committee also receives the GBAF at its meetings and focuses on the positive assurances and gaps in assurance.
54. Of the 23 risks included in the GBAF at the end of the year, three risks were rated extreme. These were described as:
If Bridgewater Community Healthcare NHS Foundation Trust does not improve its ability to evidence quality assurance there is a risk that the service is not delivering the appropriate quality of patient care. This may in turn jeopardise achievement of the transformation agenda If ambulance response times continue to be breached, patients will continue to experience delays in receiving treatment If demand exceeds capacity the urgent care system will not deliver planned performance levels as agreed with NHS Improvement
55. Acceptable risk following risk assessment can be defined as follows:
The likely consequences are insignificant. A higher risk consequence is outweighed by the chance of a much larger benefit. The occurrence is remote. The potential financial costs of minimising the risk outweigh the cost consequences of the risk itself. Mitigation of the risk could lead to further unacceptable risks in other ways.
56. Therefore it is possible that a risk with a high numerical value may be acceptable to the organisation, but that decision must be taken at Governing Body/Senior Management level.
57. In addition to the GBAF which records the risks at corporate level (those rated high or extreme) there are a number of operational risk registers managed at Assistant Director level focusing on risks assessed as medium or low.
Other sources of assurance
Internal Control Framework
58. A system of internal control is the set of processes and procedures in place in the CCG to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.
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59. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness.
60. The control environment within the CCG is established and led by the Governing Body which reserves powers for itself and delegates powers to its committees and officers of the CCG. These controls are described in the CCG’s constitution which includes standing orders, a scheme of reservation and delegation and prime financial policies. Internal controls operate over the strategic, planning, organisational, monitoring, measuring, and improvement elements of the management cycle.
61. The prime financial policies are part of the CCG’s control environment for managing the organisation’s financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration; lessen the risk of irregularities and support commissioning and delivery of effective, efficient and economical services. They also help the Accountable Officer and Chief Finance Officer to effectively perform their responsibilities. They are used in conjunction with the scheme of reservation and delegation.
62. The above control environment is underpinned by an extensive portfolio of human resources and employment policies which provide, in considerable detail, instructions to members, staff and contractors how to carry out duties and roles necessary for the CCG to achieve its objectives. The policies also provide guidance on conduct and behaviour conducive to effective and efficient working.
Annual audit of conflicts of interest management
63. The revised statutory guidance on managing conflicts of interest for CCGs (published June 2017) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework.
64. The CCG’s internal auditors have completed this work and found the three areas of governance arrangements; declarations of interests and gifts and hospitality; and reporting concerns and identifying and managing breaches/non-compliance as fully compliant and the two areas of registers of interest; and decision making processes as partially compliant.
Data Quality
65. The Governing Body receives monthly Performance and Finance Reports that cover finance and operational performance. The data contained in the reports is subject to significant scrutiny and review, both by management and by various Governing Body committees. The Governing Body is confident that the information it is presented with has been through appropriate review and scrutiny.
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Information Governance
66. The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal confidential data. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively.
67. The CCG self-assessed against the IG toolkit requirements as 8 at level 2 and 18 at level 3 giving an overall compliance level of 89%. This is a maintained position on the achievement in the previous year and has been examined in detail by the CCG’s internal auditors resulting in significant assurance.
68. We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and have developed information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities.
69. There are processes in place for incident reporting and investigation of serious incidents. We have developed information risk assessment and management procedures and a culture to address information has been fully embedded throughout the organisation.
Business Critical Models
70. No business critical models were introduced at the CCG during 2017/18. Where these are to be applied in future the CCG will ensure that quality assurance takes place in line with the recommendations in the Macpherson report.
Third party assurances
71. The CCG has received third party assurance from:
NHS Business Services Authority through its service auditor report covering governance, risk management and internal control over its prescription payments process and finance and accounting services; The report of the independent service auditors on IT general controls for the NHS Electronic Staff Record Programme;
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The Service Auditor report which NHS England has received from Capita Business Services Limited in respect of the primary care support services they provide to NHS England and CCGs.
Control Issues
72. Further to the three extreme risks referred to above, reported at the year end, the following specific actions have been taken:
Bridgewater Community Healthcare NHS Foundation Trust Commissioning Collaborative has raised a number of key concerns to NHS England Cheshire & Merseyside – in February 2018 the CCG raised quality monitoring to enhanced surveillance; A quality risk profile has been undertaken led by NHS England Cheshire & Merseyside and is to be shared with Bridgewater for their response.
Wigan Urgent Care System is developing an action plan to be presented to the Urgent & Emergency Care Board in March 2018 which will address the issues relating to handover times following NHS England/NHS Improvement guidance issued in November 2017; on 26 February the CCG wrote to the Chief Operating Officer of Greater Manchester Health & Social Care Partnership (GMHSCP) outlining the governing body’s concerns over NWAS performance and awaits a response.
In respect of emergency care performance there is a full recovery plan in place agreed with GM Urgent & Emergency Care Board with a number of work streams which should deliver improved performance; Wigan Borough has the best performance across GM for Delayed Transfers of Care and ‘stranded’ patients; Bed capacity is being explored during March to look at step up facilities; Primary care business cases are being implemented to reduce admissions.
Review of economy, efficiency & effectiveness of the use of resources
73. The CCG recognises and applies the principles of Economy: minimising the cost of resources used or required while having regard to quality; Efficiency: the relationship between the output from services and the resources to produce them; and Effectiveness: the extent to which objectives are achieved and the relationship between the intended and actual results of spending.
74. The Governing Body receives and considers a monthly Finance Report which highlights the continuing focus on efficiency including a significant underspend on running costs. The CCG self-assessed as ‘green’ for the Quality of Leadership indicator in the Improvement and Assessment Framework 2016/17.
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75. The CCG’s main efficiency saving achievement has been on prescribing efficiency and running cost reductions. Planned efficiency savings whilst maintaining national access criteria on Continuing Healthcare have not materialised so performance has been reported as under plan. Planned savings from a review of community based services have also not materialised in-year and will now be targeted in 2018/19.
76. The CCG’s internal auditors utilise an approach which is based on best practice and has been developed in accordance with professional standards. The planning methodology also ensures a contribution to supporting the CCG in achieving its strategic objectives and coverage of our business critical systems over a rolling programme. The principles of achieving value for money are included in the scope of each audit.
Delegation of functions
77. The Governing Body receives reports from its established committees and the seven SDF executive groups at each of its meetings. In this way any concerns or risks are identified and escalated where appropriate. SDFs are well-placed to take a lead on monitoring and managing performance including activity, quality and financial performance. Performance of functions operated by Greater Manchester Shared Service is quality assured through an established and regular reporting arrangement.
Counter fraud arrangements
78. The CCG’s arrangements for countering fraud and corruption are characterised by:
An Accredited Counter Fraud Specialist is contracted to undertake counter fraud work proportionate to identified risks and in accordance with the NHS Standards Contract Service Condition 24 and NHS Counter Fraud Authority’s Standards for Commissioners; The Audit Committee receiving a report against each of the Standards for Commissioners annually and progress reports at each of its meetings. There is executive support and direction for a proportionate proactive work plan to address identified risks; The Chief Finance Officer being the member of the executive team proactively and demonstrably responsible for tackling fraud, bribery and corruption.
79. NHS Counter Fraud Authority’s inspection of the CCG’s arrangements in March 2018 resulted in the following conclusion: “Based on the evidence supplied during the assessment process, all 13 standards were given a green rating. This meant the overall ratings for Strategic Governance and Inform and Involve were also green.”
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Whistleblowing Arrangements
80. The CCG is committed to ensuring the highest possible standards of service and the highest possible ethical standards in delivering this service. It is the responsibility of all staff to ensure that if they become aware that the actions of other employees or officers of the CCG or anyone working for, with or connected to it might compromise this objective, they will be expected to raise the matter.
The CCG’s Whistleblowing Policy was reviewed in July 2016 and endorsed by the staff side forum and the Corporate Governance Committee. Prior to this approval it was reviewed by the Anti-Fraud Specialist employed by Mersey Internal Audit Agency. It was rolled out to all staff by internal communication and posted on the CCG’s intranet.
Head of Internal Audit Opinion
81. Following completion of the planned audit work for the financial year for the CCG, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the CCG’s system of risk management, governance and internal control.
My opinion is set out as follows:
Basis for the opinion;
Overall opinion; and
Commentary 2.1 Basis for the Opinion
1. An assessment of the design and operation of the underpinning Assurance Framework and supporting processes.
2. An assessment of the range of individual assurances arising from our risk- based internal audit assignments that have been reported throughout the period. This assessment has taken account of the relative materiality of systems reviewed and management’s progress in respective of addressing control weaknesses identified.
3. An assessment of the organisation’s response to Internal Audit recommendations, and the extent to which they have been implemented.
My opinion is one source of assurance that the organisation has in providing its AGS other third party assurances should also be considered. In addition the organisation should take account of other independent assurances that are considered relevant.
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Overall Opinion
My overall opinion for the period 1 April 2017 to 31 March 2018 is:
High Assurance can be given that there is a strong system of internal control which has been effectively designed to meet the organisation’s objectives, and that controls are consistently applied in all areas reviewed. Substantial Assurance can be given that that there is a good system of internal control designed to meet the organisation’s objectives, and that controls are generally being applied consistently. Moderate Assurance, can be given that there is an adequate system of internal control, however, in some areas weaknesses in design and/or inconsistent application of controls puts the achievement of some of the organisation’s objectives at risk. Limited Assurance can be given that there is a compromised system of internal control as weaknesses in the design and/or inconsistent application of controls impacts on the overall system of internal control and puts the achievement of the organisation’s objectives at risk. No Assurance can be given that there is an inadequate system of internal control as weaknesses in control, and/or consistent non-compliance with controls could/has resulted in failure to achieve the organisation’s objectives.
Commentary
The overall opinion is underpinned by the work conducted through the risk based internal audit plan including reviews of Financial Systems, Care Home Quality Improvement and Information Governance.
This opinion is provided in the context that the Clinical Commissioning Group like other organisations across the NHS is facing a number of challenging issues and wider organisational factors.
Financial Position As reported to the Governing Body in March 2018, the CCG is forecasting to achieve its statutory duties in 2017/18 and achieve the planned surplus on a statutory basis of £0.054m. QIPP The planned savings against a number of QIPP schemes have not materialised, however the CCG has identified a range of in-year mitigations that fully close the efficiency gap.
The Financial Plan for 2018/19 was reported to the Governing Body in March 2018. The latest financial planning submission
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to GMH&SCP and NHS England (NHSE) indicated a QIPP requirement of £29.6m in 2018/19. This target must be delivered to ensure the CCG meets its expected statutory financial business duties and support to the single GMH&SCP control total. The CCG has not been set a control total directly by NHSE. GMH&SCP have been assigned a combined control total that covers all Greater Manchester CCG’s. However, the CCG is required to achieve a 1.0% surplus which equates to £4.6m to support the overall GMH&SCP control total. CCG Annual The CCG has been rated as ‘Good’ by NHS England in its Assessment annual assessment of performance against key performance indicators. Senior Senior management within the CCG has largely remained Management stable during 2017/18. NHS England has rated the quality of Changes leadership at the CCG as ‘Green’. Provider The CCG has continued to regularly report providers’ Performance performance against a range of targets. The CCG’s primary providers: Wrightington, Wigan and Leigh Foundation Trust, Bridgewater Community Healthcare Foundation Trust and North West Boroughs Healthcare Foundation Trust. It is noted that the CQC carried out an inspection at Wrightington Wigan and Leigh Foundation Trust and published their report in March 2018 which rated the Trust overall as ‘Good’. STP The health and social care landscape in England is changing, with huge funding pressures across all public services. The CCGs Locality Plan is underpinned by ‘Taking charge of our Health and Social Care in Greater Manchester, The Manchester Agreement’.
In Wigan, health and social care leaders have developed the Locality Plan for the borough - ‘Further, Faster towards 2020. The Plan highlights the commitment to delivering a transformed, sustainable health and care system, which is focused on what keeps people well and in control of their lives and where the barriers that prevent joined up care have been broken down.
A fundamental enabler to the plan is the development of an Accountable Care System (ACS), where commissioners and providers work collaboratively to deliver a set of ambitious
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population outcomes for borough. This is in the context of national policy changes, as set out in ‘The Five Year Forward View’ and GM Health and Social Care Devolution, ‘Taking Charge’.
It has been agreed in the first instance is to build a strong foundation for any future model, through the development of an Alliance Agreement and to have a test bed period, where the key components of the future integrated working model can be built. The Healthier Wigan Partnership (HWP) Alliance Agreement is the first formal step towards an ACS for Wigan. The partnership includes Bridgewater Community Healthcare NHS Foundation Trust, Wigan Council, Wrightington Wigan and Leigh NHS Foundation Trust, North West Boroughs Healthcare NHS Foundation Trust, Wigan Borough Clinical Commissioning Group and GP representatives.
The purpose of the Agreement is to set out the principles on which the Partners have agreed to collaborate to progress towards a fully integrated accountable care system (the "ACS"), which will involve transformation activity.
In providing this opinion I can confirm continued compliance with the definition of internal audit (as set out in your Internal Audit Charter), code of ethics and professional standards. I also confirm organisational independence of the audit activity and that this has been free from interference in respect of scoping, delivery and reporting. g|Å VÜÉãÄxç Director of Audit, MIAA March 2018
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Review of the effectiveness of governance, risk management and internal control
82. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, executive managers and clinical leads within the CCG who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports.
83. Our GBAF provides me with evidence that the effectiveness of controls that manage risks to the CCG achieving its corporate objectives have been reviewed. The quarterly assurance meetings with Greater Manchester Health & Social Care Partnership have not highlighted any areas of concern in the CCG’s system of internal control.
Conclusion
84. No significant internal control issues have been identified during 2017/18 at Wigan Borough Clinical Commissioning Group.
Trish Anderson
Accountable Officer
24 May 2018
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Appendix 1
Page 137 Page
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Remuneration and Staff Report
Remuneration Report
Remuneration Committee
85. The remuneration of the Governing Body of the Clinical Commissioning Group is the responsibility of the Remuneration Committee.
86. The Remuneration Committee has the following membership:
Dr Tim Dalton – CCG Chair; Mr Frank Costello - Lay Member and Remuneration Committee Chair; Canon Maurice Smith – Lay Member; Dr Gary Cook - Secondary Care Clinical Governing Body Member; Mrs Catherine Jackson– Nursing Governing Body Member; Mr Peter Armer, Lay member ( from September 2017); Dr Ashok Atrey - Clinical Governing Body Member; Dr Neeta James - Clinical Governing Body Member( from September 2017); Dr Mohan Kumar - Clinical Governing Body Member; Dr Jayne Davies – Clinical Governing Body Member (from September 2017): Dr Pete Marwick - Clinical Governing Body Member; Dr Sanjay Wahie - Clinical Governing Body Member; and Dr Gen Wong – Clinical Governing Body Member.
87. There have been three meetings in the year, in August 2017, November 2017 and March 2018. The August 2017 meeting was attended by all members except Dr Ashok Atrey, Dr Pete Marwick and Dr Gen Wong. The November 2017 meeting was attended by all members except Canon Maurice Smith, Dr Neeta James and Dr Jayne Davies. The March 2018 meeting was attended by all members except Mr Peter Armer.
88. The Chief Finance Officer did not attend the November 2017 meeting. The Chief Officer and Director of Quality & Safety did not attend the meeting in March 2018. A Human Resources representative was also present at all three meetings.
89. The CCG has established a clear policy whereby when decisions are made; any members who are personally affected by this decision are not included in any discussions or vote to avoid any conflict of interest.
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Policy on Remuneration of Senior Managers
90. The Remuneration Committee has responsibility for setting the pay of the CCG Governing Body.
91. In considering pay awards the Remuneration Committee will consider all relevant guidance, national pay awards, affordability and will benchmark against data for similar size organisations to enable a recommendation to be reached.
92. The pay of the Governing Body is not currently directly linked to performance, that is, there is no specific performance related pay. However, both the Governing Body and its individual members are subject to performance evaluation.
Policy on Senior Managers Contracts
93. Each Executive Governing Body member (3 in total) has a permanent contract which began on 1st April 2013.
94. This contract includes a notice period which can be served by either party.
95. The CCG may exercise its discretion to pay in lieu of notice for all or part of the notice period.
96. From September 2017 the CCG has seven Clinical Governing Body members to represent the seven Service Delivery Footprints (SDF), new contracts were issued to accommodate the changes.
97. The changes also included membership on the Healthier Wigan Partnership Board.
98. Two new Clinical Governing Body members were appointed in September 2017 to fill the Governing Body vacancy and one to represent the additional SDF.
99. The Clinical Governing Body Contract for Services contracts include termination arrangements that state:
Continuation of the appointment is contingent on the continued satisfactory performance and re-election by the members as required by the Constitution; If the members do not re-elect you as a Governing Body Member in accordance with the Constitution, the appointment shall terminate automatically with immediate affect. If the Governing Body member wishes to terminate their contract, they must give six months written notice to the Chair of the CCG;
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The CCG reserves the right to terminate the appointment from office with immediate effect and without payment of compensation by written notice; If the individual is employed on a fixed term contract, their employment will terminate on the expiry of the fixed term without the need for the CCG to give any additional notice; The CCG may require an individual to take any outstanding annual leave entitlement during their notice period, whether notice to terminate is given by them or by the CCG; Once the individual or the CCG has served notice to terminate the employment, the CCG may require the individual to remain away from work and to cease to carry out normal duties for the whole or any part of the notice period.
100. There are no special provisions for termination due to redundancy other than those stated for all employees in the CCG’s Organisational Change policy.
Senior Managers Service Contracts
101. There are five lay members of the Governing Body whose services are via a Contract for Service.
102. This includes the three Lay Members, the Secondary Care Clinical Member and the Nurse Member.
103. The increase in the Lay members from four to five is due to the appointment of the Audit Committee Lay Member who was appointed in September 2017.
104. These ‘Contract for Service’ are for a three year period from 1 April 2017 until 31 March 2020 with the exception of the Audit Committee Lay member contract that is until 30 September 2020.
105. The termination arrangements for these individuals are as follows:
Continuation of their appointment is contingent on their continued satisfactory performance and re-election/selection by the members as required by the Constitution. If the members do not re-elect the individual as a Governing Body Member in accordance with the Constitution, their appointment shall terminate automatically and with immediate effect; The individual may resign from the CCG at any time by giving a three month written notice to the Chair of the CCG; The CCG reserves the right to terminate their appointment with immediate effect and without payment of compensation by written notice; On termination of the appointment, the individual shall only be entitled to accrued fees as at the date of termination, together with the reimbursement of any expenses properly incurred prior to that date;
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Due to the terms in the contract for service there is no liability to the clinical commissioning group in the event of early termination.
Payments to Past Senior Managers and Payments for Loss of Office
106. No payments have been made to past senior managers.
107. No payments have been made to senior managers for Loss of Office.
Salaries and Allowances
108. For each member of the Governing Body who has served during the financial year 2017/18, remuneration and pension benefits are shown in the table below. This table has been subject to audit. Pension related benefits data is provided by the NHS Pensions Scheme for Greenbury reporting purposes annually.
2017/18 Remuneration and Pension Benefits – Governing Body
Long Term Expense Performance Performance All Pension Salary for payments Pay and Pay and Related Governing (taxable) - Bonuses- Bonuses - Benefits - Total - Body - bands rounded to bands of bands of bands of bands of Name and of £5,000 the nearest £5,000 £5,000 £2,500 £5,000 Title £000 £100 £000 £000 £000 £000 Dr T Dalton - CCG Chair 90-95 0 0 0 60-62.5 150-155 Mrs T Anderson - Chief Officer 140-145 0 0 0 32.5-35.0 175-180 Mr M Tate - Chief Finance Officer 115-120 74 0 0 15-17.5 130-135 Mrs J Southworth - Director of Quality and Safety 115-120 0 0 0 0**** 80-85 Mr F Costello - Lay Member 20-25 1 0 0 0 20-25 Mr M Smith - Lay Member 10-15 0 0 0 0 10-15 Dr G Cook - Secondary Care Clinical GB Member 15-20 2 0 0 0 15-20 Mrs C Jackson - Nursing GB Member** 10-15 0 0 0 0 10-15 Dr A Atrey - Clinical GB Member * 55-60 0 0 0 0 55-60 Dr M Kumar - Clinical GB Member 65-70 0 0 0 15-17.5 80-85
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Dr P Marwick - Clinical GB Member 45-50 0 0 0 0**** 0**** Dr S Wahie - Clinical GB member * 45-50 0 0 0 95-97.5 140-145 Dr G Wong - Clinical GB member * 50-55 0 0 0 247.5-250 300-305 Dr J Davies - Clinical GB member** 25-30 0 0 0 120-122.5 145-150 Dr Neeta James - Clinical GB member** 15-20 0 0 0 162.5-165 180-185 Mr P Armer - Lay Member** 0-5 0 0 0 0 0-5 Mrs C Kurzeja – Acting Chief Officer*** 0-5 0 0 0 0-2.5 0-5
Note – The total figure is expressed in bandings of £5,000 based on the actual remuneration values and therefore may vary to the total of salary bands added together.
* Dr Sanjay Wahie, Dr Ashok Atrey and Dr Gen Wong also have clinical roles in the CCG. They have separate contracts for these roles and any remuneration payable for these roles is excluded from the amounts shown above.
** Dr J Davies and Dr N James and Mr P Armer have been a Governing Body member from September 2017. The amount shown represents seven months costs.
*** Mrs C Kurzeja only has been in post since 22nd March 2018, the amount shown represents six days costs.
**** The calculation of pension related benefits resulted in a negative value which is shown as zero for reporting purposes.
The figures included as pension related benefits were not salary figures paid to any staff member. They represent the potential value of their pension, which is contributed to by the CCG, less the employees own contributions. The total figures also include this value and do not in any way reflect the salary paid to the employees.
The expense payments all relate to travel and subsistence.
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109. Remuneration and pension benefits for the prior year, 2016-17 are shown below. 2016/17 Remuneration and Pension Benefits – Governing Body
Long Term Expense Performance Performance All Pension Salary for payments Pay and Pay and Related Governing (taxable) - Bonuses- Bonuses - Benefits - Total - Body - bands rounded to bands of bands of bands of bands of Name and of £5,000 the nearest £5,000 £5,000 £2,500 £5,000 Title £000 £100 £000 £000 £000 £000 Dr T Dalton - CCG Chair 90-95 0 0 0 0*** 80-85 Mrs T Anderson - Chief Officer 140-145 0 0 0 30-32.5 170-175 Mr M Tate - Chief Finance Officer 115-120 69 0 0 15-17.5 140-145 Mrs J Southworth - Director of Quality and Safety 115-120 0 0 0 115-117.5 230-235 Mr F Costello - Lay Member 25-30 0 0 0 0 25-30 Mr M Smith - Lay Member 10-15 0 0 0 0 10-15 Dr G Cook - Secondary Care Clinical GB Member 15-20 2 0 0 0 15-20 Mrs C Jackson - Nursing GB Member** 5-10 1 0 0 25-27.5 30-35 Dr A Atrey - Clinical GB Member * 55-60 0 0 0 0 55-60 Dr T Ellis - Clinical GB Member 65-70 0 0 0 0 65-70 Dr M Kumar - Clinical GB Member 65-70 0 0 0 12.5-15 75-80 Dr P Marwick - Clinical GB Member 55-60 0 0 0 20-22.5 75-80 Dr S Wahie - Clinical GB member * 40-45 0 0 0 0*** 35-40 Dr G Wong - Clinical GB member * 45-50 0 0 0 67.5-70 115-120
* Dr Sanjay Wahie, Dr Ashok Atrey and Dr Gen Wong also have clinical roles in the CCG. They have separate contracts for these roles and any remuneration payable for these roles is excluded from the amounts shown above.
** Mrs Catherine Jackson has been a Governing Body member from July 2016. The amount shown represents nine months costs.
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*** The calculation of pension related benefits resulted in a negative value which is shown as zero for reporting purposes.
Pension Benefits
110. For each member of the Governing Body who has served during the financial year 2017/18, pension benefits are shown below. (This table has been subject to audit) Lump sum at pension Real age Real increase Total related to increase in accrued accrued in pension pension at pension Cash pension lump pension at 31st Real equivalent at sum at age at 31st March Cash increase in transfer Employer’s pension pension March 2018. equivalent Cash value at contribution age age 2018. (Bands transfer equivalent 31st to (Bands of (Bands of (Bands of of value at 1st transfer March stakeholder Name and £2,500) £2,500) £5,000) £5,000) April 2017 value 2018 pension Title £000 £000 £000 £000 £000 £000 £000 £00 Dr T Dalton - CCG Chair* 2.5-5.0 0-2.5 20-25 50-55 312 47 362 N/A Mrs T Anderson - Chief Officer 2.5-5.0 0*** 10-15 0-5 184 44 230 N/A Mr M Tate - Chief Finance Officer 0-2.5 2.5-5.0 50-55 150-155 1039 84 1134 N/A Mrs J Southworth - Director of Quality and Safety 0*** 0** 30-35 100-105 815 0*** 0 N/A Dr M Kumar - Clinical GB Member* 0-2.5 0*** 25-30 60-65 431 22 457 N/A Dr P Marwick - Clinical GB Member* 0*** 0*** 15-20 50-55 621 0*** 396 N/A Dr S Wahie - Clinical GB member 5.0-7.5 2.5-5.0 15-20 40-45 203 69 274 N/A Dr G Wong – Clinical GB member* 10-12.5 30-32.5 15-20 50-55 136 202 340 N/A Dr J Davies - Clinical GB member 5.0-7.5 12.5-15.0 5-10 10-15 0 82 82 N/A Dr Neeta James - Clinical GB member 5.0-7.5 20-22.5 5-10 20-25 0 133 133 N/A Mrs C Kurzeja – Acting Chief Officer** 0-2.5 0-2.5 0-5 0-5 13 2 15 N/A
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* Dr Sanjay Wahie, Dr Ashok Atrey and Dr Gen Wong also have clinical roles in the CCG. They have separate contracts for these roles and any remuneration payable for these roles is excluded from the amounts shown above.
** Mrs C Kurzeja only has been in post since 22nd March 2018, the amount shown represents ten days costs.
*** The calculation of pension related benefits resulted in a negative value which is shown as zero for reporting purposes.
Cash Equivalent Transfer Values
111. A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time.
112. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme.
113. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme.
114. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.
115. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.
116. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost.
117. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV
118. This reflects the increase in CETV effectively funded by the employer.
119. It does not include the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.
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Pay Multiples
120. Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid member in their organisation and the median remuneration of the organisation’s workforce. This information is subjected to audit.
121. The banded remuneration of the highest paid member of the Governing Body in Wigan Borough CCG in the financial year 2017-18 was £167,500 (2016-17, £167,500).
122. This was 5.2 times the median remuneration of the workforce (2016-17, 5.0), which was £33,895 (2016-17 £33,560).
123. In 2017-18 there was a 1% increase to the remuneration of the highest paid member of the Governing Body, agreed through Remuneration Committee in line with Agenda for Change.
124. In 2017-18, no employees received remuneration in excess of the highest paid member of Wigan Borough CCG (none in 2016-17). Remuneration ranged from £2,500 to £167,500 (2016-17 - £2,500 to £167,500).
125. Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.
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Staff Report
Staff costs 2017/18
Total Admin Programme P e rmanent P e rmanent P e rmanent Total E m ployees Other Total E m ployees Other Total E m ployees Other £'000 £'000 £'000 E mployee Benefits £'000 £'000 £'000 £'000 £'000 £'000 S alaries and wages 9 4 3,806 1 3 2,625 8 1 S ocial security costs 6,431 5,938646 4 0 399 3,594399 2 0 247 2,344247 2 0 E mployer contribution s to the NHS Pension Scheme 646 O ther pension costs 747 0 461 461 0 285 285 0 A pprenticeship Lev y 747 0 00 0 00 0 0 O ther post-employme n t benefits 0 16 12 4 O ther employment be n efits 012 04 0 T ermination benefits 16 0 00 0 00 0 0 G ross employee be n efits expenditure 0 0 9 004 4,855 0 1 003 3,161 0 8 01 L ess recoveries in re s pect of employee be n efits (note 4.1.2) 0 (161)176 0 176 (161)176 00 00 0 176 0 (161) 00 0 T otal - Net admin e m ployee benefits inc luding capitalised c o sts 7,855 7,3617,522 4 4 9 4 4,694 4,4814,642 2 2 1 3 3,161 2,8802,880 2 2 8 1
Page 147 Page 8,016 L ess: Employee cost s capitalised 0 0 0 0 00 00 0 N et employee benef its excluding capita lised costs 7,361 4 9 4 4,694 4,481 2 1 3 3,161 2,880 2 8 1 7,855(161) Staff costs 2016/17
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126. The CCG has the following number of senior managers by band as at 31st March 2018. The CCG defines senior managers as those staff on contracts of employment who are paid on Bands 8a to Band 9 and Other (VSM/Governing Body) contracts:
Band 8 - Range A 19 Band 8 - Range B 17 Band 8 - Range C 9 Band 8 - Range D 0 Band 9 5 Other – VSM/GB 18
127. The above numbers are based on head count. It excludes workers who undertake clinical roles for the CCG on a contract for service or workers for whom the CCG is a host employer.
128. The staff composition, based on contracted Whole Time Equivalent (WTE) of staff in post as at 31st March 2018 is as follows:
Male Female
Governing Body 7 4 Senior Management (8a and above) 14 31 Other Administration 18 64 Pharmacy 1 1 Nursing 1 5 Total 41 105
129. The average staff numbers for 2017-18 are:
Senior Management (8a and above) 50 Other Administration 79 Pharmacy 3 Nursing 5
Total 137
130. The above are the contracted WTE, calculated on an average across 2017-18. It includes agency, temporary and seconded in staff but excludes staff on outward secondment, Chairman and Lay Members (as these are defined as non-staff in the Annual Accounts).
131. Note 4.3 to the accounts details the CCG’s sickness absence data. For the 12 months January 2018 to December 2018, the average sickness absence reported to the Health and Social Care Information Centre for the CCG was 3% with an average sickness per full time equivalent of 7.1 days.
132. The CCG has a range of HR policies and procedures that apply in the financial year which include Recruitment and Selection policy; Learning & Development policy;
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Appraisal Development and Pay Progression policy, Flexible Working and Working Time policy, Flexi-time policy, Managging Attendance policy, Human Rights, Equality, Diversity and Equal Opportunities pollicy and Leave of Absence policy.
133. The CCG has spent £35,780 on consultancy relating to work around modelling extended access in primary care.
Off-paayroll engagements
134. The CCG policy, set by the Remuneration Committee, is that any senior official of the CCG will be contracted as an employee and paid through payrroll. There are no senior officials or members of thhe Governing Body employeed via off-payroll arrangements.
135. The CCG has put provisions in place to receive formal assurance that anyone paid at more than £245 per day and emmployed off payroll for more than six months is meeting their income tax and NIC obligations in full. If that reaassurance is not provided when requested, the contracts will be terminated.
The CCG has no off-payroll arrangemments for specialist or interim contractors as at 31st March 2018 that meet the criteria of more than £245 per day and an arrangement that lasts longer than a six month period.
Exit Packages
136. The CCG has had two exit packages in 2017/18. (The figures are subject to audit)
137. Redundancy and other departure costs have been paid in accordance with the provision of the NHS pension scheme. Exit costs in this note are full costs of departures agreed in year. Where Wigan CCG has agreed early retirements, the additional costs are met by the CCG and not by the NHS pension scheme. Ill- health retirement costs are met by the NHS Pension Scheme and are not included in this table.
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Facility Time
138. Relevant Union Officials
Number of employees who were relevant Full-time equivalent employee union officials during the relevant period number
2 2
Union Officials - Percentage of time spent on facility time
Percentage of time Number of employees 0% - 1 – 50% 2 51 – 99% - 100% -
Percentage of pay bill spent on facility time
Description Figures Total cost of facility time £5,551 Total pay bill £7.855m Percentage of the total pay bill spent on facility time, calculated as: 0.07% (total cost of facility time ÷ total pay bill) x 100
Paid trade union activities
Time spent on paid trade union activities as a percentage of total paid facility time hours calculated as:
43% (total hours spent on paid trade union activities by relevant union officials during the relevant period ÷ total paid facility time hours) x 100
Trish Anderson
Accountable Officer
24 May 2018
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Parliamentary Accountability and Audit Report
139. Wigan Borough CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the Financial Statements of this report at page 113 to 127. An audit certificate and report is also included in this Annual Report at pages 76 to 79.
Trish Anderson
Accountable Officer
24 May 2018
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SECTION 3 FINANCIAL STATEMENTS
Trish Anderson Accountable Officer 24 May 2018
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INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS WIGAN BOROUGH CCG
Report on the Audit of the Financial Statements Opinion We have audited the financial statements of NHS Wigan Borough Clinical Commissioning Group (the ‘CCG’) for the year ended 31 March 2018 which comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers Equity, the Statement of Cash Flows and notes to the financial statements, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and the Department of Health and Social Care Group Accounting Manual 2017-18 and the requirements of the Health and Social Care Act 2012. In our opinion the financial statements: give a true and fair view of the financial position of the CCG as at 31 March 2018 and of its expenditure and income for the year then ended; and have been properly prepared in accordance with International Financial Reporting Standards (IFRSs) as adopted by the European Union, as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2017-18; and have been prepared in accordance with the requirements of the Health and Social Care Act 2012. Basis for opinion We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the CCG in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Who we are reporting to This report is made solely to the members of the Governing Body of the CCG, as a body, in accordance with Part 5 of the Local Audit and Accountability Act 2014. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have formed. Conclusions relating to going concern We have nothing to report in respect of the following matters in relation to which the ISAs (UK) require us to report to you where: the Accountable Officer’s use of the going concern basis of accounting in the preparation of the financial statements is not appropriate; or the Accountable Officer has not disclosed in the financial statements any identified material uncertainties that may cast significant doubt about the CCG’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from the date when the financial statements are authorised for issue. 76 Page 153 SECTION 3: FINANCIAL STATEMENTS
Other information The Accountable Officer is responsible for the other information. The other information comprises the information included in the Annual Report set out on pages 1 to 127, other than the financial statements and our auditor’s report thereon. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. In connection with our audit of the financial statements, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of our work including that gained through work in relation to the CCG’s arrangements for securing value for money through economy, efficiency and effectiveness in the use of its resource or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. Other information we are required to report on by exception under the Code of Audit Practice Under the Code of Audit Practice published by the National Audit Office on behalf of the Comptroller and Auditor General (the Code of Audit Practice) we are required to consider whether the Governance Statement does not comply with the guidance issued by the NHS Commissioning Board or is misleading or inconsistent with the information of which we are aware from our audit. We are not required to consider whether the Governance Statement addresses all risks and controls or that risks are satisfactorily addressed by internal controls. We have nothing to report in this regard. Opinion on other matters required by the Code of Audit Practice In our opinion: the parts of the Remuneration Report and Staff Report to be audited have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2017-18 and the requirements of the Health and Social Care Act 2012; and based on the work undertaken in the course of the audit of the financial statements and our knowledge of the CCG gained through our work in relation to the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources, the other information published together with the financial statements in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements. Opinion on regularity required by the Code of Audit Practice In our opinion, in all material respects the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions in the financial statements conform to the authorities which govern them. Matters on which we are required to report by exception Under the Code of Audit Practice we are required to report to you if: we have reported a matter in the public interest under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit; or 77 Page 154 SECTION 3: FINANCIAL STATEMENTS
we have referred a matter to the Secretary of State under Section 30 of the Local Audit and Accountability Act 2014 because we had reason to believe that the CCG, or an officer of the CCG, was about to make, or had made, a decision which involved or would involve the body incurring unlawful expenditure, or was about to take, or had begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or we have made a written recommendation to the CCG under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit. We have nothing to report in respect of the above matters. Responsibilities of the Accountable Officer and Those Charged with Governance for the financial statements As explained more fully in the Statement of Accountable Officer's responsibilities set out on page(s) 36 to 37, the Accountable Officer, is responsible for the preparation of the financial statements in the form and on the basis set out in the Accounts Directions, for being satisfied that they give a true and fair view, and for such internal control as the Accountable Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Accountable Officer is responsible for assessing the CCG’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the CCG lacks funding for its continued existence or when policy decisions have been made that affect the services provided by the CCG. The Accountable Officer is responsible for ensuring the regularity of expenditure and income in the financial statements. The Audit Committee is Those Charged with Governance. Auditor’s responsibilities for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. We are also responsible for giving an opinion on the regularity of expenditure and income in the financial statements in accordance with the Code of Audit Practice. Report on other legal and regulatory requirements – Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources Matter on which we are required to report by exception - CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources Under the Code of Audit Practice we are required to report to you if, in our opinion we have not been able to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2018. We have nothing to report in respect of the above matter. 78 Page 155 SECTION 3: FINANCIAL STATEMENTS
Responsibilities of the Accountable Officer As explained in the Governance Statement, the Accountable Officer is responsible for putting in place proper arrangements for securing economy, efficiency and effectiveness in the use of the CCG's resources. Auditor’s responsibilities for the review of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources We are required under Section 21(3)(c) and Schedule 13 paragraph 10(a) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report where we have not been able to satisfy ourselves that it has done so. We are not required to consider, nor have we considered, whether all aspects of the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2017, as to whether in all significant respects, the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2018, and to report by exception where we are not satisfied. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to be satisfied that the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Report on other legal and regulatory requirements – Certificate We certify that we have completed the audit of the financial statements of NHS Wigan Borough Clinical Commissioning Group in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice. Mike Thomas Director for and on behalf of Grant Thornton UK LLP 4 Hardman Square Spinningfields Manchester M3 3EB 25 May 2018
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WIGAN BOROUGH CCG FINANCIAL STATEMENTS
Foreword to the Accounts
The Clinical Commissioning Group was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006.
These accounts for the year ended 31 March 2018 have been prepared by Wigan Borough CCG under section 17 of schedule 1A of the National Health Service Act 2006 (as amended) in the form which the Secretary of States has, with the approval of the Treasury, directed.
The National Health Service Act 2006 (as amended) requires Clinical Commissioning Groups to prepare their Annual Report and Annual Accounts in accordance with Directions issued by NHS England.
Trish Anderson Mr Mike Tate
Chief Officer Chief Finance Officer
24 May 2018 24 May 2018
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Statement of Comprehensive Net Expenditure for the Year Ended 31 March 2018
2017-18 2016-17 Note £'000 £'000
Income from sale of goods and services 2 (7,721) (4,681) Other operating income* 2 (263) (189) Total operating income (7,983) (4,870)
Staff costs 4 8,016 7,450 Purchase of goods and services 5 517,940 498,076 Depreciation and impairment charges 5 0 0 Provision expense 5 298 (67) Other Operating Expenditure** 5 193 825 Total operating expenditure 526,446 506,283
Net Operating Expenditure 518,463 501,414
Finance income Finance expense 10 0 0 Net expenditure for the year 518,463 501,414 Net Gain/(Loss) on Transfer by Absorption 0 0 Total Net Expenditure for the year 518,463 501,414 Other Comprehensive Expenditure Items which will not be reclassified to net operating costs Net (gain)/loss on revaluation of PPE 0 0 Net (gain)/loss on revaluation of Intangibles 0 0 Net (gain)/loss on revaluation of Financial Assets 0 0 Actuarial (gain)/loss in pension schemes 0 0 Impairments and reversals taken to Revaluation Reserve 0 0 Items that may be reclassified to Net Operating Costs 00 Net gain/loss on revaluation of available for sale financial assets 0 0 Reclassification adjustment on disposal of available for sale financial assets 00 Sub total 00
Comprehensive Expenditure for the year ended 31 March 2018 518,463 501,414
*Other operating income includes staff secondments and apprenticeship government grant.
**Other operating expenditure includes Chair and Non Executive members remuneration and impairments.
Notes 1 to 38 also form part of this statement.
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Statement of Financial Position as at 31 March 2018
2017-18 2016-17
Note £'000 £'000 Non-current assets: Property, plant and equipment 13 0 0 Intangible assets 14 0 0 Investment property 15 0 0 Trade and other receivables 17 0 0 Other financial assets 18 0 0 Total non-current assets 00 Current assets: Inventories 16 0 0 Trade and other receivables 17 7,504 1,053 Other financial assets 18 0 0 Other current assets 19 0 0 Cash and cash equivalents 20 4 1 Total current assets 7,509 1,054
Non-current assets held for sale 21 0 0
Total current assets 7,509 1,054
Total assets 7,509 1,054
Current liabilities Trade and other payables 23 (32,823) (26,829) Other financial liabilities 24 0 0 Other liabilities 25 0 0 Borrowings 26 0 0 Provisions 30 (440) (149) Total current liabilities (33,263) (26,978)
Non-Current Assets plus/less Net Current Assets/Liabilities (25,754) (25,924)
Non-current liabilities Trade and other payables 23 0 0 Other financial liabilities 24 0 0 Other liabilities 25 0 0 Borrowings 26 0 0 Provisions 30 0 0 Total non-current liabilities 0 0
Assets less Liabilities (25,754) (25,924)
Financed by Taxpayers’ Equity General fund (25,754) (25,924) Revaluation reserve 0 0 Other reserves 0 0 Charitable Reserves 0 0 Total taxpayers' equity: (25,754) (25,924) Notes 1 to 38 also form part of this statement.
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The financial statements were approved in accordance with the Clinical Commissioning Group Scheme of Delegation on the 24th May 2018 and signed on its behalf by:
Trish Anderson Mike Tate Chief Officer Chief Finance Officer 24th May 2018 24th May 2018
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Statement of Changes in Taxpayers’ Equity for the Year Ended 31 March 2018
General Revaluation Other Total fund reserve reserves reserves £'000 £'000 £'000 £'000 Changes in taxpayers’ equity for 2017-18
Balance at 01 April 2017 (25,924) 0 0 (25,924)
Transfer between reserves in respect of assets transferred from closed NHS bodies 0000 Adjusted NHS Clinical Commissioning Group balance at 31 March 2018 (25,924) 0 0 (25,924)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2017-18 Net operating expenditure for the financial year (518,463) (518,463)
Net gain/(loss) on revaluation of property, plant and equipment 00
Page 161 Page Net gain/(loss) on revaluation of intangible assets 00 Net gain/(loss) on revaluation of financial assets 00 Total revaluations against revaluation reserve 0 0 0 0
Net gain (loss) on available for sale financial assets 0 0 0 0 Net gain (loss) on revaluation of assets held for sale 0 0 0 0 Impairments and reversals 0000 Net actuarial gain (loss) on pensions 0000 Movements in other reserves 0000 Transfers between reserves 0000 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0 Transfers by absorption to (from) other bodies 0000 Reserves eliminated on dissolution 0000 Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (518,463) 0 0 (518,463)
Net funding* 518,633 0 0 518,633 *Cash fundingBalance received at 31 Marchin year 2018 2017-18 (25,754) 0 0 (25,754)
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Statement of Changes in Taxpayers’ Equity for the Year Ended 31 March 2017
General Revaluation Other Total fund reserve reserves reserves £'000 £'000 £'000 £'000 Changes in taxpayers’ equity for 2016-17
Balance at 01 April 2016 (23,424) 0 0 (23,424) Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition 0000 Adjusted NHS Clinical Commissioning Group balance at 31 March 2017 (23,424) 0 0 (23,424)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2016-17 Net operating costs for the financial year (501,414) (501,414)
Page 162 Page Net gain/(loss) on revaluation of property, plant and equipment 00 Net gain/(loss) on revaluation of intangible assets 00 Net gain/(loss) on revaluation of financial assets 00 Total revaluations against revaluation reserve 0 0 0 0
Net gain (loss) on available for sale financial assets 0 0 0 0 Net gain (loss) on revaluation of assets held for sale 0 0 0 0 Impairments and reversals 0000 Net actuarial gain (loss) on pensions 0000 Movements in other reserves 0000 Transfers between reserves 0000 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0 Transfers by absorption to (from) other bodies 0000 Reserves eliminated on dissolution 0000 Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (501,414) 0 0 (501,414) *Cash fundingNet funding* received in year 2016-17 498,913 0 0 498,913 Balance at 31 March 2017 (25,924) 0 0 (25,924) Notes 1 to 38 also form part of this statement.
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Statement of Cash Flows for the Year Ended 31 March 2018
2017-18 2016-17 Note £'000 £'000 Cash Flows from Operating Activities Net operating expenditure for the financial year (518,463) (501,414) Depreciation and amortisation 500 Impairments and reversals 500 Movement due to transfer by Modified Absorption 00 Other gains (losses) on foreign exchange 00 Donated assets received credited to revenue but non-cash 0 0 Government granted assets received credited to revenue but non-cash 0 0 Interest paid 00 Release of PFI deferred credit 00 Other Gains & Losses 00 Finance Costs 00 Unwinding of Discounts 00 (Increase)/decrease in inventories 00 (Increase)/decrease in trade & other receivables 17 (6,451) 759 (Increase)/decrease in other current assets 00 Increase/(decrease) in trade & other payables 23 5,994 1,994 Increase/(decrease) in other current liabilities 00 Provisions utilised 30 (7) (208) Increase/(decrease) in provisions 30 298 (67) Net Cash Inflow (Outflow) from Operating Activities (518,629) (498,935)
Cash Flows from Investing Activities Interest received 00 (Payments) for property, plant and equipment 00 (Payments) for intangible assets 00 (Payments) for investments with the Department of Health 0 0 (Payments) for other financial assets 00 (Payments) for financial assets (LIFT) 00 Proceeds from disposal of assets held for sale: property, plant and equipment 0 0 Proceeds from disposal of assets held for sale: intangible assets 0 0 Proceeds from disposal of investments with the Department of Health 0 0 Proceeds from disposal of other financial assets 00 Proceeds from disposal of financial assets (LIFT) 00 Loans made in respect of LIFT 00 Loans repaid in respect of LIFT 00 Rental revenue 00 Net Cash Inflow (Outflow) from Investing Activities 0 0
Net Cash Inflow (Outflow) before Financing (518,629) (498,935)
Cash Flows from Financing Activities Grant in Aid Funding Received 518,633 498,913 Other loans received 00 Other loans repaid 00 Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0 Capital grants and other capital receipts 00 Capital receipts surrendered 00 Net Cash Inflow (Outflow) from Financing Activities 518,633 498,913
Net Increase (Decrease) in Cash & Cash Equivalents 20 3 (21)
Cash & Cash Equivalents at the Beginning of the Financial Year 1 22
Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0
Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 4 1
Notes 1 to 38 also form part of this statement.
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Notes to the Financial Statements
Whilst many of the Notes to the Financial Statements can be directly cross referenced to the Statement of Net Comprehensive Expenditure and the Statement of Financial Position, some provide additional information and cannot be directly cross referenced (Note 12, 27, 28, 29, 31, 32, 35, 36, 37 and 38).
1 Accounting Policies
NHS England has directed that the financial statements of Clinical Commissioning Groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health.
Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2017-18 issued by the Department of Health. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards (IFRS) to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board.
Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the Clinical Commissioning Group (CCG) for the purpose of giving a true and fair view has been selected.
The particular policies adopted by the CCG are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.
1.1 Going Concern
These accounts have been prepared on the going concern basis.
Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.
Where a CCG ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis.
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1.2 Accounting Convention
These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.
1.3 Pooled Budgets
The CCG has entered in to a pooled budget with Wigan Council under Section 75 of the National Health Service Act 2006 to support integrated health and social care, known as the Better Care Fund (BCF), hosted by Wigan Council. This is a nationally mandated scheme that commenced in 2015-16.
The pool is jointly controlled by Wigan Borough CCG and Wigan Council. The Wigan Health and Wellbeing Board, made up of Council and CCG representatives, govern the use of the fund. The fund is used to commission services that support the integration of health and social care, which seeks to ensure support for people to be well and independent and in control of their own care.
Each scheme within the BCF has been allocated a lead commissioner (either the Council or the CCG) and accounting for the pool reflects these arrangements. Details are included in Note 1.7 and 35.
The CCG accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement.
The CCG recognises:
The assets the CCG controls; The liabilities the CCG incurs; The expenses the CCG incurs; and The CCG’s share of the income from the pooled budget activities.
In addition to the above, the CCG recognises:
The CCG’s share of the jointly controlled assets (classified according to the nature of the assets); The CCG’s share of any liabilities incurred jointly; and The CCG’s share of the expenses jointly incurred.
1.4 Critical Accounting Judgements & Key Sources of Estimation Uncertainty
In the application of the CCG’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources.
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The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed.
Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.
1.4.1 Critical Judgements in Applying Accounting Policies
The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements.
Pooled Budget Arrangements
Wigan Borough CCG has entered into a Section 75 (S75) agreement with Wigan Council to pool resources in order to improve the health and social care outcomes for the residents of the borough. Under the terms of the S75 agreement Wigan Council will be acting as the host for the pool.
The CCG has taken into account and consideration IFRS 10, Consolidated Financial Statements and IFRS 11, Joint Arrangements.
Under IFRS 10 the CCG considers the pool to be under the joint control of the CCG and Wigan Council. The S75 agreement states that the pool will be classified as a joint operation under IFRS 11. The CCG believe this to be consistent with the governance and control arrangements of the pool.
While there is no single organisational lead commissioner individual schemes have been allocated a lead. The CCG and Wigan Council have accounted for the pool under lead commissioning arrangements.
Leases
Leases are accounted for under IAS 17. For operating leases, where no formal lease is signed but the CCG incurs costs for the utilisation of a building, the full costs of the in-year transactions are accounted for, but future minimum lease payments are not recognised.
Further details are available in Note 1.17 and Note 12.
1.4.2 Key Sources of Estimation Uncertainty
The following are the key estimations that management has made in the process of applying the CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements.
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Prescribing Expenditure
Wigan Borough CCG receives financial information from NHS Business Services Authority (NHSBSA) relating to the costs of drugs prescribed by Wigan Borough CCG prescribers (independent GPs). The information available for actual drug costs prescribed in the year is provided in arrears, therefore the actual data received at the Statement of Financial Position date is to February only, and an estimate for March is required.
This estimate has been calculated using forecast information provided by Business NHS BSA. In 2017/18 the CCG has used the NHS BSA’s linear trend methodology which is consistent with 2016/17.
Provision for NHS Continuing Healthcare Claims for Periods of Care Post 1/4/2013
A provision has been made in the CCG accounts for an estimate of the likely future costs of claims, where patients have submitted a request to the CCG for a review of their continuing healthcare eligibility from 1 April 2013.
The provision is based upon claims made against CCG funding which have not yet been fully assessed, and where the likelihood of success is greater than 50%, a provision is made.
The likelihood of success is estimated by the Continuing Care team responsible for assessing claims. The costs are then estimated based on the average cost of nursing care per week. The cost of this provision in 2017-18 is £239,547.47. Details of provisions are found in Note 30.
The estimate is based upon the best information available at the time. However, there is a degree of uncertainty associated with this calculation and therefore a greater level of risk associated with it. However, this approach is consistent with prior years.
Provision for restructuring
A provision has been made in the CCG accounts relating to the appointment of a single Accountable Officer (AO) for the whole of the health and social care system for the Wigan Locality. As laid out in the Wigan place based strategic commissioning functions operating model approved on the 24th October 2017, there is a requirement for a single AO. This provision recognises potential future costs of this outcome.
1.5 Revenue
Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable.
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Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.
1.6 Employee Benefits 1.6.1 Short-term Employee Benefits
Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.
The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.
1.6.2 Retirement Benefit Costs
Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales.
The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the CCG of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.
For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the CCG commits itself to the retirement, regardless of the method of payment.
The assets are measured at fair value and the liabilities at the present value of the future obligations. The increase in the liability arising from pensionable service earned during the year is recognised within operating expenses. The expected gain during the year from scheme assets is recognised within finance income.
The interest cost during the year arising from the unwinding of the discount on the scheme liabilities is recognised within finance costs. Actuarial gains and losses during the year are recognised in the General Reserve and reported as an item of other comprehensive net expenditure.
1.7 Other Expenses
Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.
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Expenses and liabilities in respect of grants are recognised when the CCG has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met.
1.8 Leases
Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.
1.8.1 The CCG as Lessee
Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor.
Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the CCG’s surplus/deficit.
Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.
Contingent rentals are recognised as an expense in the period in which they are incurred.
Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.
1.8.2 The CCG as Lessor
Amounts due from lessees under finance leases are recorded as receivables at the amount of the CCG’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the CCG’s net investment outstanding in respect of the leases.
Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term.
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1.9 Cash & Cash Equivalents
Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.
In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the CCG’s cash management.
1.10 Provisions
Provisions are recognised when the CCG has a present legal or constructive obligation as a result of a past event, it is probable that the CCG will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation.
The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties.
Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows:
Timing of cash flows (0 to 5 years inclusive): Minus 2.420% (previously: minus 2.70%); Timing of cash flows (6 to 10 years inclusive): Minus 1.85% (previously: minus 1.95%); and Timing of cash flows (over 10 years): Minus 1.56% (previously: minus 0.80%).
When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.
A restructuring provision is recognised when the CCG has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it.
The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.
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1.11 Clinical Negligence Costs
The NHS Litigation Authority operates a risk pooling scheme under which the CCG pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure.
Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the CCG.
1.12 Non-Clinical Risk Pooling
The CCG participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the CCG pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising.
The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.
1.13 Continuing Healthcare Risk Pooling
In 2014-15 a risk pool scheme was been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. The risk pool is controlled and accounted for by NHS England.
1.14 Contingencies
A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the CCG, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably.
A contingent liability is disclosed unless the possibility of a payment is remote.
A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the CCG. A contingent asset is disclosed where an inflow of economic benefits is probable.
Where the time value of money is material, contingencies are disclosed at their present value.
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1.15 Financial Assets
Financial assets are recognised when the CCG becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.
Financial assets are classified into the following categories:
Financial assets at fair value through profit and loss; Held to maturity investments; Available for sale financial assets; and Loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.
1.15.1 Financial Assets at Fair Value through Profit & Loss
Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in calculating the CCG’s surplus or deficit for the year.
The net gain or loss incorporates any interest earned on the financial asset.
1.15.2 Held to Maturity Assets
Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.
1.15.3 Available For Sale Financial Assets
Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to surplus/deficit on de-recognition.
1.15.4 Loans & Receivables
Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.
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Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques.
The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset.
At the end of the reporting period, the CCG assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.
For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate.
The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables.
If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.
1.16 Financial Liabilities
Financial liabilities are recognised on the statement of financial position when the CCG becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received.
Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.
1.16.1 Financial Guarantee Contract Liabilities
Financial guarantee contract liabilities are subsequently measured at the higher of:
The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets.
1.16.2 Financial Liabilities at Fair Value through Profit & Loss
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Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the CCG’s surplus/deficit.
The net gain or loss incorporates any interest payable on the financial liability.
1.16.3 Other Financial Liabilities
After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost.
The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.
1.17 Value Added Tax
Most of the activities of the CCG are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.
1.18 Third Party Assets
Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the CCG has no beneficial interest in them.
1.19 Losses & Special Payments
Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.
Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the CCG not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).
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1.20 Joint Operations
Joint operations are activities undertaken by the CCG in conjunction with one or more other parties but which are not performed through a separate entity. The CCG records its share of the income and expenditure; gains and losses; assets and liabilities; and cash flows.
1.21 Accounting Standards that have been issued but have not yet been adopted
The DHSC Group accounting manual does not require the following Standards and Interpretations to be applied in 2017-18. These standards are still subject to FREM adoption and early adoption is not therefore permitted:
IFRS 9: Financial Instruments (application from 1 January 2018); IFRS 15: Revenue for Contract with Customers (application from 1 January 2018) IFRS 16: Leases (application from 1 January 2019) IFRS 17: Insurance Contracts (application from 1 January 2021) IFRIC 22: Foreign Currency Transactions and Advance Consideration (application from 1 January 2018) IFRIC 23: Uncertainty over Income Tax Treatments (application from 1 January 2019)
The application of the Standards as revised would not have a material impact on the accounts for 2017-18, were they applied in that year.
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2 Other Operating Revenue
2017-18 2017-18 2017-18 2016-17 Total Admin Programme Total £'000 £'000 £'000 £'000
Recoveries in respect of employee benefits* 161 161 0 0 Education, training and research 19 0 19 48 Charitable and other contributions to revenue expenditure: non-NHS 0 0 0 4 Non-patient care services to other bodies** 7,701 0 7,701 4,633 Non cash apprenticeship training grants revenue 13 13 0 0 Other revenue 89 14 75 185 Total other operating revenue 7,983 188 7,795 4,870 * Recoveries in respect of employee benefits are seconded staff to Healthier Wigan Partnership hosted by Wigan Council.
** Non patient care services £6.5m relates to the approved transformation fund bid with Greater Manchester Health and Social Care Partnership and income received from Wigan Council in respect of local authority contributions to joint health and social care priorities.
3 Revenue 2017-18 2017-18 2017-18 2016-17 Total Admin Programme Total £'000 £'000 £'000 £'000 From rendering of services 7,983 188 7,795 4,870 From sale of goods 0 0 0 0 Total 7,983 188 7,795 4,870
Revenue is totally from the supply of services. They include schemes that span Health and Social Care which will result in improvements to the quality of life for the residents of the Wigan Borough.
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4 Employee Benefits and Staff Numbers
4.1 Employee benefits
4.1.1 Employee benefits expenditure 2017-18
Permanent Total Employees Other £'000 £'000 £'000 Employee Benefits Salaries and wages 6,431 5,938 494 Social security costs 646 646 0 Page 177 Page Employer Contributions to NHS Pension scheme 747 747 0 Other pension costs 0 0 0 Apprenticeship Levy 16 16 0 Other post-employment benefits 0 0 0 Other employment benefits 0 0 0 Termination benefits (note 4.4) 176 176 0 Gross employee benefits expenditure 8,016 7,522 494
Less recoveries in respect of employee benefits (note 4.1.2) (161) (161) 0 Total - Net admin employee benefits including capitalised costs 7,855 7,361 494
Less: Employee costs capitalised 0 0 0 Net employee benefits excluding capitalised costs 7,855 7,361 494
100
SECTION 3: FINANCIAL STATEMENTS
Employee benefits expenditure 2016-17
Permanent Total Employees Other £'000 £'000 £'000 Employee Benefits Salaries and wages 6,171 5,633 539 Social security costs 609 609 0 Employer Contributions to NHS Pension scheme 670 670 0 Other pension costs 0 0 0 Apprenticeship Levy 0 0 0 Page 178 Page Other post-employment benefits 0 0 0 Other employment benefits 0 0 0 Termination benefits 0 0 0 Gross employee benefits expenditure 7,450 6,911 539
Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 Total - Net admin employee benefits including capitalised costs 7,450 6,911 539
Less: Employee costs capitalised 0 0 0
Net employee benefits excluding capitalised costs 7,450 6,911 539
101
SECTION 3: FINANCIAL STATEMENTS 4.1.2 Recoveries in respect of employee benefits
Permanent Total Employees Other Total £'000 £'000 £'000 £'000 Employee Benefits - Revenue Salaries and wages (127) (127) 0 0 Social security costs (15) (15) 0 0 Employer contributions to the NHS Pension Scheme (18) (18) 0 0 Total recoveries in respect of employee benefits (161) (161) 0 0 The table above relates to staff seconded to Healthier Wigan Partnership hosted by Wigan Council.
4.2 Average number of people employed
2017-18 2016-17 Permanently Total employed Other Total Number Number Number Number
Total 138 133 5 134
Of the above: Number of whole time equivalent people engaged on capital projects 0 0 0 0 Other includes seconded staff, interim contractors and pre September 18 apprentices. This is based on contracted whole time equivalents.
4.3 Staff sickness and ill health retirements
2017-18 2016-17 Number Number Total Days Lost 994 753 Total Staff Years 140 130 Average working Days Lost 7.1 5.8
The above figures are provided on a calendar year basis in line with NHS reporting requirements. There were no ill health retirements throughout the financial year (0 in 2016-17).
The CCG has not agreed any early retirements; therefore there are no costs to be met by the CCG.
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4.4 Exit packages and severance payments agreed in the financial year
2017-18 2017-18 2017-18 Compulsory redundancies Other agreed departures Total Number £ Number £Number£ Less than £10,000 0 0 0 0 0 0 £10,001 to £25,000 1 16,171 0 0 1 16,171 £25,001 to £50,000 0 0 0 0 0 0 £50,001 to £100,000 0 0 0 0 0 0 £100,001 to £150,000 0 0 0 0 0 0 £150,001 to £200,000 1 160,000 0 0 1 160,000 Over £200,001 0 0 0 0 0 0 Total 2 176,171 0 0 2 176,171
Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure. There have been two exit packages agreed by the CCG in 2017-18 (0 in 2016-17).
There are no non-contractual severance payments made following judicial mediation, relating to non-contractual payments in lieu of notice in 2017-18. Therefore no non-contractual payments were made to individuals where the payment value was more than 12 months of their annual salary.
No early retirements have been agreed by the CCG for 2017-18. Ill-health retirement costs are met by the NHS Pension Scheme and would not be included in the CCG tables.
Where exit packages are made to Senior Managers who are included within the Remuneration Report, details of these will also be found in the Remuneration Report. The CCG had no exit packages relating to these individuals in 2017-18.
Page 180 103 SECTION 3: FINANCIAL STATEMENTS 4.5 Pension Costs
Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.
Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities.
Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in each scheme is taken as equal to the contributions payable to that scheme for the accounting period.
In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:
4.5.1 Accounting valuation
A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2018, is based on valuation data as 31 March 2017, updated to 31 March 2018 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.
The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.
4.5.2 Full actuarial (funding) valuation
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience), and to recommend contribution rates payable by employees and employers.
The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012. The Scheme Regulations allow for the level of contribution rates to be changed by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and employee and employer representatives as deemed appropriate.
The next actuarial valuation is to be carried out as at 31 March 2016 and is currently being prepared. The direction assumptions are published by HM Treasury which are used to complete Page 181 104 SECTION 3: FINANCIAL STATEMENTS the valuation calculations, from which the final valuation report can be signed off by the scheme actuary. This will set the employer contribution rate payable from April 2019 and will consider the cost of the Scheme relative to the employer cost cap. There are provisions in the Public Service Pension Act 2013 to adjust member benefits or contribution rates if the cost of the Scheme changes by more than 2% of pay. Subject to this ‘employer cost cap’ assessment, any required revisions to member benefits or contribution rates will be determined by the Secretary of State for Health after consultation with the relevant stakeholders.
For 2017-18, employers’ contributions of £760,763 were payable to the NHS Pensions Scheme (2016-17: £679,665) were payable to the NHS Pension Scheme at the rate of 14.3% of pensionable pay, plus an employers’ levy of 0.08%. The scheme’s actuary reviews employer contributions, usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Government website on 9 June 2012. These costs are included in the NHS pension line of note 4.1. In addition to the costs shown on note 4.1, the CCG pay pension on the Chairman’s costs which is included as part of the Chair and Non-Executive members costs in note 5 as these are not classed as pay and staff costs in the CCG accounts.
Page 182 105 SECTION 3: FINANCIAL STATEMENTS 5 Operating Expenses
2017-18 2017-18 2017-18 2016-17 Total Admin Programme Total £'000 £'000 £'000 £'000 Gross employee benefits Employee benefits excluding governing body members* 7,189 4,028 3,161 6,557 Executive governing body members 827 827 0 893 Total gross employee benefits 8,016 4,855 3,161 7,450
Other costs Services from other CCGs and NHS England 2,085 608 1,477 2,094 Services from foundation trusts** 300,050 0 300,050 286,940 Services from other NHS trusts 19,151 0 19,151 18,589 Purchase of healthcare from non-NHS bodies 74,882 0 74,882 72,306 Chair and Non Executive Members 187 187 0 187 Supplies and services – clinical 2,102 0 2,102 2,129 Supplies and services – general*** 10,269 131 10,138 7,115 Consultancy services 36 36 0 82 Establishment 1,429 242 1,187 1,232 Transport 11 4 7 16 Premises**** 6,052 222 5,830 6,293 Impairments and reversals of receivables 4 0 4 0 Audit fees***** 54 54 0 81 Prescribing costs 59,351 0 59,351 59,238 Pharmaceutical services 197 0 197 235 General ophthalmic services 56 0 56 54 GPMS/APMS and PCTMS 41,833 7 41,826 40,716 Other professional fees excl. external audit****** 181 70 111 67 Legal fees 45 23 22 35 Grants to Other bodies 0 0 0 605 Clinical negligence 1 1 0 1 Education and training 144 92 52 187 Provisions 298 200 98 (67) CHC Risk Pool contributions 0 0 0 666 Non cash apprenticeship training grants 13 13 0 0 Other expenditure 0 0 0 31 Total other costs 518,430 1,889 516,542 498,833
Total operating expenses 526,446 6,744 519,703 506,283 In accordance with SI 2008 no.489, The Companies (Disclosure of Auditor Remuneration and Liability Limitation Agreements) Regulations 2008, where a Clinical Commissioning Group contract with its auditors provides for a limitation of the auditor's liability, the principal terms of this limitation must be disclosed in a note to the accounts. The liabilities of the external auditor are limited to £2m.
*The Executive Governing Body Members includes all Governing Body Members. This includes the Clinical Governing Body Members.
**A significant proportion of CCG expenditure is for services provided by NHS Foundation trusts including Acute, Community and Mental Health service provision. The increased expenditure in this area predominantly relates to the growth in demand for services and for the increased actual activity undertaken by the Foundation Trusts.
*** Supplies and services – general includes investment in Primary Care through the Primary Care Standards scheme which has improved GP services in the Borough.
Page 183 106 SECTION 3: FINANCIAL STATEMENTS **** Premises costs include all costs payable to NHS Property Services and Community Health Partnerships £6.004m. This includes the costs of the CCG’s administrative headquarters, and the payments that cover the subsidised and void space within clinics and health centres, paid by the CCG as commissioner of those health services.
***** The Audit Fee above is the fee paid to Grant Thornton UK LLP for External Audit Services of £54,000 including VAT.
******Internal Audit Services and Counter Fraud Services which are provided by Mersey Internal Audit Agency (MIAA) (£72,710), is reported within other professional fees, in 2016/17 the fees were included within NHS trusts.
6.1 Better Payment Practice Code
Measure of compliance 2017-18 2017-18 2016-17 2016-17 Number £'000 Number £'000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 11,534 138,228 12,041 133,397 Total Non-NHS Trade Invoices paid within target 11,333 137,066 11,710 131,014 Percentage of Non-NHS Trade invoices paid within target 98.26% 99.16% 97.25% 98.21%
NHS Payables Total NHS Trade Invoices Paid in the Year 2,500 322,754 2,371 315,679 Total NHS Trade Invoices Paid within target 2,456 322,736 2,280 315,362 Percentage of NHS Trade Invoices paid within target 98.24% 99.99% 96.16% 99.90% The Better Payment Practice Code requires the CCG to aim to pay all valid invoices by the due date, or within 30 days of receipt of a valid invoice, whichever is later.
6.2 Late Payment of Commercial Debt
The CCG did not incur any expenses as a result of the late payment of commercial debt.
7 Income Generation Activities
The CCG does not undertake any income generating activities.
8 Investment Revenue
The CCG does not have any investment revenue.
9 Other Gains & Losses
The CCG has not made any other gains or losses.
10 Finance Costs
The CCG has not incurred any finance costs.
11 Net Gains (Loss) on Transfer by Absorption
The CCG has no Net Gains (Loss) on Transfer by Absorption as at 31 March 2018.
Page 184 107 SECTION 3: FINANCIAL STATEMENTS 12 Operating Leases
12.1 As lessee
Leases shown below include:
Payment to NHS Property Services Limited (NHS PS). These include the costs of the lease for the CCG’s headquarters, General Practitioner (GP) rents and the cost of use of properties owned or leased by NHS PS where the costs are not fully recovered from the occupants. These are currently paid by the CCG as it commissions the services in these buildings. The funding sits within the CCG allocation; Payment to Community Health Partnerships Limited (CHP). These include General Practitioner (GP) rents and the cost of use of LIFT properties leased by CHP where the costs are not fully recovered from the occupants. These are currently paid by the CCG as it commissions the services in these buildings. The funding sits within the CCG allocation; and Lease cars. These are short term car leases of between one and three years.
The costs included within this note are shown within premises and establishment costs in note 5.
12.1.1 Payments Recognised as an Expense
2017-18 2016-17 Land Buildings Other Total Land Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Payments recognised as an expense Minimum lease payments 0 6,004 9 6,013 0 6,235 17 6,252 Total 0 6,004 9 6,013 0 6,235 17 6,252
12.1.2 Future Minimum Lease Payments
2017-18 2016-17 Land Buildings Other Total Land Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Payable: No later than one year 0 0 5 5 0066 Between one and five years 0 0 1 1 0022 After five years 0 0 0 0 0000 Total 0 0 6 6 0 0 8 8 Whilst our arrangements with CHP and NHS PS fall within the definition of operating leases, rental charge for future years has not yet been agreed. Consequently this note does not include future minimum lease payments for the arrangements only.
The above does not include the element of costs paid to NHS PS and CHP for the subsidised or void elements of the occupancy of health service property, as this is not a long term lease commitment for the CCG.
Only the known future minimum lease payments for lease car arrangements are included.
Page 185 108 SECTION 3: FINANCIAL STATEMENTS 12.2 As Lessor
The CCG are not a lessor therefore have no income receipts as a lessor.
13 Properties, Plant & Equipment
The CCG has had no property, plant or equipment throughout the financial year.
14 Intangible Assets
The CCG has had no Intangible Assets throughout the financial year.
15 Investment Properties
The CCG had no investment property as at 31 March 2018.
16 Inventories
The CCG had no inventories as at 31 March 2018.
17 Trade & Other Receivables
Current Non-current Current Non-current 2017-18 2017-18 2016-17 2016-17 £'000 £'000 £'000 £'000
NHS receivables: Revenue 177 0 357 0 NHS prepayments 400 0 406 0 NHS accrued income* 6,648 0 0 0 Non-NHS and Other WGA receivables: Revenue 55 0 97 0 Non-NHS and Other WGA prepayments 170 0 182 0 Non-NHS and Other WGA accrued income 55 0 6 0 Provision for the impairment of receivables (4) 0 0 0 VAT 3 0 6 0 Other receivables and accruals 1 0 0 0 Total Trade & other receivables 7,504 0 1,053 0
Total current and non current 7,504 1,053
Included above: Prepaid pensions contributions 0 0 *£6.5m of the NHS accrued income relates to the agreed transformation fund bid with Greater Manchester Health and Social Care Partnership.
The majority of trade is with NHS England. As NHS England is funded by Government to provide funding to CCGs to commission health services, no credit scoring of them is considered necessary.
There is no credit risk associated with any of the receivables.
No financial assets that would otherwise be past due or impaired have had terms renegotiated.
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17.1 Receivables Past their Due Date but not Impaired
2017-18 2017-18 2016-17 £'000 £'000 £'000 Non Department Department All of Health of Health receivables Group Group prior years
By up to three months 0 10 25 By three to six months 3 0 0 By more than six months 60 0 0 Total 63 10 25 The above table shows the monies owed to the CCG that are over 30 days overdue. The CCG has had confirmation that the debt over six months will be received in the first quarter of 2018/19.
The CCG did not hold any collateral against receivables outstanding at 31 March 2018.
17.2 Provision for Impairment of Receivables
2017-18 2017-18 2016-17 £'000 £'000 £'000 Non Department Department All of Health of Health receivables Group Group prior years
Balance at 01 April 2017 000
Amounts written off during the year 0 0 0 Amounts recovered during the year 0 0 0 (Increase) decrease in receivables impaired* 0 (4) 0 Transfer (to) from other public sector body 0 0 0 Balance at 31 March 2018 0 (4) 0 *The impairment relates to debt relating to a personal health budget that is currently with an external debt recovery company.
18 Other Financial Assets
The CCG had no other financial assets as at 31 March 2018.
19 Other Current Assets
The CCG had no other current assets as at 31 March 2018.
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20 Cash & Cash Equivalents
2017-18 2016-17 £'000 £'000 Balance at 01 April 2017 122 Net change in year 3 (21) Balance at 31 March 2018 4 1
Made up of: Cash with the Government Banking Service 4 1 Cash with Commercial banks 0 0 Cash in hand 0 0 Current investments 0 0 Cash and cash equivalents as in statement of financial position 4 1
Bank overdraft: Government Banking Service 0 0 Bank overdraft: Commercial banks 0 0 Total bank overdrafts 0 0
Balance at 31 March 2018 4 1
Patients’ money held by the clinical commissioning group, not included above 00
21 Non-Current Assets Held for Sale
The CCG had no non-current assets held for sale as at 31 March 2018.
22 Analysis of Impairments & Reversals – Non-current assets
The CCG had no impairments or reversals of impairments recognised in expenditure during 2017-18.
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23 Trade & Other Payables
Current Non-current Current Non-current 2017-18 2017-18 2016-17 2016-17 £'000 £'000 £'000 £'000
Interest payable 0 0 0 0 NHS payables: revenue* 6,232 0 1,700 0 NHS accruals 1,445 0 995 0 NHS deferred income 0 0 0 0 Non-NHS and Other WGA payables: Revenue** 7,517 0 2,370 0 Non-NHS and Other WGA accruals 14,735 0 17,990 0 Non-NHS and Other WGA deferred income 0 0 0 0 Social security costs 94 0 89 0 VAT 0 0 0 0 Tax 79 0 82 0 Payments received on account 0 0 0 0 Other payables and accruals 2,722 0 3,605 0 Total Trade & Other Payables 32,823 0 26,829 0
Total current and non-current 32,823 26,829 * The NHS payables includes a £4m payable to Wrightington Wigan and Leigh FT.
** The Non NHS and other WGA payables includes £1.5m for the March 2018 Better Care fund payable to Wigan Council.
There are no liabilities included above for payments due in future years under arrangements to buy out the liability for early retirement over 5 years.
24 Other Financial Liabilities
The CCG had no other financial liabilities as at 31 March 2018.
25 Other Liabilities
The CCG had no other liabilities as at 31 March 2018.
26 Borrowings
The CCG had no borrowings as at 31 March 2018.
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27 Private Finance Initiative, LIFT & Other Service Concession Arrangements 27.1 Off-Statement of Financial Position Private Finance Initiative, LIFT and Other Service Concession Arrangements
The CCG had no private finance initiative, LIFT or other service concession arrangements that were excluded from the Statement of Financial Position as at 31 March 2018. 27.2 On-Statement of Financial Position Private Finance Initiative, LIFT and Other Service Concession Arrangements
The CCG had no private finance initiative, LIFT or other service concession arrangements that were included in the Statement of Financial Position as at 31 March 2018.
28 Finance Lease Obligations
The CCG had no finance lease obligations as at 31 March 2018.
29 Finance Lease Receivables
The CCG had no finance lease receivables as at 31 March 2018.
30 Provisions
Current Non-current Current Non-current 2017-18 2017-18 2016-17 2016-17 £'000 £'000 £'000 £'000 Pensions relating to former directors 0 0 0 0 Pensions relating to other staff 0 0 0 0 Restructuring* 200 0 0 0 Redundancy 00 00 Agenda for change 0 0 0 0 Equal pay 00 00 Legal claims 0 0 0 0 Continuing care** 240 0 149 0 Other 0 0 0 0 Total 440 0 149 0
Total current and non-current 440 149
* Provision for restructuring relating to the appointment of a single Accountable Officer (AO) for the whole of the health and social care system for the Wigan Locality. As laid out in the Wigan place based strategic commissioning functions operating model approved on the 24th October 2017, there is a requirement for a single AO. This provision recognises potential future costs of this outcome.
** A provision has been made in the CCG’s accounts for an estimate of the likely future costs of NHS Continuing Healthcare claims, where patients have submitted a request to the CCG for a review of their continuing healthcare eligibility for periods of care from 1 April 2013.
The provision is based upon claims made against the CCG which have not yet been fully assessed, and where the likelihood of success is greater than 50%, a provision is made. The
113 Page 190 SECTION 3: FINANCIAL STATEMENTS likelihood of success is estimated by the Continuing Care team responsible for assessing claims. The costs are then estimated based on the average cost of nursing care per week.
There is nothing included in the provisions of the NHS Litigation Authority as at 31 March 2017 in respect of clinical negligence liabilities of the CCG.
Under the Accounts Directions issued by NHS England on 24 February 2015, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to previously unassessed periods of care, before the establishment of CCGs. The legal liability to discharge these claims remains with the CCG.
The total value of legacy NHS Continuing Healthcare provisions to 31 March 2013, which is accounted for by NHS England on behalf of this CCG as at 31 March 2018 is £726,352.82.
The table below shows the breakdown of the provisions made by the CCG in 2017-18 and expected timing for discharge.
Continuing Restructuring Care Other Total £'000 £'000 £'000 £'000
Balance at 01 April 2017 0 149 0 149
Arising during the year 200 194 0 394 Utilised during the year 0 (7) 0 (7) Reversed unused 0 (97) 0 (97) Unwinding of discount 0 0 0 0 Change in discount rate 0 0 0 0 Transfer (to) from other public sector body 0 0 0 0 Transfer (to) from other public sector body under ab 00 0 0 Balance at 31 March 2018 200 240 0 440
Expected timing of cash flows: Within one year 200 240 0 440 Between one and five years 0 0 0 0 After five years 0 0 0 0 Balance at 31 March 2018 200 240 0 440
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31 Contingencies
2017-18 2016-17 £'000 £'000 Contingent liabilities Continuing Healthcare 203 117 Net value of contingent liabilities 203 117
Contingent assets GL Hearn Rates Rebates 323 0 Net value of contingent assets 323 0 The CCG has a contingent liability relating to the NHS Continuing Healthcare claims on the CCG for periods of care from 1st April 2013. This is based upon the difference between the full potential value of the liability, and the value provided for based on likelihood of success as assessed by the Continuing Healthcare team.
The CCG has a contingent asset relating to GP rates rebates which are being managed by GL Hearn and NHS England.
32 Financial Instruments
32.1 Financial Risk Management
Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.
Because the CCG is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The CCG has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the CCG in undertaking its activities.
Treasury management operations are carried out by the finance department, within parameters defined formally within the CCG’s Standing Financial Instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the CCG and internal auditors.
32.1.1 Currency Risk
The CCG is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The CCG has no overseas operations. The CCG and therefore has low exposure to currency rate fluctuations.
32.1.2 Interest Rate Risk
The CCG borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated
115 Page 192 SECTION 3: FINANCIAL STATEMENTS assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The CCG therefore has low exposure to interest rate fluctuations.
32.1.3 Credit Risk
Because the majority of the CCG and revenue comes parliamentary funding, the CCG has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.
32.1.4 Liquidity Risk
The CCG is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament.
The CCG draws down cash to cover expenditure, as the need arises. The CCG is not, therefore, exposed to significant liquidity risks.
32.2 Financial Assets
At ‘fair value through profit Loans and Available and loss’ Receivables for Sale Total 2017-18 2017-18 2017-18 2017-18 £'000 £'000 £'000 £'000
Embedded derivatives 0 0 0 0 Receivables: · NHS* 0 6,825 0 6,825 · Non-NHS 0 110 0 110 Cash at bank and in hand 0 4 0 4 Other financial assets 0 1 0 1 Total at 31 March 2018 0 6,940 0 6,940
At ‘fair value through profit Loans and Available and loss’ Receivables for Sale Total 2016-17 2016-17 2016-17 2016-17 £'000 £'000 £'000 £'000
Embedded derivatives 0 0 0 0 Receivables: · NHS 0 357 0 357 · Non-NHS 0 103 0 103 Cash at bank and in hand 0 1 0 1 Other financial assets 0 0 0 0 Total as 31 March 2017 0 461 0 461
* NHS receivables include the accrued income of £6.5m relating to the approved transformation fund bid with Greater Manchester Health and Social Care Partnership.
These balances are reported within the Statement of Financial Position and also Note 17 and Note 20.
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32.3 Financial Liabilities
At ‘fair value through profit and loss’ Other Total 2017-18 2017-18 2017-18 £'000 £'000 £'000
Embedded derivatives 0 0 0 Payables: · NHS* 0 7,676 7,676 · Non-NHS 0 24,974 24,974 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 0 0 0 Other financial liabilities 0 0 0 Total at 31 March 2018 0 32,650 32,650
At ‘fair value through profit and loss’ Other Total 2016-17 2016-17 2016-17 £'000 £'000 £'000
Embedded derivatives 0 0 0 Payables: · NHS 0 2,695 2,695 · Non-NHS 0 23,964 23,964 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 0 0 0 Other financial liabilities 0 0 0 Total at 31 March 2017 0 26,659 26,659 * The NHS payable includes a £4m payable to Wrightington Wigan and Leigh FT.
These balances are those reported within the Statement of Financial Position and also Note 23.
As required to report, the CCG has no payable to the Department of Health, and all liabilities are expected to discharge in one year or less.
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33. Operating Segments
The CCG considers that they have only one segment which is commissioning of healthcare services.
Gross Net Total Income Total assets Net assets expenditure expenditure liabilities £'000 £'000 £'000 £'000 £'000 £'000 NHS Wigan Borough CCG 526,446 (7,983) 518,463 7,509 (33,263) (25,754) Total 526,446 (7,983) 518,463 7,509 (33,263) (25,754) 34. Pooled Budgets
The CCG has entered in to a pooled budget with Wigan Council to support integrated health and social care, known as the Better Care Fund (BCF), hosted by Wigan Council. This is a nationally mandated scheme that commenced in 2015-16.
The pool is jointly controlled by Wigan Borough CCG and Wigan Council. The Wigan Health and Wellbeing Board, made up of Wigan Council and CCG representatives, govern the use of the fund. The fund is used to commission services that support the integration of health and social care, which seeks to ensure support for people to be well and independent and in control of their own care.
Each scheme within the BCF has been allocated a lead commissioner (either the Council or the CCG) and accounting for the pool reflects these arrangements.
The total value of the pool in 2017-18 is £34,966,716. The CCG contribute £22,901,369 to the pool which provides funding to the revenue schemes of the pool. The council contribute £11,943,347 to the pool of which £3,542,794 is from the Disabled Facilities Grant, which pays for the capital schemes of the pool. In 2017-18 a further contribution of £8,522,553 was made from national monies received by the council for the Improved Better Care Fund (iBCF), which funds revenue schemes.
The CCG lead commission schemes to the value of £4.5m in 2017-18. The remainder of the schemes are lead commissioned by Wigan Council.
The Council contributes 100% of the capital funds therefore the underspend on the Disabled Facilities Capital Grant is accounted for by Wigan Council. This money is specifically earmarked for the Council within the terms of the pooled budget.
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Better Care Fund Pooled Budget Memorandum
CCG Wigan Council Pool £000 £000 £000 Income Revenue 22,901 8,523 31,424 Capital Grant 3,421 3,421 Capital Grant Underspend from 2016/17 122 122 Total Income 22,901 12,066 34,967 Expenditure Revenue expenditure 4,479 26,945 31,424 Capital expenditure 2,860 2,860
Total Expenditure 4,479 29,805 34,284
Total Underspend -683
Revenue Underspend / Overspend 0 Capital Underspend -683
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35 Related Party Transactions
Governing Body Members
The following are members of the Wigan Borough CCG Governing Body, who have declared interests with organisations that the CCG conduct business with. For Governing Body members only organisations that the CCG have transacted with are listed within the payments section of this note, although all interests declared are listed in the narrative.
Mrs Anderson (Chief Officer) is a public sector director with Wigan LIFTco (non- remunerated).The CCG do not pay Wigan LIFTco but the LIFTco is administered by Community Health Partnerships (CHP) so payments to CHP have been included for transparency. Her Husband is employed with Mersey Care NHS Foundation Trust as a Consultant Psychiatrist. Mrs Anderson is also an Associate non-executive Director at NHS East Lancashire Trust (non- remunerated).
Dr Dalton (Chair) is a GP, GP Trainer and GP Appraiser. He is a director at Shakespeare Surgery Ltd and Shakespeare Services Ltd. He is also a minor shareholder in Shakespeare Surgery Ltd, a company that provides GMS GP services to the NHS and a minority shareholder in Shakespeare Services that provides services to Non NHS organisations and private individuals in the area of travel, training and health advice. Shakespeare Surgery is a shareholder of Health First ALW Community Interest Company, which acts as a provider of various health services and a mechanism for GP federated working. Dr Dalton is also a member of the North West Leadership Academy Board.
Dr Atrey (Clinical Governing Body Member) is a general practitioner at Meadowview Surgery and Atherton Health Centre. Dr Atrey’s wife is also a GP at the same practice and a Partner.
Dr Davies (Clinical Governing Body Member) is a GP partner in the Dicconson Group Practice.
Dr James (Clinical Governing Body Member) is a GP at Braithwaite Road Surgery.
Dr Kumar (Clinical Governing Body Member) is a Senior Partner at Dr Kumar’s Surgery (Russell and Partners, the Chandler Surgery). This practice is a member of the Health First Federation. He is also Associate Dean of Primary Care and Public Health Education, Health Education North West.
Dr Marwick (Clinical Governing Body Member) is a GP at Beech Hill Medical Practice. Beech Hill Medical Practice is a member of Wigan Federation but Dr Marwick is not the named shareholder.
Dr Wahie (Clinical Governing Body Member) is a GP at SSP Health Surgeries (Ashton Medical Centre, Braithwaite Road Surgery, Ince Surgery and Lower Ince Surgery). He practices at Lower Ince and Ince Surgeries. He is a shareholder of Cardium Federation. His wife works at Lancashire Teaching Hospitals NHS Foundation Trust (Royal Preston Hospitals) and he has a family member who works at County Durham and Darlington NHS Foundation Trust.
Dr Wong (Clinical Governing Body Member) is a partner at Dr Wong and partners GP Practice (Old Henry Street Medical Practice).
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Mr Armer (Lay Member) is majority shareholder of RFM Chartered Accountants.
Dr Cook (Governing Body Secondary Care Member) has no interests to declare.
Mr Costello (Lay Member) was the former Deputy Chief Executive of Wigan Council and is the Chair of Wigan & Leigh College from January 2017.
Mrs Jackson (Governing Body Nurse Member) is a Executive Director of Nursing & Quality at Bury CCG and Nurse Clinician Marple Cottage Surgery, Stockport.
Canon Smith (Lay Member) is the Diocesan Director of Education for the Church of England in the Diocese of Manchester. He is also a National Society Council member and a Manchester University General Council member.
Ms Southworth (Executive Director of Quality & Safety) has no interests to declare.
Mr Tate (Chief Finance Officer) is married to an employee of North West Boroughs NHS Foundation Trust; she is also a Governor and Audit Chair of St John Rigby Sixth Form College and Treasurer of the Wigan Branch of ‘Guide Dogs for the Blind’.
Caroline Kurzeja (Acting Chief Officer) is married to a board member of St Helens rota.
Other Member Practices
As the CCG are responsible for the co-commissioning of GP Primary Care Services, the note also includes the related parties of all member practices. The contractual (GMS/PMS/APMS) payments for services delivered are listed in the table below per practice and payments to GP federations are also listed.
Individual declarations within the narrative are only made where a practice has declared an additional interest and where the CCG has had business with the organisation.
Dr Anis is a GP shareholder for Cardium Limted.
Dr Chan is a member of the Medical Emergency Response Incident Team for North West Ambulance Services NHS Trust.
Dr Kreppel works for the Intermediate Care Physical team run by Bridgewater Community Foundation NHS Trust.
Dr Lears is employed by Wrightington, Wigan and Leigh NHS Foundation Trust.
Dr Mudugal is a Director of Health First.
Dr Ollerton is a member of Health First Federation
Dr Saxena is a member of Cardium Limited.
Dr J Van Spelde works at the out of hours service run by Bridgewater Community Foundation NHS Trust and GP Alliance.
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Dr Wan is a member of the Wigan Borough Federation.
Dr Anderson, Dr Craver, Dr Hadjidemetriou, Dr Humphreys, Dr Lancaster, Dr Mercer, Dr Morgan, Dr Munro, Dr Pollard, Dr Tankard, Dr Unwin, Dr Wan are members of Wigan Federated Healthcare.
Dr Gerlach, Dr Jacks, Dr Kelly, Dr Kirk, Dr Lokanadam, Dr Sukhavasai, Dr Vallabhaneni are members of the SWAN Cluster.
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Details of related party transactions in 2017-18 are as follows:
Of which Of which Payments made to Receipts from amounts owed amounts due Related Party Related Party to Related Party from Related (Expenditure) (Income) (Creditors) Party (Debtors) £000 £000 £000 £000 Health Education England 019 0 0 NHS England (including Local Area Team) 193 6,526 168 6,726 Blackpool Teaching Hospitals 169 0 0 12 Mersey Care NHS Trust 570 0 20 0 NHS Bury CCG 8 0 3 0 Lancashire Teaching Hospitals Foundation Trust 2,715 0 150 0 Northwest Boroughs NHS Foundation Trust 26,677 0 60 0 Bridgewater Community Healthcare Foundation Trust 38,827 0 562 76 Wrightington Wigan and Leigh NHS Foundation Trust 181,181 0 4,956 66 Salford Royal NHS Foundation Trust 16,609 0 443 0 Royal Bolton NHS Foundation Trust 17,582 0 288 112 County Durham And Darlington NHS Foundation Trust 2 0 0 0 East Lancashire Hospitals Trust 183 0 10 0 Community Healthcare Partnerships Ltd 4,935 0 86 0 Wigan Council 40,083 1,403 6,166 42 Wigan LMC 112 0 10 0 GP Practices (Including practice) P92001 Medicentre 719 0 51 0 P92002 Braithwaite Road Surgery 698 0 54 0 P92003 The Dicconson Group Practice 1,157 0 95 0 P92004 Hindley Health Centre 1,079 0 59 0 P92005 Dr Zaman & Partner 577 0 42 0 P92006 DR Ahmed & Partners 882 0 58 0 P92007 Old Henry Street Medical Practice 893 0 64 0 P92008 Bradshaw Street Medical Practice 1,345 0 109 0 P92010 Beech Hill Medical Practice 1,830 0 136 0 P92011 Sullivan Way Surgery 1,114 0 73 0 P92012 Dr Anis & Partner 564 0 33 0 P92014 Standish Medical Practice 1,664 0 140 0 P92015 Aspull Surgery 784 0 74 0 P92016 Pennygate Medical Centre 2,770 0 180 80 P92017 Shevington Surgery 1,805 0 156 0 P92019 Pemberton Surgery 1,298 0 150 0 P92020 Coldalhurst Lane Surgery 600 0 44 0 P92021 Newton Medical Practice 932 0 63 0 P92023 Brookmill Medical Centre 1,298 0 109 17 P92024 The Chandler Surgery 508 0 32 0 P92026 Longshoot Surgery 1,053 0 74 0 P92028 Elliott Street Surgery 661 0 58 0 P92029 Dr Trivedi & Partner 568 0 34 0 P92030 Wrightington Street Surgery 583 0 38 0 P92031 Dr Ullah Practice 439 0 21 0 P92033 The Surgery, Astley 623 0 42 0 P92034 Bryn Cross Surgery 792 0 50 0 P92035 Lilford Park Surgery 511 0 40 0 P92038 Winstanley Medical Practice 406 0 23 0 P92041 Ashton Medical Centre 1,043 0 78 0 P92042 Sevenbrooks Medical Centre 615 0 52 0 P92602 Foxleigh Surgery 407 0 29 0 P92605 Boothstown Surgery 780 0 48 0 P92607 Grasmere Surgery 1,068 0 70 0 P92615 Esa Surgery Ltd 331 0 22 0 P92616 Ince Surgery 469 0 41 0 P92619 Dr Sharma Practice 252 0 16 0 P92620 Lower Ince Surgery 515 0 37 0 P92621 Premier Health 50003418 P92623 Dr Maung & Partner 294 0 24 0 P92626 Meadowview Surgery 710 0 57 0 P92630 Dr Pal & Partner 358 0 32 0 P92633 Bee Fold Lane Surgery 285 0 15 0 P92634 Mesnes View Surgery 619 0 37 0 P92635 Dr Vasanth & Partner 287 0 16 0 P92637 Astley General Practice 345 0 22 0 P92639 Family Medical Practice 400 0 24 0 P92642 Marus Bridge Practice 726 0 94 0 P92643 Direct Access Surgery 10 0 0 P92646 Dr Khatri Surgery 415 0 25 0 P92647 Hawkley Brook 442 0 25 0 P92648 Slag Lane Medical Centre 373 0 31 0 P92651 Dr Xavier Surgery 645 0 39 0 P92652 Brooks Medical Practice 561 0 51 0 P92653 Shakespeare Surgery 384 0 27 0 Y00050 Dr Gupta Practice 374 0 28 0 Y02274 Intrahealth Platt Bridge 758 0 42 0 Y02321 Intrahealth Tyldesley 915 0 79 0 Y02322 Leigh Family Practice 1,982 0 160 32 Y02378 Dr Alistair Surgery 1,069 0 68 0 Y02885 Intrahealth Marsh Green 497 0 27 0 Y02886 Intra Health Family Practice 500 0 46 1 Y02887 Intrahealth Leigh Sports Village 320 0 12 0 Wigan Federation / Alliance 2,262 0 134 0 Clusters - SWAN 346 0 25 0 Clusters - LIGA (Cardium LTD) 312 0 50 0 Clusters - WIGAN 64 0 64 0 Clusters - TABA+ 229 0 25 0 Clusters - LEIGH 25 0 25 0
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During the year, the CCG has had a significant number of material transactions with entities for which the Department is regarded as the paarent department.
The most significant of these, not already listed above, are listed below.
Payments made to Receipts from Of which amounts Of which amounts due Related Party Related Party owed to Related from Related Party (Expenditure) (Income) Party (Creditors) (Debtors) £000 £000 £000 £000 North West Ambulance Service NHS Trust 11,680 0 159 0 St Helens & Knowsley Hospitals NHS Trust 4,706 0 0 0 Central Manchester University Hospitals NHS Foundation Trust (Pre Manchester University Hospitals Acquisition) 2,309 0 0 0 Manchester University NHS Foundation Trust 3,793 0 159 0 Warrington & Halton Hospitals NHS Foundation Trust 3,355 0 0 53 2016-17 Related Party transactions are listed below for comparative purposes
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2016-17 material transactions with entities for which the Department is reggarded as the parent department.
The CCG had no material transaction with other government departmentt and other central and local government bodies that have not been listed above.
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36 Events after the Reporting Period
There are no adjusting post balance sheet events on the financial statements of the CCG.
37 Financial Performance Duties
CCGs have a number of financial duties under the National Health Service Act 2006 (as amended).
Due to new reporting guidance the planned 2017/18 surplus of £9.494m has been offset by the surplus achieved in the prior year of £9.440m, leaving a surplus of £0.054m required to be held in-year. In addition to this the CCG was required to withhold 0.5% of its allocation for the national system reserve totalling £2.267m; and release a further £0.646m relating to savings made as a result of the national changes applied to Category M drug pricing.
The CCG’s performance against those duties was as follows:
£000
Revenue Resource Limit 521,430 Net Operating Resources (518,463) Surplus, 0.5% Withhold & Cat M 2,967
Note split Surplus 54 0.5% withhold 2,267 Cat M return 646 2,967
The table below shows the year on year comparable of the Financial Performance of the CCG.
NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance against those duties was as follows:
2017-18 2017-18 2016-17 2016-17
Target Performance Target Performance Expenditure not to exceed income 529,413 526,446 515,724 506,284 Capital resource use does not exceed the amount specified in Directions 0 0 0 0 Revenue resource use does not exceed the amount specified in Directions 521,430 518,463 510,854 501,414 Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0000
Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 0 Revenue administration resource use does not exceed the amount specified in Directions 7,106 6,555 7,090 6,397
Note: Expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amounts accounted for as received in the financial year (whether under provisions of the Act or from other sources, and included here on a gross basis).
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The CCG did not incur any capital expenditure throughout the financial year.
38 Losses and Special Payments
38.1 Losses
The total number of NHS clinical commissioning group losses and special payments cases, and their total value, was as follows:
Total Total Total Total Number Value of Number of Value of of Cases Cases Cases Cases 2017-18 2017-18 2016-17 2016-17 Number £'000 Number £'000 Administrative write-offs 2 4 0 0
Total 2 4 0 0
The above losses relate to the personal health budget bad debt and the loss of a low value of stamps.
The CCG did not have any special payments in 2017-18.
The CCG did not have any losses or special payments in 2016-17.
127 Page 204 MEETING: Governing Body Item Number: 9.1
DATE: 26 June 2018
REPORT TITLE: Finance Report Month 02 (May)
CORPORATE OBJECTIVE 5. Functioning as an organisation that consistently ADDRESSED: delivers its statutory duties and participates fully in the Greater Manchester Health and Social Care Partnership.
REPORT AUTHOR: Paul McKevitt
PRESENTED BY: Craig Hall
RECOMMENDATIONS/DECISION REQUIRED: Information
EXECUTIVE SUMMARY
Executive summary is contained within the Finance Report (Page 1)
Contents: Executive Summary (Page 1) Financial position and Key Messages (Pages 2 to 5) QIPP Key messages (Page 6) Risk Register (Page 7) Working Balances (Pages 8)
FURTHER ACTION REQUIRED: Information
EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.
Page 205 Finance Report Month 02 (May)
Executive Summary
Cumulative Surplus Profiled QIPP 2018/19 - Target and Achievement £2.5m £30m £2.0m £25m £1.5m £1.0m £20m £0.5m £0.0m £15m -£0.5m Statutory Duty to Break Even -£1.0m £10m
Page 206 Page -£1.5m £5m -£2.0m -£2.5m £0m 8 8 8 9 8 8 8 8 9 9 8 8 8 8 8 9 8 8 8 8 9 9 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ------l r r t l c v y g r r t n p b n c v y g n p b n u c a p u a c e o u a e e a p u J a e o u e e a u J J J O A S F J J D A O A N S F M D A N M M M Forecast Cumulative Surplus Confirmed Achievement Estimated Achievement Cumulative Target
Surplus: Financial planning assumes a surplus of £12.407m. This is simply a return of the surplus achieved in 2017/18. However, these funds have not actually been returned to the CCG and have instead been retained centrally by NHS England. The CCG is therefore required to achieve a break-even position through its internal reporting in order to achieve its statutory financial duties.
The year-to-date (YTD) surplus of £0.0m is in line with the required surplus on a statutory basis at month 02. At month 02 the CCG’s annual in-year allocation is £519.6m. The CCG is forecasting to achieve its statutory duties in 2018/19 with a break-even year end forecast position. QIPP At this early stage of the financial year the CCG does not have data available to identify actual YTD QIPP achievement. At month 02 the CCG is assuming achievement of QIPP in line with agreed plans. This will be adjusted in future months as data becomes available to verify actual achievement. 1 | Page Financial Position & Key Messages
Key Messages:
Overview This financial report represents the first update of the 2018/19 financial year. At this early stage of the year there is limited data available to assess financial performance. This initial report will instead focus on the risks to achievement of its required statutory financial duties and QIPP delivery. The CCG submitted an updated financial plan to Greater Manchester Health & Social Care Partnership (GMH&SCP) on the 26th April 2018. Within these plans the CCG identified the requirement for QIPP savings of £29.577m in order to meet its required statutory duties. The £29.577m QIPP is equivalent to 5.7% of the CCG allocation and represents the largest value across Greater Manchester CCGs. It is joint second in percentage terms and subsequently it is also one of the largest QIPP values across the North of England. QIPP delivery will clearly prove a challenge given the significant value involved. To meet this challenge the CCG has worked up a delivery plan which has been discussed and ratified through previous Governing Body meetings.
Page 207 Page The CCG has put in place a weekly review chaired by the Deputy Accountable Officer and with membership consisting of CCG Directors and Local Authority Senior Management Team (SMT). This meeting reviews and challenges progress on identified schemes, each of which is supported by individual Project Initiation Documents (PIDs) that outline the planned phasing of delivery of savings. It also seeks to identify additional schemes should mitigations be required. There is also a locality wide QIPP group, chaired by the CCG’s Audit Committee chair to ensure the locality works to deliver the required level of sustainability. The seven, clinically led Service Delivery Footprints are central to the operational delivery of a significant element of the identified schemes and they are actively engaged in these schemes as members of the CCG’s Governing Body. This is supported via PIDs, individual delivery plans and data packs that highlight through the Right Care methodology and a risk stratification process. The on-going, in-year reporting will build upon the experiences of the Local Authority in developing reporting mechanisms that are appropriate for monitoring delivery. This reporting will also meet the in-year requirements of NHS England and GMH&SCP. As part of the financial planning process the CCG reviewed its net risk in some detail based upon prior year experience and the maturity of its identified QIPP schemes. Some of the key risks identified include but are not exhaustive: Delivery of the identified QIPP schemes; Growth in demand for acute services operating on a payment per activity basis is significantly above anticipated levels; Growth in demand for individual packages of care is significantly above anticipated levels;
2 | Page Unanticipated national increases to primary care prescribed drugs costs as seen in 2017/18; and System wide costs reductions are not achieved which will impact on the CCG’s ability to reduce its costs both in-year and in the future thus impacting on the locality’s long term sustainability. The CCG Senior Leadership team has discussed potential mitigations against these risks and have formed a view on what actions could be taken. The mitigations identified to date include: Adoption of Local Authority ‘Fresh Look’ approach to budgets. The CCG Finance Team during June will undertake a fundamental budget review on all budget lines following the Local Authorities process and principles; Assista – Use of this external company to work with the CCG contracts team to reduce Payment by Results (PbR) activity in PbR contracts; A review of off-the-shelf referral gateway solutions; and Make full use of the QIPP Phase 4 support work that has been given to the CCG from NHS England, particularly in the area of Consultant to Consultant referrals, and self-referrals to Consultants, both of which are high within the Wigan Borough. In 2018/19 the CCG is required to achieve a surplus of £12.407m which represents the level of saving achieved in 2017/18 and is approximately 2.3% of CCG allocations.
Page 208 Page Financial planning assumed a surplus of £12.407m. This is the return of the £12.407m surplus achieved in 2017/18. These funds have not actually been returned to the CCG and have instead been retained centrally by NHS England. The CCG therefore does not have access to these funds should they be required in-year. The CCG is therefore required to achieve a break-even position through its internal in-year reporting in order to achieve its statutory financial duties. It is the CCGs understanding that outside of GMH&SCP have only had to achieve a 1.0% surplus against allocations, so the additional requirement has resulted in a significant additional challenge for the CCG and is an added factor in the reason for the significant QIPP value required. As a further mitigation, the CCG has requested support through GMH&SCP for pressure to be placed on NHS England to reduce this surplus requirement down to 1.0% in line with CCGs nationally. This would free up resource that could be offset against the QIPP target. Steve Wilson, Executive Lead – Finance & Investment at GMH&SCP wrote to the CCG Chief Finance Officer (CFO) on the 10th May 2018 requesting that given the significant QIPP requirement and inherent level of risk an in-year Improvement Plan be produced. A personal statement from the CFO was also requested which gave an assessment of deliverability of the QIPP programme and mitigations. A response was provided from the CCG by the 31st May 2018 deadline. However, the CCG has requested an additional 14 days to provide the personal assurance statement given the appointment on 1st June 2018 of a new CCG Chief Officer, and a new CCG Interim Chief Finance Officer. As part of the locality approach to refresh its 3 year Wigan Locality plan, partner organisations are required to submit updated financial plans to GMH&SCP covering the period 2018/19 through to 2020/21 in order to provide an updated ‘roll-up’ financial position for the locality as a whole. The deadline to submit updated plans is the 15th June 2018. Once all organisations have submitted, a review of the locality position will be undertaken by system leaders to ensure a clear and transparent understanding and to ensure the locality is on track to achieving financial sustainability by the financial year 2020/21.
3 | Page The CCG is still awaiting receipt of the £6.5m cash agreed with GMH&SCP in 2017/18 in respect of the Transformation Fund Phase 2 bid. Should this not be received by the CCG then this will significantly increase the QIPP requirement.
In Month Position At this early stage of the financial year the CCG has limited data available to assess the financial performance. At month 02 the CCG has therefore assumed costs are in line with financial plans.
Key Conclusions on Financial Position It is clear from the risks and challenges identified above that this will be another significantly challenging year for the CCG and the wider health and social care economy. It is imperative that system wide solutions are sought to close the financial gap as given the significant financial challenges across the system it is no longer possible to achieve long term financial sustainability without the joint support of system partners. Page 209 Page
4 | Page Year to Year to Full Year Full Year Wigan Borough CCG - Summary Financial Position at Month 2 Period Date Plan Date Actual Forecast Plan £000s £000s £000s £000s
Acute Services May-18 44,200 44,200 252,411 252,411
Community Health Services May-18 6,511 6,511 37,972 37,972 s t
e Continuing Care May-18 5,405 5,405 31,982 31,982 g d u
B Mental Health May-18 6,280 6,280 38,945 38,945
e m
m Other May-18 3,727 3,727 22,261 22,261 a r Page 210 Page g o
r Prescribing May-18 10,424 10,424 62,850 62,850 P
Primary Care Contracts May-18 9,778 9,778 59,024 59,024
Allocated Committed Resources May-18 0 0 7,893 7,893
Running Costs May-18 993 993 6,280 6,280
Total CCG Budgets May-18 87,318 87,318 519,617 519,617
Total In-Year RRL May-18 87,318 87,318 519,617 519,617
Surplus/Deficit May-18 0 0 0 0
Note on Historic Surplus (Retained centrally by NHS England): Total Notified Historic RRL May-18 2,067 2,067 12,407 12,407
Historic Surplus/Deficit May-18 -2,067 -2,067 -12,407 -12,407
5 | Page QIPP
Key Messages The CCG has worked up a QIPP plan which has been discussed and ratified through the Governing Body and the delivery of the QIPP agenda has been identified as the number one priority area for the CCG in 2018/19. The phasing of QIPP schemes has been agreed by scheme lead directors and ratified through the QIPP group and this will be used to monitor progress against schemes throughout the financial year. The monitoring and reporting of QIPP schemes is being established and regular reporting of QIPP achievement will be included within the financial report and taken monthly through the QIPP group. This on-going, in-year reporting will build upon the experiences of the Local Authority in developing reporting mechanisms that are appropriate for monitoring delivery. This reporting will also meet the in-year requirements of NHS England and GMH&SCP. The seven, clinically led Service Delivery Footprints are central to the operational delivery of a significant element of the identified schemes and they are actively engaged in these schemes as members of the CCG’s Governing Body. This is supported via PIDs, individual delivery plans and data packs that highlight through the Right Care methodology and a risk stratification process. SDF members and their support teams have been meeting regularly to take forward the work at pace and are seeking areas of potential ‘quick wins’ by Page 211 Page targeting areas such as frequent attenders to the urgent care system, patients at high risk of admission, and referral variation across general practice. The CCG recently held a QIPP workshop with colleagues from both the CCG and Local Authority to ensure a consistent understanding of the QIPP agenda and its impacts on the wider health and social care system. As we are already approaching the end of quarter one, the work on QIPP is being undertaken at pace as the achievement of QIPP savings is crucial if the CCG is to achieve it statutory financial duties.
In Month Position At this early stage of the financial year the CCG has limited data available to assess the financial performance of QIPP schemes. In month 02 reporting the CCG has assumed savings are in line with agreed plans. These will be adjusted once actual performance is known.
Key Conclusions The CCG is fully focussed on the delivery of its QIPP schemes and the identifications of further mitigations should they be required. These are crucial to the achievement of its statutory financial duties and long term sustainability.
6 | Page Wigan Borough CCG Finance 2018/19 - Risk Register Finance Risk Register as at Month 02 Extreme Risk 15 - 25 Immediate Action Required by Director – Reportable to the Board High Risk 8 - 12 Attention Needed By Senior Management – Reportable to Board Committee Medium Risk 4 - 6 Management by Line or Service Manager Low Risk 1 - 3 Manage By Routine Policies/Procedures/Processes/Systems
Likelihood Impact Risk Score Control Approach Risk Description Existing Control - where risk is medium, high or extreme. Risk Action Plan Outline Target Date (1-5) (1-5) (L x I) Type Type
Regular monitoring and reporting to the Governing Body of Intrinsic/E Identification of a contingency plan - stop/delay/ other actions to reduce Not achieving overall financial balance (break even). 4 5 20 Proactive financial position - monthly. Non-ISFE returns and meetings with Ongoing xtrinsic expenditure in the system. Work with locality stakeholders. GMH&SCP. Regular QIPP meetings held. Robust regular monitoring and Non achievement of QIPP schemes and also failure to mitigate reporting of schemes in all areas through appropriate Where QIPP schemes slip or do not deliver then action plans are being 4 5 20 Extrinsic Proactive Ongoing with additional schemes. governance structures. Ensure schemes agreed for any developed to mitigate the resulting financial pressure at the earliest stage. unidentified QIPP and action plans put in place. The maximum cash drawn down will not be sufficient to allow for all cash payments required in quarter 4 if CCG QIPP schemes are not 4 4 16 Extrinsic Proactive Monitor the cash on a monthly basis. Prioritise cash payments in quarter 4. Ongoing achieved. The finance team undertakes regular investigation of significant variances Increased patient demand/usage and complexity for acute The CCG regularly monitors, investigates and reports on and movements in activity/finance which should highlight such issues. Early healthcare at trusts operating under on a payment for activity basis 3 4 12 Extrinsic Proactive significant increases and movements in its acute contracts high-level data analysis would also potentially pick up on such issues. Ongoing causes increased costs and growth above contracted levels, which CCG QIPP schemes are focussed on activity reductions. However there remains a risk that expenditure is only identified adversely impacts on the financial position of the CCG in 2018/19. retrospectively. The finance team undertakes regular investigation of significant variances Increased patient demand/usage and complexity for packages of The CCG regularly monitors, investigates and reports on and movements in activity/finance which should highlight such issues. Early healthcare such as Continuing Healthcare or Mental health 3 4 12 Extrinsic Proactive significant increases and movements in its packages of care high-level data analysis would also potentially pick up on such issues. Ongoing packages of care. This would adversely impact on the financial budget areas. However there remains a risk that expenditure is only identified position of the CCG in 2018/19. retrospectively.
Page 212 Page Primary Care and Community Services are not ready or have not Review existing funds to schemes to see if Stop, delay or other actions can Regularly monitor and report progress against transformational got sufficient capacity to deal with activity movements from 3 4 12 Extrinsic Proactive mitigate the gap. Engagement with locality stakeholders to manage capacity Ongoing schemes involving all stakeholders. Secondary Care as part of system wide transformation. shifts. The £6.5m Transformational funding is not provided by GMH&SCP Regular communications with GMH&SCP to ensure funding is to the CCG resulting in a significant increase to the required 2 5 10 Extrinsic Proactive Seek additional QIPP schemes and other mitigations. Ongoing received. 2018/19 QIPP. Breakdown in stakeholder relationships within the locality resulting Regular review of progress and identification of issues, delays 2 5 10 Extrinsic Proactive Use of 3rd parties to arbitrate between affected organisations. Ongoing in non achievement of the system wide transformation. etc., to ensure corrective action can be taken. The funding received by the CCG for the changes in the Highlight any pressures relating to specialist services changes and ensure The CCG regularly monitors, investigates and reports on commissioner responsibility (for example specialist services 3 3 9 Extrinsic Proactive any financial pressure is funded via an adjustment to allocations between Ongoing significant increases and movements in its acute contracts. transfers) does not match the actual financial impact. Commissioners through to GMH&SCP & NHS England. The finance team undertakes regular investigation of significant variances The CCG regularly monitors, investigates and reports on and movements in activity/finance which should highlight such issues. Early Unanticipated national increases to primary care prescribed drugs Prescribing expenditure and monitors the impact of changes in 2 4 8 Extrinsic Proactive high-level data analysis and close liaison with the CCG Medicines Ongoing cost such as increased NCSO or Category M drug pricing. national pricing. Engagement with GM Medicines Management Management team would also potentially pick up on such issues. However Group (GMMMG). there remains a risk that expenditure is only identified retrospectively. Work closely with our services providers, Shared Business Services (SBS) and Wrightington Wigan and Leigh Foundation Major financial services supplier failure, particularly SBS and Trust (WWL), to ensure they have contingencies in place in the Continue to review contingency plans as part of SLA monitoring and as part payroll as the CCG would not be able to pay suppliers and staff nor 2 4 8 Extrinsic Reactive Ongoing event of failure in the systems. Detailed contingency plans are in of SBS service auditor reporting. efficiently report its financial position. place and in the event of payroll failure the CCG could pay all staff manually. Provide staff with the time to develop skills and opportunities to Provide staff with the time to develop skills and opportunities to be promoted be promoted through the organisation. Each member of staff through the organisation. Each member of staff has an annual PDR and High finance, performance and commissioning staff turnover. 2 3 6 Intrinsic Proactive Ongoing has an annual PDR and training plan and are committed to staff training plan and are committed to staff development. Also provide staff a development. Also provide staff a work life balance. work life balance. The CCG monitors performance monthly. Any fall in The CCG monitors performance monthly. Any fall in performance is examined performance is examined immediately and causes identified. immediately and causes identified. These can be internal to the CCG e.g. The CCG is unable to pay its invoices within the Better Payment These can be internal to the CCG e.g. cash issues or internal 2 3 6 Intrinsic Proactive cash issues or internal process, but may also be due to issues at SBS. Action Ongoing Practice Code targets, either due to cash flow or internal process. process, but may also be due to issues at SBS. Action taken taken would depend on the cause of the issue but would always be followed would depend on the cause of the issue but would always be up and corrective action. followed up and corrective action.
7 | Page Working Balances
Wigan Borough CCG - 0-30 Days 31-60 Days 60-90 Days 90+ Days Total Not Due Wigan Borough CCG - Summary Financial Position at Month 2 Summary Financial Overdue Overdue Overdue Overdue Overdue £000 Position at Month 2 £000 £000 £000 £000 £000
Better Payments Practice Code (BPPC) – All NHS organisations are required to pay 95% of their valid invoices by value and Debtors by volume within 30 days of receipt.
100 NHS 0 154 75 0 0 229 99 98 e c 97 Non NHS 15 0 0 0 4 4 n a i l 96 p m
o 95 C
e Total Debtors 15 154 75 0 4 233 g 94 a t n
e 93 c r
e 92 P Creditors 91 90 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR NHS 19,112 0 0 4,573 0 4,573
APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Value % 100 100 Non NHS 1,049 0 0 0 0 0 Number % 100 99 Target % 95 95 95 95 95 95 95 95 95 95 95 95 Total Creditors 20,161 0 0 4,573 0 4,573 Page 213 Page
Wigan Borough CCG - Summary Financial Position at Month 2 Commentary
Planned Cash Drawdown vs Actual 50,000 In month 2 Wigan Borough CCG have achieved above the 95% Better Payment Practice Code target for both value and volume of invoices. The CCG is on course to reach its year end compliance target. 48,000
46,000 Wigan Borough CCG has £248k worth of debtors as at M2 of which £233k are overdue. The CCG has one debt Planned of £4k that has been passed for external recovery as per the standard debt collection process. The CCG does 44,000 £m not foresee any issues with the remaining debtors. Actual £m 42,000 The CCG currently has one outstanding creditor that relates to Wrightington, Wigan and Leigh Foundation 40,000 Trust. The amount will be paid to the trust on receipt of the allocation adjustment for 17/18 Greater Manchester transformation funding. 38,000 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR The remaining maximum cash drawdown at M2 is £428m. While the April 18 drawdown was above plan, this Planned £m 45,266 43,066 41,566 44,566 43,066 41,566 44,605 43,105 41,605 44,605 43,097 45,703 Actual £m 47,952 42,425 included amounts to satisfy additional year end creditors. The CCG have drawn down less funding in M2 to offset this pressure and foresee no issues, at this stage, with cash requirements exceeding the maximum amount specified by NHS England.
8 | Page This page is intentionally left blank MEETING: Governing Body Item Number: 9.2
DATE: 26th June 2018
REPORT TITLE: Performance Report: 2018/19 M02
CORPORATE OBJECTIVE ADDRESSED: All
REPORT AUTHOR: Caroline Kurzeja
PRESENTED BY: Caroline Kurzeja
RECOMMENDATIONS/DECISION To note the contents of the paper. REQUIRED:
EXECUTIVE SUMMARY
The 2018/19 Performance Report includes all key CCG performance measures contained within the Next Steps On The Five-Year Forward View planning guidance.
FURTHER ACTION REQUIRED:
EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.
Page 215 This page is intentionally left blank Wigan Borough CCG Performance Page 217 Page Report
Month 2 2018/19
Produced by Wigan Borough CCG Performance / BI Team
Page 1 Key Highlights
Urgent Care Planned Care
WWL A&E overall (Type 1 & 3) performance is below (worse 94.27% Performance against 18Wks RTT waiting times measure 93.99% than) the 95% standard, but above the 90% improvement target May 2018 continues to be above the 92% standard April 2018
Year-to-date (April to May) attendances (Type 1 & 3) have 718 The number of people waiting for treatment in April 5.02% increased compared to the same period last year Increase 2018 has increased when compared to April 2017 Increase
Leigh Walk-In-Centre performance fell below standard on 9 96.05% Diagnostic waiting times performance is above 1.29% days during May 2018. Monthly performance was achieved May 2018 (worse than) the 1% standard for a 5th consecutive month April 2018
Cancer Care Mental Health Page 218 Page
Performance against Cancer Seen Within 14 Days measure 96.54% Year-to-date (Apr 17 to Feb 18) IAPT Access Rate 17.36% continues to be above (better than) the 93% standard April 2018 is better than the year-to-date plan (15.40%) Apr 17 - Feb 18
No. of patients seen following a GP referral in April 2018 are 254 IAPT Recovery Rate performance is above (better 56.63% showing an increase when compared to April 2017 Increase than) the 50.00% standard for a 7th consecutive month February 2018
GP Referral To Treatment Within 62 Days performance 89.41% Year-to-date (Apr 17 to Dec 17) C&YP Mental Health Access 10.55% continues to be above (better than) the 85% standard April 2018 Rate is below (worse than) the year-to-date plan (24.00%) (Q1 - Q3)
Quality of Care Community Care
One MRSA Infection has been reported for Wigan 1 Year-to-date (Apr 17 to Feb 18) e-Referral Service Utilisation 57.61% Borough CCG patients during the month of April 2018 April 2018 Rate is below the ambition of 100% by the end of Q2 18/19 Apr 17 - Feb 18
WBCCG Clostridium difficile infection objective for 18/19 is 9 No. of Patients with a Personal Health Budget has increased in 19 80. A total of 9 C-Diff infections were reported in April 2018 April 2018 in 2017/18 (100) compared to 2016/17 (81) Increase
There have been 2 Mixed Sex Accommodation breaches 2 CYP Wheelchair 18 Wk Waits 17/18 ambition is 92% increasing 96.43% reported during April 2018 for WBCCG patients April 2018 to 100% in 18/19. Year to date 17/18 performance is 92.86% Q3 2017/18
Page 2 Performance Indicators
Ref. Urgent Care Target Current Period Previous Period Yr To Date Trend
EB5 A&E Waits: Within 4 Hours All Patients At WWL 95.00% May-18 94.27% n Apr-18 73.61% n 84.40% n EB5a A&E Attendances: All Patients At WWL Lower May-18 8,187 Apr-18 7,487 15,674 EB5b Walk In Centre Waits: Within 4 Hours At Leigh WIC 95.00% May-18 96.05% n Apr-18 97.76% n 96.88% n EB15a Ambulance Response: Category 1 Mean Time Across NWAS 07:00 May-18 08:10 n Apr-18 07:51 n 08:01 n EB15b Ambulance Response: Category 2 Mean Time Across NWAS 18:00 May-18 24:46 n Apr-18 23:38 n 24:13 n EBS7 Ambulance Handover: Over 30 Minutes At WWL Lower May-18 13.68% Apr-18 30.14% 21.67% EBS8 Ambulance Crew Clear: Over 30 Minutes At WWL Lower May-18 0.74% Apr-18 0.40% 0.57% EJ1 Delayed Transfer Days: Wigan LA Residents At All Providers Lower Apr-18 291 Mar-18 341 291
Ref. Planned Care Target Current Period Previous Period Yr To Date Trend Page 219 Page EB3 18 Weeks RTT: Incomplete Pathways 92.00% Apr-18 93.99% n Mar-18 93.46% n 93.99% n EBS4 18 Weeks RTT: Patients Waiting >52 Weeks 0 Apr-18 2 n Mar-18 2 n 2 n EM19 18 Weeks RTT: Non-Admitted Treatments Lower Apr-18 5,731 Mar-18 6,583 5,731 EM18 18 Weeks RTT: Admitted Treatments Lower Apr-18 1,681 Mar-18 1,814 1,681 EB4 Diagnostics: 6+ Week Waiters 1.00% Apr-18 1.29% n Mar-18 1.11% n 1.29% n
Ref. Cancer Care Target Current Period Previous Period Yr To Date Trend
EB6 Cancer Waits: Seen Within 14 Days Of GP Referral 93.00% Apr-18 96.54% n Mar-18 97.04% n 96.54% n EM16 Cancer: Patients Seen Following GP Referral Higher Apr-18 984 Mar-18 1,048 984 EB7 Cancer Waits: Breast Symptoms Seen In 14 Days 93.00% Apr-18 85.98% n Mar-18 93.15% n 85.98% n EB8 Cancer Waits: Treatment Within 31 Days Of Diagnosis 96.00% Apr-18 100.00% n Mar-18 99.20% n 100.00% n EB9 Cancer Waits: Subsequent Surgery In 31 Days 94.00% Apr-18 100.00% n Mar-18 96.30% n 100.00% n EB10 Cancer Waits: Subsequent Drug Treatment In 31 Days 98.00% Apr-18 100.00% n Mar-18 100.00% n 100.00% n EB11 Cancer Waits: Subsequent Radiotherapy In 31 Days 94.00% Apr-18 100.00% n Mar-18 100.00% n 100.00% n EB12 Cancer Waits: GP Referral To Treatment In 62 Days 85.00% Apr-18 89.41% n Mar-18 93.55% n 89.41% n EM17 Cancer: Patients Treated Following GP Referral Higher Apr-18 85 Mar-18 62 85 EB13 Cancer Waits: NHS Screening RTT In 62 Days 90.00% Apr-18 100.00% n Mar-18 100.00% n 100.00% n EB14 Cancer Waits: Consultant Upgrade To Treatment In 62 Days Higher Apr-18 92.68% Mar-18 93.18% 92.68% EA10 One Year Survival Rate: All Cancers (Annual Data Collection) Higher 2015 71.7 Mar-18 70.7 71.7
Page 3 Performance Indicators `
Ref. Mental Health Target Current Period Previous Period Yr To Date Trend
EAS1 Dementia: Diagnosis Rate 66.70% Apr-18 70.30% n Mar-18 72.14% n 70.30% n EA3 IAPT: Access Rate ### 16.80% Feb-18 1.56% n Jan-18 1.93% n 17.36% n EAS2 IAPT: Recovery Rate 50.00% Feb-18 56.63% n Jan-18 52.13% n 53.86% n EH1 IAPT: 6 Week Waits 75.00% Feb-18 98.82% n Jan-18 100.00% n 99.78% n EH2 IAPT: 18 Week Waits 95.00% Feb-18 100.00% n Jan-18 100.00% n 100.00% n EH14 Psychosis: First Treated In 2 Weeks 50.00% Apr-18 100.00% n Mar-18 100.00% n 100.00% n ER1 Learning Disabilities/Autism: Number In Inpatient Care 7 Mar-18 7 n Feb-18 8 n 7 n EBS3 Care Programme Approach: 7 Day Follow-Up 95.00% Q4 17/18 97.87% n Q3 17/18 97.25% n 97.05% n EH9 C&YP Mental Health: Access Rate 30.00% Q3 17/18 3.52% n Q2 17/18 3.75% n 10.55% n EH10 C&YP Routine Eating Disorders: 4 Week Waits 95.00% Q4 17/18 50.00% n Q3 17/18 50.00% n 40.00% n
Page 220 Page EH11 C&YP Urgent Eating Disorders: 1 Week Waits 95.00% Q4 17/18 40.00% n Q3 17/18 100.00% n 58.33% n
Ref. Quality of Care Target Current Period Previous Period Yr To Date Trend
EBS6 Urgent Operations: Cancelled For Second Time 0 Apr-18 0 n Mar-18 0 n 0 n EAS4 Healthcare Associated Infections: MRSA 0 Apr-18 1 n Mar-18 0 n 1 n EAS5 Healthcare Associated Infections: Clostridium Difficile 80 Apr-18 9 n Mar-18 10 n 9 n EBS1 Mixed Sex Accommodation: Breaches 0 Apr-18 2 n Mar-18 1 n 2 n EBS2 Cancelled Operations: Not Treated In 28 Days Lower Q4 17/18 5.99% Q3 17/18 3.60% 5.36%
Ref. Community Care Target Current Period Previous Period Yr To Date Trend
CC1 Pathfinders: Referrals Higher May-18 237 Apr-18 308 545 CC1a Pathfinders: Sent To A&E Lower May-18 8.86% Apr-18 7.14% 7.89% EN1 Personal Health Budgets: Number Of Patients Higher Q4 17/18 89 Q3 17/18 85 100 EO1 C&YP Wheelchairs: 18 Week Waits 92.00% Q3 17/18 96.43% n Q2 17/18 90.32% n 92.86% n EO2 GP Out Of Hours: Attendances Higher Apr-18 1,416 Mar-18 1,521 1,416 EP1 e-Referral Service: Utilisation Rate 79.00% Feb-18 57.61% n Jan-18 65.06% n 57.76% n QP3 GP Services: Extended Access 100.00% 2016 77.86% n 2015 77.25% n 77.86% n
Where a national or local standard/target exists, this is shown in the target column. For other indicators, the target column shows where a favourable trend would be higher or lower.
Page 4 Glossary of NHS Performance Indicators
Indicator Description Data Source Urgent Care Percentage of A&E attendances at WWL (Type 1 & 3), where the patient spent 4 hours or less in A&E from arrival to NHS England A&E Waits: Within 4 Hours at WWL transfer, admission or discharge (All Patients). A&E Attendances: Total at WWL Number of A&E attendances (Type 1 & 3) at WWL (All Patients). NHS England Walk In Centre Waits: Within 4 Hours Number of attendances at Leigh Walk In Centre (All Patients). Leigh Walk In Centre Ambulance Response: Category 1 Calls Calls from people with life threatening illnesses or injuries - Time critical life-threatening event needing immediate NHS England Across NWAS intervention and/or resuscitation. Example – Cardiac or respiratory arrest; airway obstruction; ineffective breathing; unconscious with abnormal or noisy breathing; hanging. Mortality rates high, a difference of one minute in response time is likely to affect outcome and there is evidence to support the fastest response. NWAS performance is based upon the (mean) average time (7 mins) for response to all incidents. Ambulance Response: Category 2 Calls Emergency Calls - Potentially serious conditions (ABCD problem) that may require rapid assessment, urgent on- NHS England Across NWAS scene intervention and/or urgent transport. Example – Probable MI, serious injury, stroke, sepsis, major burns, fits, unconscious with normal breathing. Mortality rates are lower; there is evidence to support early dispatch. NWAS performance is based upon the (mean) average time (18 mins) for response to all incidents.
Page 221 Page Ambulance Handover: Over 30 Minutes At Percentage of handover delays of longer than 30 minutes. Handover should be fully completed and the patients NWAS Portal WWL physically transferred onto hospital apparatus. Ambulance apparatus must have been returned, enabling the ambulance crew to leave the department (All Patients). Ambulance Crew Clear: Over 30 Minutes Percentage of crew clear delays of longer than 30 minutes. Time at which crew/vehicle should be ready for the next NWAS Portal At WWL call. Delayed Transfer Days: Wigan LA Number of delayed transfers of care (delayed days) by Local Authority (attributable to either NHS, social care or both) NHS England Residents At All Providers per month. A delayed transfer of care occurs when a patient is ready for transfer from a hospital bed, but is still occupying such a bed. A patient is ready for transfer when: (a) a clinical decision has been made that the patient is ready for transfer AND (b) a multi-disciplinary team decision has been made that the patient is ready for transfer AND (c) the patient is safe to discharge/transfer. Planned Care 18 Weeks Referral To Treatment (RTT): Percentage of incomplete pathways within 18 weeks for WBCCG patients at all providers on incomplete pathways at NHS England Incomplete Pathways the end of the period. Operational standards state that the percentage of incomplete pathways within 18 weeks should equal or exceed 92%. 18 Weeks Referral To Treatment (RTT): Total number of WBCCG patients waiting longer than 52 weeks for treatment (All providers). NHS England Patients Waiting >52 Weeks 18 Weeks Referral To Treatment (RTT): Total number of WBCCG admitted and non-admitted patients treated (All providers). NHS England Total Patients Treated: Admitted and Non-Admitted Diagnostics: 6+ Week Waiters Percentage of WBCCG patients waiting 6 weeks or more for a diagnostic test and the number of diagnostic tests NHS England carried out (All Providers).
Page 5 Glossary of NHS Performance Indicators
Indicator Description Data Source Cancer Care Cancer 14 Day Waits: Percentage/number of WBCCG patients seen within two weeks of an urgent GP referral for suspected cancer (All Total seen and Seen Within 14 Days Of An Providers). NHS England Urgent GP Referral: Cancer 31 Day Waits: Percentage of WBCCG patients receiving first definitive treatment within one month (31 days) of a cancer diagnosis Percentage Treated Within One Month of a and the percentage of patients receiving subsequent treatment for cancer with 31 days (All Providers). NHS England Cancer Diagnosis Cancer 62 Day Waits: Percentage of WBCCG patients receiving first definitive treatment within two months (62 days) of a an urgent GP NHS England Percentage Treated Within Two Months of referral for suspected cancer. Percentage of WBCCG patients receiving first definitive treatment for cancer within 62 an Urgent GP Referral days of referral from a NHS Cancer Screening Service. Percentage of patients receiving first definitive treatment for cancer within 62 days of a consultant decision to upgrade their priority status (All Providers)
Cancer One Year Survival Rate All One-year net survival for adults diagnosed with cancer (aged 15 - 99 years), 95% confidence intervals. NHS Digital Cancers:
Page 222 Page Mental Health Diagnosis rate for people aged 65 and over, with a diagnosis of dementia recorded in primary care, expressed as a NHS Digital Dementia: Diagnosis Rate: percentage of the estimated prevalence based on GP registered populations
IAPT Access Rate Proportion of people that enter treatment against the level of need in the general population; i.e. the proportion of NHS Digital people who have depression and/or anxiety disorders who receive phsychological therapies (All Providers).
IAPT: Recovery Rate The proportion of people who complete treatment who are moving to recovery. Wigan Borough CCG Patients (All NHS Digital Providers). IAPT: 6 & 18 Week Waits: The proportion of people that wait 6 & 18 weeks or less from referral to entering a course of IAPT treatment against NHS Digital the number of people who finish a course of treatment in the reporting period. Wigan Borough CCG Patients (All Providers). Early Intervention in Psychosis (EIP) Access and waiting time standard requires that more than 50% of people experiencing first episode psychosis will be NHS England treated with a NICE recommended package of care within 2 weeks of referral. % of WBCCG patients receiving treatment (All Providers). Learning Disabilities/Autism: Number In The number of people registered with the CCG who have a learning disability and/or autistic spectrum disorder that WBCCG Commissioning Inpatient Care are in inpatient care for mental and/or behavioural healthcare needs. Dept
Care Programme Approach: 7 Day Follow- The proportion of patients on Care Programme Approach discharged from inpatient care to their place of residence, NHS England Up: who receive a follow up within 7 days of discharge.
C&YP Mental Health: Access Rate The proportion of children and young people aged 0-18, with a diagnosable mental health condition, receiving NHS England treatment by NHS funded community services in the reporting period. C&YP Routine Eating Disorders: 1 & 4 The proportion of children and young people with eating disorders (urgent cases) that wait 1 week or less from referral NHS England Week Waits: to start of NICE-approved treatment. The proportion of children and young people with eating disorders (routine cases) that wait 4 weeks or less from referral to start of NICE-approved treatment.
Page 6 Glossary of NHS Performance Indicators
Indicator Description Data Source Quality of Care Number of urgent operations that are cancelled by WWL for non-clinical reasons, which have already been previously NHS England Urgent Operations Cancelled For A cancelled once for non-clinical reasons (All Patients). Second Time
Healthcare Associated Infections: MRSA Total number of cases of Methicillin-resistant Staphylococcus aureus (MRSA), by CCG. PH England
Healthcare Associated Infections: Total number of infections for patients aged 2 years and over, by CCG PH England Clostridium Difficile
All providers of NHS funded care are expected to eliminate mixed-sex accommodation, except where it is in the NHS England Mixed Sex Accommodation (MSA) overall best interest of the patient . The number of occurrences of unjustified mixing in relation to sleeping Breaches accommodation (breaches) must be resported for each patient affected. Cancelled Operations Not Treated In 28 Percentage of patients who have operations cancelled, on or after the day of admission (including the day of surgery), NHS England Days for non-clinical reasons . Patients should be offered another binding date with 28 days, or the patient's treatment to be funded at the time and hopsital of their choice. If after 28 days of a last minute cancellation the patient has not been treated then a breach is recorded. Page 223 Page Community Care The number of ambulance responses diverted to Bridgewater Community by NWAS Pathfinders. Bridgewater Community Pathfinders: Referrals: Healthcare NHS Foundation Trust Pathfinders: Sent To A&E The proportion of Pathfinder calls referred on to A&E by Bridgewater. Bridgewater Community Healthcare NHS Foundation Trust
Personal Health Budgets: The number of personal health budgets that have been in place, at any point during the reporting period. WBCCG Number Of Patients Continuing Healthcare
C&YP Wheelchairs: 18 Week Waits The percentage of children that received equipment after 18 weeks of being referred to the wheelchair service within NHS England the reporting period (quarter) .
GP Out Of Hours: Attendances Number of face to face consultations at Wigan GP Out Of Hours. Bridgewater Community Healthcare NHS Foundation Trust
e-Referral Service: Utilisation Rate The percentage of referrals for a first outpatient appointment that are made using the NHS e-Referral Service (e-RS). NHS Digital
GP Services: Extended Access The percentage of practices within a CCG which meet the definition of offering extended access; that is where patients NHS England have the option of accessing routine (bookable) appointments outside of standard working hours Monday to Friday.
Page 7 This page is intentionally left blank MEETING: Governing Body Item Number: 10.1
DATE: 26 June 2018
REPORT TITLE: Chairperson’s Report – Audit Committee
CORPORATE OBJECTIVE Functioning as an organisation that consistently ADDRESSED: delivers its statutory duties and participates fully in the Greater Manchester Health and Social Care Partnership.
REPORT AUTHOR: Peter Armer
Peter Armer PRESENTED BY:
RECOMMENDATIONS/DECISION Governing Body to note comments REQUIRED:
EXECUTIVE SUMMARY
The Audit Committee was fully informed by all standard reports.
FURTHER ACTION REQUIRED: As per agreed actions section.
EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.
Page 225 CHAIRPERSON’S REPORT
Chairperson’s Name Peter Armer (Chair) Committee Name Audit Committee Date of Meeting 23 May 2018 Name of Receiving Committee Governing Body Date of Receiving Committee Meeting 26 June 2018 Officer Lead Mike Tate
The top 3 risks identified during the meeting & initials of lead with designated responsibility 1. Liaison to take place as soon as possible with Local Authority to establish if there are any financial sustainability issues in respect of care home providers that operate within the borough. 2. The committee and external auditors recognise that the 2018/19 QIPP requirement is challenging. The monitoring of schemes and risks around deliverability will be a key role for this committee. 3. Even though the CCG has no statutory requirement to report its gender pay gap (below 250 employees) a report has been provided for information to the Corporate Governance Committee. Additional information has been requested by pay grade, which will go to that committee in July. The Audit Committee would also like to review this report when it is available, thereby ensuring compliance with legislation.
Attendance at the meeting: Quorate
Was the agenda fit for purpose and Yes reflective of the committees Terms of Reference?
Narrative report outlining the key issues of the meeting Final Annual Report and Accounts The Annual Report and Account were approved by the Committee.
Director of Internal Audit Opinion The Committee received the Director of Internal Audit Opinion 2017/18. It was reported that significant assurance had been received.
External Audit Annual Governance Report (Audit Findings) The External Audit Annual Governance Report was reviewed by the Committee.
Letter of Representation The letter of representation was received by the Committee. The Chair of the Audit Committee signed the letter of representation.
Internal Audit Progress Report The following reports have been finalised: Conflicts of Interest and Information Governance.
Internal Audit Follow Up Report The Committee received a report setting out the completion of the most recent phase of follow- ups reviewed for recommendations that had reached their agreed deadlines.
Excellent (well attended) Acceptable (some apologies) Unacceptable (not quorate) Page 226 Internal Audit Charter The Committee received and noted the Internal Audit Charter which is mandated through the Public Sector Internal Audit Standards (2016).
Annual Staff Survey Report 2017/18 The Committee was provided with the results of the Annual Staff Survey.
Anti-Fraud Services Annual Report 2017/18 The Anti-Fraud Services Annual Report was approved by the Committee.
Gifts and Hospitality Register The register was received and noted.
Tender Waivers The Committee approved the tender waiver for Scriptswitch.
Name of lead with designated responsibility for the action/s Actions Log Liaison to take place as soon as possible with the CH/MTh LA to establish if there are any financial sustainability issues in respect of care home providers that operate within the borough. Final Annual Report and Accounts Make some enquiries regarding operating MTh segments. Director of Internal Audit Opinion Include a footnote in the Director of Internal Audit KL Opinion report to reflect the revised QIPP target.
Feedback the following comments to MIAA: consider removing the ‘high assurance and ‘no SD assurance’ grades and highlight the confusion relating to the colour scheme to MIAA. External Audit Annual Governance Report (Audit Findings) Discuss transparency regarding Register of Interest All and Accounting Policies to be included in the 2018/19 Accounts at a future Audit Committee meeting.
Amend the final sentence, under the heading ‘ SH Findings’ on Page 12 of the report from: ‘As such’ the QIPP target increased by £5m as the contract value was higher than originally budgeted’ to ‘As a result’.
Discuss the action plan and the two management All responses relating to QIPP at the September Audit Committee meeting. CH to write the management responses and ensure Deputy Chief Officer, Chair of Page 227 Audit Committee and QIPP Evaluation Group approval.
Ensure that the Committee’s appreciation for the CH work involved is expressed to the Finance Team. Annual Staff Survey Report Discuss how to increase responses to the annual KW/EB Anti-Fraud Survey and include on the agenda for the next Audit Committee meeting. Chairperson’s Additional Comments A strong meeting with lively discussion. One important action remains on-going, re-establishing whether there are any financial sustainability issues with providers of Care Homes within the borough. This action is being carried forward to the next meeting.
Page 228 MEETING: Governing Body Item Number: 10.2
DATE: 26 June 2018
REPORT TITLE: Draft Chairpersons Report from the Clinical Governance Committee CO 2: Commissioning high quality services, which CORPORATE OBJECTIVE reflect the populations’ needs, delivering outcomes ADDRESSED: and patient experience within the resources available.
CO 3: Function as an effective commissioning organisation that puts patients first.
CO 4: Function as an organisation that consistently delivers its statutory duties and participates fully in Greater Manchester Devolution.
REPORT AUTHOR: Dr Ashok Atrey
PRESENTED BY: Dr Ashok Atrey
RECOMMENDATIONS/DECISION Information REQUIRED:
EXECUTIVE SUMMARY
Draft Minutes from the Clinical Governance Committee held on Wednesday 6 June 2018.
FURTHER ACTION REQUIRED:
EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.
Page 229 This page is intentionally left blank CHAIRPERSON’S REPORT Chairperson’s Name Ashok Atrey Committee Name Clinical Governance Committee Date of Meeting 6 June 2018 Name of Receiving Committee Governing Body Date of Receiving Committee Meeting 26 June 2018 Officer Lead S Forshaw, Director of Nursing & Quality
The top 3 issues identified during the meeting & initials of lead with designated responsibility
Section redacted due to inaccuracies within the report.
1.
NWBFT CAMHS Position Update A verbal update was provided. The issue of increasing waiting lists was raised at the May meeting of the Committee. Following this an Action Plan was 2. formally requested at a contracting meeting. Funding identified for Schools Link will be used to address waiting lists as a short term measure whilst the wider service re-design is being worked through. Telecoms continue to take place every two weeks. A further position update will be provided September 2018. Learning Disabilities Mortality Review (LeDeR) Programme A paper was presented for the purpose of providing the Committee with an overview of the LeDeR Programme and the work undertaken thus far to deliver 3. the agenda. In addition the paper provided a summary of the cases that have been allocated for review to date including the learning that has emerged from the same.
Page 231 Attendance at the meeting: Acceptable – some apologies
Was the agenda fit for purpose and reflective of Yes the committees Terms of Reference?
Narrative Report Outlining the Key Issues of the Meeting
SAFETY Any Urgent Business to be discussed at the Chair’s Discretion Section redacted due to inaccuracies within the report.
North West Boroughs Foundation Trust (NWBFT) Draft Quality Account 2017/18 A presentation was provided to the Committee which included organisational wide quality performance for 2017/18 and Wigan specific quality performance. Priorities for improvement for 2018/19 will include: Safety – Always Events (Year 2) Safety – Safety Huddles Effectiveness – Team Clinical Supervision Experience – Service User/Carer Involvement
WBCCG Assurance of Non NHS Provider Safeguarding Audit Tool: Care Home Safeguarding Contractual Standards 2017/18. A paper was presented providing the Committee with an overview of the findings of Safeguarding Assurance Visits conducted by the Assistant Director for Safeguarding Adults to nursing homes across the Borough for the period 1 April 2017 to 31 March 2018. The paper built on information previously provided to the Committee in February 2018. In addition to discussing the findings of the Safeguarding Assurance Visits, the paper made recommendations to improve the process of validation and to assist nursing homes in better meeting the contractual standards.
High Peak Lodge Update re: Police Investigation. A briefing paper was provided to the Committee with an update regarding the police investigation in respect of High Peak Lodge nursing home. The paper outlined the background to the case; an update regarding the Crown Prosecution Service decision not to prosecute; next steps in terms of safeguarding actions.
Learning Disabilities Mortality Review (LeDeR) Programme. A paper was provided to the Committee with an overview of the LeDeR Programme and the work undertaken thus far to deliver the agenda. In addition the paper provided a summary of the cases that have been allocated for review to date including the learning that has emerged from the same.
Page 232 Page4 2 of Quality, Safety Annual Report 2017-18. A report providing a retrospective view of the year 2017/18 was presented. The report detailed the innovative approach that the CCG has adopted to respond to how quality has and continues to influence the commissioning of safer healthcare locally. This is undertaken whilst ensuring the best possible use is made of the finances available.
Alexandra Court Update. A report detailing key findings from the CQC re-inspection which took place in January 2018 and was published on 9 May 2018 was presented to the Committee. The provider was re-rated as ‘Requires Improvement’. At the time of the inspection the CQC noted two breaches of regulations these being Medicines Management and Good Governance.
NWBFT CAMHS Position Update. A verbal update was provided. The issue was raised at the May meeting of the Committee. Following this an Action Plan was formally requested at a contracting meeting. Funding identified for Schools Link will be used to address waiting lists as a short term measure. Telecoms continue to take place every two weeks. A further position update will be provided September 2018.
Serious Incidents and Never Events (SINE) Dashboard. The position at 30 April 2018 was circulated for information.
Serious Incidents and Never Events (SINE) Panel Terms of Reference (ToR). The updated ToR detailed arrangements that are in place to ensure that provider Serious Incidents (SIs) and Never Events (NE) are investigated and reviewed in compliance with the NHSE; Serious Incident Framework – Supporting learning to prevent recurrence (March 2015); and the Revised Never Events policy and Framework (January 2018) guidance documents. The ToR have been subject to review by the CCG Serious Incident and Never Event (SINE) Panel.
NWBFT QSSG Chairperson’s Report 27 March 2018. The Chair’s report was presented to the Committee including the top four issues and position updates. These included: Safeguarding Children Training Compliance CPA Compliance Wigan Assessment Team Capacity and Demand Issues Wigan Home Treatment Team
Transforming Care Update Report. The CCG continues to work closely with the Local Authority to plan and monitor the discharges of individuals with learning disabilities and/or autism who are in non-secure hospital placements and of Wigan patients in secure placements commissioned by NHS England.
CLINICAL EFFECTIVENESS Effective Use of Resources (EUR) Q4 2017/18 Report. The report included: Effective Use of Resources (EUR) funding requests submitted for NHS Wigan Borough Clinical Commissioning Group (CCG) patients during the fourth quarter of 2017/18. Individual Funding Requests (IFR) received by the CCG, during the fourth quarter of 2017/18.
HCAIs Dashboard Report 30 April 2018. The Committee received a mandatory report on Clostriduim difficile (C.difficile) infections and methicillin resistant Staphylococcus aureus (MRSA) bacteraemia for April 2018.
Page 233 Page 3 of 4 Medicines Management Annual Report 2017/18 LS presented the report providing an overview of the activity of the Medicines Management Team and the work completed over the financial year 2017/18 to ensure the CCG meets the financial, best practice and statutory requirements in relation to medicines optimisation and prescribing.
The report focussed on the work of the CCG Medicines Management Team, the success of the team requires the full engagement of the GP Practices across the CCG. The achievements detailed within the report have required significant input from GP practices and reflects the good working relationships between Practices and the Medicines Management Team.
Medicines Management Chairperson’s Report 18 April 2018 The Chair’s report was presented to the Committee including the top three issues and position updates. These included: Medicines Management Annual Report 17/18 Medicines Optimisation QIPP Plan 18/19 WBCCG Opiod Prescribing for Chronic Pain – GP Resource Pack
PATIENT/SERVICE USER/CARER/STAFF EXPERIENCE No items.
ANY OTHER BUSINESS: Nil ITEMS FOR INFORMATION: Performance Report. Patient Story WWLFT.
Agreed actions from the Meeting Name of lead with designated responsibility for the action/s As noted within the DRAFT minutes of the meeting and As noted within the DRAFT minutes of actions log the meeting and actions log Chairperson’s Additional Comments
Page 234 Page 4 of 4 MEETING: Governing Body Item Number: 10.4
DATE: 26 June 2018
REPORT TITLE: Chairperson’s Report – Finance and Performance Committee Functioning as an organisation that consistently CORPORATE OBJECTIVE delivers its statutory duties and participates fully in ADDRESSED: the Greater Manchester Health and Social Care Partnership.
REPORT AUTHOR: Frank Costello
PRESENTED BY: Mohan Kumar
RECOMMENDATIONS/DECISION Governing Body to note comments REQUIRED:
EXECUTIVE SUMMARY
A narrative report of the Finance and Performance Committee meeting held on 21 May 2018.
FURTHER ACTION REQUIRED:
EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.
Page 235 CHAIRPERSON’S REPORT
Chairperson’s Name Frank Costello (Chair) Committee Name Finance and Performance Committee Date of Meeting 21 May 2018 Name of Receiving Committee Governing Body Meeting Date of Receiving Committee Meeting 26 June 2018 Officer Lead Mike Tate
The top 3 risks identified during the meeting & initials of lead with designated responsibility 1. Attainment of QIPP remains extremely challenging and requires assurance. 2. Need for effective processes and levels of support to SDFs in addressing variations in demand. 3. Sustaining and propelling speed of transformation change.
Attendance at the meeting: Quorate.
Was the agenda fit for purpose and Yes. reflective of the committees Terms of Reference?
Narrative report outlining the key issues of the meeting Actions Discussion took place regarding Item 6.3 on the actions log: Share the report relating to the 52 week breach (18 weeks Referral to Treatment) with the Finance and Performance Committee. As the patient who was recorded as breached chose to delay their treatment, it was queried whether the ‘Start/Stop’ rule is being applied correctly. It was agreed that this would be followed up with WWLFT.
QIPP Update An update was provided on the work undertaken to deliver QIPP targets since the presentation of the Financial Plan in March 2018. The Committee was informed that financial balance will only be achieved through joint work and support provided through the Service Delivery Footprints (SDFs). The Committee was also provided with a detailed summary of QIPP schemes.
Transformation Fund (TF)/Material Conditions Update The Committee received a joint CCG and Local Authority (LA) paper which provided an updated position on both Transformation Fund (TF) 1 and 2. This paper will also be discussed at the CCG Governing Body meeting and LA Cabinet meeting.
The following was noted: TF Phase 1 has been signed off by GM. This paper highlights to the Partnership that the CCG and Local Authority believe that material conditions relating to TF2 have been met. Therefore, GM should, hopefully, allow the release of the funding to the locality. Final Accounts will be submitted to the Audit Committee on 23 May 2018.
Page 236 Page 2 of 3 E:\Moderngov\Data\AgendaItemDocs\5\7\2\AI00053275\$dor5kusa.docx Financial Model/5 Year Plan The Committee were taken through a presentation titled, ‘Wigan Borough Planning for LCO’. The locality financial position is being refreshed and discussions are taking place with Healthier Wigan Partnership (HWP) regarding how this will be undertaken.
Cancer Investment A presentation was provided on the Cancer Investment Plan. Each locality had to submit a proforma indicating what we will provide for our investment in cancer services and how this will be delivered. Name of lead with designated responsibility for the action/s Follow up with WWLFT whether the ‘Start/Stop’ rule in PE respect of 52 week breaches (18 weeks Referral to Treatment) is being applied correctly. Liaise with NV regarding the development of a clinical CH/JC advice model to support GPs. Financial Model/5 Year Plan: Bring an updated report CH/JC back to the Committee, following the workshop with providers to identify what services will be in the LCO going forward. Circulate the ‘Action on A&E’ presentation to JT and NV, AC for information. Chairperson’s Additional Comments
See risks above.
Page 237 Page 3 of 3 E:\Moderngov\Data\AgendaItemDocs\5\7\2\AI00053275\$dor5kusa.docx This page is intentionally left blank MEETING: Governing Body Item Number: 11
DATE: 26th June 2018
REPORT TITLE: Service Delivery Footprint Primary Care Highlight Reports
CORPORATE OBJECTIVE 1. Supporting our population to stay healthy and ADDRESSED: live longer in all areas of the Borough
2. Commissioning high quality services, which reflect the population's needs, delivering good clinical outcomes and patient experience within the resources available
3. Function as an effective commissioning organisation that puts the patient first.
4. Function as an organisation that puts patients first
5. Functioning as an organisation that consistently delivers its statutory duties and participates fully in Greater Manchester Devolution
REPORT AUTHOR: Primary Care Business Transformation Managers
PRESENTED BY: Governing Body SDF Clinical Leads
RECOMMENDATIONS/DECISION For Information REQUIRED:
Page 239 EXECUTIVE SUMMARY
The CCG has continued to build the supporting infrastructure to ensure that Practices and Service Delivery Footprints (SDFs) have the expertise and support necessary to drive forward with change.
The following highlight reports have been created, and are maintained on a monthly basis, to give better visibility to Clusters, the CCG Governing Body and Wider Partners with regards to the work that is on-going across Primary Care and the relationships being built across Service Delivery Footprints.
The format of each has been focussed on giving updates on what are the highlights and lowlights of the work along with some more specific areas with regards to opportunities for improvement, cluster working and engagement with practices and patients.
It is expected that as the work across Cluster develops these reports will also develop and provide the mechanism for how information and updates can be shared.
FURTHER ACTION REQUIRED: None
EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.
Page 240 Service Delivery Footprint Highlight Report Reporting Period May 2018 Leigh
Business Transformation Diane Nicholls CCG Lead Rob Wilson Clinical Lead Dr Gen Wong Manager
1 - SDF Objectives / Background
Practices in the cluster have made a commitment to work in partnership to deliver high quality health and care services to practice populations.
Leigh Cluster will contribute to the improvement of health outcomes for the population of Leigh and work to reduce demand on secondary care services by working in partnership with key stakeholders and organisations to build robust integrated community based care models.
Page 241 Page The cluster relationship will be based on:
Equality Mutual respect and trust Open and transparent communications Co-operation and consultation A commitment to being positive and constructive A willingness to work and learn from others A shared commitment to providing excellent services to the community A desire to make the best use of resources. 2 - Status Update
Highlights
Clinical Pharmacist Business Case Clinical Pharmacists have now been allocated to the practices. KPIs are in the process of being agreed and will be presented to the Full Cluster meeting on the 22nd June for approval. Two pharmacists have already commenced, two more will commence in post in June, one in July and one in August. All staff will be in post by the 31st August 2018. The 12 month review will be completed by 31st September 2019.
PPG Cluster The Cluster PPG Mini-Conference took place in May which was held to help current PPG members and to encourage new members by
Page 242 Page explaining the role of a PPG, the role of a PPG member, help members to understand their local NHS and to explore ideas how we can get more patients to engage and become members of their own PPGs. This was attended by 25 people who represented 7 out of the 13 practices and the feedback received was extremely. The PPG Cluster continues to support the Leigh Warblers that meet on the 2nd and 4th Thursday of the month.
Mental Health Clinic The Mental Health Clinic has now been reinstated and runs one day a week from Bridgewater Medical Centre in Leigh. The Memorandum of Understanding has been developed and signatures are being obtained. Initial feedback is that there is a 100% attendance at the clinic. A meeting is being arranged with North West Boroughs to see how the service is progressing.
CAMHS Meeting has been arranged with the manager of the CAMHS Skin Camouflage Clinic in relation to a pilot that they would like to carry out in Leigh.
Nurse Led Group Consultations The third wave of group consultations is continuing within the Premier Health Surgery and discussions have now taken place with Practice Nurses around training for them to undertake group consultations within their surgeries. Group consultations have been included as part of the development of the Leigh Warblers and this is continuing. Ongoing reviews will take place with the patients and a final review will take place 6 months after their commencement date. Inspiring Healthy Lifestyles The Cluster is actively working with the lifestyle service to pilot the Activity Referral+ Scheme.
Community Link Workers Leigh practices refer around 700 patients a year into the Community Link Worker Service. This service deals with patients that have low mental health needs, debt, bereavement, housing, social isolation etc. The top five themes emerging from Leigh practices are mental health, social isolation, bereavement, support for carers and Adult Social Care. Community Link Workers also connect to wider public services through the place and huddles. Cluster practices are continuing to work with the Community Link Workers by referring into the scheme and ensure that any operational issues are addressed that have been identified by practices. Data has been received which highlights the referral rate into the service.
Cancer screening uptake Page 243 Page Practices are working alongside Cancer Research UK to increase their screening uptake on the three main cancer screening programmes which are bowel, breast and cervical. This will be an ongoing piece of work over the next 12 months.
ICS Rapid/Community Response Team for acutely unwell patients has been set up and will be accepting referrals from General Practice. Step up beds are also now available for a maximum of 72 hours in Bedford Care Home. This is for patients that don’t necessarily require acute hospital intervention but needs some additional health or social care intervention. Also, SDF Manager to link in with ICS clinicians around place based working. Good feedback has been received from the practices in relation to the Rapid Response Team.
QiPP The Cluster received initial information in relation to 2018/19 QiPP. The Cluster Executive examined the high intensity users and preliminary work is ongoing to further understand this cohort of patients and any potential collaboration with wider partners to help support these individuals. Lowlights
Inspiring Healthy Lifestyles Work is underway to encourage usage of the service as current uptake across practices is mixed. Work has also been commenced with the operational lead to look at simplifying the referral process.
Practice Priorities Identified A number of initial areas have been identified as part of the Practice priorities which will to be reviewed going forward. These include:
Estates Training for newly qualified nurses Recruitment of GPs/ANPs Page 244 Page
3 - Possible Opportunities/Horizon Scanning
The Business Transformation Manager will continue to be based within practices to provide additional support and point of contact.
Identify issues within the practice priorities to be worked on and opportunities of support will be highlighted to the Cluster Executive.
Implementation of the Clinical Pharmacists within Practices.
Partnership working with the SDF Manager for Leigh.
Ongoing meetings with North West Boroughs to measure the outcomes of the Mental Health Clinic and Advice and Guidance Service.
Meeting with CAMHS in relation to the Skin Camouflage Clinic Pilot with the Leigh Cluster. Meeting to be held with Leigh Community Trust in relation to potential links with the organisation and the Cluster.
4 – Practice Engagement/Partner Engagement
The Business Transformation Manager is now back to work full time. The additional support this gives to the cluster has continued to be evident throughout May and will continue through the coming months.
There is an opportunity to continue to encourage practices to be involved in SDF meetings
It will be essential to continue to offer support to Practice PPGs and ensure that the Cluster is well represented at Borough Wide PPG Forums. The Business Transformation Manager will continue to encourage engagement from practices, PPG members and anyone Page 245 Page interested in finding out about their local NHS and PPGs.
5 – Project Update Clinical Pharmacist
Recruitment process is now complete and some of the Clinical Pharmacists will commence in June with the remaining staff complement being complete in July. An Implementation Group has been developed to work on the evaluation criteria. The whole cluster has been engaged in developing a robust evaluation plan with support from the CCG Medicine Management team.
6 – Key Activities and Priorities For The Next Period
Work through any themes/issues which are identified through practice priorities Progress with Clinical Pharmacist Implementation Work with Healthier Wigan Partnership in respect of SDF Huddle Process Arrange to meet practices who are low referrers to the Community Link Worker Service Progress with the Cluster Executive to implement the findings of the MOU which was signed in March. Arrange to go out to practices in relation to the QiPP plan, to enable them to have some knowledge prior to the Full Cluster Meeting on the 22nd June 2018. Progress Complex Patients Day in relation to QiPP which is scheduled for the end of June. Business Transformation Manager to co- ordinate the appropriate organisations to be involved in the day. Page 246 Page Service Delivery Footprint Highlight Report - LIGA North Reporting Period May 2018 Business Transformation CCG Lead Carol McRae Clinical Lead Dr Sanjay Wahie Officer Lynne Hogan
1 - SDF Objectives / Background
SDF North Mission and Vision Statement: Delivering improved clinical outcomes and patient experience within the resources allocated to LIGA North SDF by developing a collaborative and integrated system with partners and stakeholders. By using the asset based model we will work towards improving the health and care of our SDF’s population and improve the capability of our primary care to lead in this venture. LIGA-N Objectives: 1. Supporting our population to stay healthy and live longer and to address areas of inequality and variation. Page 247 Page 2. Commissioning high quality services, which reflect the population’s needs, delivering good clinical outcomes and patient experience within the resources allocated and available to the SDF.
2 - Status Update
Highlights
SDF Development – meeting 15th May:
North LIGA Childhood Asthma Project - SDF Manager Wigan Council and the Business Transformation Manager for the Cluster presented a scope of work planned to increase uptake of asthma reviews on senior school children within our SDF footprint by GP practices working collaboratively with two local schools. Group agreed in principle to take this forward and that any nurse time needed would potentially be covered by development funding. They also agreed to undertake reviews on children that may live out of Service Delivery Footprint.
1 Next steps include:
Lead PM has been tasked with asking Practices to identify children over the age of 11 who had not attended during 17/18 for their asthma reviews and to investigate how many of these had attended A&E due to exacerbation of their condition. These numbers would then be used to measure how many children should be targeted to help reduce admissions due to exacerbations, PN Lead would speak to nurses from all practices to see if they would like to undertake these checks as additional to their normal working hours. Lead PM would also check whether there were any concerns regarding indemnity when working outside practice. LS will liaise with other CCG staff to see if there are any lessons to learn regarding indemnity.
Start Well / Sensorial Project – Start Well manager attended the cluster development meeting to provide an update on the Sensoriel project:
Slow start to this pilot but GD assured those present that all the group’s referrals had been put through appropriately.
Next steps include: Page 248 Page
Practices were tasked with going through their historic CAMHS referrals to identify any children who may benefit from referral to Start Well. All PM’s were encouraged to invite Start Well manager to practice meetings.
QIPP – CCG QIPP Director led discussions around areas practices could work collaboratively to reduce hospital attendances and out of area referrals to reduce spending across the borough.
ICS: ICS future plan trialling in Wigan - Live now for all Ashton and all Wigan and Leigh Contact numbers for the services were provided to practices to share with staff. No referral forms were needed to access the service. Practices were advised to pick up the phone and discuss any patient they had concerns about. The ICS team have access to all of the adult community services. ICS have offered to support practices with identifying high risk patients and it was agreed that 2 practices will be prioritised based on data discussed within the SDF meeting. Practices were informed about the new Step-Up Beds available in the borough at Bedford House.
2 Collaborative Memorandum of Understanding £25K Funding:
Funding has been devolved and paid to Pennygate while a separate bank account is arranged,
LIGA Cluster PM meeting: May – main topics covered:
Data Quality Manager gave a SNOMED presentation and informed the group there would be a training tool and newsletter coming out. The data quality team would provide support to practices. IT Update provided by IT team. Lead PM’s provided an update following the PCS Standards Review group meeting.
Practice Nurse Champion Update Page 249 Page Lead Practice Nurse asked PM’s to remind any staff who undertaking Cytology smears to do the online training and then add the date to cytology website and also offered cytology mentoring to any new smear takers in the cluster.
Lowlights
GP Working Well "Early Help" program
The Cluster has signed up to this Pilot - now awaiting feedback from Wigan Council as to what the requirements are and what will be the “ask” from the Group. BTM will chase for an update.
3 - Possible Opportunities/Horizon Scanning
Group Consultations is an area that the practices may wish to explore in the future.
3 4 – Practice Engagement / Partner Engagement
All practices have been visited by BTM during May during which Primary Care Standards were discussed and areas for Improvement highlighted. PPG Groups - All practices were advised of the payments due to their PPG groups. Working with Council SDF Manager to identify new areas of collaboration i.e. secondary school childhood asthma reviews. Lead PM reminded other members that Citizens Advice Bureau held sessions at Pennygate for all SDF-N practices. Lead PN is currently covering sessions at another practice till new PN can be identified as well as mentoring new Nurses in the cluster.
5 – Project Update AVS Page 250 Page
The CCG evaluation continues to take place.
6. – Key Activities and Priorities For The Next Period
1. Develop further SDF Work based on areas identified during the cluster QIPP Meeting Discussions 2. Support practices with further work around Estates. 3. Support practice re: potential branch closure – report due to PC Ops July 4. Work with Cluster Executive to identify collaborative opportunities with ICS and any other identified areas of need within the SDF. 5. Continue to develop the LIGA Cluster Exec Group 6. Continue to build up relationship with new Practice Nurses. 7. Continue to try to build relations with Practices and Care Homes 8. Create links between Cluster Exec Team and LIGA Patient Participation Forum 9. Organising practice visits between Cluster Executive team and practices 10. Explore review with Council on GM Working Well Early help programme. 11. Collaborative working with Council SDF Management around Children’s Asthma checks 12. PC Standards – discussions with practices e Improvement Plans 13. CRUK – work with practices to improve cancer outcomes
4 14. Discuss CLW referrals data NWB – arrange to meet their team once aligned to SDF Footprint Start Well - review and monitor this Sensorial scheme – Group decided to Review this again in September Page 251 Page
5 This page is intentionally left blank Service Delivery Footprint Highlight Report LIGA South Reporting Period May 2018 Business Transformation CCG Lead Carol McRae Clinical Lead Dr Neeta James Manager Anne Burgess
1 - SDF Objectives / Background
The SDF Executive team are developing plans with members to further develop the SDF and to build on the collaborative approach, driving the changes that will improve the health of the LIGA South patient population.
Mission “To work collaboratively in order to provide outstanding, safe, effective and patient centred services for patients in our local community”.
Vision Be responsive to patients needs to enable timely and appropriate acute, preventative and long term management of care. To drive up quality and standards of care that will improve outcomes for patients. Page 253 Page Develop new ways of working and collaborative opportunities that enable a sustainable and stable workforce now and in the future.
The foundations are now in place to enable the practices to start to develop an appetite for change and transformation. This is creating a very positive approach to opportunities and new ways of working presented to them. The Executive team is keen to encourage this collaborative approach and engagement of all members in order to take forward areas that develop the SDF and improve primary care and outcomes for patients.
2 - Status Update
Highlights
SDF Development
Through monthly development sessions with all members, several ideas and projects have been highlighted as opportunities to drive improvements within the SDF. Members are keen to reduce burden in practices and are undertaking discussions regarding bulk buying and policies alignment, which are
1 progressing.
A collaborative approach to Clinical provision for Wednesday afternoons, initially, is being scoped out and IT systems investigated to enable this to be implemented for consistency. Practices are open to looking at options for this on an SDF basis.
A project has been scoped out between the SDF Manager and Business Transformation Manager to address the identification of Young Carers, which has been presented to, and agreed by, all practices within the SDF. This project aims to involve community services, universal provision and Primary Care in order to provide an integrated approach to support the health and wellbeing of Young Carers. A project plan is in the process of being drawn up.
Lowlights
A practice has received a ‘Requires Improvement’ rating from a recent CQC visit. However, the practice has submitted an action plan in response to this and Page 254 Page is being fully supported in the implementation of this in order to demonstrate improvements.
3 - Possible Opportunities/Horizon Scanning
PPG group at one practice is interested in reducing medicines waste and this may be taken forward as a project to raise patient awareness of medicines and repeat prescriptions. Inter-practice referrals are a development option for the SDF, particularly exploring options around delivery of Anti-Coagulation services.
4 – Practice Engagement / Partner Engagement
Practices Practice Managers continue to meet monthly which provides a formal opportunity for discussions as a group. A minimum monthly visit with practices
2 continues, providing informal opportunities to understand the practices more and gain practical insight into how the practice operates; supporting practices directly to help resolve any issues that may have arisen, if appropriate.
Attendance and contributions at PPGs has been implemented and 3 practice PPGS have been attended.
Links with SDF manager have continued to develop and ideas for potential joint areas of work and projects have been identified. An integrated project for Young Carers has been scoped out and being planned currently.
Engagement with ICS across the SDF continues to grow and ICS have attended Development sessions with practices in order to further promote the service and encourage uptake by practices.
5 – Project Update AVS Page 255 Page No further updates to report. The evaluation has taken place.
6 – Key Activities and Priorities For The Next Period
1. Focus on Cluster PPF development at an interim PPF session to progress actions. 2. Continue to attend and contribute to active practice PPGs. 3. Follow up with the teams involved in the Wellbeing team project and involve relevant practices in Ashton. 4. Develop Practice Nurse engagement and input into the SDF with the Practice Nurse Champion. 5. Continue to plan and implement Young Carers project with SDF Manager. 6. To support the implementation of QIPP within the SDF.
3 This page is intentionally left blank Service Delivery Footprint Highlight Report SWAN Reporting Period May 2018 Business Transformation CCG Lead Carol McRae Clinical Lead Dr Mohan Kumar Manager Laura Midgley
1 - SDF Objectives / Background –(Use this section to explain more about the objectives for the SDF / Cluster e.g. Vision/Mission statement etc
Our focus is…
Primary Care Standards
Practices are working collaboratively on the implementation of the Quality and Engagement Scheme (including the Primary Care Standards) to address unwarranted variation. There is a focus on providing collaborative approaches and being supportive of each other in meeting needs and targets.
Page 257 Page Collaboration & Support
The SDF facilitate regular meetings of all member practices in order to share information, obtain feedback and develop shared ownership and delivery of plans. An Executive Group has been nominated who act on behalf of the member practice and drive forward specific pieces of work with a clear mandate. The Practice Managers and Patient Participation Group meet regularly. The practices have released Practices Nurses to attend the newly established SWAN Nurses Meeting.
A nurse attend the Huddle meetings on behalf of the cluster who will then bring cases on behalf of the practices
Continuing to build relationships with partners.
Acute Primary Care Access Hub (Business Case Delivery)
The practices are testing out new models of integrated working and primary care delivery through the creation of an ‘in hours’ acute primary care access hub, offering a more efficient model for same day and enhanced access to general practice to enable reduction in numbers of patients accessing care via A&E or the Walk In Centre. The overarching aim of the project is to enable GPs to spend more time on the care of patients with long term conditions and complex care needs. This project has now been evaluated and discussions are now in progress to establish how the model can become self-sustaining for the remainder of 18/19 and the future.
Developing an Extended Primary Care Team
The Extended Primary Care Team meets on a weekly basis (Thursday afternoons 2-5pm at Clifton Street Community Centre) and is accessible to all SWAN practices. The focus has been on building a wider support team around the Community Link Worker as a point of access for practices to connect into a broader range of services. The purpose is to provide a forum for case discussion in a safe environment using a multi-agency approach including Community Link Worker, Healthy Routes, Adult Social Care, Early Intervention, GWP, DWP, local schools, Start Well, Housing, Service Veterans and Confident Families, providing better outcomes for service users whilst reducing demand for public services.
Implementation of Integrated Community Services
The practices of SWAN are working with partner organisations to test out GP access to a Community Response Team. The overarching aim of this test bed is to prevent admission and attendance of patients that do not require acute treatment intervention in a secondary care environment. Practices have access Page 258 Page to range of community clinical services (Bridgewater and WWL services) including Community Geriatrician, Therapists – Physiotherapy/Occupational Therapy, Nursing – Integrated nursing response, Community Matrons, Advanced Nurse Practitioners, INT nursing team, District Nursing, LD team, Specialist nurses, Duty Social Work, Reablement, Moving and handling and Access to equipment. This will now link with the QIPP agenda so that practices can begin to reduce A&E admissions and redirect patient referrals to the most appropriate provider to enable savings to be made across the health economy.
New Model of Homecare
A new model of homecare will be piloted in Ashton later this year. The model will offer community based support for anyone who is eligible for adult social care and living alone. The Wellbeing Teams have partnered with Making Space to support people to live well at home and be part of their community. The practices of SWAN will focus on making connections with partners and gaining an understanding of the new model.
Workforce Development
The practices of SWAN are an approved Enhanced Training Practices hub (ETP) providing placements for multidisciplinary NHS workforce (nursing students, physicians associates, paramedics) in addition to the already existing GP training, Foundation Doctor and undergraduate placements). SWAN have an Educational Placement Coordinator and training support through this HEE project and also have training nurse mentors and supervisors to support wider placement and to encourage ‘growing our own’ NHS workforce. Practice Engagement
As with the previous locality model there will be meetings organised between practices and the Executive Team to support engagement with the QIPP agenda to ensure that practices understand the expectations from the executive team and that they are able to proceed with the work required
2 - Status Update (Use this section to record activities throughout the month - what went well and what didn't. Anything that isn't on track as per timelines)
Highlights
Primary Care Standards
The cluster is developing clinical templates and liaising with the primary care team to avoid duplication. Page 259 Page
Collaboration and Support
The SWAN Nurses have worked together to enable the roll out of Group Consultations. The training has been successfully delivered and practices are now beginning to use the principle in their own practices.
Work has commenced to develop an action plan for growth, which brings together existing and potential projects following practice discussions. The plan will include a selection of key actions across the cluster that has the potential to deliver the greatest impact. Meetings to review the action plan on a monthly basis are continuing.
Acute Primary Care Access Hub (Business Case Delivery)
The SDF continue to gather information to evidence the impact the SWAN hub has had on patients, practices, the SDF and wider system. Feedback continues to be sought from practice staff. An evaluation has been completed regarding the service and discussions regarding the continuation including the ability to be self-sustaining into the future are beginning.
Developing an Extended Primary Care Team Work is underway to improve the uptake of the huddle and case studies will be shared at a future Cluster meeting.
Implementation of Integrated Community Services
The Community Response Team is continuing to work with Swan practices to increase the usage of the service. GP liaison continues to gather feedback from practices.
New Model of Homecare
Discussions with key partners have commenced to explore the potential for joint working and to connect Wellbeing Teams into existing programmes of work such as Community Link Workers; the place based huddles and integrated community services.
Workforce Development
The Enhanced Training Practices Hub has been awarded £300k funding by HEE to provide placements for multidisciplinary NHS workforce across the whole Page 260 Page of Greater Manchester. This will include arranging placements for the whole of the non-medical workforce. The SDF have decided that they will concentrate primarily on Wigan and have outsourced to other health economies in Greater Manchester to ensure that their needs are met.
Knowing me knowing you cluster event
The Swan cluster knowing me knowing you event took place in May and involved teams from social care, schools, ICT, community police and enabled table top case discussions to take place, looking at what works well and what areas could be improved. The event was well received and the learning from this event will be shared with other clusters. Relationships have been developed and services have been promoted to enable primary care to benefit from the wealth of services available to them via the community link workers and wider. It is hoped that a follow up meeting will be arranged in the future so that relationships can continue to flourish and services can support the QIPP agenda in reducing costs and inefficiencies across the SDF footprint.
Lowlights
Acute Primary Care Access Hub (Business Case Delivery)
There is a general trend of falling attendance rates at A&E over the past 3 years. However, it is difficult to extrapolate the data and measure the potential impact of the SWAN Acute Care Hub at this point. The general trend is replicated across the borough and unfortunately the reduction can’t be totally attributed to the access hub. The service evaluation has taken place and unfortunately the funding needed to continue the service is unsustainable. An invest to save case will be needed and KPIs will need to be agreed in terms of what practices are doing with the time saved and how reductions can be made across the health economy to fund the continuation of the service. Work is being undertaken with the cluster executive team to progress this.
Clinical System Migration
Clinical system migrations have successfully taken place and practices are now working together to enable shared standards and governance across the cluster. This will support new ways of working in the cluster, enable joint working and enable to support practices through times of crisis as and when needed.
PINCER Roll Out
The roll out of PINCER to the practices of SWAN has now been completed and the IT team are supporting practices with any queries or issues they may have. Page 261 Page
3 - Possible Opportunities/Horizon Scanning
Childhood Asthma
An opportunity has been identified for SWAN practices to work with local schools around performing asthma reviews and providing training to school nurses. The SDF agreed to explore this further and planning has commenced.
Start Well
Opportunities to work with the Start Well Team to be explored. Discussions have commenced to inform the ‘operating model’ in terms of the ways in which practices can access support for children and families and work in a more integrated way with the Start Well.
Start Well into highlights – named staff from Start Well – attending huddles weekly – have a deputy manager – will be attending huddle weekly and will triage cases as they come in to see if they meet the threshold. Will be based at Clifton Street Hub.
Mental Health starting attending huddle – realigning staff in April. As of April will be working in the place. Follow up Joint Development Session – Knowing Me and Knowing You to be organised in the future
Huddle More attendance at the huddle from Bridgewater staff - need to make those links
In-House Training
Opportunities to developed in house training programmes are being explored, including CPR.
Workforce Possible opportunities shadowing – social care colleagues, Start Well colleagues etc – for students. Open the door
4 – Practice Engagement/Partner Engagement
Page 262 Page Operational
Monthly practice visits will continue to support the development of cluster working and move forward with the practice priorities identified in the SWAN Cluster.
The executive team will begin to visit practices over the month of June to support practices with the QIPP agenda and to encourage a two way discussion regarding future opportunities for development.
Working Collaboratively
Relationships are being developed between teams to ensure a system wide cohesive approach to SDF support.
5 – Project Update SWAN Acute Primary Care Access Hub
The SWAN practices continue to gather information to evidence the impact the SWAN hub has had on patients, practices, the SDF and wider system. Feedback from practice staff have been sought. In summary: Overall, the service is being positively received. It is successfully reducing the strain within the surgeries and making appointments available for those chronic patients who need to be reviewed ASAP by their regular GP. Work needs to begin to look at the time saved in practices and what the cluster can expect from practices in terms of the best use of that time to support patients and ensure they are kept out of hospital and supported in their own homes where possible.
Most reception staff from all surgeries in Chandler House feel that they are able to deal with directing patients to the correct service they require a standard governance approach has been successful developed and implemented.
All practices involved feel that the service benefits the practice and their patients as a whole in a positive way.
Discussions continue regarding the long term sustainability of the service. An Operational Manager has now been appointed to manage the service
6 – Key Activities and Priorities For The Next Period Page 263 Page
GP Access to Community Response Team: Cluster Exec to obtain feedback from GP practices during visits
Practice Nurse Development: Cluster Exec to work with Lead Practice Nurse to continue to roll out group consultations and support practice nurses to establish this new service across all SWAN practices
PPG Development: Cluster Exec to identify involvement opportunities and share with PPG Chair
Acute Primary Care Access Hub: Implementation Team to conduct regular Quality Management Meetings Implementation Team to develop long term sustainability plan and arrange a planning meeting
Governance Arrangements: Cluster Exec to support establishment of Governance Arrangements and a Governance Sub Group that would ideally include a GP, Practice Nurse and Practice Manager. Page 264 Service Delivery Footprint Highlight Report Reporting Period May 2018 TABA+ Business Transformation Stephen Green CCG Lead Rob Wilson Clinical Lead Dr Ashok Atrey Manager
1 - SDF Objectives / Background
Our focus is…
Primary Care Standards Practices are working collaboratively on the implementation of the Quality & Engagement Scheme (including the GM Primary Care Standards). There is a focus on collaborative approaches to providing access to bookable appointments on Wednesday afternoons and building on this foundation across the Cluster. One practice has already changed the way in which they work and are now open on Wednesday afternoons and do not close over the lunchtime period.
Practice Manager Collaboration & Support Page 265 Page All Practice Managers in the cluster meet on a regular monthly basis to share information, learning experiences and good practice. They continue to grow and develop a varied range of supporting networks. The group are currently working on a Group Buying as a collaborative.
Group Based Consultation TABA+ Cluster have set up a service to ensure that all their residential care or house bound patients will receive a multidisciplinary assessment on a two weekly basis to provide proactive case management and support them to remain in their usual place of residence.
Developing an Extended Primary Care Team TABA+ Cluster is looking to work collaboratively with a wider range of partners to ensure that patient centred care is provided. The starting point for this to progress is to initially invite stakeholders to a cluster meeting and work towards building relationships and develop a first class professional working relationship. Working in an integrated way is crucial to ensure that this service succeeds, provides excellent care whilst meeting the needs of the client base and moves forward to becoming a ‘role model’ for other areas to follow. 2 - Status Update
Highlights
Practice Priorities Practice visits continue to take place to discuss the themes and to complete any outstanding elements. The next step is to use the SDF profiles to align the identified themes and trends through the executive to identify the cluster/SDF and practice priorities and link these into cluster wide projects.
Business Case Delivery The service has been operational since May 2017 and focussed on the development of a routine early assessment and intervention programme which also provides a rapid response service to all patients
- in a residential care setting - the housebound population of the cluster Page 266 Page All patients within the cohort are receiving a multidisciplinary assessment leading to an individualised case management plan and where appropriate a two weekly review basis to provide proactive care.
The housebound element of the service went live ahead of schedule in September. Work is now underway to generate the evaluation criteria to provide quantative data to support the service outcome monitoring.
Performance and financial monitoring are in place to support early identification of any additional risks or pressures that could affect the service which has led to improved utilisation of existing resources.
The current project will run in its entirety until the end of June 2018, awaiting a decision if there will be an LCS introduced to continue in some capacity.
Practice Merger Two TABA+ practices have started to move forward with merging into one practice with the help, support and guidance from the Assistant Director, Business Transformation Manager and wider Primary Care Team, this process has had involvement from the Communication and Engagement Officer. A programme of engagement to speak to patients has now taken place and a draft report has been submitted to the practice for any comments. QiPP The Cluster received initial information in relation to 2018/19 QiPP. The Cluster Executive examined the high intensity users and preliminary work is ongoing to further understand this cohort of patients and any potential collaboration with wider partners to help support these individuals.
Lowlights
Business Case Issues The Service Manager post for the project became vacant early May and a temporary member of staff was placed to see the project through to the end of June 2018
Cluster Executive TABA+ have now had two cluster meetings to discuss the QIPP Financial Challenge, some good ideas have been suggested and the next step will be to discuss this further at the next Full Cluster meeting to be held in June 2018.
Page 267 Page The Clinical Lead, Lead Practice Manager and Practices are continually supported by the TABA+ Business Transformation Manager.
Staffing All staffing vacancies are advertised via the appropriate routes.
One TABA+ Practice continues to have no Practice Manager
3 - Possible Opportunities/Horizon Scanning
Estates – There is a possibility of practices working together to resolve estates issues and better utilise the estate that we have at our disposal. Initially three practices within the SDF had expressed an interest in coming together in one new purpose built location; however, one of those interested has now changed their mind. The Assistant Director and Business Transformation Manager are currently working closely with the practices interested to establish which out of the four options available would be the right one to choose. One of the practices has looked into a new community village being developed in Astley and the possibility of the practice moving into a purpose built health centre, this possibility is still in its infancy.
PPG Development - At both Cluster and Borough Wide level; TABA+ will be leading on this priority and working closely with practices to develop the partnerships at practice level to support local initiatives as well as Borough Wide Workstreams. The Business Transformation Manager is currently attending all individual practices PPG’s to establish a way forward to increasing interest in the larger Cluster PPG. The Business Transformation Manager is also currently working with the Communications and Engagement Team to provide a training and Development Plan to be rolled out to all PPG SDF wide for 2018/19
PPG 2018 development and event plans are in place, a number of relevant meetings have been arranged both within the Cluster and across the Borough to maximise the potential for an inclusive partnership arrangement across Practices, SDF’s and Cluster’s. The development and event plan is now underway.
The Business Transformation Manager continues to attend as many practices PPG’s as possible.
The cluster PPG continues to run with no appointed chair, this has been discussed within the group and a decision should be made hopefully in July 2018
4 – Practice Engagement/Partner Engagement
Operational The Business Transformation Manager continues to undertake practice visits and or telephone contact / conversations with a minimum level of at least one scheduled visit to each practice each month as well as visits on an ad-hoc basis. The aim of the visits is to continue to update and understand individual practice priorities whilst being mindful of the need to address the themes and trends that have been identified. It has been found that open discussions with staff combined with a supportive and open approach help and support practices to resolve issues and facilitates knowledge sharing between practices. Page 268 Page
General feedback from the practice visits is that there are on-going issues with:
1. Staffing (recruiting and retaining workforce) 2. Training (this has seen a good level of improvement) 3. Estates.
Going forward there is also the aim to attend practice team meetings to update, communicate and support the development of cluster working, supporting robust communication between the Cluster leads and practices.
Working Collaboratively To ensure that the cluster is supported in all aspects of their work, we are now starting to link more closely with colleagues in Finance, Medicines Management and Quality to ensure a cohesive and supportive approach with improved communication.
Collaboration across practices and clusters is being enabled through a shared approach to elements such as Buying Vaccines, working towards achievement of the Primary Care Standards, developing PPGs, unified practice policies and the QIPP financial challenge.
There were four key areas identified to take forward from the Practice Managers Collaboration Development Day:
1. GDPR Policies and Update – Two managers identified to take the lead (Ongoing) 2. Group Purchasing of Immunisations – Two managers identified to take the lead (Ongoing) 3. FeNo Machines – Two managers identified to take the lead (Ongoing) 4. Group Purchasing of Stationary etc
Practice Nurses There are plans in place to improve engagement with Practice Nurses from across the Cluster to understand and to identify any opportunities for service redesign, collaboration and improvement. The current cluster Lead Practice Nurse has stepped down to become Deputy and a new and experienced ANP has taken on the role as Lead Practice Nurse for the cluster.and will work to progress collaboration and engagement.
5 – Project Update TABA+ Care in the Community Service
The project continues to run well with visit statistics above the original forecast.
The housebound visits element of the service continues to be well received and positive feedback from professionals, patients and carers still being received. Page 269 Page
General feedback from care homes and also resident’s relatives is that the project is working very well and quality and continuity of care has improved tremendously.
The project has been extended for three months until the end of June 2018
6 – Key Activities and Priorities For The Next Period
1. Work plan with agreed KPIs, finalised (monthly updates) 2. Analyse TABA+ SDF Profile and identify / highlight any trends and themes with HWP and SDF Manager, Wigan Council 3. PPG Development 4. PPG Training Programme for PPG Members (Delivering and Supporting this) 5. eFI Project Expansion 6. Leading on Primary Care Standards 6, 9 and 13 7. Working on the proposed new build (Astley) 8. Working on current practice merger (Atherton) 9. QIPP working with and internal CCG team and with practices within the cluster to address the current financial challenges 10. Working with SDF Manager on School Absence Requests to practices 11. Working with Sexual Health Team on relocating the current service provision based at Tyldesley Clinic to within a Tyldesley GP Practice Page 270 Page Service Delivery Footprint Highlight Report Wigan Reporting Period May 2018 Business Transformation CCG Lead Jennie Gammack Clinical Lead Dr Marwick/Dr J Davies Manager Helen Kerins
1 - SDF Objectives / Background –(Use this section to explain more about the objectives for the SDF / Cluster e.g. Vision/Mission statement etc
Each Practice located within the Wigan SDFs has its own Practice Mission Statement. This sets out a suite of rules that the practice aspires to in their everyday activities, however the Wigan Cluster currently does not. This will be addressed via the Wigan Cluster Executive Meetings. Work is progressing to support this and hopefully this will be completed in the next couple of months.
Primary Care Standards The final submissions for Q4 2017/18 have now been received and will be analysed for themes and trends to be looked at by individual practices and Wigan Cluster as a whole. The final 20% of payment due to practices is now being calculated according to compliance and practices will be advised of outcomes Page 271 Page and scheduled payments in the coming month. Practices have also submitted their Practice Improvement Plans which will be used as a working document over the coming year to measure improvement and practice engagement. This will be monitored during regular visits to practice by the AD & BTM.
Since November the two working groups established within the cluster have continued to meet. The first group are looking at Standard 2, looking at how we can share and adapt the same protocols across all practices within SDFs to apply a consistent approach for all. Some work has already been completed prior to the meeting via Lead Practice Nurses and the group have started to share ideas and knowledge to enable a set of consistent processes and templates. Three protocols to support practices and aligned working have been developed and are with a GP for sign off prior to distributing to practices. The Group will now seek recommendations for the next ones to be developed. Separately to this other meetings have taken place to look at the clinical template for Learning Disabilities and Mental Health this group has representation from the CCG, LA, Bridgewater and Practices. It is anticipated that the template will be ready for circulation sometime in June.
The second group have met to look at supporting the standards IT provision such as Websites, Social Media, Online booking etc., this piece of work will run alongside already on-going work via our Primary Care Informatics Team. The group are keen to ensure that a consistent and safe approach is created to help practices with all aspects of social media. The group have liaised with practices where this is already being done and provide support to mirror good examples. The group are keen to involve practices in other clusters as they know that there are some examples of social media working well elsewhere. The Aqua presentation is being used in meetings and Kate Stephenson has offered to support the group in any aspects of social media. During April and May the Group have been looking at system templates (developing new and sharing) and also assisting practices with the switch on of Iplato.
Practice Manager Collaboration & Support All Practice Managers in the cluster meet on a regular basis monthly to share information, learning experiences and good practice. There have been recent changes to the support within the Cluster due to staff changes, the BTM for Wigan North will now cover both Service Delivery Footprints (SDF) and the Lead Practice Manager for Wigan Central is currently taking on the lead Practice Manager supporting the practices across both SDFs. The BTM and Practice Manager have already met to establish visions and agree a work stream for Practice Managers to work in a more collaborative way moving forward. Lots of ideas have been shared and the BTM will be working to draw up a document for sign off at the next PMs meeting in July.
Page 272 Page Potential Wigan Cluster Projects Wigan Cluster has expressed an interest in developing new ways of working as a cluster for the following projects: Shared Workforce/Human Resource Support Reception Triage New Patient Registration Process Skills and Training Succession planning Joint IT provisions All of the above are being picked up via BTM. The BTM will continue to monitor progress through regular practice visits and support. The BTM has met with some PMs to update the practice priorities document and is currently visiting the practices in the Central SDF to introduce herself and to update their priorities also, these will support improvement plans aligned to the PCSs. The BTM will also be looking at ways to encourage the practices to work more in collaboration and look to implement quick wins and immediate solutions cross all practices.
Wigan Cluster has decided to re-visit their priority areas for the coming financial year and will be discussing these at Exec level before further discussion takes place with Wigan Cluster. The priority for the coming months will focus on QIPP and a team of dedicated people have been assigned to each SDF to support this piece of work. Work with HWP Relationship Building with SDF Managers and Community Link Workers Start-up of Advice & Information Services in General Practice Project Group (Beech Hill & Diccinson) Start-up of Think Ahead Stroke Project Group
Strong working relationships have been made with HWP, the Local Authority, CIC and the CCG during the last months and all services have collaborated to support the two projects being delivered in Beech Hill and Standish Practices. The BTM is project leading to support these two separate pilots and it is envisaged that more pilots within practices will be started over the coming months.
The BTM will attended a meeting with Lead PMs whom are hosting the Advice pilot (Four practices Beech Hill, Dicconson, Brookmill and Pennygate) along with participants from HWP and CAB Wigan to discuss the progress of the pilot. A paper will also be taken to the HWP Board and to CCG SLT, this will report how the pilots are doing, what outcomes have been achieved and any recommendations if any to be taken forward. A Practice Nurse from Beech Hill will also conduct an audit on the pilot over this next couple of months. Data is being collated via HWP intelligence and the BTM will look to pull a draft report Page 273 Page together for the June meeting for sign off by the project group for the end of the pilot.
Think Ahead Stroke have been working with Standish Practice in which they held a launch event in practice at the beginning of March. The Practice marketed the event via social media and has also contacted Stroke survivors and their carers to attend. The attendance wasn’t as big as they would have hoped and the BTM is working with the practice to discuss how we capture the remaining patients that weren’t informed in the first cohort of Stroke Survivors at the beginning of the project. Since then work has commenced to target the remainder of the patients whom were not contacted in the first trance and Think Ahead have been a regular feature available for patients in the Practices waiting area.
2 - Status Update (Use this section to record activities throughout the month - what went well and what didn't. Anything that isn't on track as per timelines)
Highlights
Practice Priorities The next round of visits were in March and April this year, updates will be written and added to the already established profile, the BTM and Practice Manager will use this document as a mechanism to communicate any new key findings/developments within practice. The BTM attends all practices on a regular basis to support should it be needed. Update on progression of key findings in practice below:
Standish – PPG focus for the new year will be a new mini project, the BTM is working with PM to look at ideas on to too take this forward. CQC planning has been the main focus in practice these past weeks as they have a planned inspection at the beginning of June. The practice have recently promoted the reception Manager to Deputy PM and also appointed another admin manager to Practice.
Shevington – A meeting will be held in practice at the beginning of next month to look at moving forward the building project to provide an extension to the current building. The practice has been allocated monies to develop a business case. The practice will be focussing on CQC planning over the next month or so as they have been advised that their inspection may be imminent.
Beech Hill –The CAB project continues to thrive in practice . Aspull – A new Practice Manager has been successfully appointed and started in the Practice during April. The Deputy Practice manager has also left the practice at the end of May. The Practice PPG are about to embark on a new project in conduction with the local schools to design a practice logo. The BTM
Page 274 Page will be supporting this and has supplied them with a project plan to initiate the project.
Bradshaw – The practice are currently doing an admin review to try to streamline current roles in practice. This is being supported by the BTM.
Sullivan Way – The BTM will be working with the practice over the coming months to look at CQC planning. Succession planning will also be looked at as the PM is due to retire in Nov this year.
Dr Seabrook – Has a temp Practice Manager for a few months, the BTM will support her in this role.
Newtown – BTM attended practice no concerns at this time
Pemberton – BTM assisted in completion of Improvement plan, due to visit soon.
Diccinson – BTM and PM working closely to develop a work plan for PMs for the coming year.
Cluster Executive The Cluster Executive continues to meet on a bi weekly basis (when possible). This meeting is used to discuss SDF Reports for the Cluster – analysis presented Business Case review Potential future projects Wigan Cluster/PM Meeting agenda setting BTM Work plans and the Cluster split Recruitment of Pharmacists Commissioning Intentions
The priorities for the coming year have yet to be identified.
Memorandum of Understanding The Cluster Exec are signed off the Memorandum of Understanding to allow finances to flow through the Exec to practices who are delivering projects on their behalf or engaging in work as clinical or practice manager leads. The Cluster Exec will also nominate two signatories who will control the account once it has been set up. In the meantime Diccinson have agreed to take the money into a holding account in the interim with agreement from Exec.
Clinical Pharmacists in Practice Wigan Cluster will be looking into developing this project further with the assistance of the Federation.
Page 275 Page Other BTM Leading on the Quality Assurance Framework for the BTMs Weekly Bulletin introduced feedback supportive Attended PPGs in Practices Attended the Primary Care Ops Meeting Represented the Primary Care Team PBI Ops Meeting QIPP
Lowlights
NDPP roll out to Wigan Cluster There have been a number of issues surrounding the roll out of this service to Wigan Cluster. Kate Davenport and Dr N Vallabh have communicated these to the provider Reed Momenta and fed back responses to practices. It is believed that this is some way to being resolved and will hopefully regain positive impact over the coming month.
3 - Possible Opportunities/Horizon Scanning CQC planning support for all practices in Wigan cluster Mini projects evolving from Practice visits – next visits July Support at PPGs – establish relationships at all levels Practice Nurse visits and engagement Project scope via Wigan Healthier Partnership Shared IT Systems Diagnostics review Collaborative working across all SDFs Group Consultations
It is anticipated that this list will added too over the next few months as support with Improvement plans is implemented and monitored.
Page 276 Page 4 – Practice Engagement/Partner Engagement
Operational The Business Transformation Manager continues to complete Practice visits on a weekly basis, with the visits focusing on having open discussions with the staff and deal with and resolve any issues that they may be having. Working on site is having a positive impact and allowing the BTM to establish relationships throughout practices. Positive feedback has been given.
Working Collaboratively To ensure that the cluster is supported in all aspects of their work, the team is now starting to link more closely with colleagues in finance, medicines management and quality to ensure a cohesive and supportive approach with excellent communication. This work is also being mirrored by collaboratively working with the Healthier Wigan Partnership team and the SDF managers. Regular meetings have been set up with the SDF manager. The BTM is in attendance at monthly PBI (Placed based Integration Working Group) meetings to represent the team.
Practice Nurses The Team is keen to also engage with Practice Nurses from across the Cluster to understand and to identify any opportunities for service redesign, collaboration and improvement. All practices within the SDF were able to send Practice Nurse and Practice Manager representation to the Sharing Good Practice Primary Care Standards Workshop. This generated discussion and enthusiasm for future working across organisations as one SDF. Following on from the meeting a piece of work has been scoped to involve practice nurses with the Protocols that have been identified as part of the PCS. This work will commence once an overall summary re all the standards with regards to the support has been shared. The Lead Practice Nurses are also now regularly attending the Exec Cluster. The BTM recently met with PNs to discuss Group Consultations in practice or place based as to mirror the work that is already established in Leigh. The BTM will write a paper with input from the PNs to take to Exec Cluster for sign off with a view for a training event to take place in early Sept.
5 – Project Update’s
Skills, Succession & Support Change Project – On Hold
Advice & Information Services in General Practice Project Group – The project commenced from the new year and the project plans have circulated continues to be updated by the project lead. The Group have agreed to meet every month during the pilot in Beech Hill were the BTM will share an update and highlight report. Positive feedback has already been escalated via the practice and the BTM is having a weekly catch up with the CAB staff in practice. The BTM is also meeting with the chief officer of CAB on a regular basis. The BTM also continues to liaise with HWP on progress. Page 277 Page Think Ahead Stroke Support in Practice – The pilot is up and running and Think Ahead are working with the practice GPs and CLWs to promote and support stroke survivors and their carers on site, in the community and at Ashland House. The project will be supported via the BTM and regular update meetings will take place.
Dementia Friendly in Standish – The BTM is working with colleagues from Adult Social Care, SDF assigned manager, CLWs and PCSOs to market an event to make Standish a dementia friendly community. This will be done with support from practice and PPG the event will take place in June and is also being supported by pupils from Standish High School. The event is being held in June and is hoping to create a Dementia Friendly Community within Standish.
Group Consultations – A working Group has been established (as above) and a paper is being developed to take this forward.
New Patient Health Questionnaire The first draft of the New Patient Health Questionnaire, the Patient Information Booklet and the suggested process has been circulated for comments. Feedback has been received, responses have been prepared for this and will be discussed at the Wigan Practice Managers Meeting these have also been shared with the assisting GP lead on this piece of work. A business case will be submitted for Wigan Cluster to cover the costs to print these items professionally.
Carers Centre Referral and Uptake A total of 26 referrals were made from Wigan Central SDF practices to the Carers Centre, this will be picked up as part of the Primary Care Standards development projects which are being led by the Business Transformation Manager over the coming year.
9 – Key Activities and Priorities For The Next Period
Over the next few weeks priorities are to make sure that my projects are scoped and up and running. This will require liaising with Cluster PMs and establishing baseline and KPIs to put project plans together. Support CQC Inspections Enhance my business awareness PPG participation within SDF Continuous engagement with SDF Manger Page 278 Page PCS Support to Lead and Clusters MOD.gov templates to be established via team and implementation of use Sharepoint site for Cluster – Tom already started Monitor work plan and merge PPG opportunities input Primary Care Commissioning Intentions support Shevington Accommodation support PCS working group support o Protocols o Media Dementia data input SDF/HWP Links Annual Quality & Engagement Scheme final return and practice achievement. QIPP Support Complete Practice introduction visits