To Be Held on Thursday 8 April 2021 at 12.30Pm – 2.30Pm Live Streamed Via Zoom

PRIMARY CARE COMMISSIONING COMMITTEE (Public) To be held on Thursday 8 April 2021 at 12.30pm – 2.30pm Live Streamed via Zoom

A G E N D A

Ref Item Enclosure Led By Action Required 1 Apologies for Absence Verbal Chair Noting

2 Declarations of Interest Verbal Chair Discuss / The CCG’s register is available via the Noting Governance team or on the CCG website which can be accessed here.

3 Notification of Any Other Business Verbal Chair Noting

4 Minutes of the last meeting held Enc A Chair Approval on 11 March 2021

5 Matters Arising not on the Agenda, Verbal Chair Review including progressing the Action Tracker • AP129 • AP131

6 Action Tracker Enc B Chair Noting

7 Finance & Contracting:

7.1 Interim Exception Report Verbal H Tingle Noting

7.2 Primary Care Estates Strategy – Enc C S Barnes Noting Implementation Plan Update

8 Quality:

8.1 Interim Exception Report Verbal Z Head / A Ibbeson Noting

9 Strategy and Planning:

9.1 Primary Care Commissioning Enc D C Ogle / Chair Approval Committee Terms of Reference

9.2 Primary Care Commissioning Enc E Chair Consider / Committee Annual Report Discuss & Approval

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Ref Item Enclosure Led By Action Required 9.3 Primary Care Cell Update Enc F K Roberts Noting

9.4 Primary Care Networks Update Verbal C Ogle Noting

9.5 GP Forward View Enc G C Ogle Approval

10 Forward Planner Enc H Chair Review

11 Items to escalate to Governing Verbal Chair Discuss Body

12 Risk Register Enc I C Ogle Consider / Discuss

13 Any Other Business Verbal Chair Discuss

14 Date and Time of Next Meeting Thursday 13 May 2021, 12.30pm – 2.30pm, Live Streamed via Zoom.

QUORACY: Primary Care Commissioning is 4 Members including a minimum of 1 Lay Member inclusive of the Chair (or Vice Chair in the Chair’s Absence)

Page 2 of 2

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Minutes of the Primary Care Commissioning Committee (Public) Held on Thursday 11 March 2021 at 12.30 pm Live Streamed via Zoom

Voting Members S Whittle Lay Member (Chair) Present: J Pederson Chief Officer, CCG H Tingle Chief Finance Officer, CCG A Russell Chief Nurse, CCG A Fitzgerald Director of Strategy and Delivery, CCG

Non-Voting C Ogle Associate Director for Primary Care & Commissioning, Members Present: CCG K Roberts Primary Care Manager, CCG Z Head Lead Nurse Primary Care Quality, CCG Dr N Alsindi Clinical Lead Primary Care, CCG Dr M Pande South Locality Lead GP S Barnes Interim Estates Lead, CCG J Telford Healthwatch Representative P Barringer NHS England Representative D Eggitt Chief Executive Officer, LMC

In Attendance: A Small Senior Finance Manager, CCG E Ross Primary Care Engagement Officer, CCG K Smith Senior Officer, Digital Primary Care (Technical Support), CCG J Torn Executive Officer, Doncaster LMC K Connolly Senior Corporate Services Support Officer, CCG (minutes)

Meeting Start 12.30 pm Action

1. Apologies for Absence

Apologies for absence were received from:

• L Tully - Lay Member • A Ibbeson - Interim Deputy Chief Nurse & Designated Nurse for Children’s Safeguarding & LAC, CCG

2. Declarations of Interest

The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which

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might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).

Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate.

Declarations of interest from sub committees / working groups: None noted.

Declarations of interest from today’s meeting: S Barnes noted that he is also undertaking a similar role for estates for Rotherham CCG. The chair decided that there was no risk of undue gain or influence for all parties concerned.

3. Notifications of Any Other Business

No items were raised.

4. Minutes from Previous Meeting

The minutes of the last meeting held on 11 February 2021 were approved as an accurate record.

5. Matters Arising not on the Agenda

• AP127 – discussed at Strategy with feedback sent to S Whittle. An update will be provided at April’s meeting in the terms of reference review. • AP129 – an update will be provided at April’s meeting as waiting on a return to complete.

The Primary Care Commissioning Committee noted the update for actions AP127 and AP129.

6. Action Tracker

The Primary Care Commissioning Committee discussed and updated each item on the Action Tracker.

• AP100 – will be updated at June’s meeting • AP118 – will be updated at April’s meeting • AP127 – see item 5 for update • AP129 – see item 5 for update.

The latest updates can be viewed on the shared Action Tracker.

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7. Finance and Contracting

7.1 Interim Exception Report

H Tingle advised the Primary Care Commissioning Committee there was nothing significant to raise.

7.2 Primary Care Estates Strategy - Implementation Plan Update

S Barnes provided a monthly update to the Primary Care Commissioning Committee on the implementation of the CCG Estates Strategy.

Work is ongoing for the following projects:

1. Bentley Hub Project – work is concluding on the feasibility study with a draft report in circulation for comments. The feasibility study is now concluded and is in the process of review by the GP practices and Doncaster Metropolitan Borough Council (DMBC) 2. Rossington Health Centre – Work is underway to establish the scope of the project and is looking at the options for either a single practice or two practice development. 3. Mexborough GP Led Project – The District Valuer has been appointed and the developer is progressing the development 4. Scott Practice Extension and Reconfiguration – The cost plan, risk register and programme are developed, and a planning submission has been made to the Local Planning Authority (LPA). 5. Petersgate Practice Extension and Reconfiguration – Paused until June 2021 due to practice workload and Covid commitments

H Tingle advised the Bentley Project Board has been established with representation from the DCCG, DMBC and the General Practices (GPs) involved. The purpose of the board is to oversee the project and set the direction of travel for approval and delivery. Work is underway to establish the next steps for the development and progression of the business case.

The 4Doncaster project had now been removed from the capital programme.

It was noted that a number of comments had been received on the Programme Business Case which could mean a delay in the approvals process. The Board had also put a call out for reserve projects. The local team was keen to ensure that the Rossington project was fully funded over other additional projects being included.

S Barnes to request support from J Pederson if required.

With regard to the revised Primary Care Estates Strategy a proposal from Doncaster Estates Partnership was being worked through and it was hoped to appoint in the next 2-3 weeks so that a refreshed strategy could be produced by the summer.

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The Primary Care Commissioning Committee thanked S Barnes for the informative report and noted the contents.

7.3 Practice Merger Guidance Manual

E Ross presented the Practice Merger Guidance Manual to the Primary Care Commissioning Committee for approval.

The manual has been created following previously raised concerns from merged practices about discrepancies following mergers having taken place. The primary care team would like to use this manual as a guidance tool for future practice mergers. This will allow for a smoother merger process. This has been tested on a recent practice merger, has input from teams within the CCG and practice managers who have previously merged practices.

J Pederson acknowledged the work put into producing the manual and suggested it was included in the GP update and shared with other CCGs as they may also find it helpful. J Pederson will also share it at the Primary Care ICS meeting. Dr D Eggitt suggested he could also share with Local Medical Committees across the UK.

The Primary Care Commissioning Committee:

• Approved the use of the Practice Merger Guidance Manual moving forward. • Agreed the Primary Care Team will be owners of this document which will be reviewed yearly and amended as ER required.

8. Quality

8.1 Interim Exception Report

Z Head provided the Primary Care Commissioning Committee with a brief verbal update.

Over 100,00 people in Doncaster have been vaccinated, 5 sites are up and running with pop-up vaccination sites also being used. Vaccination teams are also attending places of worship to vaccinate hard to reach groups and a process is in place to identify inpatients requiring the vaccination. Primary care staff uptake has been over 90%.

No questions were raised.

The Primary Care Commissioning Committee thanked Z Head for the update and noted the incredible amount of work that has gone into the vaccination programme.

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9. Strategy and Planning

9.1 Primary Care Networks Update

C Ogle shared the Primary Care Networks update which is focused on the following:

• Additional Roles Reimbursement Scheme update on claim for

underspend • OD & Development top sliced funding confirmed • Assurance Processes NHS England feedback and local process regarding enhanced health in care homes • Update on the PCN DES for 2021/22

The Primary Care Commissioning Committee noted the update on the development of PCNs to date and plans for 2021/2022.

9.2 Primary Care Cell Update

K Roberts provided the Primary Care Commissioning Committee with an update on the Primary Care Cell and the headline areas of work they are currently undertaking:

• Pulse Oximetry@Home, Virtual Ward & Blood Pressure Monitoring • COVID Vaccinations • Managing Practice Pressures & Key Messages

• Risk Register • CCHUB Evaluation • Interface between Primary Care and DBTHFT • Faecal Immunochemical Testing (FIT) – SYB ICS Cancer Alliance

Proposed LGI Pathway Changes & Rapid Access to Gynaecology • Primary Care Cell future a dedicated strategy session to be held the following week.

The Primary Care Commissioning Committee noted the information provided in relation to the Primary Care Cell update.

9.3 ICS Development

J Pederson updated the Primary Care Commissioning Committee on the ICS Development.

The white paper provides much needed clarity for all and clearly states, amongst other things, that the ambition is for ICS’s to be established from st 1 April 2022 and for those organisations to take on the statutory responsibilities of CCGs. The ICS will also take on duties from NHS England in relation to primary care.

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We are working with the senior team at the SYB ICS, and all health and care partners across the ICS, on the implications of these proposed

changes in order to achieve a smooth transition to the new NHS operating model and to also ensure that our focus remains on delivering great care, improving patient outcomes and also maximising the potential of working collectively with all partners, including social care to reduce health inequalities.

Doncaster is in a good position and has always promoted collaborative working. The ambition is – a thriving place and a thriving partnership.

Dr D Eggitt asked how can we assure we retain strong clinical leadership

across Doncaster, South Yorkshire and Bassetlaw. J Pederson stated we should be encouraging our clinicians to get more involved and influence the process. The establishment of primary care collaboratives will help with this.

The Primary Care Commissioning Committee thanked J Pederson for the very informative update on the ICS Development.

9.4 Primary Care Delivery Plan

C Ogle updated the Primary Care Commissioning Committee on progress with the 2020/2021 Primary Care Delivery Plan which is part of the Living Well Strategic Delivery Plan and to commence planning for 2021/2022.

The plan was also shared with the Governing Body recently.

J Pederson advised support and health checks for carers was discussed at Health and Wellbeing Board and suggested if more could be added around this. A Fitzgerald commented a focus on Health Inequalities is at the forefront of Primary Care work and should be reflected in the plan.

The Primary Care Commissioning Committee:

• Noted the update on progress with the 2020/21 Delivery Plan • Considered, discussed and approved the proposed content of the Delivery Plan for 2021/22 subject to the addition of carers and a CO focus on inequalities identified above.

10. Forward Planner

The Primary Care Commissioning Committee noted the Forward Planner with no further items added.

11. Items to Escalate to Governing Body

The Primary Care Commissioning Committee agreed there were no items to escalate to Governing Body.

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12. Any New Potential Risks

The Primary Care Commissioning Committee agreed there were no new potential risks identified for Primary Care.

13. Any Other Business

No items were raised.

14. Date and Time of Next Meeting

Thursday 8 April 2021 at 12.30pm - live streamed via Zoom.

Meeting Closed 1.30pm

Enc B KEY Completed / Closed In Progress PUBLIC Primary Care Commissioning Committee To Action Open Action Tracker: 8 April 2021 To be actioned but date not yet due

Action/ Completed (RAG) Meeting Date Action Lead / Action For Timescale Agenda Ref and Date The Designated GP for Safeguarding Children and the Deputy Designated Nurse for Safeguarding Children to undertake To be Actioned but 9 July 2020 AP100 Andrea Ibbeson Jun-21 a full review of processes for Case Conference Reporting / Attendance, once normal business resumes. date not yet due L Tully to bring the Primary Care Commissioning Committee Terms of Reference back to the April 2021 meeting for 8 October 2020 AP118 L Tully Apr-21 Completed review. UPDATE: On Agenda 08.04.2021. C Rollinson to compare the CCG's Primary Care Commissioning Committee, Executive Committee and Governing Body 10 December 2021 AP127 decisions making processes with other CCG's. Update: L Tully to update at a future meeting. Agreed to discuss at the C Rollinson Apr-21 Completed April 2021 meeting along with the Terms of Reference. UPDATE: On Agenda 08.04.2021. P Barringer to find out when the remaining PCN funding will reach CCG's and feedback to the group. Update: Feedback 11 February 2021 AP129 P Barringer Apr-21 To be Actioned to be given at the April 2021 meeting. 11 March 2021 AP130 Add the Practice Merger Guidance Manual to the Forward Planner for review every 12 months. E Ross Apr-21 Completed 11 March 2021 AP131 C Ogle to inlcude addition of Carers and focus on inequalities to the Primary Care Delivery Plan. C Ogle Apr-21 To be Actioned Enc C

Meeting name Primary Care Commissioning Committee Meeting date 8 April 2021

Estates Implementation Plan Update Title of paper

Executive / Hayley Tingle, Chief Finance Officer Clinical Lead(s) Simon Barnes, Interim Estates Programme Director, Carolyn Author(s) Ogle, Associate Director of Primary Care & Commissioning

Status of the Report

To approve To consider/discuss

To note √

Purpose of Paper - Executive Summary

The purpose of this paper is to provide a monthly update to the Committee on the implementation of the CCG Estate Strategy

Recommendation(s) • The Primary Care Commissioning Committee is asked to note the contents of this report.

Report Exempt from Public Disclosure

Yes No √

Impact analysis Quality impact Support to improve the quality of the primary care infrastructure Not applicable

Tick relevant Equality box impact An Equality Impact Analysis/Assessment is not required for this report. √ An Equality Impact Analysis/Assessment has been completed and approved by the lead Director for Equality and Diversity. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. Enc C

An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability To secure sustainability of the primary care estate impact Financial Recurrent revenue consequences are a consideration with each scheme. implications Capital funding comes through ICS or NHS England Legal Premises Cost Directions & Section 2 Agreement implications Management of Conflicts of Will be preserved through the Committee’s constitution Interest Consultation / Engagement (internal To be undertaken as plans emerge departments, clinical, stakeholder and public/patient) Report previously Not applicable presented at Risk The ICS Programme Business Case isn’t approved and or funding is analysis withdrawn. Corporative Objective / CO3 ensuring that the primary care element of the primary care system is Assurance sustainable. Framework

[Complete this section if submitting a report to Primary Care Commissioning Committee / Primary Care Delivery Group. For any other committee, delete this row on the report template.]

Statutory Duty Section Tick Relevant Box Management of Conflicts of 14O Interest Duty to promote the NHS 14P Constitution Duty to exercise its functions 14Q effectively, efficiently and Primary Care economically Statutory Duty as to improvement in quality 14R √ Duties (only) of services Duty in relation to quality of 14S √ primary medical services Duties as to reducing inequalities 14T Duty to promote the involvement 14U of each patient Duty as to patient choice 14V Duty as to promoting integration 14Z1 Public involvement and 14Z2 consultation GMS, PMS and APMS contracts 83 (including the design of PMS and Enc C

APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract) Newly designed enhanced 83 services (“Local Enhanced Services” and “Directed Enhanced Services”) Design of local incentive schemes 83 as an alternative to the Quality Outcomes Framework Decision making on whether to 83 establish new GP practices in an area Approving Practice mergers 83 Making decisions on 83 ‘discretionary’ payment (e.g., returner / retainer schemes) To plan, including needs assessment, primary medical care services in Doncaster To undertake reviews of primary medical care services in Doncaster To co-ordinate a common approach to the commissioning of primary care services generally To manage the budget for √ commissioning of primary medical

care services in Doncaster

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Primary Care Commissioning Committee

8th April 2021

Doncaster CCG Estates Implementation Update for March_April 2021

Overview

The Doncaster Primary Care Estate Strategy Implementation and Improvement Plan was published in May 2019 and progress has now commenced delivering the plan.

The following sets out activities that have been undertaken in month and will be progressed in the following month.

General

1. South Yorkshire and Bassetlaw (SYB) Estates Programme Board – Doncaster CCG (DCCG) attended the March 2021 SYB Estates Programme Board and updated on progress for the Bentley, Scott Practice, Petersgate Practice and Rossington projects. 2. Primary Care Network (PCN) estates strategy refresh is progressing. 3. The estates team is working with the digital team on a 12 month roadmap. 4. The CCG is supporting several practices explore options for additional space requirements due to recruitment of staff through the Additional Roles Reimbursement Scheme (ARRS). 5. The CCG is supporting several practices explore options for future estate consolidation / reconfiguration / optimisation. This is in addition the SYB Capital programme.

Outputs and update for March 2021

Bentley Hub Project – A Project Board has been established and the first meeting was held on the 10th of March, chaired by Doncaster Metropolitan Borough Council (DMBC) and has representation from DCCG, the Bentley Practice and the Ransome Practice. The purpose of the Project Board is to oversee the governance of the project and set the direction of travel for approval and delivery. Enc C

Work is underway to establish the next steps for the development and progression of the Outline Business Case (OBC).

Rossington Health Centre Project – Work is progressing to establish the options for either a single practice or two practice development. Initial consultation has taken place with the Rossington Practice and the West End Clinic to establish their requirements. An output is expected in late April early May 2021.

Mexborough GP led Project – The developer and GPs are progressing the project and we await the draft OBC for comment.

Scott Practice Extension & Reconfiguration Project – The cost plan, risk register and programme are developed, and a planning submission has been made to the Local Planning Authority (LPA). A planning decision is expected in mid-April. Once planning has been granted the Project Initiation Document (PID) can be finalised, locally approved and then issued to NHS England for approval.

Petersgate Practice Extension & Reconfiguration Project – The project is on pause until June 2021 due to practice workload and Covid commitments.

Focus for April 2021

1. Bentley Hub Project – a) progress the Heads of terms (HoTs) with DMBC, b) progress the next phase of the development to Outline Business Case (OBC); 2. Rossington Project – Progress the options study and confirm the scale of the development; 3. Mexborough GP led Project – continue working with the project team progressing the project and progress the business case approval process; 4. Continue responding to the SYB Capital Programme Board requests; 5. Progress the estates strategy refresh; 6. Attend estates meetings with key partners; and 7. Respond as required to operational related estates requests. Enc D

Meeting name Primary Care Commissioning Committee Meeting date 8 April 2021

Title of paper Primary Care Commissioning Committee Terms of Reference

Executive / Sarah Whittle Clinical Lead(s) Lay Member, Deputy Chair Primary Care Commissioning Committee Carolyn Ogle, Associate Director of Primary Care & Commissioning, Author(s) Cheryl Rollinson Head of Corporate Governance, Sarah Whittle, Lay Member

Status of the Report

√ To approve To consider / discuss

To note

Purpose of Paper - Executive Summary

1. Introduction The Primary Care Commissioning Committee (PCCC) terms of reference (TOR) have been reviewed in order to bring them up to date. The Terms of Reference will require formal approval by the Governing Body once the Committee has agreed them.

2. Amendments The sections for consideration are:

• Paragraph 4.8 to note that the role of the Executive Committee is lifted from the scheme of reservation and delegation and therefore cannot be amended without a change to the standing orders • Paragraph 7 As these sub groups are currently formally constituted and the Primary Care Cell sits within the governance structure of the health cell, the terms of reference should not be amended until those arrangements have been stood down. It should be noted that neither the Delivery Group nor the Provider Engagement Group are currently meeting. It is likely that the Primary Care Cell will replace the Delivery Group in future and report to the Committee. • Paragraph 9.2 and 9.3 previously have been deleted as duplicates section 10 • Paragraph 11.3.1 has been amended to include a minimum of 9 meetings per year. There is nothing in the constitution or delegation arrangements that requires this. Th review in the establishment year has been deleted. • 11.3.2 Cross referencing corrected • 11.4 Due to pre meeting timings changed notification of papers to Chair to 8 working days • 13.3 updated reference to NHS England and moved timescale to annually from

quarterly

Recommendation(s)

The Primary Care Commissioning Committee is asked to: • Approve the amendments to the Terms of Reference

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Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Impact analysis Quality impact To ensure primary care functions increase quality. . Equality Meeting the health needs of the population, ensuring patient’s rights of impact choice are maintained and reducing health inequalities. Sustainability Nil impact Financial Ensuring efficiency, productivity and value for money are promoted. implications Legal Nil implications Management of Conflicts of N/A Interest Consultation / Engagement (internal departments, N/A clinical, stakeholder & public/patient) Report previously Not applicable presented at Risk N/A analysis Assurance CO2 – 2.1, 2.2, 2.3, CO3 – 3.1 Framework

Statutory Duty Section Tick Relevant Box Management of Conflicts of 14O Interest Duty to promote the NHS 14P Constitution Duty to exercise its functions 14Q X effectively, efficiently and economically Duty as to improvement in quality 14R of services Primary Care Duty in relation to quality of 14S Statutory Duties primary medical services (only) Duties as to reducing inequalities 14T Duty to promote the involvement 14U of each patient Duty as to patient choice 14V Duty as to promoting integration 14Z1 Public involvement and 14Z2 consultation GMS, PMS and APMS contracts 83 (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing Enc D branch/remedial notices, and removing a contract) Newly designed enhanced 83 services (“Local Enhanced Services” and “Directed Enhanced Services”) Design of local incentive schemes 83 as an alternative to the Quality Outcomes Framework Decision making on whether to 83 establish new GP practices in an area Approving Practice mergers 83 Making decisions on 83 ‘discretionary’ payment (e.g., returner / retainer schemes) To plan, including needs assessment, primary medical care services in Doncaster To undertake reviews of primary medical care services in Doncaster To co-ordinate a common approach to the commissioning of primary care services generally To manage the budget for commissioning of primary medical

care services in Doncaster

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Terms of Reference Primary Care Commissioning Committee

1. Introduction

1.1. NHSE has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act.

1.2. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the CCG.

1.3. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:

a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2).

1.4. The CCG will also need to specifically, in respect of the delegated functions from NHSE, exercise those set out below: • Duty to have regard to impact on services in certain areas (section 13O); • Duty as respects variation in provision of health services (section 13P).

1.5. The Committee is established as a committee of the Governing Body of NHS Doncaster CCG in accordance with Schedule 1A of the “NHS Act”.

1.6. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.

2. Accountability of the Committee

2.1. Budgetary and resource accountability is in line with the CCG Scheme of Delegation and Standing Orders. Enc D

2.2. For the avoidance of doubt, in the event of any conflict between the terms of this Scheme of Delegation and Terms of Reference and the Standing Orders of Standing Financial Instructions of any of the members, the latter will prevail.

3. Role of the Committee

3.1. Simon Stevens, the Chief Executive of NHS England (NHSE), announced on 1 May 2014 that NHSE was inviting CCGs to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG’s preference for how it would like to exercise expanded primary medical care commissioning functions. One option available was that NHSE would delegate the exercise of certain specified primary care commissioning functions to a CCG.

3.2. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHSE has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to NHS Doncaster CCG. The delegation is set out in Schedule 1.

3.3. The CCG has established the NHS Doncaster CCG Primary Care Commissioning Committee (“Committee”). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.

3.4. It is a committee comprising representatives of the following organisations: • NHS Doncaster CCG • NHS England

4. Statutory Framework

4.1. The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in Doncaster, under delegated authority from NHS England.

4.2. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and NHS Doncaster CCG, which will sit alongside the delegation and terms of reference.

4.3. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

4.4. Establishing Sub-Groups to assist in discharging delegated responsibilities of the Committee as set out in its Terms of Reference. Enc D

4.5. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act.

4.6. This includes the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract); • Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”); • Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF); • Decision making on whether to establish new GP practices in an area; • Approving practice mergers; and • Making decisions on ‘discretionary’ payment (e.g., returner / retainer schemes).

4.7. The CCG will also carry out the following activities: • To plan, including needs assessment, primary medical care services in Doncaster; • To undertake reviews of primary medical care services in Doncaster; • To co-ordinate a common approach to the commissioning of primary care services generally; • To manage the budget for commissioning of primary medical care services in Doncaster;

4.8 The Executive Committee will review, consider and recommend to the Primary Care Commissioning Committee on all service changes to primary care medical services, ensuring the services are in line with the CCG Corporate Objectives, Five Year Commissioning for Strategy, Doncaster Place Plan and the South Yorkshire and Bassetlaw Sustainability and Transformation Plan.

5. Responsibilities

5.1. Strategic Direction

• To oversee the part of the commissioning plan that relates to Primary Care, including needs assessment for safe and sustainable Primary Care Commissioning • To oversee the development and agreement of primary care contracts • To oversee the development of the Primary care workforce • To identify priorities for consideration by the Engagement and Experience Committee • To consider implications and oversee implementation of issues arising from the national, regional and local reviews • To make recommendation to the Governing Body on all issues relating to Primary Care Development. Enc D

5.2. Quality and Performance Management

• To oversee the management of the annual budget for the commissioning of Primary Medical Care services in the relevant area • To oversee individual contract performance on a regular basis – activity, finance and quality • To oversee the Quality & Outcomes framework (QOF) or local incentive scheme (LIS) • To agree contract variations and to undertake reviews of primary care services where appropriate, within delegated limits • To consider contract breaches and appropriate enforcement actions, offering support where appropriate. • To oversee programme management and delivery of the Quality, Innovation, Productivity and Prevention (QIPP) programme relevant to primary care • To oversee the financial management of GP contracts for core and enhanced services. • In partnership with Quality and Patient Safety Committee monitor delivery against range of KPIs relating to quality as they pertain to Primary Care • In partnership with the Quality and Patient Safety Committee consider trends relating to Serious Incidents (SI’s), complaints and MP enquiries relating to services commissioned • To report to the Governing Body as appropriate on issues that need escalation.

5.3 General Issues

• To agree key risks for inclusion in Risk Register for primary care commissioning • To coordinate issues for/and oversee negotiations with the Representative Body • The Governing body will receive regular summaries of the work of the Committee through the Corporate Assurance report. • To consider and act on the ‘conflict of interest’ of General Practitioners with reference to Primary care Commissioning.

6. Delegated Functions

6.1. NHS England has delegated to NHS Doncaster CCG the following functions relating to the commissioning of primary medical services under section 83 of the NHS Act: a) decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts, including but not limited to the following activities: i) decisions in relation to Enhanced Services; ii) decisions in relation to Local Incentive Schemes (including the design of such schemes); Enc D

iii) decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices; iv) decisions about ‘discretionary’ payments; v) decisions about commissioning urgent care (including home visits as required) for out of area registered patients; b) the approval of practice mergers; c) planning primary medical care services in the Area, including carrying out needs assessments; d) undertaking reviews of primary medical care services in the Area; e) decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non- compliance with standards (but excluding any decisions in relation to the performers list); f) management of the Delegated Funds in the Area; g) Premises Costs Directions functions; h) co-ordinating a common approach to the commissioning of primary care services with other commissioners in the Area where appropriate; and i) such other ancillary activities as are necessary in order to exercise the Delegated Functions.

6.2 Reserved Functions a) management of the national performers list; b) management of the revalidation and appraisal process; c) administration of payments in circumstances where a performer is suspended and related performers list management activities; d) Capital Expenditure functions; e) section 7A functions under the NHS Act; f) functions in relation to complaints management; g) decisions in relation to the Prime Minister’s Challenge Fund; and h) such other ancillary activities that are necessary in order to exercise the Reserved Functions.

6.3 Procurement of Agreed Services a) Doncaster CCG will abide by our statutory responsibilities for all contractual relationships that fall under the Public Procurement Regulations (2006) and any subsequent legislation. This will include any clinical (healthcare) services defined as Part B under the regulations, of which primary care services are included. b) Doncaster CCG will consider the benefits of introducing choice and competition when re-commissioning any of these clinical services and will, at all times, follow Monitor’s substantive guidance around the Procurement, Patient Choice and Competition Regulations for NHS funded services. Enc D

7. Sub Groups

The Primary Care Commissioning Committee has established the following sub- groups:

• Primary Care Delivery Group • Provider Engagement Group

8. Geographical Coverage

The Committee will cover the geographical area of NHS Doncaster CCG.

9. Membership

9.1. Members

The Committee shall consist of:

Members: • Lay Member with a responsibility for Primary Care Commissioning (Chair) • Lay Member (Vice Chair) • Chief Officer • Chief Finance Officer • Director of Strategy and Delivery • Chief Nurse

Attendees: • Locality Lead clinical leader from the Governing Body • NHS England representative • CCG Head of Quality and Designate Nurse for Safeguarding Children and Looked After Children • Healthwatch Doncaster representative • Doncaster Health and Wellbeing Board representative • Local Medical Committee representative • CCG-employed Clinical Lead for Primary Care • CCG Primary Care Support Manager • Primary Care Quality Nurse • Associate Director of Primary Care & Commissioning

9.2. Members are required to attend five out of seven scheduled meetings. Attendance will be monitored throughout the year and any concerns raised by the Chair with the relevant Member. Enc D

9.3. Any changes to the membership of the Committee must be approved by the CCG Governing Body.

9.4. The Committee may include attendees and may call additional experts to attend meetings on an ad hoc basis to inform discussions.

10. Appointment of Chair

The Chair of the Committee shall be the Lay Member with the responsibility for Primary Care Commissioning.

The Vice-Chair shall be a Lay Member.

11. Meetings and Conduct of Business

11.1. The Committee will operate in accordance with the CCG’s Standing Orders. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than three days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.

11.2. Quorum

11.2.1. The quorum for meetings shall be four members including a minimum of one Lay Member inclusive of the Chair (or Vice Chair in the Chair’s absence).

11.2.2. If a quorum has not been reached, then the meeting may proceed if those attending agree but any record of the meeting should be clearly indicated as notes rather than formal minutes, and no decisions may be taken by the non- quorate meeting of the Committee.

11.2.3. Members of the Committee may participate in meetings by telephone or by the use of video conferencing facilities where they are available. Participation by any of these means shall be deemed to constitute presence in person at the meeting.

11.3. Frequency

11.3.1. The Committee will aim to meet formally on a monthly basis with a minimum of 9 meetings taking place each year to ensure that meetings are scheduled at appropriate intervals which are consistent with the commissioning cycle and which enable it to efficiently discharge its duties.

11.3.2. Meetings of the Committee shall: a) be held in public, subject to the application of 11.2.3; Enc D

b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

11.3.3 Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

11.3.4 The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

11.3.5 The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions.

11.4 Notice of Meetings

Items of business for inclusion on the agenda of a meeting shall be notified to the Chair of the meeting at least 8 working days before the meeting takes place. Supporting papers for such items shall be submitted at least six working days before the meeting takes place. The agenda and supporting papers shall be circulated to all Committee members and attendees at least five working days before the date the meeting will take place.

11.5 An Annual Schedule of Meetings shall be agreed at, or before, the last meeting each year in order to circulate the schedule for the following year.

12 Decisions

12.1 The Committee will make decisions within the bounds of its remit.

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12.1 The decisions of the Committee shall be binding on NHS England and NHS Doncaster CCG.

12.2 Urgent matters arising between meetings

The Chair and Deputy Chair of the PCCC in consultation with the Chief Officer or Chief Finance Officer, may also act on urgent matters arising between meetings of the Committee. Any actions taken outside the meeting, will be minuted at the next available meeting of the Committee.

13 Voting

13.1 Each member of the Committee shall have one vote.

13.2 The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision- making wherever possible.

13.3 The Committee will produce an executive summary report which will be presented to NHS England (North East and Yorkshire) and the Governing Body of NHS Doncaster CCG annually for information.

14 Confidentiality and Conflicts of Interest / Standards of Business Conduct

14.1 All Members are expected to adhere to the CCG Constitution and Standards of Business Conduct and Conflicts of Interest Policy.

14.2 In circumstances where a potential conflict is identified the Chair of the Committee will determine the appropriate steps to take in accordance with the CCG’s Conflicts of Interest decision-making matrix. This action may include, but is not restricted to, withdrawal from the meeting for the conflicted item or remaining in the meeting but not voting on the conflicted item.

14.3 All Members shall respect confidentiality requirements as set out in the CCG Constitution.

14.4 The Committee will conduct its business in accordance with any national guidance and governance practice including the Nolan Principles.

15 Reporting Arrangements

15.1 The Committee will comply with any reporting requirements set out in the CCG constitution. Enc D

15.2 All meetings shall be formally minuted and a record kept of all reports / documents considered.

15.3 The Committee will present its minutes to the Governing Body of NHS Doncaster CCG.

15.4 The Committee will provide an Annual Work plan to the CCG Governing Body for approval and an Annual Report.

15.5 The meetings of the Committee shall normally be held in public, save for where 11.3.2 applies.

15.6 The Committee will annually review and assess its effectiveness and report its findings to the Governing Body. It will do this by:

• Reviewing its terms of reference; • Reviewing the attendance rate of Committee members; • Reviewing its work plan; • Reviewing its performance.

16 Disclosure / Freedom of Information Act (FOI)

The CCG senior officer with responsibility for corporate governance will be responsible for ensuring that FOI requirements in relation to the Committee are met. The chair of the committee will seek the advice of the senior officer with responsibility for corporate governance in relation to any matters where an exemption as defined within the Freedom of Information Act 2000 is believed to apply.

17 Links and Interdependencies

The Primary Care Commissioning Committee will link, in particular, to the following forums: • Primary Care Delivery Group • CCG Governing Body (Board) • CCG Quality and Patient Safety Committee • Engagement and Experience Committee • Executive Committee • Primary Care Information Group

18 Review Of The Terms Of Reference

The Terms of Reference will be reviewed on a two-yearly basis and submitted to the Governing Body for approval as necessary.

Last reviewed: April 2021 Enc E

Meeting name Primary Care Commissioning Committee Meeting date 8 April 2021

PCCC 2020/21 Annual Report to Primary Care Committee, Title of paper Governing Body & NHS England

Executive / Anthony Fitzgerald, Director of Strategy and Delivery Clinical Lead(s) Author(s) Sarah Whittle Vice Chair Primary Care Committee

Status of the Report

To approve x To consider / discuss x

To note

Purpose of Paper - Executive Summary To provide assurance to NHS Doncaster CCG Governing Body and NHS England with regard to the delivery of the Primary Care Commissioning Committee work programme for the period 1st April 2020 to 31st March 2021.

Recommendation(s) The Committee is asked to consider and approve the Primary Care Commissioning Committee Annual Report 2020-21 prior to submission to NHS England

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Impact analysis Nil Quality impact The report explains how the Committee has overseen quality and safety in Primary Care

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the Equality lead Head of Corporate Governance / Corporate Governance Manager. As a result impact of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

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Sustainability Nil impact Nil Financial The report explains how the Committee has received updates on the implications financial position and GP practice Covid19 costs to NHS England

Legal Nil implications Management Nil of Conflicts of

Interest Consultation / Engagement (internal Primary Care Commissioning Committee Members departments, clinical, stakeholder and public/patient) Report previously Nil presented at This report has been produced as required by the Primary Care Risk Commissioning Committee Terms of Reference and delegation analysis agreement Corporative Objective / Corporate Objective 2 (CO2.3) Assurance Framework

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Newly designed enhanced 83 services (“Local Enhanced Services” and “Directed Enhanced Services”) Design of local incentive schemes 83 as an alternative to the Quality Outcomes Framework Decision making on whether to 83 establish new GP practices in an area Approving Practice mergers 83 Making decisions on 83 ‘discretionary’ payment (e.g., returner / retainer schemes) To plan, including needs assessment, primary medical care services in Doncaster To undertake reviews of primary medical care services in Doncaster To co-ordinate a common approach to the commissioning of primary care services generally To manage the budget for commissioning of primary medical

care services in Doncaster

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1. INTRODUCTION On 1 April 2016, NHS Doncaster CCG was given delegated responsibility from NHS England for the commissioning of Primary Care medical services as set out in Schedule 2 and in accordance with section 13Z of the NHS Act. This was enacted through a Delegation Agreement (as a national model) directly between NHS England and the Primary Care Commissioning Committee (the Committee) rather than the Governing Body. The Committee thus makes decisions within the delegated functions set out in the Terms of Reference that are binding on the CCG and NHS England. Minutes of the Committee are presented to the CCG Governing Body and are available on the Public CCG Website. This report is presented for information and summarises the Committee’s work programme for the year April 2020 to March 2021

2. GOVERNANCE 2.1 Membership The Primary Care Commissioning Committee is the corporate decision-making body responsible for collective decisions on the review, planning and procurement of primary care services in Doncaster, and operates under delegated authority from NHS England. The Committee is appropriately constituted; its terms of reference are reviewed at least annually last reviewed and approved by Governing Body, October 2020

Attendees: • Locality Lead clinical leader from the Governing Body • NHS England representative • CCG Head of Quality and Nurse for Safeguarding Children and Looked After Children • Healthwatch Doncaster representative • Doncaster Health and Wellbeing Board representative • Local Medical Committee representative • CCG-employed Clinical Lead for Primary Care • Associate Director of Primary Care & Commissioning • CCG Primary Care Manager • Primary Care Quality Nurse

The Primary Care Committee has been meeting via Microsoft Teams during the Pandemic in 2020/21

Unfortunately there has been a couple of long term sickness absence effecting the membership, however the Primary Care Committee has always been quorate through the year.

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Membership / Attendance Name Role Possible Actual % Voting Members Linda Tulley Lay Member Primary Care 9 6 67% Sarah Whittle Lay Member Engagement 9 8 89% Hayley Tingle Chief Finance Officer 9 9 100% Anthony Fitzgerald Director of Strategy and Delivery 9 9 100% Jackie Pederson Chief Officer 9 8 89% Andrew Russell Chief Nurse 9 5 56% Non-Voting Members Carolyn Ogle Associate Director of Primary Care & Commissioning 9 8 89% Karl Roberts Primary Care Manager 9 8 89% Andrea Ibbeson Head of Quality & Designated Nurse for Children’s Safeguarding & Looked After 9 6 67% Children Zara Head Lead Nurse Primary Care Quality 9 8 89% Dr Dean Eggitt Local Medical Committee (LMC) Representative 9 4 44% Paul Barringer NHS England Representative 9 9 100% Dr N Alsindi Clinical Lead for Primary Care & Long Term Conditions 9 8 89% Jill Telford Healthwatch Representative 9 9 100% Dr Manju Pande Locality Lead GP 9 8 89% Simon Barnes Interim Estates Lead 9 8 89% Dr V Kumar Local Medical Committee (LMC) Representative 1 1 100%

Quorum - 4 members including 1 lay member.

2.2 Managing Conflicts of Interest: The role of the committee is to support the CCG to effectively exercise its statutory duties in terms of commissioning Primary Care services. It aims to ensure quality primary care services and reduce inequalities across our localities, whilst considering variation in provision and impact on local services. Underpinning this is a robust management of real or potential conflicts of interest. All declarations of interests made are listed in the CCG’s Register of Interests. The register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The Committee takes a robust but proportionate approach to the management of potential or real conflicts of interest. It is important to ensure full compliance with statutory guidance whilst avoiding the restriction of local innovation. In the event of any issue with a conflict of interest, the Committee will seek advice from the CCG Audit Committee Chair who acts as the conflicts of interest guardian. During the meetings covered by this report, there have been no exclusions affecting the quorum of the meetings.

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2.3 Committee Effectiveness The Committee is accountable to the Governing Body of the CCG, and operates with the support of two sub-groups: • The Primary Care Provider Engagement Group • The Primary Care Delivery Group.

During this year the CCG has had to make changes to the Governance of Primary care as a direct response to the Covid19 outbreak.

Primary Care Cell A new Primary Care Cell was set up. the rationale for the cell was to coordinate the Primary Care response for the Doncaster population. The cells principles are to enact a local response based upon national guidance and the local need. The Cell covers a multitude of different areas from PPE to new national guidance to new models of care and the input of the group ranges from general feedback and input to the creation of new services and implementation of new ideas. The cell has evolved and developed since implementation from a reactive group based upon the evolving situation that COVID-19 posed to a more proactive group ensuring that Primary Care services are prepared for ongoing care provision and the different expected COVID19 phases. The Primary Care Cell links in closely with the other COVID19 cells setup to ensure that there is consistency in delivery of key messages and to ensure that there are effective escalation routes across the wider Doncaster health community. The cell has proved to be very successful and discussions are being had about the future of the group and how we can capture the benefits of it.

The Primary Care Cell currently meets once a week and although there is no quoracy requirement the key members of the group are made up by the following: • Doncaster Clinical Commissioning Group • Primary Care Team (At least 1 member) • The Quality Team (At least 1 member) • Urgent Care (At least 1 member) • Performance & Intelligence (As required) • Medicines Management Team (At least 1 member) • Senior Management Team (At least 1 member who also Chairs) • Doncaster Local Medical Committee • Doncaster Local Pharmaceutical Committee (At least 1 member) • Primary Care Doncaster (At least 1 member) • Rotherham Doncaster & South Humber NHS Trust (At least 1 member) • Fylde Coast Medical Services (At least 1 member) • Primary Care Network Clinical Directors (At least 1 Primary Care Network Clinical Director but usually representation from each of the Primary Care Networks) • Other partners sighted through other groups e.g. health cell etc. and invited where specific agenda items require

As the meeting was setup as an immediate short to medium term response to COVID-19 no formal terms of reference have been put in place, however we have put clear principles and governance in place to ensure the groups effectiveness. Due to the success of the Primary Care Cell and the unknown nature of its end date Enc E

(relating to Doncaster’s COVID-19 response) this is something that may be looked at in the near future if it is determined the cell has a longer term place/future.

The strategic aims and objectives mirror those of the Health Cell who have a wider than Primary Care responsibility, nether the less the aims and objectives are still appropriate to what the Primary Care Cell was setup to achieve.

Strategic Aim: Coordinate and facilitate the Doncaster Primary Care response to minimise the impact of COVID19 in Doncaster and support recovery to normality as quickly as practicable.

Strategic Objectives: • Minimise the potential health impact of COVID19 at a Primary Care Level both for patients and Primary Care services (e.g. GP practices) • Minimise the potential impact of COVID19 on society and the economy • Develop and maintain a strategic overview of the impact of and response to the evolving situation on Primary Care, managing and coordinating the Primary Care response, linking in with the wider multiagency responses and reporting appropriately • Instil and maintain trust and confidence • Maximise the prioritised safety of responders and public sector services providing frontline service to the incident as far as reasonably practicable • Put in place arrangements for a sustained response for the duration of the pandemic and recovery activities • Support return to a new normal as quickly as practicable

Meeting Organisation Each meeting is chaired by a member of the SMT team from the CCG usually the Director of Strategy and Delivery and each meeting has action notes recorded. Prior to each meeting the action notes from the previous meeting as well as and Agenda are circulated to all members in advance of the meeting.

Risk Register The Primary Care Cell also has its own Risk Register which is discussed, added to and updated at every meeting based up on the discussions and escalations of the meeting. Any risks added are escalated upwards as appropriate and or it is felt that the group are unable to action appropriately and further escalations/intervention is required.

Escalation & Reporting In terms of immediate escalation any areas of concern, outside the remit of the group or where further intervention escalation is needs are escalated up to the Health cell that ensure that intern the areas are raised with the relevant national, local, ICS body for further discussion/clarification. All Primary Care decisions taken and/or decisions requiring longer term approval are taken to the Primary Care Commissioning Committee for discussion, input and approval.

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3. 2020/21 WORK PROGRAMME The list below is not explicit, but provides some insight into the 2020/21 work programme undertaken by the Committee:

Governance • Updates on key decisions made by Senior Management Team (SMT) during the Coronavirus in which they have been providing with delegated authority from the Committee. • The Committee received and discussed updates on the Primary Care Cell and the decisions it had made, it was confirmed that the Cell will work towards an exit plan but it was recognised that there is currently no end date agreed while the CCG is still dealing with the COVID-19 response. The Committee also agreed to extend the standing down of the Primary Care Delivery Group whilst the Primary Care Cell meetings are still running • Review and approval of minor amendments to the Committee’s Terms of Reference October 2020 • The outcomes and actions from the Committees 2020 self-assessment survey • An update on the Strategy & OD Forum discussion around the Committees 2020 self-assessment survey results

Covid19 • Updates on progress around the Covid19 Gap Analysis • Received an evaluation and recovery plan which covered all national and local areas affected, stood down or reduced as a result of the Covid19 pandemic

Finance • Monthly Financial Position and Quality Innovation Productivity and Prevention (QIPP) • Interim finance exception reports were received which included any GP Practice COVID-19 costs to NHS England. • Financial position as at 30th September 2020 and an update on the position for October 2020 to March 2021.

Estates • Regular updates on Primary Care Estates Strategy and the Implementation Plan and the Estates end of year report. • The Programme Business Case for the primary care capital programme which had been approved by the ICS and would be submitted to NHS England

Quality & Safety • Quarterly updates on quality and patient safety activity in relation to Primary Care in Doncaster, including the National Reporting and Learning System (NRLS) and CQC. • An interim quality exception report was received, noting that the Quality team delivered the safe guarding level 3 training for children to 200 delegates on 9 September Via `Microsoft Teams’ • An Interim Quality Exception update, new guidance was published in May around the Standard Operating Procedure (SOP) • The approval of the Primary Care Quality and Performance Framework

In addition: • An update on the SYB emergency contractors framework transferring to the national pseudo dynamic purchasing system for APMS contracts in September 2020 • An update and next steps following the publication of the Network Contract Directed Enhanced Service (DES) specification and guidance for 2020/2021 Enc E

• Presentation was provided on the 2020/21 delivery plan • Regular updates on Primary Care Networks. PCNs were required to sign a Network Agreement by the end of June 2020 and develop workforce plans by the end of August 2020. A set of draft principles for the Additional Roles Reimbursement Scheme (ARRS) and in addition the Committee discussed additional roles required in the PCN. The Committee noted the workforce plans for each of the five PCNs • An update on the new Primary Care Network guidance released in September 2020: o Amendment to the Network Contract DES 2020/21 o Arrangements for the Quality & Outcomes Framework 2020/21 o Investment and Impact Fund Guidance 2020/21 o Structured Medication Reviews and Medicines Optimisation Guidance • Noted the virtual decision around QOF Settlements for 2019/20 • Received updates on the changes to the Proactive Care specification to include Care Home provision • Received and discussed the 2020/21 flu plan • Approved the draft ICS Primary Care Strategy • Noted the presentation on the GP Patient Survey 2020 • Approved the Communication & Engagement Strategy. • The draft findings of the recent Healthwatch survey on accessing GP services during the Covid-19 pandemic • An update on the GP Forward View which covered extended access, online consultation, care navigation and funding for the GP Forward View programmes • An update on the 2020/21 Primary Care delivery plan, including progress made and challenges faced • Approved the extension to the Barnburgh Surgery contract for a further two years to May 2023 • Approved the merger of the Nelson Practice and Bentley Surgery from 1 April 2021 this will reduce the number of practices in Doncaster to 38.

4. RECOMMENDATION

Governing Body is asked to endorse the report prior to submission to NHS England.

Sarah Whittle CCG Lay Member Vice Chair Primary Care Commissioning Committee March 2021 (on behalf of Linda Tully Chair Primary Care Committee) Enc F

Meeting name Primary Care Commissioning Committee Meeting date 8 April 2021

Title of paper Primary Care Cell Briefing Paper

Executive / Anthony Fitzgerald, Director of Strategy and Delivery Clinical Lead(s) Author(s) Karl Roberts – Primary Care Manager

Status of the Report

To approve To consider / discuss

To note √

Purpose of Paper - Executive Summary

The purpose of this paper is to provide committee members with an overview of the decisions taken at the Primary Care Cell that has been put in place as a response to COVID-19 and its effect across Doncaster Primary Care provision. Via the virtual update shared in March 2021 committee members were provided with the latest overview, this paper provides the detail of the decisions & main conversations that have taken place since the last Primary Care Commissioning Committee meeting. We have also included the Primary Care risk register and other supporting documents as part of this update at the request of committee members.

Recommendation(s)

To note the information provided in relation to the PC Cell update

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Impact analysis Development of primary care networks supports the sustainability of Quality impact primary care

Tick relevant box Equality impact An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.

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Enc F An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability Development of primary care networks supports the sustainability of impact primary care as a whole Financial included in report implications Legal described in the report implications Management of Conflicts of None identified but managed within Committee constitution Interest Consultation / Engagement (internal Practice visits and practice manager discussions as well as monthly departments, Clinical Director meetings clinical, stakeholder and public/patient) Report previously Regular updates provided to Committee presented at Risk n/a analysis The report links to the following corporate objectives: Corporative • Commission high quality, continually improving, cost effective Objective / healthcare which meets the needs of the Doncaster population Assurance • Work collaboratively with partners to improve health and reduce Framework inequalities in well governed and accountable partnerships.

Statutory Duty Section Tick Relevant Box Management of Conflicts of 14O Interest Duty to promote the NHS 14P Constitution Duty to exercise its functions 14Q effectively, efficiently and economically Duty as to improvement in quality 14R Primary Care of services Statutory Duty in relation to quality of 14S Y Duties (only) primary medical services Duties as to reducing inequalities 14T Duty to promote the involvement 14U of each patient Duty as to patient choice 14V Duty as to promoting integration 14Z1 Public involvement and 14Z2 consultation GMS, PMS and APMS contracts 83 (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing

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Enc F branch/remedial notices, and removing a contract) Newly designed enhanced 83 services (“Local Enhanced Services” and “Directed Enhanced Services”) Design of local incentive schemes 83 as an alternative to the Quality Outcomes Framework Decision making on whether to 83 establish new GP practices in an area Approving Practice mergers 83 Making decisions on 83 ‘discretionary’ payment (e.g., returner / retainer schemes) To plan, including needs Y assessment, primary medical care services in Doncaster To undertake reviews of primary medical care services in Doncaster To co-ordinate a common approach to the commissioning of primary care services generally To manage the budget for Y commissioning of primary medical

care services in Doncaster

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The Primary Care Cell Meeting Overview & Delivered Actions Author: Anthony Fitzgerald & Karl Roberts

The Primary Care Cell was setup as a direct response to the COVD-19 outbreak, the rationale for the cell was to coordinate the Primary Care response for the Doncaster population. The cells principles are to enact a local response based upon national guidance and the local need.

The Cell meets once a week and covers a multitude of different areas from PPE to new national guidance to new models of care and the input of the group ranges from general feedback and input to the creation of new services and implementation of new ideas.

The cell has evolved and developed since implementation from a reactive group based upon the evolving situation that COVID-19 posed to a more proactive group ensuring that Primary Care services are prepared for ongoing care provision and the different expected COVID-19 phases.

The Primary Care Cell links in closely with the other COVID-19 cells setup to ensure that there is consistency in delivery of key messages and to ensure that there are effective escalation routes across the wider Doncaster health community.

Since the last Committee meeting the Primary Care Cell has continued to cover a wide range of key working areas, but significantly since the last update in March the headline areas discussed and actioned by the Primary Care Cell are detailed below:

1. Pulse Oximetry at Home, Virtual Ward & Blood Pressure Monitoring – The Cell continues to be apprised on the latest guidance and work in relation to the ongoing work within these areas and any necessary actions/feedback are worked through as required.

2. COVID Vaccinations – The COVID vaccinations as would be expected continue to monopolise much of the PC Cell agenda as the vaccination rollout continues across Doncaster and nationally. Most recently the key conversations have focused on:

• Patient cohorts and especially those within cohorts 1-9 and ensuring that all patient within these cohorts have been offered the vaccine • Working through the baselines and understanding the data (locally & nationally) • Improving processes locally for inviting and managing patient lists • Planning for the next cohort(s) and the potential model available • Vaccination supplies and deliveries for the Doncaster sites • Hard to reach patient groups • Additional funding available to support the COVID response

3. Managing Practice Pressures & Key messages – The group continue to be apprised of primary care pressures and has been informed of the significant increase in pressures to practices at present. Practices have seen a significant increase in phone contacts with patients making COVID vaccination enquiries which is taking up significant time and resource.

As we move through the cohorts the planning and booking in and vaccination of patients remains a significant challenge and coupled with the business-as-usual model at present all our Doncaster practices remain under significant pressure. Despite this it should continue to be acknowledged the incredible job that practices are continuing to deliver under immense

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Enc F pressure with stretched and tired workforces. (The health & wellbeing of staff is something that has been considered and is being taken forward, see Primary Care Strategy meeting)

4. Risk Register – The risk register continues to be updated based upon the information available/presented via the group and is updated on a regular basis.

5. CCHUB Evaluation & Future – Following on from the update last month there is still some work and feedback to be gathered from practices in relation to the CCHUB service which is being facilitated via the Local Medical Committee (LMC). Discussions are also moving on re the future of the CCHUB and along side the work being progressed by the LMC its thought that now is a good time do take a stock take and look at the next steps and this item is to be discussed on the agendas over the next few weeks.

6. Interface between Primary Care and DBHFT – The group continue to discuss a number of areas relating to the interface and working between Primary Care and DBHFT. Some of these conversations were picked up via the PC Cell dedicated strategy meeting (see below) and It is still the intention that some of these conversations should be picked up clinician to clinician via the 16:00 – 18:00 TARGET sessions where work continues to progress. Additionally, the group are also looking to invite partners to the cell around key issues to have some of those conversations where feasible and appropriate.

7. PC Cell Dedicated Strategy Meeting 16th March 2021 – The PC Cell held a dedicated meeting on the 16th of March 21 to looking at a number of key pre agreed areas of focus:

• Service delivery - Central Resource & Estate - Evaluation & Recovery – return to the new normal - Pathways & Priorities - Health & Wellbeing of staff • Reinstating of 16:00 - 18:00 TARGET • The future of the Primary Care Cell • Agreed Next Step and timeframes

There were a number of key conversations and actions that resulted from the meeting (a copy of the action notes is included) and these will be taken forward by the identified leads.

Touched upon earlier a significant part of the conversation was around Staff Resilience and the Health & wellbeing of staff. The group discussed and agreed the use of the 16:00–18:00 TARGET sessions as well as the in-house TARGET sessions to facilitate specific resilience and Health & Wellbeing sessions. These conversations and planning for these sessions are ongoing and further updates around their implementation will follow.

Another significant element of the strategy meeting related to future of the Primary Care cell given a very different business as usual model moving forward and the increased remit of agenda items the Primary Care Cell had started to pick up which had started to overlap with other meetings stood down e.g., Primary Care Delivery Group. Those in attendance agreed that PC Cell had been an invaluable resource and thought that we had got a good balance with membership and are all still invested in the meeting moving forward. The CCG have taken forward an action to map out how the PC Cell fits within the reporting structure and the implications to other meetings.

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The immediate plan for the PC Cell is for it to continue in its weekly format to continue to support the immediate COVID response. Longer term the plan for the cell would be for bimonthly meetings with an operational meeting and a more strategical meeting. These conversations continue to develop, and further updates will be brought via future updates to this meeting.

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Enc F Primary Care Cell – Strategy Meeting 16th March 2021 - Video/Conference Call NHS Doncaster CCG

In Attendance: Action Action Name Name Initials Initials Anthony Fitzgerald (C) (DCCG) AF Emma Serfozo (DCCG) ES Alison Maw (4Doncaster) AH Suzanne Hallworth-Manley (PCD) SHM Sue Wilson (M) SW Karl Roberts (M) (DCCG) KR Andrea Stothard (DCCG) AST Zara Head (DCCG) ZH Alex Molyneux (DCCG) AM Andrew Russell (DCCG) AR Nabeel Alsindi (DCCG) NA Tracey Edwards (FCMS) TE Carolyn Ogle (DCCG) CO Liz Leggott (PCD) LL Laura Sherburn (PCD) LS Nick Hunter (LPC) NH Lynn Murrie (LPC) LM Dean Eggitt (LMC) DE Ailsa Leighton (DCCG) AL John Bottomley (RDaSH) JB Heather Akroyd (DCCG) HA Katie Dowson (DCCG) KD Karen Leivers (DCCG) KL Jo Forrestall (DCCG) JF Professor V. Kumar (PCN CD) VK Kate Mansfield (PCN CD) KM Sue Wilson (M) (DCCG) SW Nick Tupper (PCN CD) NT Stephanie Teanby-Clark (PCN CD) STC Andrea Ibbeson (DCCG) AI Karen Johnson (DMBC) KJ Rumit Shah (PCN CD) RS Wendy Lawrence (DCCG) WL Khaimraj Singh (PCN CD) KS Jo Sanderson (DCCG) JS Rebecca Joyce (DBHFT) RJ Alison Lancaster AL Nicholas Mallaband NM Cheryl Gowland (NPC East) CG

C = Meeting chair M = Minutes taken by

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Meeting Actions:

1. Introduction & Principles of the meeting

AF set out the key principles of the meeting as:

- Clinical involvement in decision making - Keep local wherever possible the things that work for us - Focus on the priorities for the people of Doncaster

2. Service Delivery

a. Central resource/estate, the main conversation points were: 2.A1 - Exercise setting out the core principles/priorities and mapping these against - How ARRS staff are managed and situated and how they can the Primary Care Estate be facilitated to work collaboratively across practices - Potential of how the CCHUB can be flexible in 2.A2 - Production of a road map from April 21 approach/support – value of centralised resource? to April 22 linking in with PCN’s and including - What the digital impacts are likely to be, seamless digital workforce and estates options SB, KD & communication across the system LK from a workforce perspective - Local control of some space & estate flexibility of occupation - Utilisation of LIFT/PS premises and the long-term plan for this - Training space - An ICS driver for longer term planning

- What supporting estates and digital work will be needed to support all this - Road map needed covering short- and long-term plans

Enc F - How can we bring more services out of the hospital into the community? 2.B1 - We need to come up with the basic bones of what the priorities are; what we are b. Evaluation & Recovery – return to the new normal, main keeping, what we change, how we manage conversation points: patient expectations. KR to work through using Evaluation & Recovery Document - NHSE letter January 21 looked at potential key principles QoF, LTC’s etc. 2.B2 - Need some time to evaluate what we - Agreed that we cannot go back to a pre COVID model have done and the shared learning from this - Need hybrid model offering flexibility and a blended offer KR to action - Look at what we have done and what learning we can take from this and build into the new business as usual 2.C1 – AF to back feedback and suggestions to the partnership board – completed. c. Pathways & Priorities, main conversation points:

- AF shared slides with key priorities and pathways - Rapid Response needs to be amended to cater for people who think that they are in crisis but can be managed - Palliative Care missing from the model - Need to make sure that YAS linked in with models - Nothing included about quality-of-care objectives and goals and we need details and drivers for these - Need to make sure that all the different changes don’t slow down the work that we are doing - More detail needed around discharges & prescribing - Need to incorporate education of the population and need a mechanism that shows we are making a difference - More information needed with tangible evidence of what has been achieved 2.D1 – LMC to promote the RASH service

d. Health & Wellbeing of staff, main conversation points: 2.D2 – Workforce Cell to investigate how other providers are responding

Enc F - Acknowledged that staff health and wellbeing is an issue and staff do need a break or change to create head space. - Commitment to practice staff to staff resilience - We need to be seen to addressing and sorting the things we said that we would support - Can we look to use the 16:00 – 18:00 TRGET sessions to look at practice/staff resilience

3. Reinstating of 16:00 - 18:00 TARGET

3.1 STC, CO & AF to work up proposal looking Following on from the conversations relating to staff health and at options for TARGET and potential of wellbeing the group discussed if the 16:00 – 18:00 and in-house inhouse TARGET session(s) focusing on staff TARGET sessions could be used to facilitate some staff resilience health and wellbeing plans:

3.2 Contact KF as local expert in on GP - Provide resilience training & coaching via structured health & resilience for her input into the discussions wellbeing sessions

- Create breathing space to consider the new normal 3.3 The CCG will pick up any potential - Dedicated PCN/Practice time to discuss and the plan the new discussions with FCMS recover needed to normal support TARGET and any additional agreed - Can we look at additional inhouse TARGET sessions sessions (PC Sessions that did not take place).

The meeting very much focused on the potential use of the sessions to look at staff resilience, health & wellbeing but the wider conversations from the PC Cell held in advance of this meeting are still to be addressed fully in relation to the needed clinical to clinical conversations with providers and better understanding of the pathways and services in place for RDASH & DBHFT and this will need revisiting with the initial focus on staff heath and well being

4. The future of the Primary Care Cell

Enc F

The group heard an overview of how the meeting had developed from 4.1 The CCG to map out structure of the PC initial inception and had now become more than a COVID meeting as Cell meeting and links to other CCG was picking up things at a more strategic level. The PC Cell has to meetings/boards many regards replicated and enhanced that of the Primary Care Delivery Group and was more clinically driven. 4.2 The CCG to extend the PC Cell invites beyond March and will discuss at PC Cell Those in the meeting agreed that that meeting was good and the fact when the time is right to move to new model – that all were still here and invested spoke to that. Complete

It was agreed that the meetings would continue weekly for the time being to cover the still significant COVID challenges.

Looking forward look at a bimonthly meeting with the first maintaining the more operational input and the second meeting potentially picking up from a more strategic perspective and folding in the PCN CD meetings that currently take place separately

Any changes will need to look at future membership and if we need to invite other key stakeholders to the group. Secondary care was mentioned specifically.

5. Agreed Next Step and timeframes

It was agreed that the CCG would meet to debrief and summarise the 5.1 KR, CO, and AF to meet to debrief following conversations from today’s meeting the meeting and provide a summary of the agreed actions and next steps via the PC Cell.

Enc G

Meeting name Primary Care Commissioning Committee Meeting date 8 April 2021

Title of paper GP Forward View

Executive / Anthony Fitzgerald, Director of Strategy and Delivery Clinical Lead(s) Carolyn Ogle, Associate Director of Primary Care & Author(s) Commissioning

Status of the Report

√ To approve To consider / discuss

To note

Purpose of Paper - Executive Summary

The purpose of this report is to provide an update to the Primary Care Commissioning Committee on the implementation of the GP Forward View. The previous report was presented to the Committee in November 2020.

The GP Forward View covers the five years April 2016 to March 2021, however a number of the areas included in the GPFV are now being taken forward through the NHS Long Term Plan as previously noted.

This paper covers extended access, online consultation, and funding for the GP Forward View programmes.

Recommendation(s)

The Committee is asked to note the update to the GP Forward View Programme

Report Exempt from Public Disclosure

Yes No √ If yes, detail grounds for exemption:

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Enc G

Impact analysis Quality will be monitored through the Primary Care Quality Strategy and Quality impact Quality Dashboard. The aim of the GPFV is to increase quality of general practice across the board

[Summary of impact, if any, of CCG’s duty to promote equality and diversity based on Equality Impact Analysis (EIA). All reports relating to new services, changes to existing services or CCG strategies / policies must have a valid EIA and will not be received by the Committee if this is not appended to the report]. [Identify any equality impact – positive, negative or neutral]

Tick Equality relevant impact box An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability The aim of the GPFV is to invest in primary care to sustain services in to impact the future Financial Financial plan included in paper implications None Legal

implications

Management Will be preserved through the Committee’s Constitution. There are direct of Conflicts of conflicts with members of the public committee therefore paper considered Interest in confidential Consultation / Engagement (internal All relevant departments impacting on delivery of the plan have been departments, consulted through discussion at the Primary Care Delivery Group clinical, stakeholder and public/patient) Report previously The ICS finances were included in November’s paper to Committee presented at Risk Identified in the paper analysis Corporative CO3 – the workstreams in the GPFV ensure that the primary care Objective / element of the healthcare system is sutainable Assurance

Framework

[Complete this section if submitting a report to Primary Care Primary Care Commissioning Committee / Primary Care Delivery Group. For any other Statutory committee, delete this row on the report template.] Duties (only)

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Enc G

Statutory Duty Section Tick Relevant Box Management of Conflicts of 14O Interest Duty to promote the NHS 14P Constitution Duty to exercise its functions 14Q √ effectively, efficiently and economically Duty as to improvement in quality 14R of services Duty in relation to quality of 14S primary medical services Duties as to reducing inequalities 14T Duty to promote the involvement 14U of each patient Duty as to patient choice 14V Duty as to promoting integration 14Z1 Public involvement and 14Z2 consultation GMS, PMS and APMS contracts 83 (including the design of PMS and √ APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract) Newly designed enhanced 83 services (“Local Enhanced Services” and “Directed Enhanced Services”) Design of local incentive schemes 83 as an alternative to the Quality Outcomes Framework Decision making on whether to 83 establish new GP practices in an area Approving Practice mergers 83 Making decisions on 83 ‘discretionary’ payment (e.g., returner / retainer schemes) To plan, including needs assessment, primary medical care services in Doncaster To undertake reviews of primary medical care services in Doncaster To co-ordinate a common √ approach to the commissioning of primary care services generally To manage the budget for commissioning of primary medical √

care services in Doncaster

Page 3 of 6

Enc G

GP Forward View

8 April 2021

Introduction The General Practice Forward View published in April 2016 commits to an extra £2.4 billion per year to support general practice services by 20/21. This paper serves to provide an update on progress made/activities undertaken since the last update in November 2020. Any overlap with the NHS Long Term Plan published in January 2019 and the new GP Contract Framework are highlighted as required.

This update covers: • Extended Access – Quarter 3 report 2020/2021 • Online Consultation – February 2021 position • GPFV Funding 2020/21 plan

1. Extended Access

The slides attached as Appendix A show utilisation for the year to date with a focus on Quarter 3 (October to December 2020). Extended access services have been significantly hampered in year by the COVID-19 pandemic with services being suspended in March 2020 until mid September 2020 and then suspended again on 7th December 2020 with the exception of a limited health bus service operating. The Saturday morning hubs and health inclusion clinics have not recommenced hence the non inclusion/low number of appointments offered in December.

20 hours per week of the extended access service have been redeployed for the COVID hub and this data is not included in the utilisation. On average 120 hours per week are being offered against the 160 required by the contract. The vaccination programme and the establishment of the COVID vaccination hubs has also been prioritised over the extended access service in terms of support provided by Primary Care Doncaster.

Further work is required to accurately record the inclusion health data as these appointments take much longer than the other general practice appointments.

The current contract expires on 31 March 2021 and a single tender waiver is being processed to allow its continuation. The Same Day arrangements via FCMS and the First to Physio service with Chapmans will cease at the end of March 2021.

A review of extended access is therefore being undertaken to: • Ensure that national requirements continue to be met • That local practices support the model for extended access • That there is transparency of funding streams so that duplication is avoided • Ensure that procurement rules are not breached • That the service model is based on recovery and is flexible and adaptable to meet the needs of the registered population.

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The national specification is expected in autumn to enable the transitioning of the service to PCNs from 1 April 2022.

In terms of the quarterly quality update the following was noted at the recent contract meeting: • All staff have undertaken their mandatory and statutory training • There were 8 CAS alerts received and shared in October, 11 in November and 17 in December • There was one NICE alert received in each month of the quarter • No Healthwatch surveys have been undertaken due to the Saturday morning hubs having been stood down • The DNA rate has increased overall in the quarter to 6.36% (Oct 5.38%, Nov 6.53%, Dec 7.28%). Face to face appointments have been converted to online and virtual interactions which are more reliant on technology. This has led to missed telephone calls, incorrect numbers and poor internet signal impacting on the DNA rate plus an increase in hospital admissions in the winter months potentially by those patients needing to be seen urgently. • There were no complaints in the quarter in relation to extended access and one complaint relating to queuing at the vaccination site • No new significant events or incidents were reported in the quarter • There was one two week wait referral made and actioned.

2. Online Consultation

The doctorlink useage report for February 2021 is attached at Appendix B. The Committee should note the following:

• 5,246 Registrations to date. • 4,886 Symptom Assessments started. • 2,707 Symptom Assessments completed.

The report also includes the outcome categories, days and times symptom assessments were completed.

The report has been shared with Practice Managers.

The doctorlink contract is due for review by June 2021 in preparation for the termination date of end August 2021.

3. GPFV Funding

A draft finance plan for use of GPFV monies was presented to Committee in December 2020. £235,000 was allocated to Doncaster as follows:

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Enc G

Funding Pot Amount Retained Doctors £61,000 Resilience £42,000 Reception and Clerical £53,000 Online Consultation £79,000 TOTAL £235,000

The following has been allocated so far:

Pre- med school scholarship £11,400 VTS Nurse programme £160,000 Extension to ear care pilot £25,000 Practice Champion workshop £2,700 Online Consultations (new) £102,551

Although this amounts to more than the current years allocation an accrual has meant that there remains a balance of £33,500.

A few practices have requested support from resilience funding over the last few weeks including: • Practices working at scale back office function integration – telephones • Merger communication • General resilience support to be determined

Any updates will be brought to the meeting as appropriate.

Page 6 of 6

Appendix A 01/04/2021

Primary Care Doncaster

Extended Access Utilisation Report 2020 – 2021 Q3

Primary Care Doncaster

1 Appendix A 01/04/2021

Primary Care Doncaster

East F2P Service

2 01/04/2021 Appendix A

First 2 Physio

3 01/04/2021 Appendix A

FCMS Same Day

4 01/04/2021 Appendix A

Health Bus Utilisation

Inclusion Health Utilisation

5 Appendix B

Total doctorlink Registrations: Prior to implementation/switch on Practice Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Practice Total Askern Medical Practice 2 0 200000000 4 Barnburgh Surgery 1 1 2 0 0 0 00000100 5 Bentley Surgery 2 5 4 5 9 4 90 18 15 11 9 16 188 Conisbrough Group Practice 1 0 0 0 0 563 273 128 88 73 38 32 22 19 18 14 11 1280 Conisbrough Medical Practice 2 5 531124041 28 Denaby Medical Practice 1 000000001 2 Dunsville Medical Centre 2 7 4 3 6 0 1 0 00000000 23 Field Road Surgery 2 0 0 11 19 10 18 24 16 19 11 12 16 17 175 Mexborough Health Centre 1 0 0 021000000 4 Northfield Surgery 3 17 7 1 2 4 16465133 63 doctorlink Registrations Oakwood Surgery 4 7 1 36121196698 82 Park View Surgery 1 0 0 0 0 0 0 00000000 1 1239 Petersgate Medical Centre 2 0 2 0 1 7 8 10 11 3 10 2 56 Scawsby Health Centre 3 5 81 9 1 4 15272463 133 St Johns Group Practice 1 6 2 4 4 48596887 72 St Vincents Medical Centre 1 0 12 2 2 2 25525314 46 The Burns Practice 2 410532501114 38 The Edlington Practice 4103 6556810217 67 608 529 The Flying Scotsman 1 0 0 110010210 7 Great North Medical Group 1 0 0 002010000 4 337 Hatfield Health Centre 1 0 0 000000000 1 281 300 254237251 239 240 201 211 Kingthorne Group Practice 1 1 1 242 132 6 8 1 3 3 21311010 407 164 122 The Lakeside Practice 9 9 5 31 46 47 40 24 15 10 986748154 297 9 13 10 The Mayflower Medical Practice 3 21 15 10 4 7 11 13 9 10 12 6 121 20 20 20 20 19 21 21 20 20 20 20 20 20 20 20 19 19 The Medical Centre 2 1 326 87 22 22 8 7 2 46366342 511 19 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Mount Group Medical Practice 5 10 9 11 15 7 8 33 28 19 34 33 212 Jul Jan Jan Jun Oct Oct Apr Feb Feb Sep Sep Dec Dec Aug Nov‐ Nov‐ Mar The Nayar Practice 1 0 1 22312412419 60 May The Nelson Practice 3 4 4 346221112 33 The New Surgery 1 4 22 6 3 2 15142222 57 The Ransome Practice 1 0 2 030100101 9 Regent Square Group Practice 2 0 4 338704356 45 The Rossington Practice 5 7 1 2 3 14212111 31 The Sandringham Practice 1 0 0 1 5 0 0 0 00001000 8 The Scott Practice 1 333933282342392420162316 337 Tickhill & Colliery Surgery 1 0 0 65 35 42 29 28 26 21 25 18 20 25 21 356 The Village Group Practice 9 25 7 4 1 22433567 78 Thorne Moor Medical Practice 3 1 0 000310011 10 West End Clinic 1 0 0 4 0 2 32131001 18 White House Farm Medical Centre 2994010644202235 377 Monthly Totals 9 13 10 608 281 122 1239 529 337 254 237 251 300 239 201 164 240 211 Overall Total 5246 Appendix B

To date, 4886 Patients STARTED a Symptom Assessment: Practice Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Practice Total Askern Medical Practice 0 000000000 0 Barnburgh Surgery 0 1 0 0 000000200 3 Bentley Surgery 0 7 3 0 7 5 33 11 10 15 11 20 122 Conisbrough Group Practice 0 0 0 88 48 25 44 55 36 36 50 52 21 54 50 559 Conisbrough Medical Practice 0 1 000000022 5 Denaby Medical Practice 0 000000000 0 Dunsville Medical Centre 0 4 3 5 3 0 3 1 0 0 000000 19 Field Road Surgery 2 1 0 5 12 9 22 33 20 26 19 18 23 30 220 Total doctorlink Symptom Mexborough Health Centre 0 0 000000000 0 Northfield Surgery 1 35 9 2 2 3 4 3 9 11 9 1 10 4 103 Assessments STARTED Oakwood Surgery 1 2 0 1091238263 47 Park View Surgery 0 0 0 0 0 000?00000 0 477 Petersgate Medical Centre 1 0 3 0 1 5 7 5 12 5 11 3 53 Scawsby Health Centre 1 5 33 12 2 6 2 7 379754 103 383 368 St Johns Group Practice 101 6 8231817181416116 148 345 324341 327 St Vincents Medical Centre 0 8 3 3 3 4 6 411221 38 309305304316 315 280 The Burns Practice 410332533324 42 249 219 The Edlington Practice 0 9 1 7 6 2 10 10 18 2 0 14 79 The Flying Scotsman 0 0 430010010 9 Great North Medical Group 0 0 000030000 3 Hatfield Health Centre 0 0 000000000 0 11 Kingthorne Group Practice 0 4 92 173 41 26 11 6 9 7 11 455747 4124 9 The Lakeside Practice 4 9 6 40 50 70 60 43 39 30 16 14 12 17 10 14 13 21 468 20 21 20 20 20 20 19 20 20 20 19 20 21 20 19 20 20 19 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ The Mayflower Medical Practice 1 1422173 9 141215115 14137‐ ‐ Jul Jan Jan Jun Oct Oct Apr Feb Sep Feb Sep Dec Dec Aug Nov Nov Mar The Medical Centre 0 1 144 153 48 30 20 9 4 17 14 12 12 13 6 7 13 503 May Mount Group Medical Centre 3 9 1681612163735344547278 The Nayar Practice 2 1332784301878 The Nelson Practice 1 5 1 264330010 26 The New Surgery 4213 2 122121453 51 The Ransome Practice 0 1 000000000 1 Regent Square Group Practice 0 0 6125191266348 81 The Rossington Practice 4 3 2 3 1 2 0 313215 30 The Sandringham Practice 0 0 0 1 0 0 0 0 0 000200 3 The Scott Practice 47 56 56 44 37 55 53 40 45 27 24 22 506 Tickhill & Colliery Surgery 0 0 35 29 38 39 27 23 21 24 28 25 15 12 316 The Village Group Practice 6 15 3 6 5 1 2 4775101182 Thorne Moor Medical Practice 1 1 0 000100011 5 West End Clinic 0 0 2 2 932131210 26 White House Farm Medical Centre 79 77 29 34 29 20 9 16 13 9 11 4 330 Monthly Totals 4 9 11 280 383 219 477 368 309 305 304 316 324 341 345 249 315 327 Overall Total 4886

Of those, 2707 Symptom Assessments were COMPLETED to date: Practice Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Practice Total Askern Medical Practice 0 000000000 0 Barnburgh Surgery 0 1 0 0 000000200 3 Bentley Surgery 0 5 2 0731362881468 Conisbrough Group Practice 0 0 0 22 29 16 30 27 15 22 19 27 12 24 24 267 Conisbrough Medical Practice 0 1 000000001 2 Denaby Medical Practice 0 000000000 0 Dunsville Medical Centre 0 1 2 1 0 0 0 1 0 0 000000 5 Field Road Surgery 1 0 0 4 10 5 12 19 12 14 10 11 15 23 136 Mexborough Health Centre 0 0 000000000 0 Northfield Surgery 0 24 5 1 2 2 2 1 476172 64 Oakwood Surgery 1 0 0 107726022 28 Park View Surgery 0 0 0 0 0 0 0 0 000000 0 Total doctorlink Symptom Petersgate Medical Centre 1 0 1 013529181 32 Scawsby Health Centre 1 2 13 5 1 4 1 3 337433 53 Assessments COMPLETED St Johns Group Practice 3 1 6 5159119 8137 5 92 St Vincents Medical Centre 0 3 1 2 3 3 3 311111 23 216 207 206 The Burns Practice 3 5 202410012 20 199 196192 192195 188 183 183 The Edlington Practice 0 4 1 552688209 50 173 The Flying Scotsman 0 0 220010010 6 155 Great North Medical Group 0 0 000010000 1 Hatfield Health Centre 0 0 000000000 0 111 Kingthorne Group Practice 0 3 24 72 23 15 8 4 8 5 7 230435 186 96 The Lakeside Practice 3 5 4 19 22 34 26 25 25 16 13 7 10 10 6 12 7 11 255 The Mayflower Medical Practice 0 81413171178801289 The Medical Centre 0 0 52 75 23 10 9 6 3 8 5 858565 228 Mount Group Medical Centre 1 3 9 4 11 10 13 27 22 22 32 35 189 3 5 7 The Nayar Practice 1 0332453201253 20 21 20 20 20 20 20 20 19 20 19 20 21 20 19 20 20 The Nelson Practice 0 2 1 152220010 1619 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

The New Surgery 1 3 1 2 011011401 16 Jul Jan Jan Jun Oct Oct Apr Feb Sep Feb Sep Dec Dec Aug Nov Nov Mar The Ransome Practice 0 1 000000000 1 May Regent Square Group Practice 0 0 6 4411934236 52 The Rossington Practice 1 1 1 0 1 1 0 112001 10 The Sandringham Practice 0 0 0 0 0 0 0 0 0 000200 2 The Scott Practice 23 35 45 35 27 37 36 25 23 14 16 15 331 Tickhill & Colliery Surgery 0 0 22 16 31 25 20 16 13 15 18 17 7 7 207 The Village Group Practice 2 7 1 3 3 0 1 234257 40 Thorne Moor Medical Practice 1 0 0 000100000 2 West End Clinic 0 0 2 1 520131110 17 White House Farm Medical Centre 30352018169699452 163 Monthly Totals 3 5 7 96 173 111 188 199 216 196 192 183 207 192 195 155 183 206 Overall Total 2707 Appendix B

The 2707 completed Symptom Assessments to date, fell into the following outcome categories:

Emergency & Mental Health Sexual Health Community Maternity Assessment Not GP Services Self-Care Pharmacy Dentist Optician Other Service Urgent Care Services Services Services Services Available Practice Practice Total Askern Medical Practice 0000000000 0 00 Barnburgh Surgery 0300000000 0 03 Bentley Surgery 4010115001100 0 068 Conisbrough Group Practice 181332610561000 4 1267 Conisbrough Medical Practice 2000000000 0 02 Denaby Medical Practice 0000000000 0 00 Dunsville Medical Centre 4100000000 0 05 Field Road Surgery 8617206004100 2 0136 Mexborough Health Centre 0000000000 0 00 Northfield Surgery 371591020000 0 064 Oakwood Surgery 16533001000 0 028 Park View Surgery 0000000000 0 00 Petersgate Medical Centre 22721000000 0 032 Scawsby Health Centre 40751000000 0 053 St Johns Group Practice 5914152110000 0 092 St Vincents Medical Centre 15510020000 0 023 The Burns Practice 13231010000 0 020 The Edlington Practice 36370101110 0 050 The Flying Scotsman 4100001000 0 06 Great North Medical Group 0010000000 0 01 Hatfield Health Centre 0000000000 0 00 Kingthorne Group Practice 13626125302100 1 0186 The Lakeside Practice 14644438431420 0 0255 The Mayflower Medical Practice 651172201000 1 089 The Medical Centre 152372210330100 0 0228 Mount Group Medical Centre 12431237120100 0 0189 The Nayar Practice 35482121000 0 053 The Nelson Practice 8341000000 0 016 The New Surgery 11022001000 0 016 The Ransome Practice 1000000000 0 01 Regent Square Group Practice 35962000000 0 052 The Rossington Practice 7110010000 0 010 The Sandringham Practice 0020000000 0 02 The Scott Practice 24244216485000 0 1331 Tickhill & Colliery Surgery 14231189011400 1 0207 The Village Group Practice 27324000300 1 040 Thorne Moor Medical Practice 1100000000 0 02 West End Clinic 11410010000 0 017 White House Farm Medical Centre 10726183212000 4 0163 Service Totals 1805 398 293 91 27 34 23 17 3 0 14 2 Overall Total 2707 Appendix B

Days of the week Symptom Assessments are completed (total to date): Practice Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total Askern Medical Practice 0 0 0 0 0 0 0 0 Barnburgh Surgery 2 0 0 0 1 0 0 3 Bentley Surgery 16 11 12 11 9 1 8 68 Conisbrough Group Practice 71 44 54 38 29 8 23 267 Conisbrough Medical Practice 1 0 1 0 0 0 0 2 Denaby Medical Practice 0 0 0 0 0 0 0 0 Dunsville Medical Centre 2 0 0 1 0 2 0 5 Field Road Surgery 37 28 18 23 13 9 8 136 Days of the week doctorlink Symptom Mexborough Health Centre 0 0 0 0 0 0 0 0 Northfield Surgery 13 9 8 4 10 12 8 64 Assessments are completed (total to date) Oakwood Surgery 9 2 2 6 5 1 3 28 560 Park View Surgery 0 0 0 0 0 0 0 0 Petersgate Medical Centre 4 7 10 5 2 1 3 32 470 441 Scawsby Health Centre 12 14 4 12 0 6 5 53 St Johns Group Practice 31 12 7 12 10 10 10 92 388 St Vincents Medical Centre 2 1 8 3 2 3 4 23 333 291 The Burns Practice 3 4 0 5 1 4 3 20 The Edlington Practice 10 12 13 7 3 0 5 50 224 The Flying Scotsman 0 0 1 2 0 1 2 6 Great North Medical Group 0 0 0 1 0 0 0 1 Hatfield Health Centre 0 0 0 0 0 0 0 0 Kingthorne Group Practice 15 40 36 26 36 14 19 186 The Lakeside Practice 59 40 39 38 25 30 24 255 The Mayflower Medical Practice 18 12 14 12 12 8 13 89 Monday Tuesday Wednesday Thursday Friday Saturday Sunday The Medical Centre 31 43 21 36 36 22 39 228 Mount Group Medical Centre 44 27 26 22 24 20 26 189 The Nayar Practice 10 7 12 7 9 1 7 53 The Nelson Practice 6 1 4 2 2 0 1 16 The New Surgery 4 4 1 2 4 1 0 16 The Ransome Practice 1 0 0 0 0 0 0 1 Regent Square Group Practice 15 9 9 4 5 4 6 52 The Rossington Practice 0 2 3 3 1 0 1 10 The Sandringham Practice 0 0 0 2 0 0 0 2 The Scott Practice 61 58 54 49 51 25 33 331 Tickhill & Colliery Surgery 47 41 41 20 22 18 18 207 The Village Group Practice 5 12 9 6 4 2 2 40 Thorne Moor Medical Practice 0 1 0 0 1 0 0 2 West End Clinic 2 2 4 3 0 5 1 17 White House Farm Medical Centre 29 27 30 26 16 16 19 163 Total 560 470 441 388 333 224 291 Overall Total 2707 Appendix B

Time of day Symptom Assessments are completed (total to date): Practice 00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 Total Askern Medical Practice 0 0 0 0 0 0 0 0 0 0 000000000000000 Barnburgh Surgery 0 0 0 0 0 0 0 0 0 0 100000000200003 Bentley Surgery 0 0 1 1 0 1 2 2 5 7 54571064401011168 Conisbrough Group Practice 0 0 2 1 0 4 7 26 34 29 20 22 15 15 6 7 16 7 11 11 14 7 10 3 267 Conisbrough Medical Practice 0 0 0 0 0 0 0 0 0 1 000001000000002 Denaby Medical Practice 0 0 0 0 0 0 0 0 0 0 000000000000000 Dunsville Medical Centre 0 0 0 0 0 0 0 1 0 0 110000100000015 Field Road Surgery 2 0 0 0 1 2 9 15 14 15 17 7 7 5 5365475331136 Mexborough Health Centre 0 0 0 0 0 0 0 0 0 0 000000000000000 Northfield Surgery 1 0 0 0 0 0 1 6 4 6 4373211015568064 Oakwood Surgery 0 0 0 0 0 0 1 1 2 2 3130223032210028 Park View Surgery 0 0 0 0 0 0 0 0 0 0 000000000000000 Petersgate Medical Centre 2 0 1 0 0 0 1 0 4 1 3274301100020032 Scawsby Health Centre 0 0 0 0 0 1 1 1 6 4 5444533512012153 St Johns Group Practice 5 2 1 1 0 2 2 2 3 1 5656422575859492 St Vincents Medical Centre 0 0 0 0 0 0 1 2 2 1 1330302200111023 The Burns Practice 0 0 1 0 0 0 1 1 0 0 4113210110012020 The Edlington Practice 2 1 0 0 1 0 2 3 3 2 5331224322303350 The Flying Scotsman 0 0 0 0 0 0 0 0 0 1 110001001100006 Great North Medical Group 0 0 0 0 0 0 0 0 1 0 000000000000001 Hatfield Health Centre 0 0 0 0 0 0 0 0 0 0 000000000000000 Kingthorne Group Practice 0 3 1 0 1 1 7 6 9 21 19 11 7 10 8 6 14 9 9 12 13 10 4 5 186 The Lakeside Practice 4 0 2 3 1 6 9 14 26 16 14 13 8 16 14 10 12 12 15 13 10 20 13 4 255 The Mayflower Medical Practice 3 3 0 1 0 1 10 6 11 6 6633453632340089 The Medical Centre 5 0 2 3 1 6 11 10 21 11 10 11 15 13 12 7 11 8 11 11 16 15 5 13 228 Mount Group Medical Centre 1 5 2 4 3 5 5 4 14 14 19 13 8 12 12 845411136107189 The Nayar Practice 2 0 0 0 1 0 0 2 3 3 1224436542105353 The Nelson Practice 0 1 0 0 0 0 0 0 4 0 0012114200000016 The New Surgery 1 2 0 0 0 0 0 0 3 0 1101002122000016 The Ransome Practice 0 0 0 0 0 0 0 0 0 0 000000000010001 Regent Square Group Practice 2 0 0 0 0 0 4 6 4 1 4043131134432252 The Rossington Practice 1 0 0 0 0 0 0 2 0 0 0001001012101010 The Sandringham Practice 0 0 0 0 0 0 0 0 0 0 000200000000002 The Scott Practice 7 9 1 2 2 5 13 16 33 26 25 22 11 29 15 16 10 12 12 9 21 19 8 8 331 Tickhill & Colliery Surgery 5 3 1 1 1 1 6 21 18 17 14 14 8 14 12 12 8 4 16 11 4 6 9 1 207 The Village Group Practice 3 1 0 0 0 0 2 2 5 1 6332330112110040 Thorne Moor Medical Practice 0 0 0 0 0 0 0 0 0 0 100100000000002 West End Clinic 1 0 0 0 0 0 2 2 2 0 0030000102022017 White House Farm Medical Centre 4 1 2 2 0 3 6 10 6 13 11 5 8 9 7 9 14 8 3 14 10 7 10 1 163 Total 51 31 17 19 12 38 103 161 237 199 206 159 141 170 137 112 133 108 115 135 136 121 108 58 Overall Total 2707 Time of day doctorlink Symptom Assessments are completed (total to date)

237

206 199

170 161 159

141 137 133 135 136 121 115 112 108 108 103

58 51 38 31 17 19 12

00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 Enc H

PUBLIC Primary Care Commissioning Committee Forward Planner 8 April 2021 13 May 2021 10 June 2021 8 July 2021 12 August 2021 9 September 2021 14 October 2021 11 November 2021 9 December 2021

30.03.21 04.05.21 01.06.21 29.06.21 03.08.21 31.08.21 05.10.21 02.11.21 30.11.21 31.03.21 05.05.21 02.06.21 30.06.21 04.08.21 01.09.21 06.10.21 03.11.21 01.12.21 02.04.21 07.05.21 04.06.21 02.07.21 06.08.21 03.09.21 08.10.21 05.11.21 03.12.21

Agenda Items Lead Apologies for absence Chair xxxxx xxx x Declarations of Interest Chair xxxxx xxx x Notification of Any Other Business Chair xxxxx xxx x Minutes of the previous meeting Chair xxxxx xxx x Matters Arising not on the Agenda, including Chair xxxxx xxx x progressing the Action Tracker Action Tracker Chair xxxxx xxx x Finance & Contracting: Interim Exception Report Hayley Tingle xxxxxx Full Quarterly Report Hayley Tingle xx x Primary Care Estates Strategy - Implementation Plan Update Carolyn Ogle / S Barnes xxxxx xxx x Estates Programme Business Case Jude Wildgoose Local Enhanced Services Update Hayley Tingle Estates End of Year Report Simon Barnes Bentley Surgery & The Nelson Practice Merger Carolyn Ogle Practice Merger Policy Carolyn Ogle Quality: Interim Exception Report Andrea Ibbeson / Zara Head xxxxxx Full Quarterly Report Andrea Ibbeson / Zara Head xx x Flu Plan 20/21 Update Emma Serfozo Quality & Performance Framework Zara Head Strategy & Planning: Primary Care Delivery Plan 2020/21 Carolyn Ogle GP Forward View Update Carolyn Ogle Extended Access Report Laura Sherburn / Jill Telford Primary Care Commissioning Committee Terms Chair x of Reference Primary Care Networks Update Carolyn Ogle x Proactive Care Karl Roberts GPFV Funding Karl Roberts x DRAFT Primary Care Delivery Group Minutes Carolyn Ogle Primary Care Cell Update Karl Roberts xxxxx xxx x Primary Care Commissioning Committee Chair Effectiveness Review & Strategy Session Outcome of the Strategy Session Chair Integrating Care - Next steps Carolyn Ogle Integrated Care System Development Jackie Pederson Audit Report Carolyn Ogle x Primary care Commissioning Committee Annual Report Carolyn Ogle x Forward Planner Chair xxxxx xxx x Escalation of Risks to the Governing Body Chair xxxxx xxx x Risk Register Carolyn Ogle xxx x x Any New Potential Risks Carolyn Ogle xx x x Any Other Business Chair xxxxx xxx x Date and Time of the next Meeting Chair xxxxx xxx x Enc I

Meeting name Primary Care Commissioning Committee Meeting date 8 April 2021

Title of paper Risk Register

Executive / Carolyn Ogle Clinical Lead(s) Associate Director of Primary Care & Commissioning Alison Edwards Author(s) Corporate Governance Manager

Status of the Report

X To approve To consider / discuss

To note

Purpose of Paper - Executive Summary The Primary Care Commissioning risks come to the Primary Care Commissioning Committee to make the members aware of current risks.

The risks have been reviewed with the Head of Service and Corporate Governance Manager. There are currently two Primary Care risks (refer to Appendix 1 for the full details) which the committee need to be sighted: -

CO3-PCP014 (Lack of workforce sustainability and Primary Care Workforce Strategy in Doncaster which clearly highlights current position and future plan). Update 14.01.2021 – GPFV funding agreed to support pre-med school and VTS nursing to support new recruits into primary care. Mentorship scheme development through ICS and Workforce Hub. Ongoing work on recruitment plans for PCNs and maximising use of Additional Roles Spend including flexibility to support training and supervision. Update 11.02.2021 – No changes to the above.

CO3-PCP016 (Practice is currently not registered to provide services under the Health and Social Care Act as required by CQC). Update 12.01.2021 - Quality review undertaken by Primary Care Lead Nurse and presented to PCCC on 12.11.2020. No issues noted of concern and that CQC registration is being progressed. Update 11.02.2021 – no changes to the above.

Additions / Removals

There have been no additions or removals to the Risk Register since it was last reviewed.

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Recommendation(s) The Primary Care Commissioning Committee is asked to a) Review the Primary Care risks on the Corporate Risk Register and confirm all risks are appropriately scored and described. b) Confirm that they are assured that appropriate actions are taking place to mitigate potential impacts and consequences c) Identify any new risks

Report Exempt from Public Disclosure

Yes No X If yes, detail grounds for exemption:

Impact analysis Quality impact

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. An Equality Impact Analysis/Assessment has been completed and approved by the Equality lead Head of Corporate Governance / Corporate Governance Manager. As a result impact of performing the analysis/assessment there are no actions arising from the analysis/assessment. An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of None identified Interest Consultation / Engagement (internal Consultation with Risk and Assurance Lead departments, clinical, stakeholder and public/patient) Report previously None presented at Risk CO2-2.2, CO2-2.3 analysis

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Strategic Objective 2: Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population. CO2-2.2 - Quality Impact: The quality of care delivered to patients and the achievement of associated quality and performance Corporative targets could be adversely affected if we fail to commission Objective / effective, resilient and sustainable services. Assurance Framework CO2-2.3 - Primary Care: If we fail to commission effective, resilient and sustainable primary medical care services, the quality of care delivered to patients and the achievement of associated quality and performance targets could be adversely affected, and the full vision contained within the Place Plan could potentially be adversely affected.

Statutory Duty Section Tick Relevant Box Management of Conflicts of 14O Interest Duty to promote the NHS 14P Constitution Duty to exercise its functions 14Q √ effectively, efficiently and economically Duty as to improvement in quality 14R of services Duty in relation to quality of 14S primary medical services Duties as to reducing inequalities 14T Duty to promote the involvement 14U of each patient Duty as to patient choice 14V Primary Care Duty as to promoting integration 14Z1 Statutory Public involvement and 14Z2 Duties (only) consultation GMS, PMS and APMS contracts 83 (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract) Newly designed enhanced 83 services (“Local Enhanced Services” and “Directed Enhanced Services”) Design of local incentive schemes 83 as an alternative to the Quality Outcomes Framework Decision making on whether to 83 establish new GP practices in an area Approving Practice mergers 83

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Making decisions on 83 ‘discretionary’ payment (e.g., returner / retainer schemes) To plan, including needs assessment, primary medical care services in Doncaster To undertake reviews of primary medical care services in Doncaster To co-ordinate a common √ approach to the commissioning of primary care services generally To manage the budget for commissioning of primary medical

care services in Doncaster

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NHS Doncaster CCG Corporate Risk Register

Last updated: Feb 2021

Corporate Objectives (COs)

CO 1 Ensure an effective, well led, and well governed organisation and its statutory obligations are met.

CO 2 Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population.

CO 3 Ensure that the healthcare system in Doncaster is sustainable, accessible and reactive to change

CO 4 Work collaboratively with partners to improve health, care and reduce inequalities in well governed and accountable partnerships.

Consequences / Severity

Insignificant Minor Moderate Major Catastrophic Likelihood of 1 2 3 4 5 occurrence Rare 1 2 3 4 5 1 Unlikely 2 4 6 8 10 2 Possible 3 6 9 12 15 3 Likely 4 8 12 16 20 4 Almost Certain 5 10 15 20 25 5

1-3 Low The risk appetite under which risks can be tolerated is a score of 12 4-6 Medium or below. 8-12 High 15-20 Very High Risks scored at or in excess of a score of 13 must be escalated to the 25 Extreme Governing Body. Enc I

NHS Doncaster CCG Corporate Risk Register Summary

Gaps in controls and Gaps in assurance Risks Current Controls Internal and External Assurances Positive Assurance timescales for and timescales for Actions to be taken Progress Against Actions remedial action remedial action

Initial Risk Rating Risk Initial Lead Current Risk Rating Risk Current Committee / Action end Board for Date Total Total

Likely Likely delegation of Areas where we do not Areas where we actions What could happen Identified Date What controls are in place that are Where can we gain evidence that the What evidence shows we are have adequate Reference number Reference Target Risk Rating Risk Target are not receiving and should the risk operating at this level and assist in the controls / systems are placing reasonably managing our controls / systems in evidence that Detail the Actions to be taken Is the plan on track? materialise, what is delivery of aims and manage / mitigate reliance on the effective internally / risks and our objectives are place or existing controls / systems the impact risks externally? being delivered controls / systems are are effective not effective Impact / Consequence / Impact Consequence / Impact Responsible Director and Operational Lead Operational and Director Responsible

Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Risk Description: 26.03.18 4 3 12 3 3 9 4 • Primary Care Delivery Plan • Primary Care Commissioning • South Yorkshire and • None • None • Implementation of Workforce Mar-21 Quality and Risk Review: Lack of workforce • Governing Body Committee Bassetlaw Workforce Hub Strategy - Primary Care, for Patient Safety 11.02.2021 - risk reviewed by PCCC and there sustainability and • Primary Care Commissioning Committee • Federation Workforce Survey • The strategy and action plan is Doncaster, approved at PCCC Committee are no changes to be made. Primary Care minutes • Governing Body Minutes monitored at meetings on 13 December 2018. Workforce Strategy in • South Yorkshire and Bassetlaw Care • SY&B Care Workforce Group Minutes • additional investment from • Implementation of strategy 14.01.2020 - GPFV funding agreed to support pre- Doncaster which Workforce Group • Integrated Care System Workforce July 2019 for additional roles discussed at quarterly contract med school and VTS nursing to support new clearly highlights • Primary Care Network Development Workshop (27/03/18) • GPN Development Strategy meeting with PCD recruits into primary care. current position and • Monthly meetings between CCG and PCN • NHS England Application for being drafted - completed • Workforce plans to be Mentorship scheme development through ICS and future plan. Clinical Directors International Recruitment SYB Workforce and Training developed by PCNs for current Workforce Hub Additional Roles Reimbursement Scheme • NHS England working with Health Hub MOU year by 31 August 2020 Ongoing work on recruitment plans for PCNs and Primary Care Cell Education England WSP programme work • Longer term workforce plans maximising use of Additional Roles Spend Risk Cause: • NHS England procurement of APEX to be developed by 31 October including flexibility to support training and Inability to recruit GPs with CCG leading. 2020 supervision. and other clinical staff • Network agreement schedule on • CCG recruitment of Risk noted at meeting held on 12 November. Next to work in practices in workforce workforce lead meeting will be held on 11.2.2021 Doncaster region. • National workforce reporting system Daily situation reporting Risk noted at meeting held in September. Next Primary Care cell action notes meeting will be held on 12.11.20

03.11.20 - Workforce plans received from all 5 Risk Consequence PCNs. Workforce lead commences in January. Patient access to WSP programme supported by ICS in progress. care. Sustainability Pandemic impacts on workforce sustainability and PCP014 of practices, could has meant refreshing of workforce plans, integrated cause potential care delivery and understanding of workforce

Head of Primary Care Primary of Head mergers/closures. pressures through daily situation reporting Secondary care commenced w/c 26th October 2020 services could then be affected by not 27.08.2020 - August PCCC meeting cancelled. moving them into Next meeting scheduled for 10 September primary care. 25.6.2020 - PCN recruitment plans developed and recruitment to additional roles commenced SYB Workforce and Training Hub reps to attend August meeting of PCD CDs to discuss work plan Enc I

NHS Doncaster CCG Corporate Risk Register Summary Gaps in controls and Gaps in assurance and Risks Current Controls Internal and External Assurances Positive Assurance timescales for remedial timescales for remedial Actions to be taken Progress Against Actions Risk Initial t Risk Rating Rating Curren action action

Lead Committee

Total Total Areas where we do not Likely Likely What evidence shows we Action end / Board for What could happen What controls are in place that are Where can we gain evidence that have adequate controls / Areas where we are not are reasonably managing Date delegation of and should the risk operating at this level and assist in the the controls / systems are placing systems in place or receiving evidence that Detail the Actions to be our risks and our actions Is the plan on track? materialise, what is delivery of aims and manage / mitigate reliance on the effective internally / existing controls / controls / systems are taken Date Identified objectives are being Operational Lead Reference number Reference the impact Rating Target Risk risks externally? systems are not effective delivered effective Responsible Director and Director Responsible Impact / Consequence Impact / Consequence Strategic Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Risk Description: 09.07.20 4 3 12 3 3 9 4 Health and Social Care Act Meetings with CQC Regular meetings and None None DBS checks completed and 30.09.20 Primary Care Risk Review Practice is currently Contract Regulations Correspondence with Practice catch ups over email / sent to CQC. Commissioning 11.02.2021 - risk reviewed by PCCC and there are no not registered to Primary Care Commissioning Committee Minutes of Primary Care teams with the practice Provider needs to have meeting changes to be made. provide services Commissioning Committee concerned registered manager interview under the health and Virtual meetings with practice Then registration as 12.01.2021 - Q3 - Quality review undertaken by Primary social care act as partnership. Care Lead Nurse and presented to PCCC on 12.11.2020 required by CQC. Practice moving to single noted no issues of concern and that CQC registration being hander so needs then to start progressed. Next review due in February 2021. process to move to single hander. 03.11.20 - Sustainability plan from practice received for Action plan from provider discussion at PCCC in November along with quality PCCC to be assured about indicators. Progress being made regarding practice Risk Cause: action plan registration with CQC but not yet resolved. Practice is registered as single handed Risk noted at meeting held in September. Next meeting will practice. Partner be held on 12.11.20 joined in August 2019 requires revision to 09.07.20 - Risk added to the register as requested at the registration. Delays in Primary Care Commissioning meeting. actioning

PCP016 Risk Consequence Practice served

Head of Primary Care Head of notice by CQC and required to pay significant fine which it cannot afford to pay. No regulatory action can be taken against un registered practice Contractual sanctions could be applied Potential termination of contract