Meeting of the CCG Governing Body Agenda

OFFICIAL

Meeting of the CCG Governing Body

A meeting of NHS North Tyneside Clinical Commissioning Group Governing Body is to be held in Public on Tuesday 25 July 2017, 9:45am-11.00am, at the Village Hotel Club Newcastle, Cobalt Business Park, West Allotment, Newcastle upon Tyne, NE27 0BY

Members of the public are invited to meet members of the Governing Body informally prior to the annual public meeting, from 9am-9.15am

Agenda

Item Item Lead Time / No Enc/Verbal 1 Welcome and Introductions Dr J Matthews Verbal

2 Apologies for Absence Dr J Matthews Verbal

3 Confirmation of Quoracy Dr J Matthews Verbal

4 Declarations of Interest Dr J Matthews / Ms I Enclosure Walker 5 Minutes of the Previous Meeting held on 23 Dr J Matthews Enclosure May 2017

6 Matters Arising from the Previous Meeting held Dr J Matthews Verbal on 23 May 2017

7 Action Log Dr J Matthews Enclosure

8 Report from Chair and Chief Officer Dr J Matthews / Dr L Verbal Young-Murphy

9 Quality & Safety

9.1 Quality and Safety Report – July 2017 Dr M Wright / Dr L Young- Enclosure Murphy 9.2 Integrated Quality and Performance Report Dr L Young-Murphy / Enclosure Mr J Connolly

9.3 North East of England and Cumbria Clinical Dr L Young-Murphy Enclosure Commissioning Groups Research and Evidence Annual Report 2016/17

10 Finance & Contracting 11.00am

10.1 2017/18 Finance and Contracts Report Month Mr J Connolly Enclosure 3 – June 2017

11 Strategic and Commissioning Items

11.1 Commissioning Priority Areas 2017/18 Mr J Wicks / Mrs A Paradis Enclosure

12 Public and Patient Involvement 1

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12.1 Report from the Patient Forum Dr L Young-Murphy / Mrs Verbal E Hayward

13 Governance and Assurance

13.1 Risk Assurance Framework Dr L Young-Murphy / Mrs I Enclosure Walker

13.2 Conflicts of Interest – Revised Guidance June Mrs I Walker Enclosure 2017

13.3 Quality & Safety Committee Terms of Mrs I Walker Enclosure Reference

14 Minutes from Committees

14.1 • Clinical Executive: 22.03.17 • Quality & Safety Committee 02.05.17 • Patient Forum 11.05.17 • Primary Care Committee 30.03.17 • Council of Practices 15.03.17

15 Date of Next Meeting

Tuesday 26 September 2017 9.15am-11.15am: Governing Body Meeting in Public Venue: Longsands North, NTCCG, Hedley Court

KEY: Declaration made within last 6 months at date Register of Declarations of Interests: April 2017 Register v5-0 issued 29.6.17 of issue of the register. More NTCCG Governing Body than 6 months.

Type of Interest (tick as approporiate) Is the Date Declared Interest (name of interest Declaration organisation and nature of Non Financial Non Financial direct or Action taken to made Member of Surname Forename Job title Current position business) Financial Professional Interests Personal Interests indirect? Nature of interest From To mitigate risk (mm/dd/yyyy) Attendee Accountable Adams Mark Chief Officer Officer Beverley Park Leisure Ltd  Direct Director Ongoing Not relevant to CCG role 21/03/2017 Member Accountable Adams Mark Chief Officer Officer GLSKR.com Ltd  Direct Director Ongoing Will declare at meetings as21/03/2017 appropriateMember Accountable NHS Newcastle Gateshead Adams Mark Chief Officer Officer Clinical Commissioning Group  Direct Accountable Officer 01/12/2016 Ongoing Will declare at meetings as21/03/2017 appropriateMember Director of Burke Wendy Public Health LA Employee None 01/06/2017 Attendee GB member/ Committee Chief Finance member/ No conflict as Connolly Jon Officer employee JM Connolly Limited  Direct Director (Company inactive) Sep-14 company inactive 19/05/2017 Member Newcastle University, Trustee Deputy Lay Governing Member of Pension Trustee There may be a connection between Coyle Mary Chair Body Member Limited  Indirect the University and the CCG Ongoing Not required 01/06/2017 Member Deputy Lay Governing Forum Member. Northumbrian Northumbrian Water and CCG may Coyle Mary Chair Body Member Water Forum  Indirect have some connection Ongoing Not necessary 01/06/2017 Member Deputy Lay Governing Non-Executive Director, There may be connection between Coyle Mary Chair Body Member Gentoo Group  Indirect Gentoo and CCG Ongoing Not required 01/06/2017 Member Board Chair, Shared Interest Deputy Lay Governing Society and Shared Interest There may be connection between Coyle Mary Chair Body Member Foundation  Indirect Shared Interest and CCG Ongoing Not required 01/06/2017 Member North East Ambulance Secondary care Services NHS FT Medical Director (p/t) Han Kyee Clinician doctor Great North Air Ambulance Trustee Left 31.3.2017 Service A&E consultant (Part time) South Tees Hospitals NHS FT 22/11/2016 Member Susan Duncan - Daughter, HR Compliance with Governing Manager North Tyneside Susan Duncan - Daughter, HR Business Standards Hayward Eleanor Lay Member Body Member Council  Indirect Manager North Tyneside Council 4 Years Ongoing Policy 04/04/2017 Member Governing Body Member Declare conflict as James Paul Interim CFO Left 31.3.2017 Enterprise Value, Consultancy  Pre 2000 Ongoing appropriate 01/11/2016 Member Partner of Park Road Medical I will not participate in Matthews Dr. John Clinical Chair Clinical Chair Practice  Direct Partner of GMS Service Ongoing decision making 03/04/2017 Member Practice is a member of I will not participate in Matthews Dr. John Clinical Chair Clinical Chair Tynehealth  Direct Ongoing decision making 03/04/2017 Member Practice is a partner in a service development together with Northumbria FT and I will not participate in Matthews Dr. John Clinical Chair Clinical Chair Portugal Place HC  Direct Ongoing decision making 03/04/2017 Member Board member/Trustee for Wallsend Memorial Hall & Peoples Centre of Community I will not participate in Matthews Dr. John Clinical Chair Clinical Chair Service  Direct Ongoing decision making 03/04/2017 Member Spouse is a palliative care consultant at Newcastle I will not participate in Matthews Dr. John Clinical Chair Clinical Chair Hospital FT  Indirect Ongoing decision making 03/04/2017 Member Compliance with Standards of Interim CO Director of JSC Management Business Conduct Soo-Chung Janet Left 29.3.2017 Interim CO Consulting  Direct Director Mar-13 Ongoing Policy 07/11/2016 Member Is the Date Declared Interest (name of interest Declaration organisation and nature of Non Financial Non Financial direct or Action taken to made Member of Surname Forename Job title Current position business) Financial Professional Interests Personal Interests indirect? Nature of interest From To mitigate risk (mm/dd/yyyy) Attendee Northumberland County Council is not directly aligned to NTCCG and therefore no special measures are required to manage this conflict of interest other than following NTCCG Standards of Independent (and paid) member of Business Conduct Head of Northumberland County Northumberland County Council and Declarations of Walker Irene Governance CCG Employee Council  Direct Audit Committee 01/01/2013 Ongoing Interest Policy. 03/04/2017 Attendee This is unlikely to present any conflict of interest. In any event the NTCCG East Bedlington Community Centre Standards of Trust. This is a charity responsible Business Conduct for developing and managing a local and Declarations of Head of East Bedlington Community community centre in the Bedlington Interest Policy will be Walker Irene Governance CCG Employee Centre Trust. Charity.  Direct area. 01/01/2014 Ongoing followed. 03/04/2017 Attendee Head of Sister is an HR Manager for NTW Walker Irene Governance CCG Employee NTW Trust  Indirect Trust 01/01/1991 Ongoing 03/04/2017 Attendee Sister is a Ward Clerk at St George’s Head of hospital, Morpeth which is part of Walker Irene Governance CCG Employee NTW Trust - health provider  Indirect NTW Trust 01/01/2015 Ongoing 03/04/2017 Attendee Brother is a Carer at Northgate Whilst NTW is a Head of Hospital, Morpeth which is part of provider of services, Walker Irene Governance CCG Employee NTW Trust - health provider  Indirect NTW Trust 01/01/1996 Ongoing the brother’s role 03/04/2017 Attendee

Interim Chief Operating Officer to 31/3/2017 & Interim Director of Contracts & Clinical John G Wicks Healthcare Commissioinin Executive Management Ltd As per conflicts of Wicks John g from 1/4/17 Member (Management Consultancy)  Direct Director 01/04/2016 Ongoing interest policy 21/04/2017 Attendee Governing Body Lay Member: Audit Governing Willis Dave & Governance Body Member No conflict of interests 26/04/2017 Member Member Governing I will comply with the Body & Clinical standards business Executive; conduct and conflict Medical Medicines of interest policy of Wright Dr. Martin Director Optimisation Portugal Place Health Centre  Direct 1992 Ongoing the CCG 07/04/2017 Member Member Governing I will comply with the Body & Clinical standards business Executive; conduct and conflict Medical Medicines of interest policy of Wright Dr. Martin Director Optimisation Slaters Bridge Group  Direct 2008 Ongoing the CCG 07/04/2017 Member Member Governing I will comply with the Body & Clinical standards business Executive; conduct and conflict Medical Medicines of interest policy of Wright Dr. Martin Director Optimisation Tynehealth Ltd  Direct Northtyneside GP Federation 2013 Ongoing the CCG 07/04/2017 Member Member Governing I will comply with the Body & Clinical standards business Executive; conduct and conflict Medical Medicines NHCFT Wallsend of interest policy of Wright Dr. Martin Director Optimisation Development Group  Direct 2014 Ongoing the CCG 07/04/2017 Member Is the Date Declared Interest (name of interest Declaration organisation and nature of Non Financial Non Financial direct or Action taken to made Member of Surname Forename Job title Current position business) Financial Professional Interests Personal Interests indirect? Nature of interest From To mitigate risk (mm/dd/yyyy) Attendee Member Governing I will comply with the Body & Clinical standards business Executive; conduct and conflict Medical Medicines of interest policy of Wright Dr. Martin Director Optimisation Dr Livingston Ltd  Direct Director 2016 Ongoing the CCG 07/04/2017 Member Member Governing I will comply with the Body & Clinical standards business Executive; conduct and conflict Medical Medicines of interest policy of Wright Dr. Martin Director Optimisation Dr Livingston Ltd  Indirect My wife is Director 2016 Ongoing the CCG 07/04/2017 Member Member Governing I will comply with the Body & Clinical standards business Executive; conduct and conflict Medical Medicines of interest policy of Wright Dr. Martin Director Optimisation Connect Physical Therapy  Indirect A Friend is CEO 1998 Ongoing the CCG 07/04/2017 Member Member Governing I will comply with the Body & Clinical standards business Executive; conduct and conflict Medical Medicines Chair Dementia Care of interest policy of Wright Dr. Martin Director Optimisation (dementia charity) Indirect Wife is Chair 01/06/2017 ongoing the CCG 27/06/2017 Member Chief Operating Officer and Executive I am an unpaid hon fellow at Director of Northumbria University which has Young- Lesley Nursing & Fellow at Northumbria just been extended for another 3 Murphy Carol Transformation CCG Employee University  Direct years 01/04/2013 Ongoing Non required 03/04/2017 Member

North Tyneside CCG Governing Body

Minutes of the North Tyneside CCG Governing Body meeting held in public on Tuesday 23 May 2017, 9.15am , at Hedley Court

Present: Dr John Matthews Clinical Chair (Chair) Mary Coyle Deputy Lay Chair Mark Adams Chief Officer Jon Connolly Chief Finance Officer Eleanor Hayward Lay Member Dave Willis Lay Member Dr Martin Wright Medical Director

In Attendance: Irene Walker Head of Governance Dianne Effard PA (Minutes) Adele Blythe Ramsay Healthcare

NTGB/17/043 Welcome & Introductions (Agenda Item 1

Dr Matthews welcomed members of the public to the North Tyneside CCG meeting in public, and also Wendy Burke, Director of Public Health.

NTGB/17/044 Apologies for Absence (Agenda Item 2)

Apologies were noted from Dr Lesley Young-Murphy, Mr John Wicks, Ms Christine Keen, Ms Wendy Burke.

NTGB/17/045 Confirmation of Quoracy (Agenda Item 3)

The meeting was confirmed as quorate.

NTGB/17/046 Declarations of Interest (Agenda Item 4)

There were no additional declarations of interest.

NTGB/17/047 Minutes of the Previous Meeting held on 28 March 2017 (Agenda Item 5)

The minutes were agreed as an accurate record.

NTGB/17/048 Matters Arising from the Previous Meeting held on 28 March 2017 (Agenda Item 6)

There were no matters arising.

NTGB/17/049 Action Log from Meeting held on 28 March 2017 (Agenda Item 7)

NTGB/17/013, Action 4: Northumberland, Tyne and Wear & North Durham Page 1 of 6

Sustainability & Transformation Plan: Possibly to be included in June Governing Body development session.

NTGB/17/050 Report from Chair and Chief Officer (Agenda Item 8)

Dr Matthews reported on the Cyber Attack. CCG officers and staff had put in a huge amount of effort over that weekend and subsequent days and had done a good job in supporting and helping primary care in ensuring it was safe. Several had e-mailed their thanks to CCG officers for their support and the Council of Practice (CoP) had also expressed a vote of thanks to CCG officers. Thanks should also be given to NECS for their extra support.

There had been a good system-wide effort at the end of the day and NTCCG brought its major incident plan action into effect which had worked well. There will be a post incident review to ensure all lessons learned were captured, and this will be in conjunction with other colleagues across the region.

There was still an issue about how the NHS was vulnerable to such an attack and some key questions will be asked at a national, regional and local level as to how this had happened. Discussions would be held with other public sector colleagues to understand how they managed the situation.

Action 1: Dr Young-Murphy to produce a report for the Governing Body (in private) to ensure learning from the Cyber Attack is included in next version of incident plan.

Mr Adams referred to discussions held at last Governing Body meeting regarding the end of year financial position. The CCG was well placed for starting this year but there needed to be a relentless focus on quality, safety, experience of patients and QIPP.

NTGB/17/051 Quality and Safety – May 2017 (Agenda Item 9.1)

Dr Wright presented the quality and safety report on behalf of LYM and summarised the highlights.

A “never event” was reported by Newcastle upon Tyne Hospitals and following discussions an external review will be held.

On SIRMS it was noted there had been good engagement from GPs which had largely been about discharges and discharge information.

Ms Coyle noted that the Quality & Safety Committee (Q&SC) had discussed falls which was not just doing a review and reporting back, it was about how lessons learned were dealt with. An action plan should be produced and Q&SC needed to see evidence. Dr Wright advised that Trust was optimistic and frustrated, but confident that over the next quarter implementation of the policy would show progress. Falls was a specific issue for North Tyneside, and regular updates will be included in the Quality & Safety report, and followed up in Q&SC. Page 2 of 6

It was thought that it had been a long time since there were any cases of MRSA assigned to a Trust, and now there were three at Newcastle. Dr Wright advised that there had been sporadic incidences which were always reviewed with a root cause analysis to see if any lessons could be learned.

The Governing Body received the report.

NTGB/17/052 Integrated Quality and Performance Report (Agenda Item 9.2)

Dr Wright presented the quality and performance report on behalf of Dr Young-Murphy and summarised the highlights.

Ms Coyle noted that the report was available on the CCG website and members of the public were encouraged to engage with us but any member of the public reading this report would not understand about the work streams, and would need an explanation of the abbreviations.

Mr Willis queried the situation on the Northumbria Specialist Emergency Care Hospital (NSECH) at Cramlington and Mr Adams advised that there was a lot of focus on NSECH both internal and external, and the CCG ought to be assured that there was a lot of work going on to get them to a better position. It was very difficult for the staff at NSECH at the moment as the system was not working the way it had been expected it to. The CCG should maintain a clear focus on assurance; providing system support to ensure the delivery of improvement in line with the agreed action plan.

With regard to the NHS Constitution Dr Wright advised that the 95% threshold for four hours waits had been breached, but Northumbria Healthcare FT (NHC) had done better than other Trusts. This impacts on the quality premium.

There was concern over ambulance handovers and despite information being provided in reports since NSECH opened and being told that work was going on, there appeared to be no improvement. Mr Adams advised that looking at Accident & Emergency performance and handovers, there were other Trusts in the area who were not performing as well as NHC. North Tyneside generally performed well in comparison to rest of the North and rest of the country and showed the pressures which organisations were under.

Mrs Hayward noted that representatives from NHC had attended a Patient Forum meeting which had proved very helpful and it was suggested inviting them to come to talk to NTCCG Governing Body.

Action 2: Dr Wright to invite NHC to attend a future NTCCG Governing Body meeting.

Dr Wright advised that the four hour waits breached across the board were being addressed through same process as the handover delays.

Mr WiIlis noted that the issue relating to the quality premium had been discussed at Audit Committee on Friday. NHS England had needed to Page 3 of 6

change their approach and clarification was being sought.

The Governing Body noted the content of the report.

NTGB/17/053 Month 1 Finance Update (Agenda Item 10.1)

Mr Connolly advised that there was no report produced for month 1. The CCG was dependent on information received from providers to support where it was in terms of its financial position. Information was expected during the first week in June.

Mr Connolly advised that this week’s Finance Committee meeting would look at the Deloitte report on QIPP. He also suggested reviewing the frequency of Finance Committee meetings.

NTGB/17/054 Report from the Patient Forum (Agenda Item 11.1)

Mrs Hayward gave a verbal update on the Patient Forum meeting held on 11 May 2017. Mr Connolly had been introduced to the Forum, who was pleased that the CCG now had a permanent Chief Finance Officer.

The Forum had held a meeting to review what would be looked at by them in the next twelve months; this included a patient on-line service, mental health provision especially for young people, STP implications and consultation, the urgent care outcomes. A plan for next year is now being prepared for the working groups. It was noted that everyone was eager to hear the outcome of the urgent care commissioning.

At the last Patient Forum the primary care strategy had been discussed and members felt they were presented with a plan but had not been consulted or engaged with. Dr Young-Murphy advised that they had been involved in different parts of the strategy and for various reasons the plan had to be prepared to a timescale, and she reminded the group that Dr Hugo Minney will be meeting with a group from the Patient Forum to talk specifically about the strategy. She assured the group that there would be further opportunities for engagement as the strategy progresses. On the whole the Forum welcomed the primary care strategy and looked forward to seeing it being rolled out.

NTGB/17/055 Terms of Reference (Agenda Item 12.1)

Ms Walker presented terms of reference for the Finance Committee, Clinical Executive and QPAC for approval by the Governing Body, and explained what the changes were

Finance Committee: There was a change to quoracy because not all executive directors were members of the committee. The Terms of Reference (ToR) now stated that quoracy would be a lay member and either the Chief Officer or the Chief Finance Officer. The Finance Committee were happy with the change. The primary care representative was also changed to a Clinical Director. The Governing Body approved Finance Committee terms of reference as presented. Page 4 of 6

Clinical Executive: The paper to Governing Body advised that the Clinical Executive ToR was to note. However, Ms Walker advised that the approval of the ToR remained outstanding. The ToR had previously been presented to the Governing Body and had been referred to the Chair for action following concern that the ToR stated that the Clinical Executive could approve procurements up to £1m and business cases up to £0.5m. This had subsequently been discussed at the Directors meeting and the majority view was that there were sufficient safeguards listed in the five bullet points in para 8.2v to allow Clinical Executive to approve procurements up to £1m and business cases up to £0.5m. Dr Matthews noted bullet 4 of 8.2v which was “subject to the restrictions at item 7”. He said this should be focussed on as anything which had a reputational risk needed to come to the Governing Body, and assurance was needed that this would be followed. It was agreed that all checks and balances in terms of governance would ensure the right decisions were made in the right circumstances. The Governing Body approved the Clinical Executive terms of reference as presented.

QPAC: QPAC is sub-committee of Clinical Executive and normally the Governing Body would not be asked to approve a sub-committee ToR. However, it was being brought to the Governing Body as the constitution stated that if a sub-committee had decision-making powers any changes to the ToR would need to come to the Governing Body. The change related to approval of new programmes of work and projects. Previously QPAC had discussed these and referred them to the Clinical Executive for decision, but this was not an efficient process. Ms Walker advised that item 8 of the ToR listed caveats, including that if a project required investment which had not been approved it would need to go to Clinical Executive. Governing Body approved the QPAC terms of reference as presented.

NTGB/17/056 Minutes from Committees (Agenda Item 13)

The Governing Body received the following minutes from Committees: • Quality & Safety Committee 23.01.17, 07.03.17, 04.04.17 • Patient Forum 16.03.17 • Council of Practices 18.01.17 • Clinical Executive 25.01.17, 22.02.17 • Primary Care Committee 15.12.16

NTGB/17/057 Date of Next Meeting (Agenda Item No 14)

The next meeting of NHS North Tyneside Clinical Commissioning Group Governing Body is to be held in public on Tuesday 25 July 2017, 9.15am- 11.15am. As this meeting was also the AGM, a suitable alternative venue should be sought. The Rising Sun has been used last year, but was not really suitable, and CoP had also mentioned that in relation to their meetings.

Dr Matthews advised that representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which Page 5 of 6

would be prejudicial to the public interest.

Dr Matthews thanked the members of the public for attending the meeting, which closed at 10am.

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North Tyneside Governing Body (Public)

Date Minute Action Action Resp. Officer Target Date Status No. 24.01.17 NTGB/17/013 4 Northumberland, Tyne and Wear & North Ms I Walker June 2017 Included in June Durham Sustainability & Transformation Governing Body Plan: development session. It was agreed that a development session is Complete required for the Governing Body members on this area to better understand the implications. 23.05.17 NTGB/17/050 1 Report from Chair and Chief Officer: Dr L Young- June 2017 Information reported Dr Young-Murphy to produce a report for the Murphy to Governing Body Governing Body (in private) to ensure learning meeting in Private. from the Cyber Attack is included in next version Complete of incident plan. 23.05.17 NTGB/17/052 2 Integrated Quality and Performance Report: Dr M Wright September MW has contacted Dr Wright to invite NHC to attend a future 2017 NHC and suggested NTCCG Governing Body meeting. attendance at the September Governing Body meeting. Ongoing

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Report to: Governing Body Date: 25 July 2017 Agenda item: 09.1 Title of report: Quality and Safety Report – July 2017 Sponsor: Dr Lesley Young-Murphy, Executive Director of Nursing and Chief Operating Officer, North Tyneside Clinical Commissioning Group

Author: Julie Bee, Senior Clinical Quality Officer, North of England Commissioning Support (NECS) Purpose of the report and action required: This report provides the Governing Body of North Tyneside Clinical Commissioning Group (NTCCG) with a summary of activity in May and, where available, June 2017 in those areas of clinical quality not covered by the Quality and Performance Report. A full report is provided to the Quality and Safety Committee and exceptions are reported here.

Executive summary: • Between May 2016 and June 2017, 88 SIs were reported that required closure by North Tyneside CCG, of these 55 were closed. There are 34 SIs awaiting closure, including 11 where the reports are not due, 12 where the SI reports are overdue, including NHCFT (n=8) NTWFT (n=2) and NuTHFT (n=2), 3 reports are awaiting review prior to listing for panel, 4 where additional information has been requested prior to closure by the Panel and 4 listed for panel.

• Friend and Family Test (FFT) response rates (April data) for Northumbria Healthcare NHS Foundation Trust (NHCFT), Newcastle upon Tyne NHS Foundation Trust (NuTHFT), and Northumberland, Tyne and Wear FT (NTWFT) continue to be below the national average, although improved performance can be seen in recommendation rates. NEAS staff FFT results show a considerable improvement in both areas; recommendation for care has increased to 91% (previously 65%) and as a place to work has increased to 76% (previously 32%).

• NHCFT continue to breach the 2 day and 60 day serious incident (SI) reporting timeframes and the Trust was asked to provide an action plan at the July QRG on how it will improve its performance.

• Two ‘never events’ were reported in June 2017, including one retained swab which occurred at the NHCFT Northumbria Specialist Emergency Care Hospital and one involving the removal of the wrong tooth at the Dental Hospital, NuTHFT. The latter is a specialised commissioned service and closure of the SI will be managed by NHS England.

• In May and June 2017 15 (52%) North Tyneside practices reported a total of 53 incidents (May

n=29, June n=24). Of those reported, 22 (42%) were in respect of NHCFT.

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• NHS Safety Thermometer data for June 2017 indicates that NuTHFT are above the national average in reported new pressure ulcers. NTWFT reported slightly above the national average for rates of falls with harm. It should be noted that due to the NHS cyber-attack, NHCFT was unable to submit data in time for inclusion in the June release

• One case of MRSA was reported by NuTHFT in May 2017 and assigned to the Trust following the Post Infection Review (PIR) process.

Governance and Compliance

1. Links to corporate objectives

2017/18 corporate objectives Item links to objectives √ 1. Commission high quality care for patients, that is safe,  value for money and in line with the NHS Constitution 2. Deliver the Financial Recovery Plan, leading to the achievement of the CCG’s statutory financial duties and future sustainability 3. Work collaboratively with partners and stakeholders to  develop health and social care fit for the future in North Tyneside 4. Continue to develop North Tyneside CCG as a patient  focused, clinically led commissioning organisation with a continuous learning culture

2. Consultation and engagement Not applicable

3. Resource implications Not applicable

4. Risks Patient safety risks following serious incidents, process in place to undertake root cause analysis following SI to ensure lessons learned . 5. Equality assessment Not applicable

6. Environment and sustainability assessment Not applicable

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Quality and Safety Committee Report

July 2017

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Contents

Section Content Page Provider Quality Issues • Updates from Quality Review Groups 5-8 • Reporting Types Serious Incidents • Status of Reports 9-10 • Reporting Rates • Reporting Rates GP Practice Reported Issues (SIRMS) 11 • Reporting Types • Safety Thermometer Key Quality Indicators • Healthcare Acquired Infections 12 • Friends and Family Test Other Quality Issues • Complaints 13

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Provider Quality Updates Quality Review Groups Quality Review Groups (QRGs) are held on a regular basis with Providers to obtain assurance on the quality of services delivered and take place every two months for Acute Trusts and quarterly for the Mental Health Trust. QRGs were held on the following dates for the named providers and some of the issues raised are noted below, along with updates where available: • Northumbria Healthcare NHS Foundation Trust – 11 July 2017 • Newcastle Upon Tyne Hospitals NHS Foundation Trust – 8 June 2017 • North East Ambulance Service NHS Foundation Trust – 26 May 2017 • Northumberland, Tyne and Wear NHS Foundation Trust – due to be held 02 August 2017

Northumbria Healthcare NHS Foundation Trust

• An update will be provided in the September 2017 Governing Body report.

Northumberland, Tyne and Wear NHS Foundation Trust • An update will be provided in the September 2017 Governing Body report.

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Provider Quality Updates

Newcastle upon Tyne Hospitals NHS FT • Serious incidents: the Trust presented a Q4 2016/17 performance report and acknowledged there was some slippage in performance. The Trust aims to submit reports within the 60 days, however there are occasions where this is not possible and the reasons for these delays were included in the report. It was noted that some cases are complicated and therefore require longer time to investigate and review. Where there are delays, the Trust will liaise with NECS to notify them of this. It was noted that over the last year the Trust has made notable improvement each quarter in two day reporting and submission of reports. • SIRMS: it was advised that there was a noticeable reduction in incidents reported in respect of discharges in A&E for Q3 2016/17, with the introduction of the new ‘paper-light’ electronic First Net process contributing to improvement in both the timeliness and quality of discharge information now being sent from A&E to GPs. • Performance: the commissioner exception report continues to be generally very positive although A&E continues to be marginally below the 95% standard. NuTHFT are performing well nationally compared to other Trusts. • Seven day working: it was reported the Trust is 86.3% compliant with Standard 2 (seen and accessed within 14 hours of arrival) and 93% compliant with Standard 8 (ongoing review). Both these figures show an increase on the previous report

• Clinical audit: in addition to the clinical audit activity undertaken by the clinical directorates the Clinical Governance and Risk Department (CGARD) undertakes a programme of clinical audit in relation to Trust-wide issues. This includes specific audits which CGARD has undertaken together with key Trust priorities including Sign Up To Safety Requirements (e.g. NEWS, PEWS), Seven Day Working, resuscitation Committee Requirements and Patient Identification. There are 15 separate audits to be undertaken during 2017/18. • Patient safety: it was noted that there has been an increase in falls in April 2017 from last year rising above the internal target but not the national; however the harm from falls remains low. There are a number of areas which are trying to achieve a 20% reduction in pressure ulcers but it is noted that this is challenging. For Safety Thermometer the Trust continues to achieve over 95% harm free care. Staffing remains a challenge and the band 5 vacancy and total fill rate continues to be closely monitored.

• Patient experience: It is noted that the Patient Relations Department has facilitated 48 Resolution Meetings this year to date (22 Early

Intervention Meetings and 26 Local Resolution Meetings) which is a significant increase on the 15 carried out in the same period last year. 6 Page

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ProviderNorth East Ambulance Quality Service Updates

• Incident management: the Trust reported a backlog from April of open incidents due to capacity. The Trust will monitor the number of open incidents on a weekly basis and any members of staff with a backlog of incidents will be addressed directly to ensure incidents are closed on the system. Previously, a high number of inappropriate incidents were being reported to NEAS by the Police. NEAS has therefore been working collaboratively with the Police and have a joint agreement with the, which has resulted in the numbers of incidents reported has reducing, as the incidents being reported are now appropriate. Updates on incidents reported will continue to be monitored through the QRG.

• Ambulance delays: within the 2017/18 Quality Accounts, the Trust has included longest waits as a quality priority. Delays continue to be an issue particularly in rural areas. This on-going issue is being addressed by an escalation plan which is being continually developed. The escalation plan highlights those patients experiencing waits and ensures that they are passed to the clinical hub for review. The plan will also review any harm experienced as a result of a wait and also look to improve patient experience. The escalation plan will be published at the end of June and will be shared with QRG in July.

• Workforce: recruitment and retention continues to be a challenge. The Trust updated the Group on paramedic recruitment and confirmed that 38 additional paramedics would be fully operational and deployed by January 2018. 111 training for new call handlers has also taken place in May, and further full and part time training courses are taking place over the next few months. Sickness levels continue to be above the Trust target of 5% and however Trust-wide absence rates fell to 6.14% in May.

• Serious incidents: the Trust reported five SIs in May, however it is likely to request de-registration for two of these incidents. A deep dive report is being produced, in collaboration with the NECS clinical quality team, examining serious incident themes and actions taken which will be presented to the QRG on 14 July. The Yorkshire Ambulance Service (YAS) is using a new algorithm when determining if an incident should be reported as a SI. NEAS will look to compare SIs reported with the algorithm used by YAS. The algorithm also reviews staffing, vehicles, staff breaks etc. to provide a true understanding of why there has been an ambulance/treatment delay.

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Serious Incidents

Serious incident close down panels were held in May and June 2017; 18 new cases were presented and 14 SIs were closed. Serious incidents are closed when the panel is assured that the investigation report and resulting action plan is complete and the provider has demonstrated that, where appropriate, lessons have been learned from the incident and associated actions have been taken. The graphs below show:

1) A comparison of North Tyneside CCG SIs reported between May 2016 and June 2017 and the number of those SIs that were closed

by North Tyneside CCG in the same time period. 2) The status of ongoing SIs requiring sign off by North Tyneside CCG.

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Serious Incidents

Between May 2016 and June 2017, there were 88 SIs reported that required closure by North Tyneside CCG, of these 55 were closed. There are 34 SIs awaiting closure, including 11 where the reports are not due, 12 where the SI reports are overdue, including NHCFT (n=8) NTWFT (n=2) and NuTHFT (n=2), 3 reports are awaiting review prior to listing for panel, 4

where additional information has been requested prior to closure by the Panel and 4 listed for panel.

9 2 never events, were reported in June 2017, including: • 1 retained swab which occurred at Northumbria Specialist Emergency Care Hospital, NHCFT Page • 1 involving the removal of the wrong tooth which occurred at the Dental Hospital, NuTHFT. This is a specialised 9 commissioned service and will be managed by NHS England.

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GP Practice Reported Issues (SIRMS)

All 29 GP practices in North Tyneside are registered on SIRMS to report incidents. In May and June 2017 15 (52%) North Tyneside practices reported a total of 53 incidents. A full SIRMS report is produced quarterly with details of themes, trends and feedback which is shared across the CCG,

Practices and Provider Trusts. The next quarterly report will be compiled for quarter 1 2017/18.

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Key Quality Indicators

Pressure Improving/ better than Pressure Falls Catheters VTEs C.Diff* MRSA* FFT Provider Ulcers All Ulcers with with UTIs New May May 17 Apr national average/on target May 17 New harm May 17 May 17 17 May 17 May 17 17 Performance worse than Northumbria national average

Healthcare NHS FT Deteriorating performance/ The Newcastle upon Tyne worse than national average Hospitals NHS FT Northumberland Tyne and Wear NHS FT

• It should be noted that due to the NHS cyber-attack, NHCFT was unable to submit data to NHS England in time for the June 2017 release of May 2017 NHS Safety Thermometer data • NuTHFT have risen above the national average in reported new pressure ulcers • NTWFT reported slightly above the national average for rates of falls with harm

• NuTHFT reported one case of MRSA in May 2017

• All Trusts continue to perform poorly in FFT response rates 11 Page

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Other quality issues

Complaints

In May 2017, five formal complaints and one concern were considered by the NECS complaints team in respect of North Tyneside CCG residents. Two of the complaints were closed and three remain on-going. The concern was a reopened case in respect of a CHC restitution claim.

In June 2017, nine formal complaints and one Member of Parliament (MP) constituent enquiry were considered by the NECS complaints team in respect of North Tyneside CCG residents. Seven of the complaints were closed and two remain on-going. The MP constituent enquiry was also closed.

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Report to: Governing Body Date: 25 July 2017 Agenda item: 09.2 Title of report: Integrated Quality and Performance Report Sponsor: Lesley Young-Murphy, Director of Nursing and Transformation Authors: James Martin, Commissioning & Performance Manager and Clair Carpenter, Information Analyst Purpose of the report and action required: To report progress against the CCG quality and performance measures. Members are asked to note the current progress in 2017/18 against the listed measures. Executive summary: The 2017/18 Integrated Quality and Performance Report shows delivery against NHS Constitution, CCG Health Outcomes, Quality Premium, and Quality measures. The CCG is held to account for the delivery of these measures by NHS England. The performance to note identified in this report is: NHS Constitution – → The numbers of ambulance handover delays at Northumbria FT have continued to be an issue. Work is ongoing within the system-wide Unscheduled Care Performance Improvement Plan. The “Framework for Delivery” has been sectioned into four major work-streams: Assess to Admit, Today’s Work Today, Discharge to Assess and Responsive Transport, all supported by overarching Engagement and Communication actions. Many actions aren’t expected to be completed until quarter 2 or quarter 3. The recording of handover delays were affected by the national IT issues in May particularly at Northumbria FT treatment sites and may not provide a true representation of the delays faced during handover. → In April Northumbria FT were below the 95% threshold and Newcastle FT were marginally above by 0.1 percentage points for 4 hour A&E waits. Both providers are working on actions to cope with demand on emergency care services with the development of ED streaming pathways including the direction of patients to other services outside of the ED. Actions through each of the work-streams mentioned above are expected to ease pressures throughout the urgent care pathway on a system-wide basis, rather than the focus being on individual targeted areas. → Category ‘Red 1’, ‘Red 2’ and the 19 minute transport response times in were below the threshold. Work continues within the urgent care system and “Responsive Transport” has become an area of focus under the system-based Improvement Plan. NHS Outcomes Framework: 15 indicators are currently performing above their thresholds and are rated as green. → Due to the national IT issues in May, data for the hospital-based metrics has been delayed until mid-July → Both recovery rate and coverage of IAPT were below their respective thresholds for May. IAPT coverage has not recently been below the 15% threshold. The drop in access and recovery is primarily due to the loss of staff to the IAPT Long Term Conditions programme. A combination of new agency staff and additional PWP workers starting in the service is expected to improve the position.

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→ All three of the patient experience of GP surgeries measures are rated as amber. The July 2017 publication of the GP survey will be used to assess the impact of 2016/17 initiatives targeted towards improving patient experiences of Primary Care.

NHS Quality Premium – There are a number of new national Quality Premium measures for 2017/18, many of which do not have any data available as yet. Bloodstream infections is a new area of monitoring; based on May YTD the CCG is over the trajectory however programmes to improve the number of E. coli infections over 2017/18 have not yet been implemented to their full effect. It is expected that it will be later in 2017/18 when the trajectory will seem more achievable.

Other Quality Measures - The NHS Quality Dashboard for April 2017 highlighted no issues of note.

Governance and Compliance

1. Links to Corporate Objectives

2017/18 Corporate Objectives Item links to objectives √ 1. Commission high quality care for patients, that is safe, √ value for money and in line with the NHS Constitution 2. Deliver the Financial Recovery Plan, leading to the achievement of the CCG’s statutory financial duties and future sustainability 3. Work collaboratively with partners and stakeholders to develop health and social care fit for the future in North Tyneside 4. Continue to develop North Tyneside CCG as a patient focused, clinically led commissioning organisation with a √ continuous learning culture

2. Consultation and Engagement Not applicable

3. Resource Implications Not applicable

4. Risks Not applicable

5. Equality Assessment Not applicable

6. Environment and Sustainability Assessment There are no environmental or sustainability issues arising from this report.

Quality and Performance Report

July 2017

Contents

This quality and performance report is based upon data available up to 4th July 2017. Note due to the IT issues faced by the NHS in May some information is incomplete or has been delayed.

Section Indicators Page • Referral to access treatment times • Diagnostic waits • A&E waits • Cancer waits NHS Constitution 6 – 9 • Red category ambulance response times • Mixed sex accommodation • Cancelled operations • Care programme approach Ambulance Handover Delays • Trend monitoring of Ambulance Handover Delays at Northumbria FT 10 • Preventing people from dying prematurely • Enhancing quality of life for people with LTC CCG Health Outcomes • Helping people to recover from episodes of ill health 11 – 12 • Ensuring people have a positive experience of care • Ensuring a safe environment • Trend monitoring of C. Difficile infections for North Tyneside CCG, Northumbria FT Healthcare Associated Infections – C. Difficile 13 and Newcastle FT • National measures Quality Premium • Local measures 14 – 15 • NHS constitution measures Other Quality Measures • NHS England Quality Dashboard 16 – 17

NHS Constitution

Note: QP - Linked to Quality Premium

Issues to Note on Constitution Measures Constitution Synopsis of Issue Actions taken to resolve issue Timeline Level Owner measure of risk

A&E waits of 4 The A&E 4 hour target was missed by CCG: Work is ongoing within the system-wide Unscheduled Q1 Med MC/JM hours or less both FTs for 2016/17 with Newcastle FT Care Performance Improvement Plan. The “Framework for 2017/18 at 94.4% and Northumbria FT at 93.9% Delivery” has been sectioned into four major work-streams: Assess to Admit, Today’s Work Today, Discharge to Assess Northumbria FT have reported 92% of and Responsive Transport, all supported by overarching patients waiting under 4 hours for April. Engagement and Communication actions.

As per NHSE recommendations ED assessment and streaming will be commissioned at NSECH. Further information on the key priority areas can be found detailed under the “Ambulance Handover Delays” heading. Northumbria FT have a number of actions/schemes running to improve the flow of patients throughout NSECH and are engaging with the CCGs and NEAS on managing patient care across the network of NHFT urgent care sites.

Issues to Note on Constitution Measures Constitution Synopsis of Issue Actions taken to resolve issue Timeline Level Owner measure of risk

Category Red Category ‘Red 1’, ‘Red 2’ and the 19 CCG: “Responsive Transport” has become a work stream Q4 High MC/JM ambulance minute transportation response times are within the system-wide Unscheduled Care Performance 2018/19 response times below the respective thresholds for April. Improvement Plan. Actions from the group include developing alternative response mechanisms to 999 calls and transport With the exception of ‘Red 1’, response arrangements for non-life threatening patients, work with other times have shown measured organisations and health professionals to support falls improvements over the previous few prevention and pilots to reduce the number of cancelled months however seem to have reached a journeys with focus on inappropriate bookings. plateau in April. The Trust have forecast to recover performance for national standards by the end of 2018/19 and have identified they have the fewest number of paramedics operating compared to other equivalent ambulance trusts.

Cancelled In quarter 4 there were 14 operations at CCG: Issue raised in contract performance meeting with Trust. On-going Low JM operations for non- Northumbria FT cancelled for non-clinical Expectation is that these were all one off cases rather than a clinical reasons to reasons and not rescheduled with the systemic issue. be rescheduled required 28 day timeframe. Newcastle FT reported issues within Cardiothoracic, Surgical within 28 days Capacity issues due to increased demand and Children’s services over Q4, and a Norovirus outbreak over the winter period and scheduling affected bed availability at the Trust sites during this time difficulties where an operation can only go period. ahead when specific consultants are in attendance.

Issues to Note on Constitution Measures Constitution Synopsis of Issue Actions taken to resolve issue Timeline Level Owner measure of risk

Ambulance The number of handover delays at CCG: Work is ongoing within the system-wide Unscheduled Q2 High MC/JM handover delays Northumbria FT were higher than would Care Performance Improvement Plan. The “Framework for 2017/18 be expected for May, with 9.3% of Delivery” has been sectioned into four major work-streams: handovers taking over 30 minutes. This is Assess to Admit, Today’s Work Today, Discharge to Assess comparable to numbers observed in and Responsive Transport, all supported by overarching December rather than recent trends. Engagement and Communication actions.

The number of delays > 60 minutes at Providers: NEAS recording of handovers was affected at Northumbria FT were at Winter levels in some hospitals during the period in May when the cyber attack May (2.3% of delays compared to <1% for was active. This issue was resolved in the latter part of May March and April). The number of but does appear to have affected the number of delays handover times recorded at Northumbria recorded in May, particularly at Northumbria FT sites. were lower than usual, with a 52% The Contracting and Operations teams will continue to hold handover completion rate for the week discussions with commissioners to tackle increasing hospital th ending 14 May. delays. Northumbria FT are working on a number of schemes involving patient streaming at the front door at NSECH, Early indications show the number of providing more care, in particular for the frail and elderly recorded delays in June are far lower than across the Base Sites and on the flow of patients through the those recorded in May with the number of hospitals and the wider urgent care system. handovers recorded at usual levels. Newcastle FT have noted delays recorded in May continue to be attributed to the administrative process within the IT system, for which the trust is engaging with NEAS to resolve.

Ambulance Handover Delays

Following the opening of NSECH in June 2015, Ambulance Handover Delays for Northumbria FT have increased significantly, with the emergence of a significant proportion of delays over 60 minutes over the Winter/Spring months. The problem of ambulance handover delays at NSECH represents one of the foremost risks to system performance and resilience across the North Tyneside – Northumberland CCG footprint. The issue has been under continuous review for a period of over a year, with numerous local action plans being agreed and implemented in that time however the various changes have all failed to produce a significant and sustained reduction in the number of ambulance delays. There is a ‘Northumberland and North Tyneside Systemwide Unscheduled Care Performance Improvement Plan’ in place and the actions expected to impact handover delays are detailed below. The majority of these actions are expected to be completed in Q2 and Q3.

Priorities – Discharge to assess / Going home work group Priorities – Assess to admit work group Priorities – Today’s work today work • Embed ‘home first’ philosophy right at the front end always asking why not home? • Assessment criteria for implementing ED group • Expansion of discharge to assess/ at scale streaming • Analysis of GP urgent visits • Expansion of Trusted Assessor model • Home first’ – is home suitable for the patient – • • Estimated date of discharge – proactive planning form admission for discharge with reduced function/ Work to date compiled on primary care access links to carers / paramedic pathfinder • challenge as to why the EDD changes so much Consultant triage for GP referrals • GP Hotline – Better use of consultant physician • • Understand what can be done in community that can aid discharge Advice and support for ambulance crews on ‘See • Frailty and Treat’ • Find any duplication and streamline across providers • Bed Management • Transport arrangements – alternatives available • Ambulatory care and correct use of Urgent Care • Map the NEAS/ Northumbria FT plan to the three work stream areas and conveyance of patients between Centres for those patients suitable • Transport – important element including reducing NEAS cancellations, tailored transport options, PTS NSECH/base sites • More appropriate use of discharge ambulance • Explore expansion of end of life rapid response • Consistency in response times to GP urgent • Review of Family Choice policies and how we work with families to facilitate decisions in a more timely way referrals • Explore how NDUC out of hours can enhance discharge – eg. planned calls or visits to discharged10 patients • Expansion and development of enhanced care models such as virtual wards, hubs, complex MDTs

CCG Health Outcomes

Note: QP - Linked to Quality Premium TBC - To be confirmed * - North of England Commissioning Support (NECS) calculated data

Issues to note on CCG Health Outcome Indicators There are 22 indicators relating to health outcomes. The CCG currently has 15 indicators with a green rating and 7 indicators with an amber rating. Note: Due to the IT issues facing the NHS in May data for April onwards is not yet available for the hospital-based metrics. Outcome Synopsis of Issue Actions taken to resolve issue Time Level Owner measure -line of risk IAPT IAPT coverage for May is Coverage has not recently been highlighted as an issue for the CCG. 2016/17 ended with a coverage of Q2 Medium AP coverage at 9.7% against a target of 17.3% against a 15% threshold. The access rate has fallen below trajectory in 2017/18 due to the loss 15%. Coverage was also of staff to the IAPT Long Term Conditions programme. A combination of new agency staff and low in April. additional PWP workers starting in the service is expected to improve the access rate. The service is also offering options into either cCBT or other forms of therapy/group work to ensure that they are receiving some form of timely and appropriate therapy. It is expected that the Access rate will improve by the beginning – mid Q2 and this will be monitored via the monthly performance meetings between the CCG and Trust. IAPT Rolling Quarter Recovery As predicated, the recovery rate has fallen below the national target. It has been previously reported Q2 Medium AP recovery rate at 45% for May that the expansion of IAPT into Long Term Conditions has resulted in a number of staff members against a national target of leaving the core service. Recruitment has been made to the vacant posts but not all staff are yet in 50%. post. It is also relevant to note that a number of new staff have just completed their academic programme and therefore will not yet be able to carry a full workload. The contract with the new cCBT provider is now in place and it is expected that this will have a positive impact. The recovery rate continues to be monitored at monthly performance meetings between the CCG and Trust. It is expected that the recovery rate will improve by the end of Q2 GP patients 2.5% below target for the These were new measures for 2015/16 as part of the primary care co-commissioning agenda and July Medium JM experience satisfaction with the therefore joint improvement trajectories with NHS England. Although satisfaction has decreased 2017 overall care measure, compared to the previous survey period, it is worth highlighting that this is a national trend and all 1.8% below target for the measures are well above the England average. The July 2017 publication of the GP survey will be used overall experience of to assess the impact of 2016/17 initiatives targeted towards improving patient experiences of Primary making an appointment Care. measure CCG actions: Initial scoping analysis to identify the practices that are low scoring for these measures 6 points below the was completed and the Transformation team is working into 7 practices currently with improvement satisfaction with the quality actions. These actions include supporting workforce planning, implementation of a new telephone of consultation measures system, review of appointment and admin systems, and the release of an app for patients at two practices.

Safe Environment - Healthcare Associated Infection (C.Difficile)

The CCG and both FTs met their respective targets for C. diff cases in 2016/17.

North Tyneside CCG has a 2017/18 target of 74 C. diff cases. There were 4 reported infections in April.

Northumbria FT has a 2017/18 target of 30 C. diff cases. There were 3 reported infections in April.

Newcastle FT has a 2017/18 target of 77 C. diff cases. There were 4 reported infections in April.

2017/18 Quality Premium

Note: OF - Linked to CCG Health Outcomes (Outcomes Framework) NHSE - Linked to Strategic Plan C - Linked to NHS Constitution * - North of England Commissioning Support (NECS) calculated

Issues to Note on Quality Premium Indicators The CCG currently has three of the eleven Quality Premium indicators with a green rating, one indicator with an amber rating, however there are seven measures with data not yet available. The total Quality Premium payment for a CCG is reduced if the listed NHS Constitution rights or pledges for patients are unmet. Currently the CCG is achieving two of the four Constitution measures. QP measure Synopsis of Issue Actions taken to resolve issue Timeline Level of Owner risk Data A number of measures are new Measures will be updated as and when information becomes available. August Low JM availability data collections and as such do not 2017 have any current data available for monitoring. Overall July 2016 data shows the CCG The July 2017 publication of the GP survey will be used to assess the August Medium JM Experience of level at 77% against a target of impact of 2016/17 initiatives targeted towards improving patient 2017 making an 80% experiences of Primary Care. The 2016 data showed a small decrease in appointment Publication for 2017 is due later in patient experience of making a GP appointment compared to the previous July. survey period. A funded initiative was put in place with GP practices for 2016/17 to provide each practice with standardised data on current capacity and demand. This work also underpins the improving access section of the North Tyneside Primary Care Strategy. Bloodstream CCG May YTD infections at 37, 13 Bloodstream infections is a new indicator in the Quality Premium; based on Q3 Low JM infections – infections over the YTD trajectory. May YTD the CCG is over the trajectory however programmes to improve 2017/18 reduction in E. the number of E. coli infections over 2017/18 have not yet been coli infections implemented to their full effect. It is expected that it will be later in 2017/18 when the trajectory will seem more achievable. CCG Mapped A&E attendances completed within Organisations across the North of Tyne patch are working towards a Q1 Med JM/MC 4 hour A&E 4 hours marginally under the 95% sustainable program of delivering Urgent Care across the network. Further 2017/18 waits threshold at 94.1 %. details of actions can be found in the NHS Constitution section and under Ambulance Handover Delays headings. Category Red At provider level NEAS are below Underperformance is being raised with the provider through the regional Q1 High JM/MC 1 calls the 75% standard for response contract meetings as described in the Constitution section. 2017/18 responded times to Category Red 1 patients. within 8 This measure is based on the minutes region wide performance of NEAS rather than being North Tyneside specific.

Quality Dashboard – June 2017

The quality dashboard shows performance indicators for quality measures that have not already been included within the NHS Constitution, Outcomes Framework or Quality Premium.

Glossary:

DTOC – Delayed Transfer of Care

NRLS – National Reporting and Learning System

VTE - Venous Thromboembolism

Other Quality Measures Quality Dashboard - The quality dashboard is a snapshot of NHS England’s quality dashboard and shows performance indicators for quality measures that have not already been included within the NHS Constitution, Outcomes Framework or Quality Premium.

Quality Synopsis of Issue Actions taken to resolve issue Timeline Level Owner Dashboard of risk measure

No issues of note in the NHSE Quality Measures

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Report to: Governing Body Date: 25 July 2017 Agenda item: 09.3 Title of report: North East of England and Cumbria Clinical Commissioning Groups Research and Evidence Annual Report 2016/17 Sponsor: Dr Lesley Young-Murphy, Chief Officer Author: Research and Evidence Team, North of England Commissioning Support Unit Purpose of the report and action required: Members are asked to note the content of the report for information.

Executive summary:

This report supports the Clinical Commissioning Groups (CCGs) statutory duties in relation to research and evidence. This shares the activity for 2016/17 as well as the plans and priorities for 2017/18.

1. To support and promote research. 2. To use evidence from research to support commissioning decisions. 3. To ensure the treatment costs in research are resourced.

All data refers to 1st April 2016 to 31st March 2017 and is collated from various sources. All data is correct at the time of publishing.

A number of research projects are running and in development with support from research interested CCGs and primary care staff. Some are small scale linked to service development whilst others are feasibility to inform a larger scale research bid. The team has active links with all North East universities which can support and advise on potential research as necessary. The team also provides assurance to all research and known evaluations.

Newcastle Gateshead, Northumberland, North Tyneside and DDES CCGs are current holders of Research Capability Funding.

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OFFICIAL Governance and Compliance

1. Links to corporate objectives

2017/18 corporate objectives Item links to objectives √ 1. Commission high quality care for patients, that is safe, √ value for money and in line with the NHS Constitution 2. Deliver the Financial Recovery Plan, leading to the achievement of the CCG’s statutory financial duties and future sustainability 3. Work collaboratively with partners and stakeholders to √ develop health and social care fit for the future in North Tyneside 4. Continue to develop North Tyneside CCG as a patient √ focused, clinically led commissioning organisation with a continuous learning culture

2. Consultation and engagement None applicable.

3. Resource implications None applicable.

4. Risks None applicable.

5. Equality assessment An Equality Impact Assessment has been completed in Section 10 of the policy.

6. Environment and sustainability assessment None applicable.

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North East of England and Cumbria Clinical Commissioning Groups Research and Evidence

Annual Report 2016/17

North East of England and Cumbria Clinical Commissioning Groups Research and Evidence Annual Report 2016/17 This report supports the Clinical Commissioning Groups (CCGs) statutory duties in relation to research and evidence. This shares the activity for 2016/17 as well as the plans and priorities for 2017/18 1. To support and promote research. 2. To use evidence from research to support commissioning decisions. 3. To ensure the treatment costs in research are resourced.

Introduction This is supplied annually to each CCG from the Research and Evidence team in NHS North of England Commissioning Support (NECS). This team now comprises of:  Dr Shona Haining Head of Research and Evidence  Helen Riding Research Manager  Jody Nichols Research Facilitator  Jill Riding Research Project Support Officer  Julia Ho Administration Assistant As part of the research & evidence service we are keen to deliver what the CCGs need, provide as professional and satisfactory service as possible and add value to your organisations. Any feedback and comments are welcome. Please email Shona Haining, Head of Research & Evidence at NECS - [email protected] This report provides information and assurance on: Annual report 2016/17 activity 1. Support and Promote Research (p.3)  Strategic developments (p.3-4)  Research Strategy (p.5)  Developing and Commissioning Research and Evaluations (p.6-7)  Research and Evaluation projects supported in 2016/17 (p.8-17)  Research Capability Funding (RCF) (p.18)  Local Clinical Research Network North East and North Cumbria Activity ) (p.19-22)  Recruitment activity in NHS providers of services commissioned (p.23-24) 2. Use of evidence from research for commissioning decision making (p.25) 3. Excess Treatment Costs (p.26) Plans and priorities for 2017/18 (p.27-33) 1. Support and Promote Research (p.27)  Deliver the Government’s mandate to NHS England for 2017-18 - OBJECTIVE 7: To support research, innovation and growth (p.27-28)  Research Capability Funding (p.29-30)  Developing Research relevant for commissioners (p.31) 2. To use of evidence from research for commissioning decision making (p.32) 3. To ensure the treatment costs in research are resourced (p.33 Appendix 1: Recruitment to all research studies in each CCG - data (p.35-76) All data refers to 1 April 2016 to 31st March 2017 and is collated from various sources.

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1. Support and Promote Research

 Strategic developments for 2017/18

Planning guidance

The recently published NHS Operational Planning and Contracting Guidance 2017 – 2019 has references to supporting the National research agenda, delivering the NHS England research plan (https://www.england.nhs.uk/wp-content/uploads/2017/04/nhse-research- plan.pdf) as well as evaluating key planning changes for example Mental Health and Diabetes services.

The Research and Evidence team will work across NECS and CCGs as these plans emerge to support and advice as required. Please email Shona Haining, Head of Research & Evidence at NECS - [email protected] if your CCG wish to explore further.

The Government’s mandate to NHS England for 2017-18 - OBJECTIVE 7: To support research, innovation and growth

Just as a strong NHS depends on a strong economy, so a strong NHS can contribute to the growth of a strong economy, especially in health and life sciences. We ask NHS England to promote and support participation by NHS organisations, patients and carers in research funded both by commercial and non-commercial organisations, so that the NHS supports and harnesses the best research and innovations and becomes the research partner of choice. We expect to see NHS England help the NHS contribute to economic growth, to support the NHS to reduce the impact of ill health and disability, and to support and harness research and innovation to enable cost effective, affordable, transformative new treatments to reach patients and their carers more quickly, whilst also securing better value from companies.

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As part of this, we expect NHS England to work with the life sciences sector and Government as it develops a life sciences strategy that makes the UK the best place in the world to invest in life sciences and develop innovative, cost effective and affordable new products. NHS England should also support the NHS to make better use of digital services and technology to transform patients’ and their carers’ access to and use of health and care, including online access to their personal health records. The plan to deliver this mandate is in the 2017/2018 work plan section

Overall 2020 goals:  Support the Department of Health and the Health Research Authority in their ambition to improve the UK’s international ranking for health research.  Implement research proposals, initiatives and deliverables in the NHS England research plan.  Measurable improvement in NHS uptake of innovations prioritised by the Accelerated Access Partnership, focusing on those that are affordable and cost-effective.  Work with Genomics England to embed genomic medicine and application of genomic technologies into NHS care building upon the 100,000 Genomes Project and the UK Strategy for Rare Diseases. 2017/18 deliverables:  Evaluate the implementation of the Excess Treatment Costs guidance to understand its impact and to further support implementation, and agree further actions that need to be taken with partners  Promote and support participation by NHS organisations and patients in research funded both by commercial and non-commercial organisations, demonstrating progress through publication of the NHS England research plan and monitoring its deliverables.  Improve NHS commissioner input into identifying research needs in the NHS.  Work with the Department of Health to agree a clear role for NHS England in implementation of the recommendations of the Accelerated Access Review23, to be set out in the Government response.  Develop, jointly with Genomics England, the approach to begin to embed genomics into routine care and engage other national partners including NHS Improvement, NHS Digital, Health Education England and Public Health England.

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CCG Research Strategy

The Research and Evidence team are collaborating with CCGs to support and assist with devising CCG strategy regarding research and evidence as required. This is a service that is available to all CCGs. Please email [email protected] if you want to follow this up.

NOW LAUNCHED Newcastle Gateshead CCG Research and Evidence Strategy for Clinical Commissioning Groups 2016-2021

A research strategy and action plan has been developed by the Research and Evidence team in collaboration with Newcastle Gateshead CCG. The purpose of the strategy is to support the CCG to deliver their statutory duties in respect of research. To view the strategy: http://www.newcastlegatesheadccg.nhs.uk/wp- content/uploads/2017/02/NewcastleandGatesheadCCGResearchStrategy-FINAL-v.1.0- 2017.pdf

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Developing and Commissioning Research and Evaluations

A number of research and evaluation projects are running and in development with support from research interested CCGs and primary care staff. Some are small scale linked to service development whilst others are feasibility to inform a larger scale research bid. The team has active links with all North East universities which can support and advise on potential research as necessary. The Research Governance activity also provides assurance to all research and known evaluations.

Summary of non-portfolio research and evaluation projects supported by the NECS R&E team 2016/17

Total research studies supported 16 Total evaluations supported 12

Health Research Authority approval (HRA) HRA Approval is the new process for the NHS in England that brings together the assessment of governance and legal compliance, undertaken by dedicated HRA staff, with the independent Research Ethics Committee (REC) opinion provided through the UK Health Departments’ Research Ethics Service. This has been in place since 1 April 2016.

Total number of HRA approval studies 10 Q1 2 Q2 5 Q3 2 Q4 1 Number where formal confirmation of capacity 4 and capability required Average confirmation time (working days) 15

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Research passports / Letters of Access issued in 2016/17

The research passport scheme is a national scheme which provides a framework for employers to provide assurance to other organisations where a researcher will be working, that the employer has undertaken the appropriate employment checks (e.g. confirmation of identity, criminal record, occupational health checks, etc.). It is designed to prevent delays caused by every organisation in which a researcher may be working repeating all of these employment checks. A Letter of Access (LOA) is the terms and conditions under which a person that holds an NHS employment contract, or whose activities will not impact patient care, may conduct research activities that impact on patient care in an NHS organisation. There is a standard template and nationally agreed process for obtaining an Honorary Research Contract in the NHS.

LOAS issued April 2016 – December 2016 18 LOAS issued January 2017 – March 2017 22 Average time to issuing letter (April 2016 – December 2016) 7.75 working days Average time to issuing letter (January 2017 – March 2017) *New process in place 4.09 working days Total LOAs issued 40

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Research and Evaluation projects supported in 2016/17 Title Description Progress to date

Self-management COPD management is The project is due to be complete in planning for COPD. a local priority. This May 2017 and the final report (Professor Eileen mixed methods published. The findings will be Kaner, Dr James research project aims disseminated. Recommendations Newham, Dr Paul to identify what factors regarding the self-management Netts) contribute to improved intervention materials will be provided self-management of and the findings will be published in Newcastle Gateshead the condition and peer reviewed journals. CCG potentially reduce re-admission to hospital.

UTIs in Care homes. The research aims to Discussion is underway with Durham (Dr James Larcombe, look at the hydration University as to potential evaluation Jane Lawson) of patients in care options. Durham, Dales, homes and how this Easington and can be improved. Sedgefield CCG

Exploring patients lack The aim of the study The study is gaining advice regarding of engagement with is to identify factors Health Research Authority approval structured diabetes that influence the lack education (Professor of engagement, of Vivien Coates) people newly diagnosed with type 2 South Tyneside CCG diabetes with structured diabetes education (SDE) in order to inform and broaden the reach of future SDE from a sound evidence base.

Qualitative exploration The purpose of this This study is currently awaiting of the social lives' of study is to provide an Research Ethics Committee review. older adults living in in-depth exploration of care homes. (Dr Holly the social lives of Standing) those living in residential care facilities. In particular, Newcastle Gateshead the study aims to give CCG a holistic approach to exploring residents’ social lives.

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Title Description Progress to date An Investigation into the leadership skills The aim of this project The IRAS form is awaiting clearance individual team and is to establish the key from Teesside University. service operational skills which team and managers use to service managers deliver high quality & require as clinical cost effective leaders to deliver an continuing healthcare effective continuing services. (James healthcare (CHC) Graham- NECS Lead service locality manager Continuing Healthcare)

NECS

Evaluation of the HealthPathways is an The study has recently been granted implementation of electronic clinical HRA approval, and interviews are HealthPathways in guidelines/referral underway. South Tyneside (Joy system used by GPs Akehurst) and hospital doctors. South Tyneside is the South Tyneside CCG first UK site to deploy this system. This study will evaluate the implementation process to date and will analyse data on the use of the system and carry out interviews with NHS staff to understand the implementation process for future sites.

Attitudes, perceptions This study will explore The study is recruiting via 17 member and behaviours the experience of practices in Northumberland CCG. associated with patients who are Hospital Admission registered on the Early results presented at the Avoidance in the Frail Northumberland High Evaluation Event. and Elderly (HAAFE Risk Patient study). (Professor Scott Programme and Wilkes) explore the enablers and barriers of staying Northumberland CCG at home when frail and elderly.

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Title Description Progress to date

Feedback Loops for Alongside the Year of Newcastle Gateshead CCG has Improving Practice Care Programme a granted Research Capability Funding (FLIP) - a feasibility practice in Newcastle to fund this project. study (Dr Rebecca Gateshead CCG is Haines) hoping to test the feasibility of closed Newcastle Gateshead text messaging CCG feedback loop to obtain perceptions on patients’ views on collaborative care and support planning (CSP) for people living with long term conditions (LTCs).

St Anthony’s Health The practice is piloting Newcastle Gateshead CCG has Centre - Shared a relatively new way granted Research Capability Funding Medical of consulting with to fund this project. Appointments/Group patients commonly Consultations/Plus referred to as Shared Appointments (Aileen Medical Parkins, Dr Jonathan Appointments. Coates) They're widely used in Australia, USA and Newcastle Gateshead Canada. The basic CCG concept is that, instead of attending a 1:1 appointment, patients attend in small groups.

Identifying ways to This project aims to Lead by Dr Gillian Vance, Clinical enhance the active develop a better Senior Lecturer / honorary consultant involvement of real understanding of the in paediatric allergy, School of Medical patients in factors that influence Education Newcastle University and undergraduate medical involvement of ‘real’ being delivered by Dr Doyin Alao GP education. (Dr Gillian patients in Registrar and Education ITP trainee in Vance) undergraduate South Tees. medical education. All CCGs

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Title Description Progress to date

Co-designing dementia The primary objective Health Research Authority (HRA) care to improve value. of the research is Approval has been granted. This Action research project exploring the design action research project is now involving patients, of optimal care recruiting in the Durham area. carers, providers and packages for patients commissioners of with dementia and to health and social care identify the barriers in Durham (Dr Mara and facilitators to Airoldi). implementing quality improvements in Durham, Dales, dementia care. Easington and Funded by the Health Sedgefield CCG Foundation. North Durham CCG

A scoping study and This project will be The Research and Evidence team early evaluation of the undertaken as were approached by Dr Karen Jones Integrated Personal collaboration between from the study team at the University Commissioning Pilot two DH-funded policy of Kent/ Policy Innovation Research Programme. (Dr Karen research units – the Unit (PIRU). The Research and Jones) Policy Innovation Evidence team provided governance Hartlepool and Research Unit (PIRU), support for this project and the study is Stockton CCG and the Economics of now underway in Hartlepool and Social and Healthcare Stockton CCG. Research Unit (ESHCRU). Together, they will undertake an early evaluation of the IPC pilots, and also provide some advice and recommendations on feasible research questions and methods for a longer- term outcome evaluation of IPC.

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Title Description Progress to date

Exploring staff views of The aim of the study Helen Riding, Research Manager with the link between is to explore through the Research and Evidence team is Research Activity and semi-structured undertaking a Masters of Clinical Quality Indicators in interviews GP and Research at Newcastle University. Primary Care. (Dr Practice Managers Data collection has been ongoing and Shona Haining) views on use and data analysis is now commencing. Due All 11 CCGs effectiveness and to be complete in August 2017. relevance of quality indicators in primary care in relation to research.

A phenomenological The study aims to We are supporting academic study to understand understand how researcher Jill Simpson, a Programme pharmacists’ personal pharmacists view their Manager from NHS England. The leadership qualities and own leadership skills study has obtained Health Research their perceived impact and behaviours and Authority approval. The study is on pharmacists’ how these have sponsored by Teesside University. integration into General contributed to their Practice teams (Maddie experience of working Hooton). within general practice.

All 11 CCGs

ALTER10 study: 10 Alter-10 is a research The Research and Evidence team are year outcomes of study accessing providing governance support to this minimally deranged patient data to add to study. serum alanine an existing study that transferase in a looks at the community population. relationship between (Dr Mark Hudson) liver function tests and All 11 CCGs liver mortality.

An exploration of The will include a This is being led by a team at approaches to survey of hydration Northumbria University. The Research preventing, recognizing practices in care and Evidence team are providing and treating homes and analysis of governance support to this study. dehydration in older hospital admission care home residents in data for dehydration; Gateshead and exploration of Newcastle care homes. professionals’ (Professor Glenda perspectives and Cook) Newcastle stakeholder workshop. Gateshead CCG

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Title Description Progress to date

Assessment and This evaluation project The Research and Evidence team are clinical decision making will inform the process providing governance support to the of the acutely ill older of implementing research team based at Northumbria care home resident: NEWS into care home University. Implementation of in Gateshead as part NEWS (National Early of the Vanguard Warning Score) in the evaluation programme Gateshead Vanguard Also understanding of programme. (Dr Philip broader issues of Hodgson) illness presentation Newcastle Gateshead and clinical decision CCG making.

British Heart Gateshead is leading The Research and Evidence team are Foundation House of one of five projects, supporting the publication of the Care Programme (Jody funded by British evaluation reports and working with Nichols and Sarah Heart Foundation, the programme team at Newcastle Waite) piloting the House of Gateshead CCG to develop the Newcastle Gateshead Care for people with evaluation plan. CCG CVD disease.

Together in a Crisis This project aims to The Research and Evidence team are Mental Health Proof of provide a supportive providing support in the evaluation Concept Evaluation. mental health planning stage and the proof of (Mental Health recovery process for concept in due to be mobilised in April Concern) people with an urgent 2017. Newcastle Gateshead but non-clinical mental CCG. health need.

Making Health Simple – We worked with Julie This project is now complete and the Right Place, First Time. Stevens, Research and Evidence team provided (Julie Stevens and Commissioning & input into the evaluation process. Jody Nichols) Delivery Manager from South Tees CCG South Tees CCG to aid support of the evaluation plan.

Follow-up of Abnormal The aim of this study This study has recently received HRA Patient Test Results in is to evaluate the approval and is starting recruitment of Primary Care - follow-up of abnormal practices in Northumberland CCG Abdulaziz Mohammed test results in and to (Northumberland explore staff CCG) experiences.

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Title Description Progress to date Evaluation of New intervention for Working with Alistair Monk and Julie Implementation of CRP practices and Bailey and looking for an academic near home testing in evaluation required partner / master student to undertake GP practice in South the work Tees South Tees CCG Morbidity after A study exploring the This study is in the funding proposal emergency laparotomy: effects of stage. Led by Newcastle hospitals and an observational study postoperative the Research and Evidence team have All CCGs complications on provided feasibility information to patients’ lives after inform the design of the study. discharge from hospital

Pharmacist led care in This study aims to We are supporting researcher General Practice explore the Tahmina Rokib, an academic (PLAGE) Study. perceptions of GPs in Pharmacist Practitioner from the relation to pharmacist University of Sunderland. The study is led care in the general currently obtaining Health Research All 11 CCGs practice setting. Authority approval.

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North East Vanguards Evaluation (NEVE) Projects Title Description of Progress to date Evaluation

Overarching evaluation The objectives of this Interim Report has been of key themes across all evaluation are to: presented to plan (31/03/17) 5 Vanguards in North East - delivered by -identify the potential Final Report scheduled for University Consortium organisational and June 2017 from Newcastle, cultural facilitators and Northumbria and barriers to the Durham. implementation of each of the North East All CCGs Vanguards Programme

- explore the role and nature of multidisciplinary team (MDT) working in the delivery of each Vanguard’s aims and objectives

- explore the role of technology and digital solutions in the delivery of each Vanguard’s aims and objectives

- assess the costs and cost-consequences as part of an economic evaluation which will provide information on the sustainability of each programme

Evaluation of Newcastle Explore key Data collection is complete and Gateshead Enhanced stakeholders’ data analysis is ongoing. Health and Care in perceptions of current Care Homes Vanguard ways of working as a Interim Report has been Programme – result of the Enhanced presented to plan (31.03.17) Readiness and health and care in care Development of a homes new model of Final Report scheduled for Provider Alliance care Vanguard June 2017. Network implementation. This includes perceptions of Newcastle Gateshead barriers and CCG opportunities in relation to the current situation

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and any future change. It will examine the views of both providers and commissioners

Assessment and clinical 1. To assess the Data analysis is ongoing. decision making of the relationship between acutely ill older care NEWS score and frailty, Interim Report has been home resident: cognitive impairment, presented to plan (31/03/17) Implementation of dependency, functional NEWS in Gateshead ability and treatment Final Report scheduled for Care Homes outcomes in the acutely June 2017. ill older care home resident indicators. R+E Team supported governance and access to data Newcastle Gateshead 2. To explore care home issues CCG staff, NHS community nurses working into care homes and GPs’ understanding of the factors that are key determinants of the presentation of acute illness in frail older people.

3. To explore care home staff, NHS community nurses working in to care homes and GPs’ views, experiences and barriers to the use of NEWS.

4. To examine the impact of the introduction of NEWS on clinical decision making process in relation to treatment of the acutely ill older care home resident An exploration of Objectives approaches to - To investigate daily Interim Report has been preventing, recognizing fluid intake and presented to plan (31/03/17) and treating dehydration of care Final Report scheduled for dehydration in older home residents June 2017. care home in Newcastle & Gateshead - To explore approaches to assessing residents’ hydration requirements,

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Newcastle Gateshead support required, and CCG practices to promote hydration and monitoring of fluid intake - To undertake critical case analysis of residents who present with a diagnosis of dehydration.

North East Urgent & The North East Urgent Data collection is complete and Emergency Care Care Network is data analysis is ongoing. Vanguard undertaking a wide range of projects which Interim Report has been aim to transform the presented to plan (31/03/17) regional urgent and All CCGs emergency care system Final Report scheduled for to further improve June 2017. consistency of care and clinical standards, by linking services together better and delivering high quality and responsive health and social care.

Evaluation is specifically around the impact of the network Clinical Hub project.

Evaluation of the Roles, This project seeks to This project is due to start in Responsibilities and explore the environment April 2017. Relationships of for the diffusion of Managers (NHS and innovation of new care Final Reporting due September Partner organisations) models. 2017. and their views and experiences of Barriers and Drivers to Innovation in the health service: Vanguard New care models study

All CCGs

If any CCGs have other evaluations currently in development or underway please contact [email protected] to ensure the Research and Evidence team can support and share as appropriate.

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Research Capability Funding (RCF)

Research Capability Funding (RCF) is allocated to research-active NHS organisations to help research-active NHS organisations to act flexibly and strategically to maintain research capacity and capability. This is awarded when at least 500 research participants are recruited during the reporting period of 1st October – 30th September. Newcastle Gateshead, Northumberland, North Tyneside and DDES CCGs held this funding in 2016/17.

These CCGs are all working in collaboration with a wide range of academia and clinical researchers in the North East to appropriately utilise the funding.

Some examples of how the funding has been used:  A partnership between a university and a CCG to explore a high priority area for example, funding a research project that investigates elderly patients with a high risk of hospital admission and what factors enable them to stay at home. The information gained from this could be used to improve the management of these patients and/or develop interventions to enable more elderly patients to avoid admission to hospital, and build research capacity in the CCG and University.

 A team from a CCG is working with a university to explore the evidence and implementation of NICE guidelines with regards to UTI’s in care homes. A systematic review protocol has been developed and this will now be used to inform the next steps of the project. This builds research capacity and capability in nursing and primary care staff.

 A CCG has explored recruiting a Research Nurse to increase the capacity to recruit to research studies.

To see more examples of how RCF has been used by CCGs see page 12 of ‘Comments from the Department of Health on reports on the use of Research Capability Funding in 2015/16’ document: https://www.nihr.ac.uk/research-and- impact/documents/RCF%202015_16%20DH%20Feedback_Nov2016.pdf

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Local Clinical Research Network (LCRN) North East and North Cumbria (NENC) Activity

From April 1st 2016 all NIHR portfolio projects delivery and governance is undertaken by NIHR Clinical Research Network North East & North Cumbria staff aligned to primary care. The team have kindly and will continually provide all network related data. If you have any queries regarding this information please contact Hilary Allan - Research Delivery Manager NIHR CRN NENC - [email protected].

Please see Appendix 1 for CCG research activity data

CCGs are represented on the LCRN NENC partnership group by Dr John Matthews, North Tyneside CCG, representing the Northern CCG Forum and Dr Tim Butler representing NHS England.

The LCRN invited applications for practice engagement leads. We are awaiting confirmation of the engagement leads for 2017/18 from the NIHR. We will confirm the agreed Engagement Leads in the 2017/18 Quarter 1 report.

All practices across all CCG’s have the opportunity to be involved in research on a number of levels:

 Signposting potential participants to research projects either opportunistically at a consultation or via a database search and mail out. This is acting as a “Participant Identification Centre” (PIC)”.

 Recruit and deliver the study intervention in the practice either by the Practice Nurse, GP or Research Nurse. This is the practice acting as a “recruiting site”.

This supports The NHS Constitution which pledges to “offer patients the opportunity to be involved in research where applicable”.

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Number of participants recruited per CCG 2016/17 1400 1306

1200

1000

800

572 600 449

400 351 324 323 348

212 195 200 131 71

*NHS Durham Dales, Easington and Sedgefield CCG ** NHS Hartlepool and Stockton-On-Tees CCG

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Number of participants recruited per CCG comparision 2015/16 and 2016/17 1800 1601 1600

1400 1306

1200

1000

800 680 572 600 449 373 400 347 351 317 324 323 348 329 187 212 208 195 134 149 131 200 102 71 0

2015/16 recruitment 2016/17 recruitment

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The following graph shows recruitment for 2016/17 per CCG area weighted by 100,000 population for the North East and Cumbria.

450

400

350

300

250

200

150 Number recruited 100

*NHS Durham Dales, Easington and Sedgefield CCG * NHS Hartlepool and Stockton-On-Tees CCG Average recruitment per CCG weighted by 100,000 population.

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Recruitment activity in NHS providers of services commissioned The following information is provided to you as commissioners of providers fulfilling the NHS standard contract which now includes important conditions for NHS providers regarding research:  The Provider must put arrangements in place to facilitate recruitment of Service Users and Staff as appropriate into Approved Research Studies.  The Parties must abide by and promote awareness of the NHS Constitution, including the rights and pledges set out in it. The Provider must ensure that all Sub- Contractors and all staff abide by the NHS Constitution including the pledge to inform service users about any research which may be relevant to their treatment.

This is information provided monthly by the Local Clinical Research Network – see table on next page. What is included: The table includes the number of commercial and non-commercial NIHR Portfolio patients recruited in the CRN: North East and North Cumbria 1 April 2016 – 31 March 2017. Total: The total number of recruits for each Specialty recruiting in the CRN: North East and North Cumbria in each of the providers of services. Data is correct as of 28th April 2017.

Key to abbreviations:

CDD: County Durham and Darlington NHS Foundation Trust CHS: City Hospitals Sunderland NHS Foundation Trust CP: Cumbria Partnership NHS Foundation Trust GH: Gateshead Health NHS Foundation Trust NCUH: North Cumbria University Hospitals NHS Trust NEAS: North East Ambulance Service NHS Foundation Trust PCL: Primary Care Location NHC: Northumbria Healthcare NHS Foundation Trust NTH: North Tees and Hartlepool NHS Foundation Trust NTW: Northumberland, Tyne and Wear NHS Foundation Trust NUTH: The Newcastle upon Tyne Hospitals NHS Foundation Trust ST: South Tyneside NHS Foundation Trust STH: South Tees Hospitals NHS Foundation Trust TEWV: Tees, Esk and Wear Valleys NHS Foundation Trust

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Non- CDD CHS CP GH NCUH NEAS NHC NTH NTW NUTH PCL ST STH TEWV Managing Specialty NHS Ageing 0 0 0 0 16 0 0 0 0 188 54 0 0 0 5 Anaesthesia, perioperative medicine and pain 279 277 0 177 180 0 134 96 0 724 0 44 431 0 0 management Cancer 226 328 0 57 292 0 64 114 2 870 18 65 597 0 0 Cardiovascular disease 5 26 0 1 77 70 78 44 0 517 31 38 286 0 69 Children 77 108 3 0 2 0 4 38 0 1,216 0 0 125 0 0 Critical care 44 29 0 16 1 528 39 11 0 113 0 9 76 0 0 Dementias and neurodegeneration 5 28 381 40 6 3 755 11 346 270 102 0 58 237 0 Dermatology 112 0 0 0 5 0 39 14 0 354 3 6 64 0 0 Diabetes 43 13 160 3 0 0 29 11 0 37 1,588 0 25 0 8 Ear, nose and throat 0 32 0 0 3 0 0 0 0 84 0 0 13 0 0 Gastroenterology 57 37 0 25 2 0 26 101 0 495 0 165 42 0 0 Genetics 6 0 0 0 24 0 0 0 0 500 6 0 6 0 0 Haematology 9 16 0 3 3 0 47 3 0 105 0 3 0 0 0 Health services and delivery research 84 172 86 72 74 1 221 60 1 61 12 3 222 234 0 Hepatology 59 59 0 27 26 0 42 56 0 842 0 28 71 0 0 Infectious diseases and microbiology 45 20 25 0 2 0 12 1 0 274 0 0 63 0 0 Injuries and emergencies 9 142 0 1 3 32 590 24 0 277 0 2 232 0 0 Mental Health 0 6 273 0 4 0 1 0 1,007 6 91 7 4 607 4 Metabolic and endocrine disorders 2 78 0 232 0 0 112 11 0 286 0 0 171 0 0 Musculoskeletal disorders 43 42 0 30 18 0 152 0 0 1,464 1 0 139 1 0 Neurological disorders 0 16 13 0 0 0 3 0 1 283 0 0 50 0 0 Ophthalmology 0 129 0 0 0 0 0 0 0 32 0 0 14 0 0 Oral and dental health 0 0 0 0 0 0 0 0 0 349 75 0 0 0 6 Primary Care 11 0 0 0 11 0 0 0 6 120 2,229 0 2 0 0 Public health 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Renal disorders 11 88 0 0 29 0 0 0 0 468 0 0 158 0 0 Reproductive health and childbirth 138 551 0 250 21 0 40 94 0 1,900 6 103 477 0 0 Respiratory disorders 16 0 12 36 37 0 145 104 0 371 25 59 4 0 0 Stroke 77 35 0 38 1 153 143 29 1 125 21 4 50 0 0 Surgery 3 60 0 13 4 0 80 17 0 244 55 0 76 0 0 Total 1,361 2,292 953 1,021 841 787 2,756 839 1,364 12,575 4,317 536 3,456 1,079 92

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2. Use evidence from research for commissioning decision making CCGs have a duty to use evidence from research to inform commissioning decision making. The NECS R&E team have undertaken a variety of activities to support this including  Throughout the year a range of new research findings from research undertaken nationally and in the North East in primary care are shared  Links to accessing evidence and suggested sources are communicated to CCGs including social media sources  This information is shared with NECS staff supporting the commissioners decision making process  Access to journals via on line access is available from the Research and Evidence team using Open Athens passwords. This provides free access to online academic journals  NECS have trained some staff on accessing and critiquing evidence from research to upskill and refresh hence ensuring appropriate evidence is considered  Evidence leads are now identified and embedded into NECS across teams and hubs to ensure it becomes everyone’s business within their commissioning support role

The first Evaluation sharing event was held in February 2017. This shared learning from a variety of evaluations being undertaken across the area, from clinicians and from evaluators. Workshops on key evaluations topics like qualitative research and health economics were also undertaken. The event was evaluated as successful, helped with the day job and increased the awareness of people to support and advise and ways of doing evaluations.

NECS R&E team now produce bi –monthly bulletins for NECS and CCGs. These provide up to date information on research and evaluations in progress as well as spot light on specific pieces of work.

For more information please email [email protected]

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3. Excess Treatment Costs Commissioners have a duty “to ensure that excess treatment costs (ETC) associated with research are funded “. NECS, working with all NHS providers in the North East and Cumbria manage a process of collating and scrutinising any ETC applications. The agreed CCG decision maker then received the relevant applications. Often this involves considerable conversations and negotiations before the application is submitted to CCGs. This is to ensure correct and appropriate costs are being applied for. Shona Haining is working with R&D providers regionally and with key stakeholders and NHS England nationally, following a recent NHS England guideline in which excess treatment savings need to be considered as well as excess treatment costs. All ETC applications now routinely ask providers for any related savings to be quantified before excess costs are considered.

All CCGs are provided with updates in the quarterly reports on expected and actual excess treatment costs.

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Plans and priorities for 2017/2018

These plans are guided by local and national priorities and mandates as well as Research & Evidence team skills and knowledge to support. These will be reported on with regards updates and challenges in the quarterly reports.

1. Support and Promote Research

Deliver the Government’s mandate to NHS England for 2017-18 - OBJECTIVE 7: To support research, innovation and growth Below describes the deliverables set out in the Mandate as well as the NECS plans to support CCG delivering these in 2017/18: 2017-18 deliverables: NECS Activity

Evaluate the implementation of Shona Haining is a member of a National Research the Excess Treatment Costs Costing and Attribution Group in DH. She is also working Guidance to understand its with the NHS Providers in North East and Cumbria on impact and to further support Excess Treatment costs and savings. implementation, and agree further actions that need to be taken with partners The Local Clinical Research Network (LCRN) provides Promote and support the support to delivery of research in NE&C, hosted by participation by NHS Newcastle Hospitals. organisations and patients in Dr John Matthews on behalf of the CCG forum and Dr research funded both by Tim Butler on behalf of NHS England represent CCGs commercial and non- and primary care on the Partnership groups: both commercial organisations, supported by R&E team demonstrating progress The delivery in primary care is becoming more focussed through publication of the NHS at federation level and a range of engagement leads are England research plan and in place. monitoring its deliverables. Shona Haining and John Matthews are working to bring these components together and ensure CCGs are sighted and can promote and support research delivery.

Improve NHS Commissioner National calls for feeding into research priority setting input into identifying research sent to CCG research named leads. Shona Haining is a needs in the NHS member of the School for Primary Care Research at Newcastle University (for NE) and supports local research bids to ensure the correct CCG/primary care representation is included.

Work with the Department of Health to agree a clear role for http://www.gov.uk/government/organisations/accelerated- NHS England in access-review implementation the recommendations of the Accelerated Access Review 23, to be set out in the Government response.

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Develop, jointly with Genomics Scope this work in CCG/NECS to consider best England, the approach to approach. begin to embed genomics into routine care and engage other national partners including NHS Improvement, NHS Digital, Health Education England and Public Health England.

Additional NECS plans  Work with CCGs to decide the data required for primary care research activity that reflects quality.  Share Helen Riding Masters dissertation Research activity and quality indicators – an explorative qualitative interview study in primary care.  Continue quarterly reporting showing NE and Cumbria CCG wide research activity, benchmarking and sharing learning.

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Research Capability Funding (RCF)

For 2017/2018 only three CCGs will receive RCF – Newcastle Gateshead, Northumberland and Cumbria. The R&E team will continue to advise, support and report as required.

We have been informed that the criteria for RCF is to be revised in 2017/18. Shona Haining has expressed an interest to be part of the consultation in order that the CCG voice can be heard.

At present the RCF funding is predicated on October to September accrual activity. We will therefore also update the CCGs per quarter on this time period of activity. In addition we will share with the LCRN team that promotes delivery of research resulting in this activity to ensure a shared understanding and joined up planned approach

Plans  Contribute to RCF consultation nationally to ensure CCGs and primary care is not disadvantaged  Support RCF funded CCGs with advise to get most effective spend to meet RCF requirements and CCG priorities  Update the CCGs per quarter on this time period of activity so they are aware of how close to the target they are and any short term plans needed to reach this.  Share this CCG data with the local clinical research network (LCRN) primary care managers to encourage support to reach the targets required at CCG level  CCG Forum will discuss how CCGs can be supported to reach this target with senior leadership in LCRN

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Current accrual activity per CCG to contribute to potential RCF funding

RCF qualifying number of participants recruited per CCG October 16 -March 2016 900 764 800 700 600 500 400 356 300 165 155 176 186 200 147 107 63 100 49 36 0

500 accruals RCF current qualifying recruitment number *NHS Durham Dales, Easington and Sedgefield CCG ** NHS Hartlepool and Stockton-On-Tees CCG

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Developing Research relevant for commissioners

The R&E team work closely with all North East Universities and clinical academics. This allows proactive as well as reactive activity. In addition Shona Haining is now a member of the executive of the School for Primary Care Research (SPCR) at Newcastle University to allow the CCG agenda to be more closely aligned to the SPCR plans.

Plans  Continue to proactively link with all relevant academics to inform research plans and bids  Link relevant CCG leads into research bids - as funded collaborators where possible to bring resource into CCG  Promote importance of CCGs role in research  Promote NECS role in supporting and hosting research grants  Promote CCG role in research at Society for Academic Primary care research meeting North in November 2017  Work with LCRN, Health Education England and CCGs to consider how to attract GP researchers in NE, growing a quality workforce as well as research skills and interest.

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2. To use evidence from research to support commissioning decisions

The R&E team work with relevant CCG and NECS staff involved in all aspects of the commissioning cycle to ensure that evidence from research is easily obtained, can be scrutinised and applied appropriately to the service redesigns being considered. This may include skills and knowledge training as well as expert input from the R&E team as relevant.

CCG quarterly reports included new evidence to CCGs from local or national research. In addition websites/links where new evidence could be available was regularly shared.

In addition R&E team undertook on-going promote the importance of evaluation of new services providing advice and frameworks to consider the most appropriate evaluations. Evaluations themselves will have to be undertaken from the project /CCG resources but the R&E team can advise on how best to deliver this and link with key evaluators as necessary. This has happened for a range of evaluations over many CCGs throughout 16/17.

Plans

 Bulletin to be circulated bi-monthly on updated research and evaluation projects and outcomes  Training on accessing and using evidence from research as well as evaluation tools and skills are available from R&E team on request  Evidence from the North East Vanguards to be shared at an event open to all CCGs on Tuesday 27th June. Contact [email protected] for more information.  Outcomes from research & evidence event for all CCGs planned for Autumn 2017

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3. To ensure the treatment costs in research are resourced

The resourcing of excess treatment costs is an ongoing challenge that has been around for years and no one locally or nationally has found an agreeable solution. It has probably taken up more resource discussing than the ETC applications themselves. The R&E team always wishes to take a pragmatic approach whilst understanding the CCG financial challenges and constraints

Plans  Revised application form so that all provider R&D leads are aware of the application and have considered any savings that being part of a research active CCG brings and can offset any costs  Share with NHS providers the Newcastle hospitals approach to ETC applications which has a £50,000 cap, below which no application is made to commissioners  STP level agreement to be scoped

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Authors: Shona Haining Helen Riding Research & Evidence Team NECS

May 11 2017

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Local Clinical Research Network North East and North Cumbria Activity 2016/17

Appendix 1: Recruitment to all Research Studies in each CCG

The following table shows recruitment to all NIHR studies, including commercial studies across the CCGs in the North East and North Cumbria. Recruitment activity records each participant recruited to a study as an accrual. This information is based on figures provided by the Open Data Platform (ODP) as at 2nd May 2017.

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Cumbria CCG Study name CCG Name Practice Participants Comparison of ADR reports received via Yellow Card app with casenotes NHS CUMBRIA CCG ASPATRIA MEDICAL GROUP 1 The United Kingdom Aneurysm Growth Study NHS CUMBRIA CCG BIRBECK MEDICAL GROUP 1 The United Kingdom Aneurysm Growth BRAMPTON MEDICAL Study NHS CUMBRIA CCG PRACTICE 1 TIME - Treatment in Morning Versus BRUNSWICK HOUSE MEDICAL Evening NHS CUMBRIA CCG GROUP 1 BRUNSWICK HOUSE MEDICAL DRN082 (DARE) NHS CUMBRIA CCG GROUP 1 The United Kingdom Aneurysm Growth Study NHS CUMBRIA CCG CARLISLE HEALTHCARE 1 CASTLEGATE AND DERWENT DRN082 (DARE) NHS CUMBRIA CCG SURGERY 72 Enhanced Passive Surveillance for Enzira/Seqirus (formerly bioCSL) CASTLEGATE AND DERWENT Influenza Vaccine NHS CUMBRIA CCG SURGERY 60 CASTLEGATE AND DERWENT CANDID NHS CUMBRIA CCG SURGERY 56 CASTLEGATE AND DERWENT WELCOME-GP NHS CUMBRIA CCG SURGERY 54 CASTLEGATE AND DERWENT TWICS NHS CUMBRIA CCG SURGERY 15 Helicobacter Eradication Aspirin CASTLEGATE AND DERWENT Trial (HEAT) NHS CUMBRIA CCG SURGERY 15 A study of common and rare genetic variants associated CASTLEGATE AND DERWENT with thinness. NHS CUMBRIA CCG SURGERY 3 COllectioN Devices to reduce Urine ConTamination CASTLEGATE AND DERWENT (CONDUCT) NHS CUMBRIA CCG SURGERY 1 PATH-GP NHS CUMBRIA CCG COURT THORN SURGERY 1 DRN082 (DARE) NHS CUMBRIA CCG DERWENT HOUSE SURGERY 32 TIME - Treatment in Morning Versus LONGTOWN MEDICAL Evening NHS CUMBRIA CCG CENTRE 1 DRN082 (DARE) NHS CUMBRIA CCG MANSION HOUSE SURGERY 5 MARYPORT HEALTH DRN082 (DARE) NHS CUMBRIA CCG SERVICES 6 The United Kingdom MARYPORT HEALTH Aneurysm Growth NHS CUMBRIA CCG SERVICES 1

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Study CATCH-uS: Children with ADHA in transition to adult services NHS CUMBRIA CCG NHS CUMBRIA CCG 3 Community Hospitals: profile, patient experience and comm NHS CUMBRIA CCG NHS CUMBRIA CCG 1 NORTH CARLISLE MEDICAL DRN082 (DARE) NHS CUMBRIA CCG PRACTICE 2 The United Kingdom Aneurysm Growth NORTH CARLISLE MEDICAL Study NHS CUMBRIA CCG PRACTICE 1 DRN082 (DARE) NHS CUMBRIA CCG SEASCALE HEALTH CENTRE 1 DRN082 (DARE) NHS CUMBRIA CCG SPENCER ST SURGERY 12 Tele-First: telephone triage in general THE LAKES MEDICAL practice - Version 1 NHS CUMBRIA CCG PRACTICE 1 TIME - Treatment in Morning Versus THE LAKES MEDICAL Evening NHS CUMBRIA CCG PRACTICE 1 TIME - Treatment in Morning Versus UPPER EDEN MEDICAL Evening NHS CUMBRIA CCG PRACTICE 1 Total Financial Year 2016/17 351

Darlington CCG

Study name CCG Name Practice Participants TIME - Treatment in Morning Versus NHS DARLINGTON BLACKETTS MEDICAL Evening CCG PRACTICE 3 NHS DARLINGTON CARD 4754 CCG CARMEL MEDICAL PRACTICE 23 RIVER Registry - RIVaroxaban Evaluation in Real NHS DARLINGTON life setting CCG CARMEL MEDICAL PRACTICE 13 Helicobacter Eradication Aspirin NHS DARLINGTON Trial (HEAT) CCG CARMEL MEDICAL PRACTICE 11 2307 CARD NHS DARLINGTON PARAGON CCG CARMEL MEDICAL PRACTICE 6 NHS DARLINGTON CARD 5390 CCG CARMEL MEDICAL PRACTICE 2 TIME - Treatment in Morning Versus NHS DARLINGTON Evening CCG CARMEL MEDICAL PRACTICE 1 TIME - Treatment in Morning Versus NHS DARLINGTON CLIFTON COURT MEDICAL Evening CCG PRACTICE 2

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TIME - Treatment in Morning Versus NHS DARLINGTON Evening CCG DENMARK STREET SURGERY 3 TIME - Treatment in Morning Versus NHS DARLINGTON Evening CCG FELIX HOUSE SURGERY 2 TIME - Treatment in Morning Versus NHS DARLINGTON Evening CCG MOORLANDS SURGERY 1 TIME - Treatment in Morning Versus NHS DARLINGTON Evening CCG NEASHAM ROAD SURGERY 2 A study of common and rare genetic variants associated NHS DARLINGTON with thinness. CCG NEASHAM ROAD SURGERY 1 TIME - Treatment in Morning Versus NHS DARLINGTON WHINFIELD MEDICAL Evening CCG PRACTICE 1 Total Financial Year 2016/17 71

Durham Dales, Easington and Sedgefield CCG Study name CCG Name Practice Participants NHS DURHAM DALES, EASINGTON AND DRN082 (DARE) SEDGEFIELD CCG AVENUE FAMILY PRACTICE 11 ECASS - Evaluation of a Computer Aid NHS DURHAM DALES, for assessing EASINGTON AND BEWICK CRESCENT Stomach Symptoms SEDGEFIELD CCG SURGERY 29 Developing an Intervention for Fall NHS DURHAM DALES, Related Injury in EASINGTON AND BEWICK CRESCENT Dementia SEDGEFIELD CCG SURGERY 2 Helicobacter NHS DURHAM DALES, Eradication Aspirin EASINGTON AND BISHOPGATE MEDICAL Trial (HEAT) SEDGEFIELD CCG CENTRE 20 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND BISHOPGATE MEDICAL Evening SEDGEFIELD CCG CENTRE 1 The United Kingdom NHS DURHAM DALES, Aneurysm Growth EASINGTON AND BISHOPGATE MEDICAL Study SEDGEFIELD CCG CENTRE 1 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND BISHOPS CLOSE MEDICAL Evening SEDGEFIELD CCG PRACTICE 3 NHS DURHAM DALES, EASINGTON AND BLACKHALL AND PETERLEE ALL-HEART SEDGEFIELD CCG PRACTICE 8 ECASS - Evaluation of a Computer Aid NHS DURHAM DALES, for assessing EASINGTON AND BLACKHALL AND PETERLEE Stomach Symptoms SEDGEFIELD CCG PRACTICE 3

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TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND BLACKHALL AND PETERLEE Evening SEDGEFIELD CCG PRACTICE 2 NHS DURHAM DALES, QOF indicator EASINGTON AND BLACKHALL AND PETERLEE piloting SEDGEFIELD CCG PRACTICE 1 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND Evening SEDGEFIELD CCG DR SIMPSON & PARTNERS 2 The United Kingdom NHS DURHAM DALES, Aneurysm Growth EASINGTON AND Study SEDGEFIELD CCG DR SIMPSON & PARTNERS 1 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND FERRYHILL AND CHILTON Evening SEDGEFIELD CCG MEDICAL PRACTICE 1 NHS DURHAM DALES, EASINGTON AND CADPC-II v1 SEDGEFIELD CCG MARLBOROUGH SURGERY 1 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND Evening SEDGEFIELD CCG MURTON MEDICAL CENTRE 1 Comparison of ADR reports received via NHS DURHAM DALES, NHS DURHAM DALES, Yellow Card app EASINGTON AND EASINGTON AND with casenotes SEDGEFIELD CCG SEDGEFIELD HQ 1 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND Evening SEDGEFIELD CCG OLD FORGE SURGERY 1 The United Kingdom NHS DURHAM DALES, Aneurysm Growth EASINGTON AND OXFORD ROAD MEDICAL Study SEDGEFIELD CCG PRACTICE 1 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND PEASE WAY MEDICAL Evening SEDGEFIELD CCG CENTRE 2 NHS DURHAM DALES, EASINGTON AND SILVERDALE FAMILY DRN082 (DARE) SEDGEFIELD CCG PRACTICE 23 Enhanced Passive Surveillance for Enzira/Seqirus NHS DURHAM DALES, (formerly bioCSL) EASINGTON AND Influenza Vaccine SEDGEFIELD CCG SKERNE MEDICAL GROUP 80 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND Evening SEDGEFIELD CCG SKERNE MEDICAL GROUP 4 NHS DURHAM DALES, EASINGTON AND DRN082 (DARE) SEDGEFIELD CCG SKERNE MEDICAL GROUP 4 Developing an Intervention for Fall NHS DURHAM DALES, Related Injury in EASINGTON AND Dementia SEDGEFIELD CCG SKERNE MEDICAL GROUP 1 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND ST ANDREW'S MEDICAL Evening SEDGEFIELD CCG PRACTICE 1

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ECASS - Evaluation of a Computer Aid NHS DURHAM DALES, for assessing EASINGTON AND STATION VIEW MEDICAL Stomach Symptoms SEDGEFIELD CCG CENTRE 1 TIME - Treatment in NHS DURHAM DALES, Morning Versus EASINGTON AND THE NEW SEAHAM MEDICAL Evening SEDGEFIELD CCG GROUP 1 NHS DURHAM DALES, EASINGTON AND DRN082 (DARE) SEDGEFIELD CCG WILLIAM BROWN CENTRE 38 Helicobacter NHS DURHAM DALES, Eradication Aspirin EASINGTON AND Trial (HEAT) SEDGEFIELD CCG WILLIAM BROWN CENTRE 11 Developing an Intervention for Fall NHS DURHAM DALES, Related Injury in EASINGTON AND Dementia SEDGEFIELD CCG WILLIAM BROWN CENTRE 2 NHS DURHAM DALES, EASINGTON AND WILLINGTON MEDICAL WELCOME-GP SEDGEFIELD CCG GROUP 57 NHS DURHAM DALES, EASINGTON AND WILLINGTON MEDICAL PRIM 5039 SEDGEFIELD CCG GROUP 2 The Adult Autism NHS DURHAM DALES, Spectrum Cohort - EASINGTON AND WILLINGTON MEDICAL UK SEDGEFIELD CCG GROUP 2 A study of common and rare genetic NHS DURHAM DALES, variants associated EASINGTON AND WILLINGTON MEDICAL with thinness. SEDGEFIELD CCG GROUP 1 Measuring quality of NHS DURHAM DALES, life in adults on the EASINGTON AND WILLINGTON MEDICAL autism spectrum SEDGEFIELD CCG GROUP 1 NHS DURHAM DALES, EASINGTON AND WILLINGTON MEDICAL CADPC-II v1 SEDGEFIELD CCG GROUP 1 Development of oral health initiatives to NHS DURHAM DALES, improve glycaemic EASINGTON AND WILLINGTON MEDICAL control v1 SEDGEFIELD CCG GROUP 1 NHS DURHAM DALES, EASINGTON AND WILLINGTON MEDICAL Flexi-Quest SEDGEFIELD CCG GROUP 1 Total Financial 324 Year 2016/17

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Hartlepool and Stockton-on-Tees CCG

Study name CCG Name Practice Participants Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG ALMA MEDICAL CENTRE 2 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- Evening TEES CCG ALMA MEDICAL CENTRE 2 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- Evening TEES CCG BANKHOUSE SURGERY 2 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG CHADWICK PRACTICE 2 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- Evening TEES CCG DR RASOOL 1 The United Kingdom NHS HARTLEPOOL Aneurysm Growth AND STOCKTON-ON- Study TEES CCG DR RASOOL 1 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- EAGLESCLIFFE MEDICAL Dementia TEES CCG PRACTICE 1 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- EAGLESCLIFFE MEDICAL Evening TEES CCG PRACTICE 1 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG ELM TREE SURGERY 1 A system-level NHS HARTLEPOOL evaluation of the AND STOCKTON-ON- HARTLEPOOL BOROUGH Better Care Fund TEES CCG COUNCIL 1 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- HAVELOCK GRANGE Evening TEES CCG PRACTICE 4 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- HAVELOCK GRANGE Dementia TEES CCG PRACTICE 3 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG KINGSWAY MEDICAL CENTRE 2 NHS HARTLEPOOL AND STOCKTON-ON- MARSH HOUSE MEDICAL CADPC-II v1 TEES CCG PRACTICE 1 Developing an NHS HARTLEPOOL Intervention for Fall AND STOCKTON-ON- MARSH HOUSE MEDICAL Related Injury in TEES CCG PRACTICE 1

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Dementia Tele-First: telephone NHS HARTLEPOOL triage in general AND STOCKTON-ON- practice - Version 1 TEES CCG MCKENZIE HOUSE SURGERY 34 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG MCKENZIE HOUSE SURGERY 6 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- Evening TEES CCG MELROSE SURGERY 1 A system-level NHS HARTLEPOOL evaluation of the AND STOCKTON-ON- NHS HARTLEPOOL AND Better Care Fund TEES CCG STOCKTON-ON-TEES CCG 1 Tele-First: telephone NHS HARTLEPOOL triage in general AND STOCKTON-ON- practice - Version 1 TEES CCG NORTON MEDICAL CENTRE 52 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG NORTON MEDICAL CENTRE 1 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG PARK LANE SURGERY 1 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- QUEENS PARK MEDICAL Dementia TEES CCG CENTRE 4 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- Evening TEES CCG QUEENSTREE PRACTICE 2 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG QUEENSTREE PRACTICE 1 The United Kingdom NHS HARTLEPOOL Aneurysm Growth AND STOCKTON-ON- RIVERSIDE MEDICAL Study TEES CCG PRACTICE 1 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- STOCKTON NHS HEALTH Evening TEES CCG CARE CENTRE 1 A system-level NHS HARTLEPOOL evaluation of the AND STOCKTON-ON- STOCKTON-ON-TEES Better Care Fund TEES CCG BOROUGH COUNCIL 1 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- TENNANT STREET MEDICAL Dementia TEES CCG PRACTICE 2 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- TENNANT STREET MEDICAL Evening TEES CCG PRACTICE 2 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- Evening TEES CCG THE DENSHAM SURGERY 1

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The United Kingdom NHS HARTLEPOOL Aneurysm Growth AND STOCKTON-ON- Study TEES CCG THE DOVECOT SURGERY 1 NHS HARTLEPOOL AND STOCKTON-ON- THE HEADLAND MEDICAL DRN082 (DARE) TEES CCG CENTRE 27 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- Evening TEES CCG THE ROSEBERRY PRACTICE 2 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- THORNABY & BARWICK Evening TEES CCG MEDICAL GROUP 2 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- THORNABY & BARWICK Dementia TEES CCG MEDICAL GROUP 1 Development of oral health initiatives to NHS HARTLEPOOL improve glycaemic AND STOCKTON-ON- VICTORIA MEDICAL control v1 TEES CCG PRACTICE 7 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- WEST VIEW MILLENIUM Dementia TEES CCG SURGERY A 1 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG WOODBRIDGE - INGELBY 1 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- Evening TEES CCG WOODBRIDGE PRACTICE 1 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- WOODLANDS FAMILY Dementia TEES CCG MEDICAL CENTRE 3 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- WOODLANDS FAMILY Evening TEES CCG MEDICAL CENTRE 2 The United Kingdom NHS HARTLEPOOL Aneurysm Growth AND STOCKTON-ON- WOODLANDS FAMILY Study TEES CCG MEDICAL CENTRE 1 ECASS - Evaluation of a Computer Aid NHS HARTLEPOOL for assessing AND STOCKTON-ON- Stomach Symptoms TEES CCG YARM MEDICAL PRACTICE 41 TIME - Treatment in NHS HARTLEPOOL Morning Versus AND STOCKTON-ON- Evening TEES CCG YARM MEDICAL PRACTICE 32 NHS HARTLEPOOL AND STOCKTON-ON- DRN082 (DARE) TEES CCG YARM MEDICAL PRACTICE 32 NHS HARTLEPOOL AND STOCKTON-ON- ALL-HEART TEES CCG YARM MEDICAL PRACTICE 18 CANDID NHS HARTLEPOOL YARM MEDICAL PRACTICE 7

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AND STOCKTON-ON- TEES CCG The Adult Autism NHS HARTLEPOOL Spectrum Cohort - AND STOCKTON-ON- UK TEES CCG YARM MEDICAL PRACTICE 4 Fluenz Tetra Enhanced Safety NHS HARTLEPOOL Surveillance 2016 - AND STOCKTON-ON- 17 TEES CCG YARM MEDICAL PRACTICE 2 Developing an Intervention for Fall NHS HARTLEPOOL Related Injury in AND STOCKTON-ON- Dementia TEES CCG YARM MEDICAL PRACTICE 2 Total Financial Year 2016/17 323

Newcastle Gateshead CCG Study name CCG Name Practice Participants The value and cost of different forms of oral NHS NEWCASTLE health information GATESHEAD CCG 76-78 KENTON LANE 9 CAP Trial - Case Note Review NHS NEWCASTLE AVENUE MEDICAL Study (CNRS) GATESHEAD CCG PRACTICE 1 NHS NEWCASTLE BEACON VIEW MEDICAL ALL-HEART GATESHEAD CCG CENTRE 3 CFASII Dementia Diagnosis Study NHS NEWCASTLE BENFIELD PARK MEDICAL (CADDY) GATESHEAD CCG GROUP 5 Newcastle 85+ study 10 year NHS NEWCASTLE BENFIELD PARK MEDICAL follow up GATESHEAD CCG GROUP 1 TIME - Treatment in Morning Versus NHS NEWCASTLE BENFIELD PARK MEDICAL Evening GATESHEAD CCG GROUP 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE BETTS AVENUE MEDICAL (CADDY) GATESHEAD CCG GROUP 15 Newcastle 85+ study 10 year NHS NEWCASTLE BETTS AVENUE MEDICAL follow up GATESHEAD CCG GROUP 2 Developing an Intervention for Fall Related Injury NHS NEWCASTLE BETTS AVENUE MEDICAL in Dementia GATESHEAD CCG GROUP 1 TIME - Treatment in Morning Versus NHS NEWCASTLE BETTS AVENUE MEDICAL Evening GATESHEAD CCG GROUP 1 CFASII Dementia NHS NEWCASTLE BIDDLESTONE HEALTH Diagnosis Study GATESHEAD CCG GROUP 7

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(CADDY) The United Kingdom Aneurysm Growth NHS NEWCASTLE BIDDLESTONE HEALTH Study GATESHEAD CCG GROUP 2 TIME - Treatment in Morning Versus NHS NEWCASTLE Evening GATESHEAD CCG BIRTLEY MEDICAL GROUP 1 TIME - Treatment in Morning Versus NHS NEWCASTLE BLAYDON GP LED Evening GATESHEAD CCG PRACTICE 1 TIME - Treatment in Morning Versus NHS NEWCASTLE BROADWAY MEDICAL Evening GATESHEAD CCG CENTRE 6 NHS NEWCASTLE BROADWAY MEDICAL CARE-Study GATESHEAD CCG CENTRE 5 CFASII Dementia Diagnosis Study NHS NEWCASTLE (CADDY) GATESHEAD CCG BRUNTON PARK 6 Newcastle 85+ study 10 year NHS NEWCASTLE follow up GATESHEAD CCG BRUNTON PARK 3 Developing an Intervention for Fall Related Injury NHS NEWCASTLE in Dementia GATESHEAD CCG BRUNTON PARK 2 TIME - Treatment in Morning Versus NHS NEWCASTLE CENTRAL GATESHEAD Evening GATESHEAD CCG MEDICAL GROUP 1 TIME - Treatment in Morning Versus NHS NEWCASTLE CHAINBRIDGE MEDICAL Evening GATESHEAD CCG PARTNERSHIP 1 The United Kingdom Aneurysm Growth NHS NEWCASTLE CHAINBRIDGE MEDICAL Study GATESHEAD CCG PARTNERSHIP 1 Developing an Intervention for Fall Related Injury NHS NEWCASTLE CHAPEL HOUSE PRIMARY in Dementia GATESHEAD CCG CARE CENTRE 1 TIME - Treatment in Morning Versus NHS NEWCASTLE CRAWCROOK MEDICAL Evening GATESHEAD CCG CENTRE 1 CAP Trial - Case Note Review NHS NEWCASTLE CROWHALL MEDICAL Study (CNRS) GATESHEAD CCG CENTRE 2 Newcastle 85+ study 10 year NHS NEWCASTLE CRUDDAS PARK follow up GATESHEAD CCG SURGERY 2 Developing an NHS NEWCASTLE CRUDDAS PARK 2

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Intervention for GATESHEAD CCG SURGERY Fall Related Injury in Dementia CFASII Dementia Diagnosis Study NHS NEWCASTLE DENTON PARK MEDICAL (CADDY) GATESHEAD CCG GROUP 10 Developing an Intervention for Fall Related Injury NHS NEWCASTLE DENTON PARK MEDICAL in Dementia GATESHEAD CCG GROUP 1 TIME - Treatment in Morning Versus NHS NEWCASTLE DENTON PARK MEDICAL Evening GATESHEAD CCG GROUP 1 Novel pulse device for diagnosis of NHS NEWCASTLE DENTON TURRET PAD (NOTEPAD) GATESHEAD CCG MEDICAL CENTRE 25 Helicobacter Eradication Aspirin NHS NEWCASTLE DENTON TURRET Trial (HEAT) GATESHEAD CCG MEDICAL CENTRE 18 Developing an Intervention for Fall Related Injury NHS NEWCASTLE DENTON TURRET in Dementia GATESHEAD CCG MEDICAL CENTRE 2 CFASII Dementia Diagnosis Study NHS NEWCASTLE DENTON TURRET (CADDY) GATESHEAD CCG MEDICAL CENTRE 1 TIME - Treatment in Morning Versus NHS NEWCASTLE DENTON TURRET Evening GATESHEAD CCG MEDICAL CENTRE 1 The United Kingdom Aneurysm Growth NHS NEWCASTLE DENTON TURRET Study GATESHEAD CCG MEDICAL CENTRE 1 The United Kingdom Aneurysm Growth NHS NEWCASTLE Study GATESHEAD CCG FALCON MEDICAL GROUP 1 TIME - Treatment in Morning Versus NHS NEWCASTLE Evening GATESHEAD CCG FELL COTTAGE SURGERY 1 NHS NEWCASTLE FELL TOWER MEDICAL ALL-HEART GATESHEAD CCG CENTRE 2 Molecular Genetics of Adverse Drug Reactions NHS NEWCASTLE FELL TOWER MEDICAL (MOLGEN) GATESHEAD CCG CENTRE 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE (CADDY) GATESHEAD CCG FENHAM HALL SURGERY 9

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Newcastle 85+ study 10 year NHS NEWCASTLE follow up GATESHEAD CCG FENHAM HALL SURGERY 1 CAP Trial - Case Note Review NHS NEWCASTLE Study (CNRS) GATESHEAD CCG FENHAM HALL SURGERY 1 TIME - Treatment in Morning Versus NHS NEWCASTLE GLENPARK MEDICAL Evening GATESHEAD CCG CENTRE 4 CFASII Dementia Diagnosis Study NHS NEWCASTLE GOSFORTH MEMORIAL (CADDY) GATESHEAD CCG MED.CTR 9 Developing an Intervention for Fall Related Injury NHS NEWCASTLE GOSFORTH MEMORIAL in Dementia GATESHEAD CCG MED.CTR 2 CFASII Dementia GRAINGER & Diagnosis Study NHS NEWCASTLE SCOTSWOOD MEDICAL (CADDY) GATESHEAD CCG PRACTICES 1 TIME - Treatment GRAINGER & in Morning Versus NHS NEWCASTLE SCOTSWOOD MEDICAL Evening GATESHEAD CCG PRACTICES 1 The United Kingdom GRAINGER & Aneurysm Growth NHS NEWCASTLE SCOTSWOOD MEDICAL Study GATESHEAD CCG PRACTICES 1 CAP Trial - Case Note Review NHS NEWCASTLE GRANGE ROAD MEDICAL Study (CNRS) GATESHEAD CCG PRACTICE 4 TIME - Treatment in Morning Versus NHS NEWCASTLE GRANGE ROAD MEDICAL Evening GATESHEAD CCG PRACTICE 3 The United Kingdom Aneurysm Growth NHS NEWCASTLE GRANGE ROAD MEDICAL Study GATESHEAD CCG PRACTICE 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE (CADDY) GATESHEAD CCG HEATON ROAD SURGERY 5 Newcastle 85+ study 10 year NHS NEWCASTLE follow up GATESHEAD CCG HEATON ROAD SURGERY 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE (CADDY) GATESHEAD CCG HOLLY MEDICAL GROUP 10 TIME - Treatment in Morning Versus NHS NEWCASTLE Evening GATESHEAD CCG HOLLY MEDICAL GROUP 3 CFASII Dementia NHS NEWCASTLE HOLMSIDE MEDICAL Diagnosis Study GATESHEAD CCG GROUP 7

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(CADDY) CAP Trial - Case Note Review NHS NEWCASTLE HOLMSIDE MEDICAL Study (CNRS) GATESHEAD CCG GROUP 6 Newcastle 85+ study 10 year NHS NEWCASTLE HOLMSIDE MEDICAL follow up GATESHEAD CCG GROUP 2 Developing an Intervention for Fall Related Injury NHS NEWCASTLE HOLMSIDE MEDICAL in Dementia GATESHEAD CCG GROUP 2 TIME - Treatment in Morning Versus NHS NEWCASTLE HOLMSIDE MEDICAL Evening GATESHEAD CCG GROUP 1 NHS NEWCASTLE LONGRIGG MEDICAL DRN082 (DARE) GATESHEAD CCG CENTRE 30 The United Kingdom Aneurysm Growth NHS NEWCASTLE METRO INTERCHANGE Study GATESHEAD CCG SURGERY 1 CAP Trial - Case Note Review NHS NEWCASTLE METRO INTERCHANGE Study (CNRS) GATESHEAD CCG SURGERY 1 TIME - Treatment in Morning Versus NHS NEWCASTLE MILLENNIUM FAMILY Evening GATESHEAD CCG PRACTICE 1 Novel pulse device for diagnosis of NHS NEWCASTLE PAD (NOTEPAD) GATESHEAD CCG NEWBURN SURGERY 15 CFASII Dementia Diagnosis Study NHS NEWCASTLE (CADDY) GATESHEAD CCG NEWBURN SURGERY 10 Newcastle 85+ study 10 year NHS NEWCASTLE follow up GATESHEAD CCG NEWBURN SURGERY 2 Developing an Intervention for Fall Related Injury NHS NEWCASTLE in Dementia GATESHEAD CCG NEWBURN SURGERY 2 TIME - Treatment in Morning Versus NHS NEWCASTLE Evening GATESHEAD CCG NEWBURN SURGERY 1 TIME - Treatment in Morning Versus NHS NEWCASTLE NEWCASTLE MEDICAL Evening GATESHEAD CCG CENTRE 2 IPS Mental Health & Employment Support NHS NEWCASTLE NHS NEWCASTLE Evaluation v2.0 GATESHEAD CCG GATESHEAD CCG 59 Identification and NHS NEWCASTLE NHS NEWCASTLE 1

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Care of Patients at GATESHEAD CCG GATESHEAD CCG Risk of Post Stroke Dementia NHS NEWCASTLE DRN082 (DARE) GATESHEAD CCG OLDWELL SURGERY 23 Exploring views on alcohol intervention delivery in primary NHS NEWCASTLE healthcare GATESHEAD CCG OLDWELL SURGERY 2 The Adult Autism Spectrum Cohort - NHS NEWCASTLE OXFORD TCE & RAWLING UK GATESHEAD CCG RD MEDICAL GROUP 1 TIME - Treatment in Morning Versus NHS NEWCASTLE OXFORD TCE & RAWLING Evening GATESHEAD CCG RD MEDICAL GROUP 1 Measuring quality of life in adults on OXFORD TERRACE AND the autism NHS NEWCASTLE RAWLING ROAD MEDICAL spectrum GATESHEAD CCG GROUP 1 The United Kingdom OXFORD TERRACE AND Aneurysm Growth NHS NEWCASTLE RAWLING ROAD MEDICAL Study GATESHEAD CCG GROUP 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE (CADDY) GATESHEAD CCG PARK MEDICAL GROUP 18 TIME - Treatment in Morning Versus NHS NEWCASTLE Evening GATESHEAD CCG PARK MEDICAL GROUP 2 CAP Trial - Case Note Review NHS NEWCASTLE PARKWAY MEDICAL Study (CNRS) GATESHEAD CCG GROUP 8 Developing an Intervention for Fall Related Injury NHS NEWCASTLE PARKWAY MEDICAL in Dementia GATESHEAD CCG GROUP 3 Newcastle 85+ study 10 year NHS NEWCASTLE PARKWAY MEDICAL follow up GATESHEAD CCG GROUP 2 The United Kingdom Aneurysm Growth NHS NEWCASTLE PARKWAY MEDICAL Study GATESHEAD CCG GROUP 1 Developing an Intervention for Fall Related Injury NHS NEWCASTLE PONTELAND ROAD in Dementia GATESHEAD CCG HEALTH CENTRE 3 A study of NHS NEWCASTLE PONTELAND ROAD common and rare GATESHEAD CCG HEALTH CENTRE 1

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NHS Protect genetic variants associated with thinness. CFASII Dementia Diagnosis Study NHS NEWCASTLE PROSPECT MEDICAL (CADDY) GATESHEAD CCG CENTRE 6 TIME - Treatment in Morning Versus NHS NEWCASTLE PROSPECT MEDICAL Evening GATESHEAD CCG CENTRE 3 Developing an Intervention for Fall Related Injury NHS NEWCASTLE PROSPECT MEDICAL in Dementia GATESHEAD CCG CENTRE 2 Developing an Intervention for Fall Related Injury NHS NEWCASTLE REGENT MEDICAL in Dementia GATESHEAD CCG CENTRE 1 TIME - Treatment in Morning Versus NHS NEWCASTLE Evening GATESHEAD CCG ROSEWORTH SURGERY 2 TIME - Treatment in Morning Versus NHS NEWCASTLE ROWLANDS GILL MEDICAL Evening GATESHEAD CCG CENTRE 1 Identification and Care of Patients at Risk of Post NHS NEWCASTLE Stroke Dementia GATESHEAD CCG SAVILLE MEDICAL GROUP 2 TIME - Treatment in Morning Versus NHS NEWCASTLE Evening GATESHEAD CCG SAVILLE MEDICAL GROUP 2 Developing an Intervention for Fall Related Injury NHS NEWCASTLE in Dementia GATESHEAD CCG SAVILLE MEDICAL GROUP 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE ST.ANTHONY'S HEALTH (CADDY) GATESHEAD CCG CENTRE 6 Developing an Intervention for Fall Related Injury NHS NEWCASTLE ST.ANTHONY'S HEALTH in Dementia GATESHEAD CCG CENTRE 2 Newcastle 85+ study 10 year NHS NEWCASTLE ST.ANTHONY'S HEALTH follow up GATESHEAD CCG CENTRE 1 Exploring views on alcohol intervention delivery in primary NHS NEWCASTLE TEAMS MEDICAL healthcare GATESHEAD CCG PRACTICE 6 A study of NHS NEWCASTLE TEAMS MEDICAL 3

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NHS Protect common and rare GATESHEAD CCG PRACTICE genetic variants associated with thinness. NHS NEWCASTLE THE GROVE MEDICAL ALL-HEART GATESHEAD CCG GROUP 10 Newcastle 85+ study 10 year NHS NEWCASTLE THE GROVE MEDICAL follow up GATESHEAD CCG GROUP 3 TIME - Treatment in Morning Versus NHS NEWCASTLE THE GROVE MEDICAL Evening GATESHEAD CCG GROUP 3 Developing an Intervention for Fall Related Injury NHS NEWCASTLE THE GROVE MEDICAL in Dementia GATESHEAD CCG GROUP 2 Newcastle 85+ study 10 year NHS NEWCASTLE THE SURGERY-OSBORNE follow up GATESHEAD CCG ROAD 3 CFASII Dementia Diagnosis Study NHS NEWCASTLE THE SURGERY-OSBORNE (CADDY) GATESHEAD CCG ROAD 2 TIME - Treatment in Morning Versus NHS NEWCASTLE THE SURGERY-OSBORNE Evening GATESHEAD CCG ROAD 2 CFASII Dementia Diagnosis Study NHS NEWCASTLE THORNFIELD MEDICAL (CADDY) GATESHEAD CCG GROUP 13 Newcastle 85+ study 10 year NHS NEWCASTLE THORNFIELD MEDICAL follow up GATESHEAD CCG GROUP 2 Developing an Intervention for Fall Related Injury NHS NEWCASTLE THORNFIELD MEDICAL in Dementia GATESHEAD CCG GROUP 2 CAP Trial - Case Note Review NHS NEWCASTLE THORNFIELD MEDICAL Study (CNRS) GATESHEAD CCG GROUP 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE THROCKLEY PRIMARY (CADDY) GATESHEAD CCG CARE CENTRE 13 Novel pulse device for diagnosis of NHS NEWCASTLE THROCKLEY PRIMARY PAD (NOTEPAD) GATESHEAD CCG CARE CENTRE 13 Developing an Intervention for Fall Related Injury NHS NEWCASTLE THROCKLEY PRIMARY in Dementia GATESHEAD CCG CARE CENTRE 3 Newcastle 85+ NHS NEWCASTLE THROCKLEY PRIMARY study 10 year GATESHEAD CCG CARE CENTRE 1

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NHS Protect follow up A study of common and rare genetic variants associated with NHS NEWCASTLE THROCKLEY PRIMARY thinness. GATESHEAD CCG CARE CENTRE 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE (CADDY) GATESHEAD CCG WALKER MEDICAL GROUP 13 Newcastle 85+ study 10 year NHS NEWCASTLE follow up GATESHEAD CCG WALKER MEDICAL GROUP 1 Developing an Intervention for Fall Related Injury NHS NEWCASTLE in Dementia GATESHEAD CCG WALKER MEDICAL GROUP 1 TIME - Treatment in Morning Versus NHS NEWCASTLE Evening GATESHEAD CCG WALKER MEDICAL GROUP 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE WEST ROAD MEDICAL (CADDY) GATESHEAD CCG CENTRE 8 Newcastle 85+ study 10 year NHS NEWCASTLE WEST ROAD MEDICAL follow up GATESHEAD CCG CENTRE 2 Developing an Intervention for Fall Related Injury NHS NEWCASTLE WEST ROAD MEDICAL in Dementia GATESHEAD CCG CENTRE 1 Developing an Intervention for Fall Related Injury NHS NEWCASTLE WESTERHOPE MEDICAL in Dementia GATESHEAD CCG GROUP 7 The Adult Autism Spectrum Cohort - NHS NEWCASTLE WESTERHOPE MEDICAL UK GATESHEAD CCG GROUP 2 Newcastle 85+ study 10 year NHS NEWCASTLE WESTERHOPE MEDICAL follow up GATESHEAD CCG GROUP 1 CFASII Dementia Diagnosis Study NHS NEWCASTLE WESTERHOPE MEDICAL (CADDY) GATESHEAD CCG GROUP 1 TIME - Treatment in Morning Versus NHS NEWCASTLE WHICKHAM COTTAGE Evening GATESHEAD CCG MEDICAL CENTRE 5 The United Kingdom Aneurysm Growth NHS NEWCASTLE WHICKHAM COTTAGE Study GATESHEAD CCG MEDICAL CENTRE 1 PATH-GP NHS NEWCASTLE WHICKHAM PHARMACY 1

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GATESHEAD CCG TIME - Treatment in Morning Versus NHS NEWCASTLE WREKENTON MEDICAL Evening GATESHEAD CCG GROUP 1 Total Financial Year 2016/17 572

North Durham CCG

Study name CCG Name Practice Participants TIME - Treatment in Morning Versus NHS NORTH BELMONT & SHERBURN Evening DURHAM CCG MEDICAL GROUP 3 A study of common and rare genetic variants associated NHS NORTH with thinness. DURHAM CCG BRIDGE END SURGERY 2 Exploring views on alcohol intervention delivery in primary NHS NORTH healthcare DURHAM CCG BRIDGE END SURGERY 2 TIME - Treatment in Morning Versus NHS NORTH Evening DURHAM CCG CESTRIA HEALTH CENTRE 3 TIME - Treatment in Morning Versus NHS NORTH CHASTLETON MEDICAL Evening DURHAM CCG GROUP 5 NHS NORTH CLAYPATH & UNIVERSITY DRN082 (DARE) DURHAM CCG MEDICAL GROUP 59 Helicobacter Eradication Aspirin NHS NORTH CLAYPATH & UNIVERSITY Trial (HEAT) DURHAM CCG MEDICAL GROUP 24 TIME - Treatment in Morning Versus NHS NORTH CLAYPATH & UNIVERSITY Evening DURHAM CCG MEDICAL GROUP 6 NHS NORTH CLAYPATH & UNIVERSITY ARRISA-UK DURHAM CCG MEDICAL GROUP 3 NHS NORTH DRN082 (DARE) DURHAM CCG CONSETT MEDICAL CENTRE 47 TIME - Treatment in Morning Versus NHS NORTH Evening DURHAM CCG CONSETT MEDICAL CENTRE 1 The United Kingdom Aneurysm NHS NORTH Growth Study DURHAM CCG CONSETT MEDICAL CENTRE 1 TIME - Treatment in Morning Versus NHS NORTH COXHOE MEDICAL Evening DURHAM CCG PRACTICE 1 The United NHS NORTH COXHOE MEDICAL 1

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Kingdom Aneurysm DURHAM CCG PRACTICE Growth Study TIME - Treatment in Morning Versus NHS NORTH Evening DURHAM CCG DENHOLM HOUSE 1 TIME - Treatment in Morning Versus NHS NORTH DUNELM MEDICAL Evening DURHAM CCG PRACTICE 1 The United Kingdom Aneurysm NHS NORTH DUNELM MEDICAL Growth Study DURHAM CCG PRACTICE 1 TIME - Treatment in Morning Versus NHS NORTH Evening DURHAM CCG GREAT LUMLEY SURGERY 1 NHS NORTH DRN082 (DARE) DURHAM CCG LEADGATE SURGERY 37 TIME - Treatment in Morning Versus NHS NORTH MIDDLE CHARE MEDICAL Evening DURHAM CCG GROUP 2 TIME - Treatment in Morning Versus NHS NORTH PELTON & FELLROSE Evening DURHAM CCG MEDICAL GROUP 4 NHS NORTH DRN082 (DARE) DURHAM CCG QUEENS ROAD SURGERY 70 Helicobacter Eradication Aspirin NHS NORTH Trial (HEAT) DURHAM CCG QUEENS ROAD SURGERY 19 TIME - Treatment in Morning Versus NHS NORTH Evening DURHAM CCG QUEENS ROAD SURGERY 1 TIME - Treatment in Morning Versus NHS NORTH SACRISTON MEDICAL Evening DURHAM CCG CENTRE 2 The United Kingdom Aneurysm NHS NORTH SACRISTON MEDICAL Growth Study DURHAM CCG CENTRE 1 TIME - Treatment in Morning Versus NHS NORTH Evening DURHAM CCG STANLEY MEDICAL GROUP 1 TIME - Treatment in Morning Versus NHS NORTH TANFIELD VIEW MEDICAL Evening DURHAM CCG GROUP 1 NHS NORTH WELCOME-GP DURHAM CCG THE HAVEN SURGERY 23 NHS NORTH CANDID DURHAM CCG THE HAVEN SURGERY 20 ECASS - Evaluation of a Computer Aid for assessing NHS NORTH Stomach Symptoms DURHAM CCG THE HAVEN SURGERY 3

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NHS Protect

A study of common and rare genetic variants associated NHS NORTH with thinness. DURHAM CCG THE HAVEN SURGERY 1 NHS NORTH ALL-HEART DURHAM CCG THE HAVEN SURGERY 1 Total Financial Year 2016/17 348

North Tyneside CCG

Study name CCG Name Practice Participants NHS NORTH 49 MARINE AVENUE WELCOME-GP TYNESIDE CCG SURGERY 41 Novel pulse device for diagnosis of NHS NORTH 49 MARINE AVENUE PAD (NOTEPAD) TYNESIDE CCG SURGERY 12 NHS NORTH 49 MARINE AVENUE ARRISA-UK TYNESIDE CCG SURGERY 3 Newcastle 85+ study 10 year NHS NORTH 49 MARINE AVENUE follow up TYNESIDE CCG SURGERY 2 Exploring views on alcohol intervention delivery in primary NHS NORTH 49 MARINE AVENUE healthcare TYNESIDE CCG SURGERY 1 The United Kingdom Aneurysm Growth NHS NORTH Study TYNESIDE CCG APPLEBY SURGERY 1 NHS NORTH BATTLE HILL HEALTH CARE-Study TYNESIDE CCG CENTRE 7 TIME - Treatment in Morning Versus NHS NORTH BATTLE HILL HEALTH Evening TYNESIDE CCG CENTRE 7 TIME - Treatment in Morning Versus NHS NORTH Evening TYNESIDE CCG BEAUMONT PARK SURGERY 2 The United Kingdom Aneurysm Growth NHS NORTH Study TYNESIDE CCG BEAUMONT PARK SURGERY 1 Newcastle 85+ study 10 year NHS NORTH follow up TYNESIDE CCG BEWICKE MEDICAL CENTRE 2 TIME - Treatment in Morning Versus NHS NORTH Evening TYNESIDE CCG BEWICKE MEDICAL CENTRE 1

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Patient involvement in improving patient safety in primary NHS NORTH care v1 TYNESIDE CCG COLLINGWOOD SURGERY 11 TIME - Treatment in Morning Versus NHS NORTH Evening TYNESIDE CCG COLLINGWOOD SURGERY 3 Newcastle 85+ study 10 year NHS NORTH follow up TYNESIDE CCG COLLINGWOOD SURGERY 2 CAP Trial - Case Note Review NHS NORTH Study (CNRS) TYNESIDE CCG COLLINGWOOD SURGERY 1 The United Kingdom Aneurysm Growth NHS NORTH EARSDON PARK MEDICAL Study TYNESIDE CCG PRACTICE 1 TIME - Treatment in Morning Versus NHS NORTH FOREST HALL HEALTH Evening TYNESIDE CCG CENTRE 4 Newcastle 85+ study 10 year NHS NORTH FOREST HALL HEALTH follow up TYNESIDE CCG CENTRE 2 CAP Trial - Case Note Review NHS NORTH JUBILEE PARK MEDICAL Study (CNRS) TYNESIDE CCG PRACTICE 1 Developing an Intervention for Fall Related Injury NHS NORTH in Dementia TYNESIDE CCG LANE END SURGERY 5 Newcastle 85+ study 10 year NHS NORTH follow up TYNESIDE CCG LANE END SURGERY 3 A study of common and rare genetic variants associated with NHS NORTH thinness. TYNESIDE CCG LANE END SURGERY 3 Development of oral health initiatives to improve glycaemic NHS NORTH control v1 TYNESIDE CCG LANE END SURGERY 2 NHS NORTH MARINE AVENUE MEDICAL DRN082 (DARE) TYNESIDE CCG CTR 81 A study of common and rare genetic variants NHS NORTH MARINE AVENUE MEDICAL associated with TYNESIDE CCG CTR 4

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NHS Protect thinness. TIME - Treatment in Morning Versus NHS NORTH MARINE AVENUE MEDICAL Evening TYNESIDE CCG CTR 1 Molecular Genetics of Adverse Drug Reactions NHS NORTH MARINE AVENUE MEDICAL (MOLGEN) TYNESIDE CCG CTR 1 TIME - Treatment in Morning Versus NHS NORTH MONKSEATON MEDICAL Evening TYNESIDE CCG CENTRE 3 Newcastle 85+ study 10 year NHS NORTH follow up TYNESIDE CCG NELSON HEALTH CENTRE 1 The United Kingdom Aneurysm Growth NHS NORTH Study TYNESIDE CCG NELSON MEDICAL GROUP 1 Novel pulse device for diagnosis of NHS NORTH NORTHUMBERLAND PARK PAD (NOTEPAD) TYNESIDE CCG MEDICAL GROUP 9 TIME - Treatment in Morning Versus NHS NORTH NORTHUMBERLAND PARK Evening TYNESIDE CCG MEDICAL GROUP 1 NHS NORTH PARK ROAD MEDICAL DRN082 (DARE) TYNESIDE CCG PRACT 48 Newcastle 85+ study 10 year NHS NORTH PARK ROAD MEDICAL follow up TYNESIDE CCG PRACT 2 The United Kingdom Aneurysm Growth NHS NORTH PARK ROAD MEDICAL Study TYNESIDE CCG PRACT 1 TIME - Treatment in Morning Versus NHS NORTH PORTUGAL PLACE HEALTH Evening TYNESIDE CCG CTR 3 Developing an Intervention for Fall Related Injury NHS NORTH PORTUGAL PLACE HEALTH in Dementia TYNESIDE CCG CTR 2 CAP Trial - Case Note Review NHS NORTH PORTUGAL PLACE HEALTH Study (CNRS) TYNESIDE CCG CTR 1 The Adult Autism Spectrum Cohort - NHS NORTH UK TYNESIDE CCG PRIORY MEDICAL GROUP 4 Patient involvement in NHS NORTH improving patient TYNESIDE CCG PRIORY MEDICAL GROUP 3

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NHS Protect safety in primary care v1 The United Kingdom Aneurysm Growth NHS NORTH Study TYNESIDE CCG PRIORY MEDICAL GROUP 2 Measuring quality of life in adults on the autism NHS NORTH spectrum TYNESIDE CCG PRIORY MEDICAL GROUP 1 TIME - Treatment in Morning Versus NHS NORTH Evening TYNESIDE CCG PRIORY MEDICAL GROUP 1 NHS NORTH REDBURN PARK MEDICAL WELCOME-GP TYNESIDE CCG CENTRE 47 The Adult Autism Spectrum Cohort - NHS NORTH REDBURN PARK MEDICAL UK TYNESIDE CCG CENTRE 1 The United Kingdom Aneurysm Growth NHS NORTH REDBURN PARK MEDICAL Study TYNESIDE CCG CENTRE 1 TIME - Treatment in Morning Versus NHS NORTH SPRING TERRACE HEALTH Evening TYNESIDE CCG CENTRE 1 TIME - Treatment in Morning Versus NHS NORTH SWARLAND AVENUE Evening TYNESIDE CCG SURGERY 12 NHS NORTH SWARLAND AVENUE DRN082 (DARE) TYNESIDE CCG SURGERY 11 Developing an Intervention for Fall Related Injury NHS NORTH SWARLAND AVENUE in Dementia TYNESIDE CCG SURGERY 4 Development of oral health initiatives to improve glycaemic NHS NORTH SWARLAND AVENUE control v1 TYNESIDE CCG SURGERY 3 A study of common and rare genetic variants associated with NHS NORTH SWARLAND AVENUE thinness. TYNESIDE CCG SURGERY 1 Newcastle 85+ study 10 year NHS NORTH THE MEDICAL CENTRE, follow up TYNESIDE CCG ADDINGTON DRIVE 2 Newcastle 85+ study 10 year NHS NORTH THE VILLAGE GREEN follow up TYNESIDE CCG SURGERY 3

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TIME - Treatment in Morning Versus NHS NORTH THE VILLAGE GREEN Evening TYNESIDE CCG SURGERY 2 NHS NORTH WELLSPRING MEDICAL DRN082 (DARE) TYNESIDE CCG PRACT. 36 Exploring views on alcohol intervention delivery in primary NHS NORTH WELLSPRING MEDICAL healthcare TYNESIDE CCG PRACT. 9 TIME - Treatment in Morning Versus NHS NORTH WELLSPRING MEDICAL Evening TYNESIDE CCG PRACT. 3 Newcastle 85+ study 10 year NHS NORTH WELLSPRING MEDICAL follow up TYNESIDE CCG PRACT. 1 Developing an Intervention for Fall Related Injury NHS NORTH in Dementia TYNESIDE CCG WEST FARM SURGERY 4 Newcastle 85+ study 10 year NHS NORTH follow up TYNESIDE CCG WEST FARM SURGERY 3 Identification and Care of Patients at Risk of Post NHS NORTH Stroke Dementia TYNESIDE CCG WEST FARM SURGERY 2 TIME - Treatment in Morning Versus NHS NORTH Evening TYNESIDE CCG WEST FARM SURGERY 1 TIME - Treatment in Morning Versus NHS NORTH WHITLEY BAY HEALTH Evening TYNESIDE CCG CENTRE 7 Newcastle 85+ study 10 year NHS NORTH WIDEOPEN MEDICAL follow up TYNESIDE CCG CENTRE 1 Developing an Intervention for Fall Related Injury NHS NORTH WIDEOPEN MEDICAL in Dementia TYNESIDE CCG CENTRE 1 CAP Trial - Case Note Review NHS NORTH WOODLANDS PARK HEALTH Study (CNRS) TYNESIDE CCG CTR 3 Developing an Intervention for Fall Related Injury NHS NORTH WOODLANDS PARK HEALTH in Dementia TYNESIDE CCG CTR 1 TIME - Treatment in Morning Versus NHS NORTH WOODLANDS PARK HEALTH Evening TYNESIDE CCG CTR 1

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Total Financial Year 2016/17 449

Northumberland CCG Study name CCG Name Practice Participants The United Kingdom NHS Aneurysm Growth NORTHUMBERLAND BEDLINGTONSHIRE Study CCG MED.GROUP 1 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND BELFORD MEDICAL Evening CCG PRACTICE 15 Diabetes Remission NHS Clinical Trial NORTHUMBERLAND (DiRECT) CCG BELLINGHAM PRACTICE 2 Identification and Care of Patients NHS at Risk of Post NORTHUMBERLAND Stroke Dementia CCG BELLINGHAM PRACTICE 1 Diabetes Remission NHS Clinical Trial NORTHUMBERLAND (DiRECT) CCG BRANCH END SURGERY 8 Development of oral health initiatives to improve NHS glycaemic control NORTHUMBERLAND v1 CCG BRANCH END SURGERY 5 Use of a frailty NHS index in end of life NORTHUMBERLAND care CCG BRANCH END SURGERY 1 NHS Primary care and NORTHUMBERLAND liver disease CCG BRANCH END SURGERY 1 NHS NORTHUMBERLAND BROCKWELL MEDICAL DRN082 (DARE) CCG GROUP 148 COllectioN Devices to reduce Urine NHS ConTamination NORTHUMBERLAND BROCKWELL MEDICAL (CONDUCT) CCG GROUP 2 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND BROCKWELL MEDICAL Evening CCG GROUP 2 Developing an NHS Intervention for NORTHUMBERLAND BROCKWELL MEDICAL Fall Related Injury CCG GROUP 1

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NHS Protect in Dementia A study of common and rare genetic variants NHS associated with NORTHUMBERLAND BURN BRAE MEDICAL thinness. CCG GROUP 4 NHS NORTHUMBERLAND BURN BRAE MEDICAL SEED WS4 CCG GROUP 4 NHS NORTHUMBERLAND BURN BRAE MEDICAL ARRISA-UK CCG GROUP 3 Diabetes Remission NHS Clinical Trial NORTHUMBERLAND BURN BRAE MEDICAL (DiRECT) CCG GROUP 2 NHS NORTHUMBERLAND BURN BRAE MEDICAL DRN082 (DARE) CCG GROUP 1 Diabetes Remission NHS Clinical Trial NORTHUMBERLAND (DiRECT) CCG CHEVIOT MEDICAL GROUP 7 A study of common and rare genetic variants NHS associated with NORTHUMBERLAND thinness. CCG CHEVIOT MEDICAL GROUP 4 Helicobacter Eradication NHS Aspirin Trial NORTHUMBERLAND (HEAT) CCG CHEVIOT MEDICAL GROUP 3 NHS NORTHUMBERLAND COLLINGWOOD MEDICAL CADPC-II v1 CCG GROUP 1 The United Kingdom NHS Aneurysm Growth NORTHUMBERLAND COLLINGWOOD MEDICAL Study CCG GROUP 1 NHS NORTHUMBERLAND DRN082 (DARE) CCG COQUET MEDICAL GROUP 27 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND Evening CCG COQUET MEDICAL GROUP 9 Patient involvement in improving patient NHS safety in primary NORTHUMBERLAND CORBRIDGE HEALTH care v1 CCG CENTRE 9

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NHS Protect

Helicobacter Eradication NHS Aspirin Trial NORTHUMBERLAND CORBRIDGE HEALTH (HEAT) CCG CENTRE 8 CAP Trial - Case NHS Note Review NORTHUMBERLAND CORBRIDGE HEALTH Study (CNRS) CCG CENTRE 6 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND CRAMLINGTON MEDICAL Evening CCG GROUP 1 The value and cost of different NHS forms of oral NORTHUMBERLAND health information CCG DENTAL SURGERY 37 NHS NORTHUMBERLAND DRN082 (DARE) CCG ELSDON AVENUE SURGERY 19 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND Evening CCG FORUM FAMILY PRACTICE 3 CAP Trial - Case NHS Note Review NORTHUMBERLAND GAS HOUSE LANE Study (CNRS) CCG SURGERY 2 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND GAS HOUSE LANE Evening CCG SURGERY 1 NHS NORTHUMBERLAND GUIDEPOST MEDICAL DRN082 (DARE) CCG GROUP 35 Novel pulse device for NHS diagnosis of PAD NORTHUMBERLAND GUIDEPOST MEDICAL (NOTEPAD) CCG GROUP 31 Exploring views on alcohol intervention NHS delivery in primary NORTHUMBERLAND GUIDEPOST MEDICAL healthcare CCG GROUP 2 Development of a preference-based NHS outcome measure NORTHUMBERLAND GUIDEPOST MEDICAL for Palliative Care CCG GROUP 1 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND GUIDEPOST MEDICAL Evening CCG GROUP 1 NHS NORTHUMBERLAND GUIDEPOST MEDICAL GARFIELD CCG GROUP 1 Diabetes NHS HAYDON BRIDGE & Remission NORTHUMBERLAND ALLENDALE MEDICAL 8

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NHS Protect

Clinical Trial CCG PRACT (DiRECT) The Adult Autism NHS HAYDON BRIDGE & Spectrum Cohort NORTHUMBERLAND ALLENDALE MEDICAL - UK CCG PRACT 2 A Study into NHS Suicide by NORTHUMBERLAND Prisoners CCG HMP NORTHUMBERLAND 1 Patient involvement in improving patient NHS safety in primary NORTHUMBERLAND HUMSHAUGH & WARK MED care v1 CCG GRP 5 Exploring views on alcohol intervention NHS delivery in primary NORTHUMBERLAND HUMSHAUGH & WARK MED healthcare CCG GRP 3 Development of oral health initiatives to improve NHS glycaemic control NORTHUMBERLAND HUMSHAUGH & WARK MED v1 CCG GRP 3 NHS NORTHUMBERLAND HUMSHAUGH & WARK MED ARRISA-UK CCG GRP 3 Identification and Care of Patients NHS at Risk of Post NORTHUMBERLAND HUMSHAUGH & WARK MED Stroke Dementia CCG GRP 2 Measuring quality of life in adults on NHS the autism NORTHUMBERLAND HUMSHAUGH & WARK MED spectrum CCG GRP 1 NHS Primary care and NORTHUMBERLAND HUMSHAUGH & WARK MED liver disease CCG GRP 1 The Adult Autism NHS Spectrum Cohort NORTHUMBERLAND HUMSHAUGH & WARK MED - UK CCG GRP 1 NHS NORTHUMBERLAND INFIRMARY DRIVE MEDICAL DRN082 (DARE) CCG GROUP 47 NHS NORTHUMBERLAND INFIRMARY DRIVE MEDICAL ARRISA-UK CCG GROUP 3 A study of NHS common and rare NORTHUMBERLAND INFIRMARY DRIVE MEDICAL genetic variants CCG GROUP 2

Page 63 of 76

NHS Protect associated with thinness. NHS NORTHUMBERLAND DRN082 (DARE) CCG NETHERFIELD HOUSE 9 Molecular Genetics of Adverse Drug NHS Reactions NORTHUMBERLAND (MOLGEN) CCG NETHERFIELD HOUSE 2 The Adult Autism NHS Spectrum Cohort NORTHUMBERLAND - UK CCG NETHERFIELD HOUSE 1 Measuring quality of life in adults on NHS the autism NORTHUMBERLAND NETHERFIELD HOUSE spectrum CCG SURGERY 1 NHS NORTHUMBERLAND NHS NORTHUMBERLAND NOTEPAD WP5A CCG CCG 9 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND PONTELAND MEDICAL Evening CCG GROUP 3 Developing an Intervention for NHS Fall Related Injury NORTHUMBERLAND PONTELAND MEDICAL in Dementia CCG GROUP 1 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND Evening CCG PRUDHOE MEDICAL GROUP 2 CAP Trial - Case NHS Note Review NORTHUMBERLAND Study (CNRS) CCG RIVERSDALE SURGERY 6 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND Evening CCG RIVERSDALE SURGERY 5 Diabetes Remission NHS Clinical Trial NORTHUMBERLAND SCOTS GAP MEDICAL (DiRECT) CCG GROUP 4 NHS NORTHUMBERLAND SEATON PARK MEDICAL DRN082 (DARE) CCG GROUP 22 NHS NORTHUMBERLAND DRN082 (DARE) CCG STATION MEDICAL GROUP 78 NHS NORTHUMBERLAND WELCOME-GP CCG STATION MEDICAL GROUP 71 Novel pulse NHS STATION MEDICAL GROUP 11

Page 64 of 76

NHS Protect device for NORTHUMBERLAND diagnosis of PAD CCG (NOTEPAD) NHS NORTHUMBERLAND ALL-HEART CCG STATION MEDICAL GROUP 4 A study of common and rare genetic variants NHS associated with NORTHUMBERLAND thinness. CCG STATION MEDICAL GROUP 3 Development of a preference-based NHS outcome measure NORTHUMBERLAND for Palliative Care CCG STATION MEDICAL GROUP 2 CAP Trial - Case NHS Note Review NORTHUMBERLAND Study (CNRS) CCG STATION MEDICAL GROUP 2 Measuring quality of life in adults on NHS the autism NORTHUMBERLAND spectrum CCG STATION MEDICAL GROUP 1 The Adult Autism NHS Spectrum Cohort NORTHUMBERLAND - UK CCG STATION MEDICAL GROUP 1 NHS NORTHUMBERLAND DRN082 (DARE) CCG THE BONDGATE SURGERY 122 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND Evening CCG THE BONDGATE SURGERY 7 NHS NORTHUMBERLAND ARRISA-UK CCG THE BONDGATE SURGERY 4 The United Kingdom NHS Aneurysm Growth NORTHUMBERLAND Study CCG THE BONDGATE SURGERY 2 A study of common and rare genetic variants NHS associated with NORTHUMBERLAND thinness. CCG THE BONDGATE SURGERY 1 INjection versus SplinTing in Carpal Tunnel NHS Syndrome NORTHUMBERLAND (INSTinCTS) CCG THE BONDGATE SURGERY 1 NHS DRN082 (DARE) NORTHUMBERLAND THE GLENDALE SURGERY 27

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CCG NHS NORTHUMBERLAND ALL-HEART CCG THE GLENDALE SURGERY 7 NHS NORTHUMBERLAND ARRISA-UK CCG THE GLENDALE SURGERY 4 The United Kingdom NHS Aneurysm Growth NORTHUMBERLAND Study CCG THE GLENDALE SURGERY 1 NHS NORTHUMBERLAND DRN082 (DARE) CCG THE ROTHBURY PRACTICE 74 A study of common and rare genetic variants NHS associated with NORTHUMBERLAND thinness. CCG THE ROTHBURY PRACTICE 1 NHS NORTHUMBERLAND PATH-GP CCG THE ROTHBURY PRACTICE 1 Novel pulse device for NHS diagnosis of PAD NORTHUMBERLAND THE SELE MEDICAL (NOTEPAD) CCG PRACTICE 11 NHS NORTHUMBERLAND THE SELE MEDICAL BARACK D CCG PRACTICE 3 NHS NORTHUMBERLAND THE SELE MEDICAL GARFIELD CCG PRACTICE 3 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND THE SELE MEDICAL Evening CCG PRACTICE 1 NHS NORTHUMBERLAND THE SELE MEDICAL TWICS CCG PRACTICE 1 NHS NORTHUMBERLAND THE SELE MEDICAL CANDID CCG PRACTICE 1 The United Kingdom NHS Aneurysm Growth NORTHUMBERLAND THE SELE MEDICAL Study CCG PRACTICE 1 NHS NORTHUMBERLAND UNION BRAE & NORHAM DRN082 (DARE) CCG PRAC 29 TIME - Treatment NHS UNION BRAE & NORHAM in Morning Versus NORTHUMBERLAND PRAC 1

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Evening CCG NHS NORTHUMBERLAND WELCOME-GP CCG VILLAGE MEDICAL GROUP 70 NHS NORTHUMBERLAND DRN082 (DARE) CCG VILLAGE MEDICAL GROUP 24 NHS NORTHUMBERLAND ALL-HEART CCG VILLAGE MEDICAL GROUP 10 A study of common and rare genetic variants NHS associated with NORTHUMBERLAND thinness. CCG VILLAGE MEDICAL GROUP 7 Development of oral health initiatives to improve NHS glycaemic control NORTHUMBERLAND v1 CCG VILLAGE MEDICAL GROUP 5 NHS NORTHUMBERLAND ARRISA-UK CCG VILLAGE MEDICAL GROUP 3 NHS NORTHUMBERLAND PATH-GP CCG VILLAGE MEDICAL GROUP 1 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND Evening CCG VILLAGE MEDICAL GROUP 1 The United Kingdom NHS Aneurysm Growth NORTHUMBERLAND Study CCG VILLAGE MEDICAL GROUP 1 NHS NORTHUMBERLAND WATERLOO MEDICAL ALL-HEART CCG GROUP 5 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND WATERLOO MEDICAL Evening CCG GROUP 2 Molecular Genetics of Adverse Drug NHS Reactions NORTHUMBERLAND WATERLOO MEDICAL (MOLGEN) CCG GROUP 1 NHS NORTHUMBERLAND WELL CLOSE MEDICAL DRN082 (DARE) CCG GROUP 53 Helicobacter NHS WELL CLOSE MEDICAL Eradication NORTHUMBERLAND GROUP 17

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NHS Protect

Aspirin Trial CCG (HEAT) A study of common and rare genetic variants NHS associated with NORTHUMBERLAND WELL CLOSE MEDICAL thinness. CCG GROUP 3 Tele-First: telephone triage in general NHS practice - Version NORTHUMBERLAND 1 CCG WELLWAY MEDICAL GROUP 25 Helicobacter Eradication NHS Aspirin Trial NORTHUMBERLAND (HEAT) CCG WHITE MEDICAL GROUP 38 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND Evening CCG WHITE MEDICAL GROUP 5 Diabetes Remission NHS Clinical Trial NORTHUMBERLAND (DiRECT) CCG WHITE MEDICAL GROUP 1 TIME - Treatment NHS in Morning Versus NORTHUMBERLAND Evening CCG WIDDRINGTON SURGERY 1 Total Financial Year 2016/17 1306

South Tees CCG Study name CCG Name Practice Participants TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG ALBERT HOUSE CLINIC 1 NHS SOUTH TEES BENTLEY MEDICAL DRN082 (DARE) CCG PRACTICE 47 TIME - Treatment in Morning NHS SOUTH TEES BENTLEY MEDICAL Versus Evening CCG PRACTICE 1 TIME - Treatment BOROUGH ROAD & in Morning NHS SOUTH TEES NUNTHORPE MEDICAL Versus Evening CCG GROUP 1 The Million Women Study: Disease BOROUGH ROAD & Susceptibility in NHS SOUTH TEES NUNTHORPE MEDICAL Women CCG GROUP 1 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG BROTTON SURGERY 1

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NHS Protect

TIME - Treatment in Morning NHS SOUTH TEES CAMBRIDGE MEDICAL Versus Evening CCG GROUP 2 NHS SOUTH TEES CROSSFELL HEALTH CADPC-II v1 CCG CENTRE 1 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG HILLSIDE PRACTICE 9 ECASS - Evaluation of a Computer Aid for assessing Stomach NHS SOUTH TEES Symptoms CCG HILLSIDE PRACTICE 3 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG HUNTCLIFF SURGERY 1 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG MARSKE MEDICAL CENTRE 1 NHS SOUTH TEES MARTONSIDE MEDICAL OPAL CCG CENTRE 1 TIME - Treatment in Morning NHS SOUTH TEES NEWLANDS MEDICAL Versus Evening CCG CENTRE 2 TIME - Treatment in Morning NHS SOUTH TEES NORMANBY MEDICAL Versus Evening CCG CENTRE 1 The United Kingdom Aneurysm Growth NHS SOUTH TEES NORMANBY MEDICAL Study CCG CENTRE 1 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG PARKWAY MEDICAL CENTRE 1 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG SPRINGWOOD SURGERY 4 Comparison of ADR reports received via Yellow Card app NHS SOUTH TEES with casenotes CCG SPRINGWOOD SURGERY 1 ECASS - Evaluation of a Computer Aid for assessing Stomach NHS SOUTH TEES THE COATHAM ROAD Symptoms CCG SURGERY 10 TIME - Treatment NHS SOUTH TEES THE COATHAM ROAD 1

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NHS Protect in Morning CCG SURGERY Versus Evening Tele-First: telephone triage in general practice - Version NHS SOUTH TEES 1 CCG THE DISCOVERY PRACTICE 11 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG THE DISCOVERY PRACTICE 10 NHS SOUTH TEES DERM 5560 CCG THE DISCOVERY PRACTICE 3 ECASS - Evaluation of a Computer Aid for assessing Stomach NHS SOUTH TEES Symptoms CCG THE DISCOVERY PRACTICE 2 Tele-First: telephone triage in general practice - Version NHS SOUTH TEES 1 CCG THE ENDEAVOUR PRACTICE 33 Electronic intervention to reduce antibiotic prescribing NHS SOUTH TEES (eCRT2 Study) CCG THE ENDEAVOUR PRACTICE 1 The United Kingdom Aneurysm Growth NHS SOUTH TEES Study CCG THE ENDEAVOUR PRACTICE 1 The Million Women Study: Disease Susceptibility in NHS SOUTH TEES Women CCG THE ENDEAVOUR PRACTICE 1 NHS SOUTH TEES ALL-HEART CCG THE GARTH 9 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG THE GARTH 4 ECASS - Evaluation of a Computer Aid for assessing Stomach NHS SOUTH TEES THE GREEN HOUSE Symptoms CCG SURGERY 5 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG THE LINTHORPE SURGERY 1

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The United Kingdom Aneurysm Growth NHS SOUTH TEES Study CCG THE LINTHORPE SURGERY 1 ECASS - Evaluation of a Computer Aid for assessing Stomach NHS SOUTH TEES Symptoms CCG THE SALTSCAR SURGERY 19 NHS SOUTH TEES ALL-HEART CCG THE SALTSCAR SURGERY 13 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG THE SALTSCAR SURGERY 2 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG VILLAGE MEDICAL CENTRE 2 TIME - Treatment in Morning NHS SOUTH TEES WESTBOURNE MEDICAL Versus Evening CCG CENTRE 1 TIME - Treatment in Morning NHS SOUTH TEES WOODLANDS ROAD Versus Evening CCG SURGERY 1 TIME - Treatment in Morning NHS SOUTH TEES Versus Evening CCG WOODSIDE SURGERY 1 Total Financial Year 2016/17 212

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South Tyneside CCG

Study name CCG Name Practice Participants NHS SOUTH WELCOME-GP TYNESIDE CCG CENTRAL SURGERY 64 NHS SOUTH DRN082 (DARE) TYNESIDE CCG CENTRAL SURGERY 35 A study of common and rare genetic variants associated with NHS SOUTH thinness. TYNESIDE CCG CENTRAL SURGERY 7 TIME - Treatment in Morning Versus NHS SOUTH COLLIERY COURT MEDICAL Evening TYNESIDE CCG GROUP 1 Fluenz Tetra Enhanced Safety COMMUNITY Surveillance 2016 NHS SOUTH DERMATOLOGY CLEADON -17 TYNESIDE CCG PARK PCC 1 The United Kingdom Aneurysm Growth NHS SOUTH Study TYNESIDE CCG EAST WING PRACTICE 1 TIME - Treatment in Morning Versus NHS SOUTH Evening TYNESIDE CCG ELLISON VIEW SURGERY 3 The Adult Autism Spectrum Cohort - NHS SOUTH UK TYNESIDE CCG ELLISON VIEW SURGERY 1 TIME - Treatment in Morning Versus NHS SOUTH Evening TYNESIDE CCG FARNHAM MEDICAL CTR. 2 The United Kingdom Aneurysm Growth NHS SOUTH Study TYNESIDE CCG FARNHAM MEDICAL CTR. 1 Patient involvement in improving patient safety in primary NHS SOUTH care v1 TYNESIDE CCG IMEARY STREET PRACTICE 7 NHS SOUTH Flexi-Quest TYNESIDE CCG IMEARY STREET PRACTICE 1 TIME - Treatment in Morning Versus NHS SOUTH MARSDEN RD. HEALTH Evening TYNESIDE CCG CENTRE 24 The United Kingdom NHS SOUTH MARSDEN RD. HEALTH Aneurysm Growth TYNESIDE CCG CENTRE 1

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Study TIME - Treatment in Morning Versus NHS SOUTH Evening TYNESIDE CCG TALBOT MEDICAL CENTRE 1 TIME - Treatment in Morning Versus NHS SOUTH Evening TYNESIDE CCG THE G.P.SUITE 1 TIME - Treatment in Morning Versus NHS SOUTH Evening TYNESIDE CCG TRINITY MEDICAL CENTRE 1 NHS SOUTH VICTORIA MEDICAL DRN082 (DARE) TYNESIDE CCG CENTRE 16 Development of a preference-based outcome measure NHS SOUTH VICTORIA MEDICAL for Palliative Care TYNESIDE CCG CENTRE 2 A study of common and rare genetic variants associated with NHS SOUTH VICTORIA MEDICAL thinness. TYNESIDE CCG CENTRE 1 TIME - Treatment in Morning Versus NHS SOUTH Evening TYNESIDE CCG WAWN STREET SURGERY 2 NHS SOUTH DRN082 (DARE) TYNESIDE CCG WESTOE SURGERY 19 TIME - Treatment in Morning Versus NHS SOUTH Evening TYNESIDE CCG WHITBURN SURGERY 3 Total Financial Year 2016/17 195

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NHS Protect

Sunderland CCG

Study name CCG Name Practice Participants The United Kingdom Aneurysm Growth NHS SUNDERLAND ASHBURN MEDICAL Study CCG CENTRE 1 TIME - Treatment in Morning NHS SUNDERLAND BARMSTON MEDICAL Versus Evening CCG CENTRE 1 TIME - Treatment in Morning NHS SUNDERLAND CHURCH VIEW MEDICAL Versus Evening CCG CENTRE 4 TIME - Treatment in Morning NHS SUNDERLAND COLLIERY MEDICAL Versus Evening CCG GROUP 1 Molecular Genetics of Adverse Drug Reactions NHS SUNDERLAND CONCORD MEDICAL (MOLGEN) CCG PRACTICE 1 TIME - Treatment in Morning NHS SUNDERLAND DEERNESS PARK MEDICAL Versus Evening CCG GROUP 1 TIME - Treatment in Morning NHS SUNDERLAND Versus Evening CCG DR AKK HEGDE 1 The United Kingdom Aneurysm Growth NHS SUNDERLAND Study CCG DR AKK HEGDE 1 TIME - Treatment in Morning NHS SUNDERLAND Versus Evening CCG DR BRIGHAM & PARTNERS 1 NHS SUNDERLAND DR STEPHENSON & WELCOME-GP CCG PARTNERS 37 NHS SUNDERLAND DR STEPHENSON & GARFIELD CCG PARTNERS 2 TIME - Treatment in Morning NHS SUNDERLAND DR STEPHENSON & Versus Evening CCG PARTNERS 1 TIME - Treatment in Morning NHS SUNDERLAND FULWELL MEDICAL Versus Evening CCG CENTRE, 1 TIME - Treatment in Morning NHS SUNDERLAND Versus Evening CCG HAPPY HOUSE SURGERY 1 TIME - Treatment NHS SUNDERLAND HERRINGTON MEDICAL in Morning CCG CENTRE 1

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NHS Protect

Versus Evening Helicobacter Eradication Aspirin Trial NHS SUNDERLAND (HEAT) CCG HETTON GROUP PRACTICE 18 TIME - Treatment in Morning NHS SUNDERLAND Versus Evening CCG HETTON GROUP PRACTICE 2 NHS SUNDERLAND PATH-GP CCG HETTON GROUP PRACTICE 1 TIME - Treatment in Morning NHS SUNDERLAND HOUGHTON MEDICAL Versus Evening CCG GROUP, 2 TIME - Treatment in Morning NHS SUNDERLAND KEPIER MEDICAL Versus Evening CCG PRACTICE 1 TIME - Treatment in Morning NHS SUNDERLAND MILLFIELD MEDICAL Versus Evening CCG GROUP 1 The United Kingdom Aneurysm Growth NHS SUNDERLAND MILLFIELD MEDICAL Study CCG GROUP 1 TIME - Treatment in Morning NHS SUNDERLAND Versus Evening CCG NATHAN JR 1 The United Kingdom Aneurysm Growth NHS SUNDERLAND Study CCG NHS SUNDERLAND CCG 2 TIME - Treatment in Morning NHS SUNDERLAND Versus Evening CCG PALLION FAMILY PRACTICE 1 TIME - Treatment in Morning NHS SUNDERLAND RED HOUSE MEDICAL Versus Evening CCG CENTRE 1 The United Kingdom Aneurysm Growth NHS SUNDERLAND RED HOUSE MEDICAL Study CCG CENTRE 1 NHS SUNDERLAND RICKLETON MEDICAL ALL-HEART CCG CENTRE 4 Helicobacter Eradication Aspirin Trial NHS SUNDERLAND RICKLETON MEDICAL (HEAT) CCG CENTRE 3 Helicobacter Eradication Aspirin Trial NHS SUNDERLAND THE BROADWAY MEDICAL (HEAT) CCG PRACTICE 16

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NHS Protect

NHS SUNDERLAND THE BROADWAY MEDICAL DRN082 (DARE) CCG PRACTICE 16 The United Kingdom Aneurysm Growth NHS SUNDERLAND THE BROADWAY MEDICAL Study CCG PRACTICE 1 TIME - Treatment in Morning NHS SUNDERLAND Versus Evening CCG THE OLD FORGE SURGERY 1 Development of oral health initiatives to improve glycaemic control NHS SUNDERLAND VICTORIA MEDICAL v1 CCG PRACTICE 3 Total Financial Year 2016/17 131

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OFFICIAL

Report to: Governing Body

Date: 25.07.2017 Agenda item: 10.1

Title of report: 2017/18 Finance and Contracts Report Month 3 – June 2017

Sponsor: Jon Connolly - Chief Finance Officer

Author: Jeff Goldthorpe – Head of Finance

Purpose of the report and action required:

• The report details North Tyneside Clinical Commissioning Group’s financial position as at month 3.

• The Governing Body is requested to acknowledge and note the specific issues as set out in the executive summary.

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1. Executive Summary

1.1 Key Messages

• At Month 3 the CCG is forecasting an outturn surplus position of £2m which is consistent with the annual plan prepared by the CCG.

• For Month 3 financial reporting the CCG assumes that acute expenditure will be consistent with budgeted expenditure levels. Whilst we have some activity information, data inconsistencies generated by the recent cyber- attack mean that it is inappropriate to base year to date performance and forecast outturn on this information.

• Of the £12.2 efficiency savings target, a number of schemes began at the start of the year resulting in the delivery of £2.3m to Month 3. The CCG is forecasting to deliver an outturn £12.2m by 31 March 2018.

1.2 Overview

North Tyneside Clinical Commissioning Group (CCG) is required to deliver against a number of national and local financial targets as detailed in the Table 1 showing the forecast delivery against these targets.

Table 1 – Key financial targets Forecast Annual/ Year CCG Plan Delivery Delivery Metric To Date Metric Description of Metric Target £'m £'m against Rating (A/ YTD) plan £'m

To deliver a £2m surplus of revenue resource Financial Outturn A (2.0) (2.0) (2.0) limit over expenditure

To operate within the allocated CCG running Running Costs A 4.7 4.7 4.7 cost allowance

Reserves A To hold a 0.5% reserve 1.6 1.6 1.6

To fully deliver against a efficiency savings Efficiency Sdavings Plan A (12.2) (12.2) (12.2) target

The maximum amount to be left in the CCG Cash Limit A 0.50 0.50 0.50 bank account on close of play 31 March 2018

To ensure that 95% of invoices are paid within Better Payment Practice Code YTD 95% 95% 99.2% 30 days of receiving invoice

1.3 Context

The CCG reported a deficit position of £16.2m in the 2016/17 financial year resulting in an equivalent £16.2m allocation reduction in 2017/18. The CCG is planning to deliver a £2m in-year surplus in 17/18 which will reduce the brought forward deficit to £14.2m. To deliver the in-year surplus of £2m the CCG plans to deliver efficiency savings of £12.2m.

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2 Financial position

2.1 Summary Financial Position

The CCG is reporting a forecast outturn surplus of £2.0m, with a year to date surplus of £747k as shown in table 2 below.

Table 2 – Financial Position Annual YTD Forecast Forecast YTD Budget YTD Actual Budget Variance Outturn Variance £000's £000's £000's £000's £000's £000's

In Year Allocation 344,660 85,054 85,054 0 344,660 0

Healthcare Commissioned Services Northumbria contract 102,491 26,011 26,011 0 102,491 0 Newcastle contract 61,171 15,297 15,297 0 61,171 0 Other acute contracts 16,146 3,503 3,475 (28) 16,140 (6) Mental Health Services 24,732 6,183 6,151 (32) 24,751 19 Community Health Services 25,669 6,070 6,061 (9) 25,671 2 Continuing Care Services 21,968 5,492 5,521 30 22,086 118 Prescribing 37,406 9,351 9,354 3 37,417 11 Primary Care 32,075 8,134 8,121 (13) 32,080 5 Better Care Fund 9,497 2,374 2,374 0 9,497 0 Other Programme Services 2,285 571 574 3 2,297 12 Reserves - Mandated 4,727 396 396 (0) 4,727 0 Reserves - CCG (530) (84) (71) 13 (475) 55 Reserves - In Year Allocations 320 80 80 (0) 320 (0) 1617 Accruals Benefits 0 0 (214) (214) (214) (214) Healthcare Commissioned Services Total 337,957 83,378 83,130 (248) 337,957 0

Running Costs Total 4,703 1,176 1,176 0 4,703 (0)

Total Expenditure 342,660 84,554 84,306 (248) 342,660 0

In Year (Surplus)/Deficit (2,000) (500) (747) (247) (2,000) 0

2.1.1 Underlying position

At Month 3 the CCG is forecasting delivery of an underlying (recurring) surplus financial position of £2m for 2017/18.

2.1.2 Run rate

Table 3 – Run Rate Difference Pro Rata YTD Plan Spend Spend Difference Difference £m £m £m % Expenditure 337.22 342.66 5.44 0.02

If we extrapolate Month 3 expenditure across the remaining months of the year, the CCG would be expected to spend £5.44m less than plan as shown in table 3 above. This can be explained by the phasing of budgets. More costs are factored into the latter part of the year and as at Month 3 reported costs account for 24.6% of total expenditure as opposed to 25% if phased equally. In particular we hold reserves that we expect to be released later in the year.

2.2 Revenue Resource Limit

The initial revenue resource limits for the CCG are £313.5m for programme expenditure, £4.7m for running costs and £28.4 for the primary care delegated

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budget. At the end of June 2017 the allocations available to the CCG total £328.5m. Table 4 below details the baseline allocation and the year-to-date resource limit adjustments. The deficit of £16.2m that was incurred in 2016/17 has been deducted from the initial allocation. This is in line with NHS CCG accounting regulations that mandate that this has to be repaid in the following year.

Table 4 - Revenue Resource Limit Recurrent Non Recurrent Total

£000's £000's £000's April Initial CCG Programme Allocation 313,469 0 313,469

Initial CCG Running Cost Allocation 4,694 0 4,694

Newcastle Hospitals - Ambulatory Recoding 71 71

Newcastle Hospitals - block drugs disaggregation 721 721

Allocation adjustments of the drugs block in the Newcastle contract 2017-18 (126) (126)

IR Changes (1,366) (1,366)

HRG4+ changes (726) (726)

2017-18 Primary Care Delegated budget 28,426 28,426

Total NHS England Allocation April 2016 347,255 (2,092) 345,163

Surplus/Deficit Carry Forward - Planned (16,210) (16,210)

Surplus/Deficit Carry Forward - 1617 Final Outturn 19 19

CHC Risk Share Contribution (1,009) (1,009)

Primary Care Delegated - Clinical Waste budgets undelegated (57) (57)

Primary Care Delegated - Needles & Syringes budgets undelegated (25) (25)

Primary Care Delegated - Interpretation budgets undelegated (71) (71)

Reception and clerical training - (Training Care Navigators and Medical Assistants) 38 38

NHS WiFi 17 17

Market Rents - Admin adjustment 9 9

Market Rents - Programme adjustment 330 330

Paramedic Rebanding Additional Funding 2017-18 36 36

HSCN Funding 53 53

CYPT IAPT Trainee staff support costs 6 6

Adult IAPT Wave 1 108 108

Acute hospital urgent & emergency liaison mental health services 62 62

Total Funding as reported in June 2017 347,102 (18,633) 328,470

2.3 Acute Services - Northumbria Healthcare

The contract for Northumbria Healthcare Trust has been finalised and signed for 17/18 and is based on full National Tariff principles.

The detail below is based on Month 2 flex data submitted by the Trust. This has been overridden at total contract level due to the data quality issues following the cyber-attack. At a total contract level the position is reported at break even and the analysis below should be treated as indicative.

The following variances were reported at the month 2 flex position:

• A&E - Financial under performance against contract plan at Month 2 of £32k. The flex data is not fully coded so an estimate has been included for the true cost of Month 2 activity. This will be finalised when the freeze data is submitted and is therefore subject to change.

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Northumbria FT - 17/18 A&E Cumulative Activity compared to Plan 60,000 50,000 40,000 30,000 20,000 10,000 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

A&E 17/18 Plan A&E 17/18 Actuals

• Ambulatory Care is showing a large overspend year to date of £211k which is consistent with a switch from Non Elective Short Stay to Ambulatory Care.

• Elective activity is showing a financial over performance against contract plan at Month 2 of £88k and an activity under performance, which is due to an element of QIPP being assigned against the plan for elective activity. The main area of over performance are Musculoskeletal System (£60k), Haematology, Infectious Diseases, Poisoning and Non-Specific Groups (£34k) which are being offset by an under-performance against Digestive System (£91k).

• Maternity Pathways are showing an under performance against contract plan at Month 2 of £83k. This is mainly due to under performance against the antenatal pathway (£78k).

• Non Elective activity is showing a slight over performance against contract plan at Month 2 of £26k. QIPP of £140k has been assigned against the plan for Non Elective activity year to date. This is offset by an underperformance against Non Elective Short Stay as outlined above in the Ambulatory Care section. Currently, the main areas of over performance are Immunology, Infectious Diseases and

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other contacts with Health Services (£235k). This is being partially offset by an underperformance against Urinary Tract and Male Reproductive System (£194k).

2.4 Acute Services – Newcastle upon Tyne Hospitals Trust

The contract for Newcastle upon Tyne Hospitals Trust has been finalised and signed for 17/18 and is based on full National Tariff principles.

Again, the detail below is based on Month 2 flex data submitted by the Trust. This has been overridden at total contract level due to the data quality issues following the cyber attack. At a total contract level the position is reported at break even and the analysis below should be treated as indicative.

The following variances have been noted at month 2:

• Critical care £127k overspend. This has arisen due to a one-off long stay patient in May 2017.

• Elective Care £157k underspend. The majority of the underspend relates to a reduction in MSK activity.

Newcastle FT - 17/18 Elective Cumulative Activity compared to Plan 20,000

15,000

10,000

5,000

0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

EL 17/18 Plan EL 17/18 Actuals

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• Excess Beddays £102k underspend as a result of the level of uncoded data.

• Other Services £154k overspend

• Outpatient First and Follow Up £283k underspend. The main specialties where this is occurring are Neurosurgery, Paediatrics and Cardiology

2.5 Mental Health

The contract with Northumberland Tyne and Wear Foundation Trust is a block contract arrangement with a 0.1% cap. At Month 3 the budget shows a forecast outturn overspend of £19k.

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Table 5 - Northumberland, Tyne and Wear NHS FT Finance & Activity Month 2 Activity (YTD) £000s (YTD)

Plan Actual Variance Plan Actual Variance POD Summary Affective Disorders - Inpatients 0 63 63 0 11 11 Tyne - Villa 19 103 123 20 37 38 1 North East Drive Mobility 7 13 6 9 10 1 Northumberland Head Injuries Team 0 3 3 0 0 0 Walkergate Park Outpatients - Neuro Rehab Outpatients 32 0 (32) 4 0 (4) Walkergate Park Outpatients - Botulinum Spastisity 27 0 (27) 5 0 (5) Walkergate Park Outpatients - Botulinum Dystonia 83 153 70 31 43 12 CBT Centre 131 112 (19) 39 37 (2) Regional Disability Team 97 95 (2) 32 32 (0) Community Multiple Sclerosis 125 84 (41) 41 38 (2) Other 3,044 12,725 9,681 2,986 2,977 (9) Underlying Position 3,650 13,371 9,721 3,183 3,187 3 0.1% contract cap 0 0 0 0 0 0 Contract Month 2 Total 3,650 13,371 9,721 3,183 3,187 3

Estimate for Month 3 1,825 7,028 5,203 1,592 1,558 (33) Reported Month 3 Position 5,475 20,399 14,924 4,775 4,745 (30)

Non-NHS mental health spend predominately relates to jointly commissioned arrangements with North Tyneside Local Authority. These arrangements cover those patients that have been sectioned under Section 117 of the Mental Health Act (1983) and LD patients who require care to be provided out of area (OOA). Both areas are showing break even positions year to date and forecast outturn.

2.6 Community Services

The majority of community services are provided by Northumbria Healthcare Foundation Trust and Newcastle upon Tyne Hospitals Foundation Trust. Both contracts are block contracts and are breaking even year to date and forecasting a break even position at year end.

The largest element of non NHS community contracts are provided by Akari, Marie Curie and St Oswalds. The Akari and St Oswald’s contracts are forecasting overspends (£7k) whereas the Marie Curie contract is forecasting a slight underspend of 2k.

2.7 Continuing Health Care

The forecast outturn position for continuing health care (CHC) (which includes funded nursing care) shows an overspend of £131k. The overspend relates primarily to the requirement to expand the CHC case management team.

2.8 Primary Care Prescribing

In the absence of the Prescription Prescribing Authority financial profile the GP prescribing outturn position has been estimated to be in line with budget expectations.

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2.9 Primary Care

From 1 April 2017 the CCG has accepted joint responsibility for the management of primary care services. A budget of £28.3m has been delegated to the CCG by NHS England.

As at 30 June 2017 the budget is forecasting to underspend by £3k.

The remaining Primary care budgets include local enhanced services, out of hours, oxygen services and GP IT costs. These budgets are forecasting an overspend position of £8k.

2.10 Better Care Fund

The Better Care Fund is a pooled programme of expenditure which spans both health and local government. Its aim is to join up health and social care services so that people can live independently within their communities for as long as possible. This includes reablement services, carer’s breaks and the implementation of the Care Act. The health elements of the BCF remain within other CCG budgets.

The Better Care Fund is forecasting to break even in 2017/18.

The Section 75 agreement between North Tyneside Council and the CCG which governs the operation of the Better Care Fund has yet to be signed for 2017/18.

2.11 Reserves and Contingency

In line with NHSE requirements the CCG is holding a 0.5% contingency and a 1% non-recurring reserve. The contingency is available for the CCG to utilise during the financial year. 0.5% of the reserve must be held by the CCG during the financial year. The remaining 0.5% is available for the CCG to utilise to support non-recurring expenditure.

2.12 CCG Running costs

The CCG has an annual running cost allowance of £4.7m and is forecasting a break even position at 31 March 2018.

Table 6 – Running Cost Expenditure Annual YTD YTD Forecast Forecast Budget Budget YTD Actual Variance Outturn Variance £000's £000's £000's £000's £000's £000's Pay 2,572 643 643 0 2,572 0 Non Pay 552 138 138 0 552 0 NECS 1,579 395 395 0 1,579 0 TOTAL 4,703 1,176 1,176 0 4,703 0

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3. Cash

Table 7 outlines the CCG’s cash drawings and payments for April 2017 to June 2017.

Table 7 – Cash position to date Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast April May June July August September October November December January February March £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

Income Balance bfwd 123 104 291 260 119 211 61 160 115 109 81 66 DOH Income 27,400 26,700 27,300 25,000 26,200 23,900 23,400 25,300 23,000 23,400 25,300 22,000 Supplementary /Cash Return 0 0 0 0 0 0 0 0 0 0 0 0 Prescribing/Home Oxygen Therapy Charge to Cash Limit 2,755 3,086 2,781 3,075 3,247 3,124 3,105 3,092 3,010 3,115 3,154 3,207 CHC Risk Pool 0 0 0 0 0 0 0 0 0 0 0 0 Better Care Fund 0 0 0 0 0 0 0 0 0 0 0 0 Other Income 263 65 165 210 220 200 210 220 200 210 220 220 Total Income 30,541 29,955 30,537 28,545 29,786 27,435 26,776 28,772 26,325 26,834 28,755 25,493

Expenditure Pay (174) (178) (192) (150) (150) (150) (150) (150) (150) (150) (150) (150) NHS Payments including contracts (19,016) (20,396) (21,697) (19,103) (18,204) (18,151) (17,218) (17,156) (17,245) (17,212) (17,221) (19,799) Other Payments - BACS/CHAPS/CHQS (7,859) (5,293) (2,390) (5,300) (4,820) (5,290) (5,345) (5,105) (5,152) (5,478) (5,010) (1,628) Prescribing/Home Oxygen Therapy (2,755) (3,086) (2,781) (3,075) (3,247) (3,124) (3,105) (3,092) (3,010) (3,115) (3,154) (3,207) CHC Risk Pool 0 0 0 0 0 0 0 0 0 0 0 0 Better Care Fund (501) (501) (2,997) (501) (2,996) (501) (501) (2,996) (501) (501) (2,996) (501) Other (132) (210) (220) (297) (158) (158) (297) (158) (158) (297) (158) (158) Total Expenditure (30,437) (29,664) (30,277) (28,426) (29,575) (27,374) (26,616) (28,657) (26,216) (26,753) (28,689) (25,443) BALANCE CFWD 104 291 260 119 211 61 160 115 109 81 66 50

At the end of June 2017 the CCG holds a cash balance of £160k. At year end it is expected the CCG will meet the planned cash target of a minimum of £50k.

4. Better payments practice code

The better payments practice code stipulates that it is good practice to pay 95% of all invoices within 30 days of receipt of the invoice or goods, whichever is later. Table 8 details the number and value of invoices paid from 1 April to 30 June 2017 for both non NHS and NHS suppliers. The CCG has paid 99.2% of the total number of invoices which equates to 99.9% of the total value of invoices.

Table 8 – Better payments practice code Better Payment Practice Code - 30 Days NUMBER £000's

Non-NHS Total Non-NHS Trade Invoices Paid in the Year 1,693 20,237 Total Non-NHS Trade Invoices Paid Within 30 Day Target 1,681 20,171 Percentage of Non-NHS Trade Invoices Paid Within 30 Day Target 99.29% 99.68%

NHS Total NHS Trade Invoices Paid in the Year 440 60,664 Total NHS Trade Invoices Paid Within 30 Day Target 435 60,647 Percentage of NHS Trade Invoices Paid Within 30 Day Target 98.86% 99.97%

Total Total Trade Invoices Paid in the Year 2,133 80,900 Total Trade Invoices Paid Within 30 Day Target 2,116 80,818 Percentage of NHS Trade Invoices Paid Within 30 Day Target 99.20% 99.90%

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5. Statement of financial position

Table 9 shows the month 3 statement of financial position for the CCG.

Table 9 – Statement of Financial Position Jun-17 May-17 Movement £000's £000's £000's

Non Current Assets Property, plant and equipment 69 69 0 Intangible Assets 0 0 0 Other Financial Assets 0 0 0 Total Non Current Assets 69 69 0

Current Assets Trade and other Receivables 2,609 2,593 16 Prepayments & Accrued Income 3,358 (966) 4,324 Cash and cash equivalents 260 291 (31) Total Current Assets 6,227 1,918 4,309

Total Assets 6,296 1,987 4,309

Current Liabilities Trade and other payables (3,223) (6,450) 3,227 Accruals (17,537) (12,066) (5,471) Other liabilities 0 0 0 Provisions 0 0 0 Borrowings 0 0 0 Total Current Liabilities (20,760) (18,516) (2,244)

Non-Current Assets plus/less Net Current Assets/Liabilities (14,464) (16,529) 2,065

Non-Current liabilities Other liabilities 0 0 0 Provisions 0 0 0 Borrowings 0 0 0 Total Non-Current Liabilities 0 0 0

TOTAL ASSETS EMPLOYED (14,464) (16,529) 2,065

Financed by Taxpayers Equity

Capital & Reserves General Fund (14,464) (16,529) 2,065 Revaluation Reserve 0 0 0 Other reserves 0 0 0

TOTAL TAXPAYERS EQUITY (14,464) (16,529) 2,065

6. Efficiency Savings Plan

The financial plan for the year is based on the delivery of a £2m in year surplus. This control total is predicated on delivering £12.2m efficiency savings.

At month 3 it is forecast that £12.2m will be delivered during the financial year.

Table 10 Efficiency Savings Plan YTD Annual Forecast Forecast YTD Plan YTD Scheme Name Variance Plan Outturn Variance £000's £000s £000s £000's £000s £000s

Older People & People with Complex Needs 812 812 0 2,390 2,390 0 Prescribing 571 571 0 2,534 2,534 0 System Pathways 554 554 0 2,235 2,235 0 Transactional 333 333 0 3,701 3,701 0 Urgent Care Access 0 0 0 825 825 0 Primary Care Strategy 30 30 0 496 496 0 2,300 2,300 0 12,181 12,181 0

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7. Risks and mitigation strategies

Table 11 lays out potential risks and mitigations. The table shows that the CCG has sufficient mitigation to manage the current view of potential risk.

Table 11 - Financial risks

Risk Value £'m

Risks Acute SLA -4.08 MH SLA -0.03 QIPP underdelivery -1.82 Other Risks -0.02 Total Mitigations -5.95

Mitigations Contingency Held 1.58 Contract Reserves 4.37 Other mitigations 0.00 Total Mitigations 5.95

Net Risk 0.00

8. Recommendations

The Governing Body are asked to acknowledge the contents of this report.

Report authors: Jeff Goldthorpe – Head of Finance

Report date: 18 July 2017

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Governance and Compliance

1. Links to corporate objectives

2017/18 corporate objectives Item links to objectives √ 1. Commission high quality care for patients, that is safe, value for money and in line with the NHS Constitution 2. Deliver the Financial Recovery Plan, leading to the √ achievement of the CCG’s statutory financial duties and future sustainability 3. Work collaboratively with partners and stakeholders to develop health and social care fit for the future in North Tyneside 4. Continue to develop North Tyneside CCG as a patient focused, clinically led commissioning organisation with a continuous learning culture

2. Consultation and engagement

Not applicable

3. Resource implications

The CCG has a revenue resource limit, and expenditure needs to be managed within this, however the CCG is reporting a £19.3m deficit.

4. Risks

Refer to section 7.

5. Equality assessment

Not applicable.

6. Environment and sustainability assessment

Not applicable.

Official

Report to: Governing Body Date: 25 July 2017 Agenda item: 11.1 Title of report: Commissioning Priority Areas 2017/18 Sponsor: John Wicks, Interim Director of Commissioning & Contracting Author: Anya Paradis, Head of Planning & Commissioning Purpose of the report and action required: This report is for information on the CCG’s Commissioning Priority Areas for 2017/18 and to seek comment Executive summary:

The attached document describes our draft Commissioning Priority Areas for 2017/18, which both builds on the progress we have made to date in implementation of our previous Five Year Strategic Plan 2014/15 to 2018/19, and also how we will fulfil our commissioning obligations as detailed in the Northumberland Tyne & Wear & North Durham Sustainability and Transformation Plan.

When developing our Commissioning Priority Areas 2017/18, we have taken into account how we will begin to address the 9 nationally identified “must dos” for as well as how we will progress on the national requirements to: • Close the health and wellbeing gap • Close the care and quality gap • Close the finance and efficiency gap

We also take into account our strategic vision and strategic priority themes for changing the health care system by 2020, working together with our partners, which remain as follows: • Keeping healthy, self care • Caring for people locally • Hospital when it is appropriate.

For 2017/18 onwards, financial recovery continues to be an area of primary focus. Decisions about our priorities and use of our resources will be governed by this, with all commissioning priorities considered against their potential contribution towards recovery, robustness and financial sustainability. The document itself does not detail financial information, focussing on quality improvements. Financial aspects of the commissioning priority areas are bound within the CCG’s Operational Plan and Financial Recovery Plan.

The Commissioning Priority Areas triangulate the STP requirements, the details included in the CCG Operational Plan 2017-2019 and the CCG Organisation Development Plan to provide a single, cohesive document.

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Official

Governance and Compliance

1. Links to corporate objectives

2017/18 corporate objectives Item links to objectives √ 1. Commission high quality care for patients, that is safe, √ value for money and in line with the NHS Constitution 2. Deliver the Financial Recovery Plan, leading to the √ achievement of the CCG’s statutory financial duties and future sustainability 3. Work collaboratively with partners and stakeholders to √ develop health and social care fit for the future in North Tyneside 4. Continue to develop North Tyneside CCG as a patient √ focused, clinically led commissioning organisation with a continuous learning culture

2. Consultation and engagement Feedback on the draft Commissioning Priority Areas have been gained from the CCG Patient Forum and has also been shared with Healthwatch. These comments will be taken into account in the final version. Once finalised, it will be published on the CCG web-site. This process was used for 2016/17 and satisfied Auditors requirements.

3. Resource implications There are no resource implications in relation to this paper although there are resource implications for the individual commissioning priority areas.

4. Risks This paper is to inform Governing Body on the CCG’s commissioning priority areas and to seek comment. There is no risk identified from this action.

5. Equality assessment Equality assessments would be undertaken as appropriate for each of the individual commissioning priority areas.

6. Environment and sustainability assessment There are no environmental or sustainability issues arising from this report.

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COMMISSIONING PRIORITY AREAS 2017/18

Commissioning Priority Areas 2017/18

1. Introduction

This document describes our draft Commissioning Priority Areas for 2017/18, which both builds on the progress we have made to date in implementation of our previous Five Year Strategic Plan 2014/15 to 2018/19, and also how we will fulfil our commissioning obligations as detailed in the Northumberland Tyne & Wear & North Durham Sustainability and Transformation Plan.

. Close the health and wellbeing gap . Close the care and quality gap . Close the finance and efficiency gap

When developing our Commissioning Priority Areas, the CCG has taken into account its local commissioning priorities in the challenging context of an increasingly elderly population, health inequalities and the CCG’s financial circumstances.

2. Sustainability & Transformation Plan Overview

“A place-based system ensuring that Northumberland, Tyne and Wear and North Durham is the best place for health and social care”

Our Northumberland, Tyne & Wear and North Durham (NTWND) vision builds upon existing work underway within each of our Local Health Economy areas (LHEs) and enables us to take a transformative approach to addressing the key challenges we face across the system. Our key aims for Health and Care by 2021 are to: • Experience levels of health and wellbeing outcomes comparable to the rest of the country and reduce inequalities across the NTWND STP footprint area • Ensure a vibrant Out of Hospital Sector that wraps itself around the needs of their registered patients and attracts and retains the workforce it needs • Maintain and improve the quality hospital and specialist care across our entire provider sector- delivering highest levels of quality on a 7-day basis

We mentioned above that the Northumberland, Tyne & Wear and North Durham STP wide framework for a future health and care model is based on an assessment of current re-design programmes within each Local Health Economy (LHE), including the North East Wide Vanguard Programmes. North Tyneside CCG and Northumberland CCG are working together to develop and deliver our LHE plan which, over 2017/18 and 2018/19, will have specific focus on:

• Continuing the development of the Northumberland ACO to allow the proof of concept of a PACS model supported by a new commissioning arrangement with the local authority to be fully tested and evaluated. The development of the ACO vanguard is hugely important for the NTWND STP and for colleagues looking at similar models across the country. It is important for this to continue to develop so that the benefits can be properly measured and the knowledge needed to spread the model wider learned.

• Exploring how Newcastle Gateshead CCG might support North Tyneside CCG with a joint management team across both CCGs, to give consistent and strong leadership whilst focusing on immediate financial recovery.

• Continuing to support Northumbria Healthcare NHS FT and Northumberland, Tyne and Wear NHS FT to deliver outstanding care whilst ensuring the former can deliver 7 day services as a key part of acute care provision for the wider North of Tyne population centre

From 2019/20 onwards we will look to identify the most appropriate care model for North Tyneside by assessing the options presented by a mature ACO arrangement in Northumberland and the model of care identified for the population

3. Overview of Commissioning Priority Areas

This document describes our current Commissioning priorities, which have several elements: • How we will help deliver the STP Priorities • How we will help deliver our LHE priorities • How we will address our current financial challenges • How we will continue to ensure the highest quality healthcare in North Tyneside.

Our Commissioning Priority Areas were re-orientated for 2016/17 to address our financial challenges. For 2017/18 onwards, financial recovery continues to be an area of primary focus. Decisions about our priorities and use of our resources will be governed by this, with all commissioning priorities considered against their potential contribution towards recovery, robustness and financial sustainability.

As an organisation we are continuing to stabilise the financial situation, whilst mitigating clinical and financial risk, and building resilience to realise service transformation and longer-term delivery of our statutory duties.

Much of the work already started in North Tyneside is addressing the key priorities of the national planning guidance, the NHS Five Year Forward View, published in October 2014 and the Forward View into Action: Planning for 2015/16, published by NHS England in December 2014. We are also working with key partners to implement the requirements of the Mental Health Forward View and the GP Forward View. We are already progressing the development of a local approach towards integrated services for older people, and reshaping primary care to meet future demand. Improving and developing the integration of health and social care is also an important cross cutting priority for both the CCG and Local Authority.

Our strategic vision is supported by ambitious plans to change the way that care is delivered by 2020. The schematic and text below summarises our strategic priority themes for changing the health care system by 2020, working together with our partners, as follows: • Keeping healthy, self care • Caring for people locally • Hospital when it is appropriate.

Improving and developing the integration of health and social care is also an important cross cutting priority for both the CCG and Local Authority.

Commissioning Initiative Summary Impact & Outcomes Priority area

Strategic Theme - Keeping healthy, self care High quality Reduce We intend to introduce or reinforce a range of initiatives aimed at Reduce smoking prevalence rates affordable health smoking reducing smoking prevalence. These initiatives are being to 13% by 2020 care prevalence implemented on a region-wide basis, across the Sustainability & rates transformation Plan footprint. 7500 less smokers in North Tyneside by 2020 • Work with Northumbria Healthcare Trust to establish a smoke free NHS and build this into contracting and Improved health and wellbeing at a procurement processes population level • Proactively work with staff providing healthcare interventions so that smoking is not perceived as a lifestyle Reduced smoking related mortality choice and is understood to be “tobacco dependency and morbidity which is a chronic and relapsing condition” • Implement “stop before you op” for all elective procedures Lower demand on primary and • Continue to monitor the stop smoking in pregnancy secondary care pathway • Provide 50% of smokers a Very Brief Advice intervention Improved outcomes following in primary care elective surgery. Reduced bed day • Make use of the new clinical navigator role and establish usage & readmissions facilitated/active referrals from primary care to stop smoking services Potential to make savings on • Review the current respiratory pathways with the aim to reduced demand on inhalers (short identify opportunities to support and enable patients to term) and costs associated with stop smoking and/or reduce the impact of second hand treating cancer (longer term) smoke (smoke free house) • Review stop smoking provision for patients with a mental health provision • Identify evidence based self-help stop smoking resources

Commissioning Initiative Summary Impact & Outcomes Priority area for smokers and provide support to hose patients who opt to use web-based and stop smoking apps rather than a formal stop smoking service. • Evaluate the above and consider how to roll into following years High quality Diabetes Key actions for 2017/18 include: Increased identification of patients affordable health Prevention • Develop a Sustainability & Transformation Plan wide with a high risk of developing type care submission to the national Diabetes Prevention 2 diabetes Programme (NDPP) – wave 3 • Map out current provision and identify opportunities for Lower type 2 diabetes prevalence current provision to complement the NDPP as a result of providing appropriate • Provide evidence based interventions that will support and timely interventions to reduce those at high risk of developing type 2 diabetes in reducing the risk of developing type 2 their level of risk e.g. weight management and physical diabetes activity programmes. • Use the NHS health checks programme as an effective Lower level of adult obesity in way to identify those at risk of developing type 2 diabetes North Tyneside and develop local systems to refer patients into the NDPP. Reduction in demand on primary and secondary care associated with the ongoing management of type 2 diabetes

High quality Alcohol During 2017/18, in line with the Sustainability & Transformation Reduction in the number of alcohol affordable health Plan, we will begin to implement the following initiatives: attributable admissions care • Deliver alcohol identification and brief advice (IBA) in NHS Reduction in alcohol related harm settings in primary and secondary care as well as in other public sector organisations • Review alcohol hospital teams Commissioning Initiative Summary Impact & Outcomes Priority area • Engage within the NHS about the impact of alcohol, utilising planned social marketing campaigns • Standardise pathways for the management of alcohol dependency between acute and community settings. • Evaluate the above and consider how to roll into future years

High quality Health At Work Promote the Better Health at Work programme Healthy, productive workforce with affordable health reduce sickness absence care • Encourage every GP practice to work within the scheme • Support the work of Northumbria Healthcare Foundation Reduce NHS Trusts sickness Trust as an exemplar pilot project for promoting the health absence rates to 3.8% by 2021 of the NHS workforce Supporting the long term unemployed back to work, particularly those with mental health and MSK problems

High quality Up-Scaling Key actions for 2017/18 include: A regional approach that places affordable health Prevention Working with the STP prevention work stream and Public Health prevention within every aspect of care to implement the priorities within the agreed plan into the delivery the health and social care of health care in North Tyneside. To date, this Plan includes: infrastructure. • Smoking (which has already been identified separately) • Alcohol (which has already been identified separately) A health and social care delivery • Giving every child the best start in life model that prevents the known • Reducing the prevalence of excess weight in adults and causes of mortality and morbidity. children • Health at work (which has already been identified separately) Commissioning Initiative Summary Impact & Outcomes Priority area • Increasing flu immunisation rates amongst specific groups including; staff in primary and secondary care, staff in residential/care homes and amongst at risk groups. • Increase screening uptake rates and reduce the health inequality gaps in uptake at a practice level. • Increase of preventive spending across the health and care system • Development of community centred and asset based approaches to enhance self-care, increase independence, self-esteem and self-efficacy • Mandatory training for NHS staff in Making Every Contact Count • Develop a targeted prevention programme that includes tobacco and cancer awareness and deliver this in primary care. High quality Commitment to The North Tyneside Commitment to Carers Plan will build on the affordable health Carers success of the North Tyneside Adult Carers Strategy and the • Improvement of support care Young Carers Strategy. within primary care to identify and support young The Plan sets out how we intend to respond to the needs of all carers by use of the Key carers who regularly care for ill or disabled family members and Plan friends. Key priorities include: • To improve the health and wellbeing of all carers living in North Tyneside, and support them to have a life outside caring. • To actively promote open, honest working in co-production with carers.

Key actions for 17/18 include: • Learn from the outcome of use of NHS England’s self- Commissioning Initiative Summary Impact & Outcomes Priority area assessment tools to develop an Action Plan to address identified areas for improvement. • Ensure the CCG is better at involving patients and carers, and empowering them to manage and make decisions about their own care and treatment and; • Raise the profile of carers, including young carers and development of a specific Action Plan for Young Carers High quality Self- Commissioning requirements around self-care and self- • Reduced reliance on affordable health Management management are focussed on ensuring there is the appropriate hospital care care self-management tools and a “Menu of Choice” for patients. The • The right care at the right CCG and a sub-group of the Patient Forum continue to work on time in the right place promoting self-care across a range of areas. An overarching strategy is to be developed an agreed.

High quality Diabetes Structured education for patients with diabetes has been proven • More structured education affordable health Structured to prolong the period of time that patients stay and well and do availability in North care Education not require medication Tyneside • Improved self-management National Institute Clinical Excellence (NICE) Technology opportunities for patients Appraisal 60 states: “structured education is made available to all with diabetes people with diabetes at the time of initial diagnosis and then as • Reduced reliance on required on an ongoing basis, based on a formal, regular hospital care assessment of need.” The NHS Five Year Forward View also described the need to develop evidence based diabetes prevention programmes. The Sustainability & Transformation Plan (STP) for Northumberland Tyne and Wear and North Durham commits to rolling out the diabetes prevention programme, which includes the provision of education services around type 2 diabetes.

Commissioning Initiative Summary Impact & Outcomes Priority area As well as working on a regional basis to maximise national funding opportunities, the CCG will commission appropriate structured education (both provision of and administration of structured education) for people with diabetes to ensure quick, timely access, which we will do through existing NHS Procurement rules.

Strategic Priority - Caring for people locally Care for older Continuing There are a number of strands of work already in place to meet Commissioned packages of care people healthcare demographic changes in North Tyneside. These include will respond to assessed needs, (CHC) - quality development of a policy for Continuing Health Care (CHC), taking patient preferences into and value focussing on quality and value for money. We have also consideration in line with CCG commissioned a new service provider which will took during Policy and transparency and 2016. equality in relation to the care packages will be achieved Other work strands include: • Risk/gain share with the Local Authority In relation to quality of service • Proportionate fast track packages of care provision, the initiatives will: • Ensure all reviews up to date prioritising high cost cases • Provide ongoing assurance in • Review of all shared care cases relation to CHC assessment • Decommission excess block beds toolkit recommendations in • Outlier providers consistent approach to quality and cost order to promote equity • Pool budgets • Ensure providers meet the • Joint quality review in nursing homes service Key Performance Indicator thresholds and therefore patients are involved in the assessment process which will be timely and support transition to the most Commissioning Initiative Summary Impact & Outcomes Priority area appropriate care location • Ensure commitment to working with the Local Authority in an integrated way so that the care needs of people in North Tyneside are met and transition into CHC is a seamless process • Ensure existing commissioned providers to understand their contribution to care packages.

Care for Older Dementia The CCG currently has an early dementia diagnosis rate which Identification of service People diagnosis exceeds the national target of at least two-thirds of the estimated improvement areas with joint number of people with dementia. We are finalising a joint strategy responsibility established and a with North Tyneside Council on mental health services for older relevant Action Plan developed people, including dementia.

We will also review the work currently being undertaken by the Clinical Network and will use the information from this to help plan future commissioning intentions.

We remain committed to improving our early dementia diagnosis rate and are also considering options to improve post diagnostic support available to people in North Tyneside.

Commissioning Initiative Summary Impact & Outcomes Priority area Care for older Development of We will secure a more consistent service experience across Deliver service outputs, waiting people a single model North Tyneside for older people with mental health problems, times and patient outcomes to of mental health working with both current older people mental health providers to ensure that all older people with care for older effect this. mental health have timely and people across appropriate access to mental North Tyneside health provision.

Care for Older Intermediate A review of intermediate care services was completed in More community provision will be people Care February 2016. Recommendations from the review were available, enabling people to return considered and implemented. An intermediate care Mobilisation to their own homes appropriately Group has been established and Phase 1 of our intentions to and timely. provide a bed based community and home based treatment model is in place,

We are developing plans for Phase 2 of our intentions which will focus on further community based bed provision for medically stable patients with more complex needs.

Care for Older Falls The CCG will develop an action plan, working with key partners, Reduce the number of falls being People Minimisation to minimise the number of falls being experienced by people in experienced and prevent the harm North Tyneside. The Action Plan will describe what programmes caused by falls. will be available and will be evidence based. It will detail what needs to be provided and will include details of when Identify more patients at risk of improvements can expect to be seen and what impacts the Plan falls and provide evidence based will have. interventions to prevent falls.

Commissioning Initiative Summary Impact & Outcomes Priority area Provide evidence based interventions such as balance and strength training for those who have experienced a fall, with the aim to prevent second falls.

Lower number of emergency admissions due to falls. High quality Maternity We will continue to commission services which achieve high Maternity services in North affordable health Services outcomes for women and babies in North Tyneside in line with Tyneside will continue to meet care national guidance. national guidance and the expectations of the national The Northern England Clinical Networks Maternity Clinical maternity review. Advisory Group is leading on implementation of the national review of maternity services, Better Births, across the region. NHS North Tyneside CCG will continue to engage with this work and play its part in developing the local maternity system and implementing the outputs of the review. Recently, seven early adopter sites have been selected to spearhead this work, and our region will learn the lessons from these sites.

An Action Plan for the region, based on the review, is expected in October 2017.

High quality Realignment of Improving how community services work for patients is critical to • Improved outcomes for patients affordable health community making healthcare in North Tyneside more effective and efficient. with care delivered closer to care services We recognise that Community services, such as District Nursing home services and rehabilitation services, have the potential to provide • Realignment of service more effective care closer to home for the patient. We recognise provision in light of new service Commissioning Initiative Summary Impact & Outcomes Priority area that community services have historically developed and grown developments e.g. New models without the opportunity to review and realign in light of other of care developments.

We will review community services to assess impact and identify opportunities for realignment based on a number of other developments such as New Models of Primary Care and Referral Management Systems themes, both of which are described below in this document. This is to ensure streamlined service provision, maximise resources and eradicate duplication.

High quality Community We are continuing to work with Northumberland, Tyne and Wear • Significantly improved quality of affordable health based mental NHS Foundation Trust (NTWFT) to implement improved care for patients, with a care health services community mental health pathways. This is in recognition that the recovery focus from day 1 majority of the Trust’s resources have been directed towards • Enhanced skills of the inpatient services, accessible to a minority of patients. workforce with a doubling of patient facing time We are working with NTW Trust and other partners and key • Reduced reliance on inpatient stakeholders to review the existing community pathways to beds and resulting cost savings highlight what is working well and where further improvement is • Improved ways of working and needed. interfaces across providers, thereby minimising the risk of We expect that there will be minimal waiting lists, treatment inappropriate admissions or a packages will be evidence based and staff will be trained to “bouncing” around the deliver a broader range of NICE recommended interventions. healthcare system.

Also, the North Tyneside Mental Health Crisis Concordat Strategy Group continues to meet on a bi-monthly basis to review and update our Action Plan to prevent mental health crises.

Commissioning Initiative Summary Impact & Outcomes Priority area

High quality Eating The CCG is involved in regional work to review current • affordable Health Disorders community eating disorder services. This follows on from some Care local work to understand how the Tier 3 commissioned service currently operates. The CCGs are committed to working together to ensure that services meet the national standards for eating disorders and are efficient and effective, meeting the needs of patients.

High quality ADHD/Autism We are working with colleagues in other CCGs to review the • Improved transition pathway, affordable Health community ADHD & autism service which has been funded by eradicating delays and waits in Care the CCG aiming to ensure it has more community focus and the system integration with community mental health teams. We will also • Improved adult ADHD and review the transition arrangements from childrens to adult autism services, based in the services. community • Provision of specialist assessment hub

High quality Children & We are committed to continuing to work collaboratively with our A number of outcomes have been affordable Health Adolescent partners to commission mental health services for children and identified in the transformation Care Mental Health young people to ensure that their mental health needs have parity Plan which vary from project to Services of esteem with their physical health needs. Children and young project. people’s emotional health and wellbeing are a high priority in North Tyneside and the Youth Council is working to ensure that The CCG received national funding mental health education is improved. We are currently to effect the North Tyneside implementing our refreshed CAMHS Transformation Plan, Transformation Plan which has working in partnership with key stakeholders. Key features of our been allocated to specific projects, Transformation Plan are: described opposite. - Investment into Children & Young Peoples IAPT services to Commissioning Initiative Summary Impact & Outcomes Priority area ensure we achieve the national target of all areas being part of Children & Young Peoples IAPT by 2018. Staff in the North Tyneside service has undergone training during 2015/16 and further staff members will undergo training during 2016/17. Investment includes backfill funding for staff members to undergo the training. - Investment into eating disorder services at tier 3 level to offer direct clinical provision as well as ensuring pathways for children & young people requiring onward referral are as smooth as possible - Investment into development of information packs, social media apps etc for use by children & young people and schools. - Funding a research project into crisis services - Funding into crisis services - Development of improved access to CAMHS, including more evening appointments, reorganisation of MDT process, and introduction of self-referral in specific circumstances. - High quality Learning The Local Authority and North Tyneside CCG have established affordable Health Disabilities joint processes to enhance and/or integrate services that • Less reliance on hospital beds Care Services underpin living well in the community. • Greater focus on early intervention The North Tyneside Implementation plan for people with learning • Greater focus on crisis disabilities and/or autism takes in to account the STP planning prevention assumptions and the CCG will continue to work as part of the • Delivery of a sustainable regional Transformational Board on developing a system wide out outcome focused community of hospital care and allow people with complex learning model, which is affordable and disabilities to be appropriately and safely support closer to home. safe to use Commissioning Initiative Summary Impact & Outcomes Priority area

Priorities for the North Tyneside Integration Board for 17/18 include: Prevention of challenging behaviours - Requires early years support to family and child. Identifying triggers where possible, removing or managing the trigger or using desensitisation and positive behavioural support to minimise response; working closely with family, carer and school to adapt assessment and therapies as child develops; maximising communication tools for the individual to seek help and providers to understand when therapies are initiated or withdrawn.

Medication Influencing Mood: - Alternative intervention should be tried in a reasonable timescale before medication is introduced or increased. The CCG is working with NTW FT and Northumbria Healthcare on a medical optimisation programme to ensure patients and carers are involved in decision making about medication, its use and review.

Care Co-ordination and Pathways -This work will focus on three areas: . Prevention, community support and early intervention programmes. . Implementation of Positive Behaviour Support . Improve crisis support.

Joint Commissioning Framework- North Tyneside CCG and the Local Authority has developed a joint commissioning framework for a specialist list of providers in supporting those individuals with more challenging needs. Commissioning Initiative Summary Impact & Outcomes Priority area Work is progressing to further develop this framework with the aim of establishing joint commissioning arrangements and intentions.

Mortality Reviews - North Tyneside CCG is working with NTW and acute and community services in the undertaking of mortality reviews for people who are known to services as having a Learning Disability who have died. The aim of the reviews is to get a better understanding of the reasons and causes of death and to identify what opportunities can be developed in to better manage the health of this population group through informed education, reasonable adjustments and increased early interventions.

High quality Better Care The Better Care Fund remains an important vehicle for driving A revised Better Care Fund plan affordable Health Fund forward the integration agenda across Health and Social Care in for 2017/18 with funding aligned in Care North Tyneside. accordance with the minimum fund requirements. In our Better Care Fund Plan we are developing our aspiration to collectively design a North Tyneside system to address the broader determinants of health that affect people’s lives enabling change through joint commissioning, system redesign and joining up workforce capacity and capability to deliver against shared goals and ambitions.

Our Plan will be overseen by a Better Care Fund Partnership Board. We will review and realign our focus whilst continuing to achieve the national standards and requirements. A realignment of the existing Better Care Fund Plan will ensure we reflect the Commissioning Initiative Summary Impact & Outcomes Priority area North Tyneside transformation agenda and our new model of care recognising the vision and ambition outlined within our Sustainability and Transformation Plan.

The delivery chain, evidence base, agreed investment, and impact and success factors, outlined for each initiative in the Plan, will allow those initiatives to be adapted into realistic deliverable projects. They will contribute to the delivery of affordable contracts.

High quality Section 117 S117 mental health aftercare is a joint responsibility between the Patients will receive a care affordable Health Mental Health CCG and the Council. package suitable to meet their Care Act (mental needs and will have the care health after Following a mapping exercise and updates to the s117 Panel package reviewed at timely care) process, the CCG and Council continue to ensure timely case intervals to ensure their mental reviews of s117 cases and presentation of cases to the s117 health aftercare needs continue to Aftercare Panel. be appropriately met

The CCG and Council can be more certain that they are meeting their responsibilities under the Mental Health Act

High quality Implementation We are committed to delivering the Mental Health Five Year People who require access and affordable Health of Mental Health Forward View. treatment for those identified Care Forward View mental health services should be The Mental Health Integration Board which includes Public able to do so within national Health, North Tyneside Local Authority, NTWFT and NHCFT, as timescales. well as the CCG continues to meet bi-monthly. During 2016/17, Commissioning Initiative Summary Impact & Outcomes Priority area an adult mental health strategy was been developed and was signed off via the Health & Well-Being Board. An Action Plan is in the process of development which focuses on the areas highlighted in the strategy document and national priorities for adult mental health services.

Similar strategies are being developed by the CCG and Local Authority for older peoples mental health services and Children & Young Peoples Mental Health & Emotional Well-Being which will also be presented for agreement at the Health & Well-Being Board

High quality Expansion of North Tyneside has been selected as an Early Adopter site for • Increased number of trained affordable IAPT expansion of IAPT services to people with Long Term Conditions IAPT staff in the area healthcare and Medically Unexplained Symptoms. The CCG and • Increased access to IAPT Northumbria Healthcare are in the process of implementing this services service. Funding for this expansion is initially from national funds and the CCG and Trust are working together to identify future potential savings which are expected to fund the service in the future.

High quality Review liaison In North Tyneside, we commission Northumbria Healthcare to • Will meet national expectations affordable Health psychiatry provide a liaison psychiatry service for older people, based in for ED liaison psychiatry Care / Urgent Care services inpatient and rehabilitation wards at North Tyneside General • Reduction of admissions Hospital. We are closely monitoring the impact of this service and • Reduction of length of inpatient are seeing a reduction in the average length of stay for older stay people following intervention from the liaison psychiatry team. • Reduction in mental health assessment waiting times Commissioning Initiative Summary Impact & Outcomes Priority area A&E based liaison psychiatry is provided by Northumberland • Will ensure model(s) of Tyne & Wear Mental Health Trust and is based at The provision will meet patients Northumbria Hospital in Cramglington. During 2015, the North needs and will be based on Tyneside team and Northumberland team began working evaluation of the existing pilots together as one team • Parity of Esteem

Following a pilot of a 24/7 service. North Tyneside CCG has agreed additional funding to invest in the service to ensure it continues to operate on a 24/7 basis. Both North Tyneside and Northumberland CCGs are working with the Trust and Northumbria Healthcare NHS Trust to consider how it can move fully towards the national “Core 24” model which offers additional services to the current 24/7 service. A joint bid for national STP Transformation funds has been prepared and submitted to NHS England. We expect to hear the outcome of this around March 2017 and, if successful, the CCGs and Trusts will work together to agree an implementation Plan during 2017/18.

High quality Medicines Medicines Optimisation continues to be an important feature of • Ensure efficient use of our affordable Health Optimisation & the CCG’s planning intentions into 2017/18 and 2018/19, as it prescribing budgets within Care Prescribing has been in previous years. During the next two years, we intend our service transformation to undertake a number of initiatives as described below. proposals, enabling people to manage their health, We will: reduce the need for acute • Implement interventions to support optimal medicine taking intervention and maintain to enhance the quality of life and experience of care for independence. people with long term conditions • Be integral to and play a key • Reduce waste within the overall system through use of role in the development of a electronic prescribing and repeats systems and avoidable new paradigm of healthcare Commissioning Initiative Summary Impact & Outcomes Priority area waste in care homes, in line with the 5 year • Support the judicious use of antibiotics to appropriately Forward View manage infections and minimising the risk of the • development of healthcare acquired • Support local implementation of NICE clinical and technical guidance supporting the development of local integrated pathways and guidance, allied to effective horizon scanning.

High quality New model of New models of primary care are already being implemented in Over the period of May 2016 to affordable health primary care North Tyneside. Patients with multiple long term conditions are September 2016: care (Care Plus) offered an enhanced care package, based on wrapping services • admissions (a count of both around the patient, with a shift from reactivity to proactivity and elective and non-elective spells) prevention, rather than the patient being dictated to by current have reduced by 20% for the organisational arrangements. We call this the Care Plus model. patients within the service over the same period in 2015. North Tyneside New Models of Care (Care Plus) is a partnership • length of hospital stay has between Health services (Hospitals, community and GP reduced by 36% for the patients Practices), Social care and Age UK who will work together to within the service over the provide: same period in 2015. Coordinated proactive and reactive care for a stratified • outpatient appointments have population (4%) defined as severe or moderate on the frailty decreased slightly by 1% for the index. patients within the service over Core GMS sub contracted services for patients whilst registered the same period in 2015. within the service. • A&E attendances have reduced Promoting independence guided conversations and support via by 15% for the patients within Age UK the service over the same period in 2015. It is expected that Care Plus will free up capacity in primary care • an average of 5.8 per patient Commissioning Initiative Summary Impact & Outcomes Priority area as a result of caring for this cohort of patient in a different way. appointments have been dealt There is a compact with the practices involved who have agreed with by the Care Plus service. to target those patients with mild frailty in order to provide This equates to circa 1100 proactive interventions therefore delaying the need for more appointments being saved in specialist services and improving quality of life. In addition to this primary care. they will work together to explore mechanisms to deliver primary Potential to save 7329 GP care at scale and improve access. appointments if the target of 530 patients referred to the service is Care Plus continues to be developed and reviewed in North achieved. Tyneside. High Quality Primary Care We will implement the North Tyneside GP Forward View In • Improved sustainability and Affordable Forward View conjunction with the local GP Federation and Newcastle & North quality in General Practice. Healthcare Tyneside LMC. There are 3 components to our Strategy: • Improve access to General Practice 1. Redesigning Access to Primary Care • Ensure that resources match We propose a GP led clinical team with a mix of skills and patients needs and in the right disciplines utilising new technologies to manage patients who location need same day appointments, notionally available 8am-8pm 7 days per week. We believe that redesigning access in this way will both improve access to same day appointments in primary care as well as freeing up sufficient GP time to properly support those patients with more complex needs.

2. Extended Primary Care Team (EPCT) More complex care has moved out of hospitals and into primary care. The EPCT will enrich the team with a range of healthcare professionals of complementary disciplines, working together to deliver the best care for each patient, and free up GP time to do the things that only GPs can do – diagnosing the complex patient safely in the community. Commissioning Initiative Summary Impact & Outcomes Priority area

3. Integrating Specialist Support Many patients have multiple co-morbidities, and specialists need to bring their skills into the community, closer to patients, to support the primary care team to deliver whole-person healthcare. These specialists can continue to be employed by the hospital or any other provider, and provide mobile clinics and transfer of knowledge to healthcare professionals in the community. This is about joining up the care provided by professionals who support the same people. This will be achieved by shifting the care resources to manage the health and care needs of patients to the most appropriate location.

High Quality System-wide Rightcare is a system which uses data to identify areas of Quality improvements to identified Affordable Pathways variation in clinical services across the country. It is an enabler for services Healthcare Reviews CCGs to look at those areas of variation and using national and local data, to understand the reasons for the variation. Using this information, it can be used to identify opportunities to use robust clinical leadership to deliver sustainable service transformation and drive clinical change.

We will use RightCare methodology to identify areas of variation in North Tyneside and will develop a programme of review on those service areas which are identified as priority areas for North Tyneside. We have prioritised the following areas for improvement: . Musculo-skeletal . Respirtatory . Circulation . Gastrointestinal Commissioning Initiative Summary Impact & Outcomes Priority area . Cancer

We are working collaboratively with Northumberland CCG & Northumbria Healthcare NHS FT to develop change programmes and ensuring that we will use national support effectively to gain the maximum outcomes.

Care for older Enhanced care Around 80% of diabetes care is provided through self The aim will be to deliver high people/Urgent care for long term management. The CCG invests in the diabetes resource centre quality cost effective care, by conditions - based at North Tyneside General Hospital, and funds an shifting care outside of hospital. diabetes enhanced service in primary care to support care planning, and shared decision making and goal setting. In addition, there is We will have quicker access to the evidence that significant numbers of people with diabetes are DESMOND programme of receiving hospital care. structured education for patients with diabetes. Following an audit of the current services undertaken in 2015/16, we have identified ways that we will strengthen the pathway for We will have improved pathways to people with diabetes. access to the specialized Diabetic Resource Centre. We will: • Develop a new specification to describe the services provided at the Diabetic Resource Centre in North Tyneside, commissioned by the CCG • Review access to podiatry services for people with diabetes • Optimise any further funding opportunities for national funding for diabetes services

Care for older Cancer Following the work undertaken in 2016/17, we have identified key Improved use of tools that help Commissioning Initiative Summary Impact & Outcomes Priority area people/Urgent care survivorship priority areas. Our focus will be to: predict risk of admission by practices 1. Develop survivorship pathways which also compromises of a fully comprehensive Recovery Package based on the following Medium and long term measures principles: will apply from June through 15/16 • Risk stratification of Care – based on tumour type, treatment and 16/17 on improved care and personal circumstances. planning. • Health needs Assessment –everyone with cancer should be offered a Holistic Needs Assessment. • Personalised Care Plan – for all patients diagnosed, focussing on individual needs along with a treatment summary for the patient and those involved with their Care. Adopting the principles of the “Year of Care” model by putting patients in the driving seat of their care, supporting then to self-manage and allow for a constructive dialogue between the GP and the person living with cancer. • Information and Education – that enables choice and confidence to self-manage. • Remote monitoring – provision of safe, effective monitoring at a distance with timely interventions. • Care co-ordination – linked intrinsically with the care plan that aims to ensure the needs of the individual are met seamlessly across organisational boundaries.

2. Focus on self-management as early as possible after diagnosis for all cancer pathways. Taking to account local data on readmissions and premature deaths, North Tyneside CCG will initially focus on developing three new survivorship pathways for patients living with and beyond cancer. Activity will begin in 2017/18 to agree the priority for these actions Commissioning Initiative Summary Impact & Outcomes Priority area across breast, colorectal and prostate cancer. This will include a review of the feasibility of how to implement the clinical nurse specialists/key worker model as being delivered within the Long Term Conditions approach to care.

High Quality End of Life Care During 2016/17, North Tyneside CCG worked with Northumbria • Continued improvement of Affordable Healthcare, who are working with Marie Curie, to deliver a range responsive and expert Healthcare of expert care and support for people with complex, advanced support and care for people terminal illness, and their families. The recently commissioned with complex, advanced RAPID service aims to deliver a more responsive in hours and terminal illness and their out of hours at home service. families

We will continue to monitor the progress of this new initiative during 17/18. In addition, North Tyneside CCG will develop a plan to implement the recommendations set out North Tyneside CCG End of Life Strategy Achievements report (Feb 2016). This includes: • Working with GPs and support practices to increase percentage of North Tyneside Practice patients on the palliative care register to meet the national target. This will be achieved by proactive communications with GPs and users of the register evidencing how it is being used within practices. To undertake further Patient Voice/Unbiased User Surveys. • Maximizing our community assets – moving more beyond the medicalised forms of delivery engaging the community. • Working with stakeholders to embed the principles and messages around End of Life education. Commissioning Initiative Summary Impact & Outcomes Priority area • Reviewing Bereavement Services across all settings in North Tyneside ensuring that CCG managers cross reference current and future projects with regard to end of life. • Reviewing any projects relating to vulnerable and minority groups to ensure these people have equal access to services that support a ‘Good Death’. • Establishing a target for an increase in the reported 15.23% of palliative care patients who have an emergency health care plan (EHCP).

High quality Review There is an increasing over reliance on utilising community • Improved coordination affordable health Community services to facilitate discharge rather than avoid unnecessary between services care Services hospital contacts and a gradual redefining of criteria and • Focus on outcomes for boundaries which distances the community contract from wider patients community services rather than integrate and maximise the use • Improve contracts and of scarce resources. Also, there hasn’t been a review of what specifications for services existing services do or what we need them to do to be fit for the with greater incentives future. • System approach to care delivery Given the local and national NHS challenges, all services need to be agile and adapt to increasing demands and maximise the opportunities of working together to deliver optimum community services supported by technology and workforce changes as an enabler.

A combination of demographic changes, changes in how Public Health services are commissioned, the newly published GP Forward View and changes in responsibility for commissioning Commissioning Initiative Summary Impact & Outcomes Priority area GP services collectively provide an opportunity to commission fit for purpose community services in order to ensure sustainability in response to these changes.

NHS North Tyneside CCG now has an important opportunity to commission community services in a way that will support this shift to more co-ordinated care for patients closer to home.

• Move to new ways of working or new models of care that are better for patients with a focus on outcome delivery. • Test which providers are most likely to achieve the changes that commissioners want for patients to embrace a new “community services” delivery model • Move to new contracts that provide greater transparency and accountability for wider community services provision, as well as greater incentives for providers to improve services for patients. • Focus upon the population where the greatest need lies and provide a system approach to care delivery whilst maintaining universal services for other patients rather than a piecemeal approach to services.

Commissioning Initiative Summary Impact – Outcomes and Priority area Financial Contribution

Strategic Priority - Hospital when it’s appropriate Urgent care New model of The Right Care, Time & Place review of urgent care services By designing an urgent care model urgent care provides the CCG with an opportunity to create a local urgent that better meets the needs of care system which delivers the objectives set out in the Urgent & patients and the public outside of Emergency Care Strategy. In 2017/18 the CCG will commission hospital, it is anticipated that this a new integrated urgent care service for North Tyneside which will enable a more cost-effective will consist of: service to be delivered. The new • A single integrated urgent care centre providing 24/7 model will be implemented from access to urgent care services for the residents of North 2017/18 onwards. Tyneside • Assessment and streaming at the front door with patients We expect the outcomes of the being given the option of alternative appointment with a Right Care, Time & Place review to suitable primary care service be: • Booked appointments within the Centre available via NHS • Better patient outcomes and 111 experience • Seamless integration of in-hours and out-of-hours urgent • Improved access to urgent care care services services • The provision of a high quality, The CCG will support the Local A&E Board’s delivery of the 5 financially sustainable, urgent mandated improvement initiatives by; care service • Commissioning urgent and emergency care services • The implementation of an which include assessment and streaming as a core part ‘assess to admit’ based of the service specification approach to urgent care, with • Work with primary care to increase the accessibility and services which are designed to availability of primary care services for people with an direct patients to the most appropriate urgent care need. appropriate point of care • Continue to support the development of the regional • Greater integration of primary Clinical Hub and ensure that appropriate alliance and secondary care Commissioning Initiative Summary Impact – Outcomes and Priority area Financial Contribution arrangements are built into the specification of future • Better lateral integration service contracts. between urgent care, • Continue to develop and test ambulance crew protocols emergency care and specialist aimed at increasing the utilisation of local urgent care services services. • Less waste and duplication of • Continue to support the implementation of the SAFER services Bundle and Full Capacity Protocols for hospital sites with a Type 1 A&E facility. • Build on the success of the ‘discharge to assess’ pilot at North Tyneside General Hospital and bring this into mainstream practice during 2017/18.

Urgent care Alternatives to The CCG is continuing to enhance the Directory of Service By encouraging the use of urgent hospital care profile for community pharmacies in North Tyneside, working care services outside of hospital, with the Local Pharmacy Committee to do so. This will increase the aim will be to reduce the number of NHS 111 referrals to community pharmacy attendances at A&E and urgent services and reduce the volume of minor ailments activity being care centres. directed to urgent care centres, GP practices and GP Out of Hours services.

High quality Primary care “The Referral Management Scheme in North Tyneside aims to • Reduction in variation at affordable health quality and reduce variation in referral practice within primary care, resulting practice and locality level in care productivity in more effective management of referrals within primary care elective activity. schemes and savings from a reduced use of hospital services. • Reduction in elective activity • Reduction in spend on elective Practices will be supported to improve their understanding of activity Commissioning Initiative Summary Impact – Outcomes and Priority area Financial Contribution activity trends to implement improvement actions to help reduce • Improved quality of care in variation. primary care

The Referral Management Service and engagement with local GP practices to review variation in referral levels has supported local acute trusts to manage the increasing levels of demand experienced through local demographic change.

We will continue to review this work during 2017/18. High quality Procedures of Continued implementation of the North East wide value based affordable health limited clinical commissioning policy that details a number of procedures and care value the criteria under which they will be funded. We have agreed a two stage reform programme which is underway: • Stage one – focuses on primary care and aims to reduce the flow of patients into hospital for procedures which are considered of low clinical value and contained in the Value Based Commissioning Policy • Stage two – a process within secondary care to ensure only procedures that have an Individual Funding Request approval are undertaken by provider organisations.

High quality Musculoskeletal For the last few years, NHS North Tyneside Clinical The new service will deliver and affordable health Services Commissioning Group has been reviewing its model of pre- evidence the following key care Review hospital musculoskeletal (MSK) services – primary care outcomes: physiotherapy and Intermediate Musculoskeletal Assessment • Reduced referrals to and Treatment Teams (IMATTs) – and considering the best way orthopaedics and rheumatology to improve the situation. There were two separate providers of in secondary care. primary care physiotherapy and two separate providers of • Referrals to secondary care will IMATTs, supported by a separate provider of Magnetic have improved patient Commissioning Initiative Summary Impact – Outcomes and Priority area Financial Contribution Resonance Imaging (MRI). The clinical model could be information, including a referral significantly improved as the pathway was fragmented and letter detailing diagnostic tests confusing for both patients and referrers, and patients often and indication of diagnoses “bounced” around the system. NHS North Tyneside CCG’s eliminated if applicable. population was a significant outlier in terms of volumes of • Increased conversion rates for patients being referred for consultant opinion within secondary surgery. care. Developing an integrated pathway was the nationally and • Increased confidence in locally recognised change that would result in positive outcomes managing MSK conditions in for patient experience, quality and cost. primary care. • Evidence of patients self- During 2016, NHS North Tyneside CCG decided that the best managing their condition. way forward was to procure an integrated musculoskeletal service. An open procurement exercise was carried out, and the The biggest improvements are: successful bidder, Northumbria Healthcare NHS Foundation • integrated service / less Trust, has been working closely with the CCG to mobilise the “bouncing” around the system; service. The new service, North Tyneside Integrated • clearer access and route Musculoskeletal Service, went live from 1 January 2017. through to secondary care; • increased appointment

availability - Monday-Friday 8.30-5 / evenings / Saturday mornings; • reduced costs of the service High quality Specialised A transfer of responsibility to CCGs for some services which More locally commissioned affordable health Services were previously commissioned at a North-East level by the pathways and, potentially, care specialised commissioning team in NHS England is will take services. place during 2016/17. This includes bariatric surgery and specialised wheelchair services.

A number of actions will take place to determine the future commissioning of these services: Commissioning Initiative Summary Impact – Outcomes and Priority area Financial Contribution • Confirm which services are involved • Confirm allocation adjustments from NHS England to the CCG for those services involved • Undertake any required contract variations between NHS England, the CCG and providers • Undertake pathways impact assessment and work with providers to vary pathways as appropriate and agreed.

OFFICIAL

Report to: Governing Body Date: 25 July 2017 Agenda item: 13.1 Title of report: Risk Assurance Framework Sponsor: Lesley Young-Murphy, Executive Nurse and Chief Operating Officer Author: Irene Walker, Head of Governance Purpose of the report and action required: Governing Body is asked to review and receive the Risk Assurance Framework (RAF), with a particular focus on extreme and high risks. Executive summary: The Governing Body has overall responsibility for governance, assurance and management of risk. The Governing Body has a duty to assure itself that the organisation has properly identified the risks it faces and that it has controls in place to mitigate those risks to a level consistent with the CCG’s risk appetite and that appropriate assurances are in place.

The RAF is reviewed by the responsible committees (i.e. Finance Committee, Quality & Safety Committee and Clinical Executive Committee). Audit Committee then receives the RAF for review to enable it to provide assurance to Governing Body that risks are properly identified, assessed and effectively managed and that appropriate sources of assurance exist.

The RAF which is aligned to the corporate objectives is attached at Annex 1.

Action Governing Body is asked to receive and review the RAF with a particular focus on extreme and high risks (which are highlighted in the ‘Heat Map’ - Appendix 1 below).

Governance and Compliance

1. Links to corporate objectives

2017/18 corporate objectives Item links to objectives √ 1. Commission high quality care for patients, that is safe, value for √ money and in line with the NHS Constitution 2. Deliver the Financial Recovery Plan, leading to the √ achievement of the CCG’s statutory financial duties and future sustainability 3. Work collaboratively with partners and stakeholders to develop √ health and social care fit for the future in North Tyneside 4. Continue to develop North Tyneside CCG as a patient focused, √ clinically led commissioning organisation with a continuous learning culture

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OFFICIAL

2. Consultation and engagement The RAF is presented quarterly to Finance Committee, Quality & Safety Committee, Clinical Executive Committee and Audit Committee for consideration ahead of submission to Governing Body.

3. Resource implications The management of risk is continuous and inherent within day to day management of business.

4. Risks The risk of not identifying and managing risk effectively is failure to deliver statutory requirements and the CCG’s corporate objectives.

5. Equality assessment Consideration of equalities issues is inherent as part of the CCG assessing its risks.

6. Environment and sustainability assessment Consideration of environmental issues is inherent as part of the CCG assessing its risks.

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OFFICIAL Appendix 1 Risk Matrix Impact score

5 Likelihood 1 2 3 4

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

Target Risk Score Impact score

5 Likelihood 1 2 3 4 Catastrophic Negligible Minor Moderate Major

5 Almost Certain

4 Likely

3 Possible 543/539/540/560 188 189/538/541/544/

2 Unlikely 193 551/545/554/ 138/534/542 75/550/552/

1 Rare 559 536/558/535/ 557/

Residual Risk Score Impact score

5 Likelihood 1 2 3 4

Negligible Minor Moderate Major Catastrophic

5 Almost Certain

4 Likely 550/551/558/560 188/552/

3 Possible 543/539/540/193 536/545/554/ 557 75/189/538/541/

2 Unlikely 544/138/534/535/ 542

1 Rare 559

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NTCCG Risk Assurance Framework 2017-18 v2-0 Governing Body 25 July 2017 First LineSecond of Deferenc LineThird of LineDefen of Defence Gaps in Assurance Target Risk Score Risk Description Controls Detail Gaps in Controls Responsible Corporate Consequence Consequence Residual score Review date Corp Objective Risk Owner Strategic LikelihoodInitial score Assurance Likelihood Date enteredRisk Ref. Director Actions

C S

•CCG Constitution reflects NHS Constitution • No Primary Care Streaming • CCG Constitution on CCG website, subject to regular review • Inadequate assurance • Workstream to in A&E relating to ECIST action introduce Primary Care  plan Streaming in A&E by Oct 17 • Regular Provider performance management meetings • Notes of Provider performance management meetings •Assurance required from A&E Delivery  Board regarding delivery of ECIST report/action plan • Monthly performance reporting to Clinical Executive, with • Performance reporting to Clinical Executive and minutes of those  corrective actions identified and followed up meetings • Regular performance reports to Governing Body • Performance reports to Governing Body and minutes of those Risk of failure to clearly  meetings Performance & demonstrate compliance Chief Finance • Annual report of year-end performance against NHS Constitution • CCG Annual Report and Annual Public Meeting 02/05/2013 75 Commissioning S with NHS Constitution 4 44 4 16  4 2 8 05/09/2017 4 1 Officer targets Manager rights and pledges • Monthly performance reports to Commissioning, Performance • Internal Audit review of Performance Management NTC 1617/10 and Finance Committee, to align performance issues with gave significant assurance (issued Jan 17)  contracting discussion • NHS constitution measures included in the penalty schedule • Notes of Commissioning, Performance and Finance Meetings  within provider contracts • Independent review of NSECH by ECIP and resulting system • Penalty schedule - monthly  action plan. • North East wide improvement plan for NEAS focusing on • Successful Q2 16/17 assurance discussions with NHSE recruitment, demand functions and productivity. • ECIP Acton plan monitoring by QRG and Q&S 

• NEAS action plan monitoring by QRG and Q&S  • NTCCG is an active member of the formal control of infection • Agenda and notes of the control of infection partnership  partnership, covering Gateshead and North of the Tyne • HCAI is a standard agenda item for Quality Review Groups • Agenda and notes of Quality Review Groups  • Robust arrangements evidenced in FTs including FT Infection • CCG records of FT Infection Protection and Prevention Control Risk of inadequate Protection and Prevention Control meetings and HCAI Action meetings and HCAI Action Plans  procedures for Health Plans Care Acquired Infection • CCG has received and reviewed FT HCAI action plans; HCAI is • Agenda and notes of CCG Quality and Safety Committee and Executive Director Deputy Director of  (HCAI) resulting in a included in provider contract monitoring meetings Governing Body 20/05/2013 188 of Nursing & Chief Nursing, Quality & C 4 4 16 4 3 12 05/09/2017 12 1 patients contracting an • CCG HCAI action plan in place, approved by Quality and Safety • Quality and performance reports to Governing Body Operating Officer Safety  avoidable infection which Committee, refreshed as required could prove fatal • HCAI regularly reported to CCG Quality and Safety Committee, • Internal Audit review NTC 1516/13: Quality Assurance and escalated to Governing Body as required Improvement provided Significant Assurance with no issues of  note (issued March 2016) • HCAI included in quality and performance reports to Governing • Performance remains within trajectory.  Body • NECS producing weekly update reports • Standard NHS Contracts in place with NHS Providers - joint • Contract documentation - 2016/17 contracts are currently in the contract with local authority for domiciliary services & nursing process of being signed, and include quality standards  homes • Regular Provider performance management meetings • Notes of contract monitoring meetings  • CCG is an active member of the Quality Review Groups (QRG) • Notes of Quality Review Groups, received by Quality and Safety  Committee • Specific quality issues are actively performance managed (e.g. • Quality and performance reports to Quality and Safety ambulance handover delays) and reported to QRG and CCG Committee  Quality and Safety Committee, escalated as appropriate • Regular quality reports to Quality and Safety Committee and to • Minutes of Quality and Safety Committee and Governing Body  Governing Body • Quality issues in Nursing Homes and other CHC care settings • FT Quality Accounts are published and include CCG comments are actively monitored and reported to Quality and Safety  Committee • CCG sign off annual FT Quality Accounts • Quality of care in Nursing Homes subject of regular reports to   Executive Director Deputy Director of Risk of commissioning Quality and Safety Committee 20/05/2013 189 of Nursing & Chief Nursing, Quality & S services that are not of 4 4 16 • Working in partnership with Local Authority to monitor and • Quality of care for people with learning disabilities subject of 4 2 8 05/09/2017 8 1 improve quality of care in Nursing Homes regular reports to Quality and Safety Committee, Clinical Executive Operating Officer Safety sufficiently high quality.   and Governing Body, including progress on 'transforming services'

• Working in partnership with Local Authority to monitor and • Systematic approach to capturing soft intelligence includes the improve quality of services to people with learning disabilities, patient forum (minute and reported to Governing Body), SIRMS including implementing the national programme of work on (information collated and reported to Q&S committee), Practice   'transforming services' nurse forum (notes), feedback from complaints and MP letters (reported to Q&S committee) • Structured approach to capturing and acting on soft intelligence • Internal Audit review NTC 1516/13: Quality Assurance and Improvement provided Significant Assurance with no issues of  note (issued March 2016) • Programme of announced and unannounced visits to all • CQC inspection reports  providers arranged • Serious Incident (SI) review panels  • Internal Audit of Serious Incidents NT1617/03 substantial assurance (August 2016) 

• Quality and Safety Committee has a robust programme of work • Q&S cycle of business, agenda, papers and minutes of Q&S   to maintain a focus on quality of services meetings • Q&S committee provide regular reports to the Governing Body, • Q&S written and verbal reports to Governing Body meetings  providing assurance on quality matters

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First LineSecond of Deferenc LineThird of LineDefen of Defence Gaps in Assurance Target Risk Score Risk Description Controls Detail Gaps in Controls Responsible Corporate Consequence Consequence Residual score Review date Corp Objective Risk Owner Strategic LikelihoodInitial score Assurance Likelihood Date enteredRisk Ref. Director Actions

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• CCG is an active participant in Quality Review Groups, • Minutes of QRGs, Safeguarding Boards, CHC panels, Health Safeguarding Boards and other formal and informal quality fora, Care Acquired Infection committee, Medicines Optimisation   continuing to give this work a high priority committee • Executive Director of Nursing and Transformation and Medical • Role descriptions in CCG Constitution and Job Descriptions for Director have a continuing commitment to maintaining and where Executive Director of Nursing and Transformation and Medical  possible improving quality of services Director • In the FRP, QIPP schemes are subject to a Quality Impact • Completed Quality Impact Assessments for QIPP schemes and Assessment, with an escalation process in place where concerns follow up actions  are raised about quality issues • Completion of a Quality Impact Assessment (QIA) for every QIPP • Internal Audit of NTC 1516/13: Quality Assurance and Risk of unexpected and  Project. Improvement gave significant assurance (issued March 16) Executive Director Deputy Director of unacceptable decline in • PoaP for each QIPP project is signed off by Clinical Sponsor and • QIAs to be reviewed and agreed by two of following; Deputy 16/11/2015 538 of Nursing & Chief Nursing, Quality & C quality of services due to 4 4 16 4 2 8 05/09/2017 8 1 Executive Director Director of Nursing, Quality and Patient Safety, Executive Director Operating Officer Safety focus on Financial of Nursing and Transformation, Medical Director. Recovery Plan



• Permanent Chief Finance Officer appointed

• CCG Governing Body, Clinical Executive and other key • Agenda, papers and minutes of CCG Governing Body, Clinical committees balance the imperative to deliver financial recovery Executive, Finance Committee and other key committees   alongside longer term sustainable health and social care services

• CCG meetings with NHS England Team consider both immediate • Notes and action plans from CCG monthly meetings with NHS Risk of short term issues, forecast end of year position and development of medium England Team   Director of finance pressures term plans 16/11/2015 541 Chief Officer Contracting & C overriding the need to 4 4 16 • CCG programme of work focused on service transformation, with • CCG work programme and QIPP project plans 4 2 8 05/09/2017 8 1 Commissioning deliver sustainable QIPP projects contributing to enhanced quality as well as financial  solutions recovery • 2 year financial plan in place. Plan to deliver underlying financial • CCG commissioning plans  balance by end of 17/18 • Agreement of Intermediate Care Model though Clinical Executive  and Older People's Board • Internal Audit QIPP Assurance NTC1617/09 - substantial  assurance

• CCG employs professional staff with knowledge of DoL • Safeguarding Teams have briefed the Head of Patient Safety regulations and developing DoL case law and the Executive Nurse 

• CCG staff aware of patient group who are the responsibility of the • Reports to Safeguarding Committee and to Quality and Safety  CCG who may require a DoL assessment Committee Risk of inadequate • Process for checking which patients have had or who need a • Local action plans implementation of DoL assessment and who have or who need a court of protection  Executive Director Deputy Director of 'Deprivation of Liberty' order (including Orders that have expired or are about to expire) 19/11/2015 543 of Nursing & Chief Nursing, Quality & C (DoL) criteria leading to 3 4 12 • Detailed plans being put in place to ensure relevant court • Process for identifying need for DoLs assessor, job description, 3 3 9 05/09/2017 9 1  Operating Officer Safety the required Court applications are made recruitment and selection process Orders not being in place • The financial impact on the CCG (e.g. the cost of the Court • DoL Assessments included in new CHC specification with Local  as required application and associated legal fees) is being calculated Authority • Staff attended MCA/DoLs seminar on 24/5/16 at Ward Hadaway to clarify CCG responsibilities • CCG staff have requested a list of CHC patients living at home from NECs - now received (updated 6/7/16) • Patients who require DoLS identified at panel on 6.7.16

• Adult Safeguarding Board and Local Children Safeguarding • Minutes of Adult & children Safeguarding Board; Minutes of  Boards in place; CCG an active member LSCB • Regular performance reports to the CCG from NHS Providers to • Designated Professionals Job Descriptions and work plans confirm and evidence that they have robust safeguarding  arrangements in place • Expertise of designated health professionals and named GP • Policies in place, on the CCG website and reviewed as  appropriate • Child and Adult Safeguarding Policies in place (revised • CCG annual report and Governing Body records  November 2015); CCG staff up to date with Safeguarding training • Governing Body provided with Prevent and Safeguarding training • SI policy documents and notes of SI closedown panels  • Serious Incident Management system in place, compliant with • Verbal report to Governing Body  NHS England framework • Quality and Safety Committee receive regular reports on serious • Monthly report to Quality and Safety Committee.  incidents and safeguarding issues)

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• Governing Body receive regular reports on safeguarding issues • Internal Audit review of Safeguarding NTC 1617 - 04 resulted in  Head of substantial assurance (issued November 2016) Safeguarding: • CCG has been rated as fully compliant with all KLOE/Standards Designated Nurse Risk of adult or child  Executive Director set out in the NHS benchmarking/assurance tool 06/04/2016 Safeguarding safeguarding incident or 21/05/2013 544 of Nursing & Chief S 4 4 16 • Internal Audit of Serious Incidents NT1617/03 substantial 4 2 8 05/09/2017 8 1 Children/Deputy other significant quality Operating Officer assurance (August 2016) Director of failure incident Nursing, Quality & Safety



Risk that the transfer of • SLA with Local Authority • Regular reports to Quality & Safety Committee • Outstanding legacy • CCG to hold NECS to the CHC financial  issues with NECS account for the delivery assurance process to the against plan Local Authority results in • Daily transition calls • Monthly finance reports re trajectory  a breach of targets. • CHC Policy in place •Deputy Director of Nursing, Quality and Patient Safety on CHC Risk is closed as LA is Panel. meeting targets and target risk score is 548 Executive Director Deputy Director of reached. 10/05/2016 of Nursing & Chief Nursing, Quality & C 4 4 16 4 2 8 05/09/2017 8 1 •Robust governance process. Operating Officer Safety • Contract monitoring meetings • Monthly CHC performance monitoring meeting • Gainshare arrangement in place to assist in achievement of financial target. • NECS Transition Plan • Invoices for CHC exceeding £700 (week)are referred to CCG for authorisation

Risk that the delay in • NHS England has issued a SOP to all practices Gaps in control fall to NHSE • Updates from NHS England • Process is not working • Continue to embed Primary Care Support as anticipated following process England Services:  delays Executive - Primary care records Executive Director Director of delayed transfer 09/06/2016 550 of Nursing & Chief C 4 4 16 4 4 16 05/09/2017 4 1 Nursing & Chief - Delay in receiving Operating Officer • Monitored by Primary Care Board (Joint between CCG and • Reduction in negative reports from GPs • Monitor via practices Operating Officer medical supplies causes  NHSE) delays in treatment and • Minutes of Primary Care Board • Continue to raise to safeguarding incidents   NHSE

• Transition plans in place • Operational meeting minutes • Assurance relating to a Review performance of specific Nursing Home nursing home in  which is in safeguarding safeguarding

Intermediate Care - level • Model previously signed off by CCG, NHCFT and LA • Assurance meeting minutes of system resilience, Executive Executive Director delayed discharges, and  Director of 04/08/2016 551 of Nursing & Chief C not realising their 4 4 16 4 4 16 05/09/2017 8 1 Nursing & Chief Operating Officer potential for Operating Officer rehabilitation. • Part of older people's board • Operational team • Assurance and Operational meetings in place to monitor progress • System Risk Register in place • Detailed operational plan and service specifications developed

• Regular director level meetings with NHCFT and NEAS No Primary Care Streaming in • Daily updates on delays and diverts from NESCH • Inadequate assurance • Workstream to A&E relating to ECIST action introduce Primary Care  plan Streaming in A&E by Oct 17 • Action plans developed and implemented • Daily updates fed up to director level meetings and NHSE Assurance required from A&E Delivery  Board regarding delivery of ECIST Risk that delayed report/action plan ambulance handovers

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ambulance handovers Director of • ECIST (national expert team for urgent care) appointed to review • Regular reports to Quality & Safety Committee Commissioning impacts negatively on 04/08/2016 552 Contracting & C 4 5 20 NSECH process and recommend improvements - report supplied 4 3 12 05/09/2017 4 1 Manager patient safety and patient Commissioning Dec 16. flow. 

• Local A&E Delivery Board overseeing response to ECIST report.

• CCG working collaboratively with Northumberland CCG to reduce walk in activity at NSECH to increase capacity for ambulance conveyed patients.

• Experienced Deputy Director of Nursing, Quality & Safety leading • Capacity to enable CHC to • Regular reports against delivery of transition plan • Results of Internal Audit • Design of in house

arrangements for the transfer of CHC administration back in house be managed in house  of CHC 16/17 due services completion March 17 • Transition plan in place to ensure smooth transition of CHC • Design of in house • Recruitment to administration back in house arrangements and structure provide capacity to enable CHC to be managed in house Risk that CHC payments • Regular meetings with LA during transition • Communication with • Communication plan may be interrupted as a stakeholders developed so that result of LA giving 7 stakeholders are aware Executive Director Deputy Director of weeks notice on the of changed 16/02/2017 555 of Nursing & Chief Nursing, Quality & C 4 4 16 4 1 4 05/09/2017 4 1 contract, impacting on arrangements Operating Officer Safety the delivery of CHC • Continuous oversight of transition arrangements by the Executive • Monitoring • Reports to Quality & provision Director of Nursing & Transformation Safety Committee of the status and management of the risk Risk Closed as LA has withdrawn notice. Residual risk score therefore changed from 12 to 4.

• Key stakeholders engaged in the planning and delivery of New New revised model requires • New Models of Care Project Board in place, inclusive of key Obtain activity data Models of Care, including Foundation Trusts, LA, Healthwatch, testing to ensure delivery of stakeholders, reports to North Tyneside Integration Board. from Care Plus to Patient Forum and LMC logic outcomes  enable monitoring and testing

• Council of Practices, as key clinical decision making CCG • Patient Forum involved in design of New Models of Care, committee, committed to this development and the clinical benefits informing its development and enhancing understanding of and its will bring commitment to 

Risk of not being able to implement New Models • Clinical Blueprint clearly set out and articulated • Council of Practices briefed and involved; this discussion  Executive Director Primary Care of Care (now Care Plus), minuted 12/09/2014 536 of Nursing & Chief Development C with the consequent risk 4 4 16 • Programme of work to included phased implementation, to • Clinical Blueprint facilitated by NHS IQ complete 4 3 12 15/09/2017 4 2  Operating Officer Manager of services not being fit enable continuous learning and improvement to meet the needs of the • Expected benefits of New Models of Care clearly articulated and • 4 localities signed up as pilot sites and Whitley Bay  ageing population implementation monitored against KPIs implementation work streams in place • New Models of Care programme part of QIPP work, with  supporting documents in place, including KPIs • Workforce fully staffed with Geriatrician, Nurse Practitioner, OT • Project Plan and finances signed off by QPAC 27/06/2016.  and Physiotherapist. • Service live across North Shields and Whitley Bay Localities from • New Models of Care Project Board monitors performance.  June 2017. • Project Plan in place • Weekly updates on activity of new service  • Revised model agreed with GP Federation and member • Monthly Programme to oversee progress practices.  • CCG Committee membership includes Clinicians - Council of • No Secondary Care Doctor. • Governing Body and Committee Terms of Reference, meeting • Patchy engagement • Recruit Secondary Practices, Quality and Safety Committee, Clinical Executive, Audit papers and minutes  and further work care doctor Committee, Finance Committee necessary. • CCG Chair is a GP, supported by Medical Director (GP), 3 • 1 Locality Director posts • CCG Constitution and papers and minutes of the meetings of the • Recruit 1 Locality  Clinical Directors (GPs) and a range of Clinical Leads unfilled. Council of Practices Director • CCG Governing Body members include an experienced • CCG annual report • Development of executive nurse and secondary care specialist doctor  practice engagement plan • Practice Managers are members of Quality and Safety • Practice Nurse Forum notes  Committee and the Clinical Executive Committee • CCG Constitution sets out matters reserved to Members, • Monthly newsletters enacted through a structured programme of meetings of the  Council of Practices • Practice Nurse Forum facilitated by CCG Quality team • Locality Group meeting notes and reports to the Clinical Risk of insufficient clinical  input into the work of the Executive • Monthly newsletter to all practices highlighting commissioning • Clinical Chair and Chief Officer programme of joint practice visits, Head of CCG if clinical leaders  16/11/2015 539 Chief Officer S 3 4 12 3 3 9 15/09/2017 9 2 Governance and member practices issues with follow up actions  CCG are not effectively • Development of locality working actively supported by CCG • Practice facilitators work programme and achievements engaged • Clinical Chair and Chief Officer programme of joint practice visits • Internal Audit review of Clinical Engagement 2014/15 NTC4806 provided Significant Assurance with one issue of note (issued Feb  2015). Issue of note has been addressed.

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First LineSecond of Deferenc LineThird of LineDefen of Defence Gaps in Assurance Target Risk Score Risk Description Controls Detail Gaps in Controls Responsible Corporate Consequence Consequence Residual score Review date Corp Objective Risk Owner Strategic Likelihood Initial score Assurance Likelihood Date enteredRisk Ref. Director Actions

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• Practice facilitators in post, working into Practices to support local • 360° Stakeholder Survey implementation of FRP 

• Changes to constitution and remit of Council of Practices and • CoP minutes and agendas Clinical Executive Committee, resulting in improved clinical insight 

• CoP actively involved in development of CCG QIPP

• PMO/CFO scheduled to attend locality meetings

• Appointment of New Clinical Director

• Lay Member for Patient and Public Involvement in post • Role of Lay Member for Patient and Public Involvement set out in

CCG Constitution and evidenced in her work in the CCG 

• Active Patient Forum, Chaired by Lay Member and facilitated by • Patient Forum work programme, meeting notes and reports to CHCF, with programme of work and effective sub groups; Patient CCG Governing Body  Forum reports to Governing Body • Communications and engagement services from NECS to • Communications and engagement strategy in place, supported  support the work of the CCG by specific plans for identified work streams • CCG planning predicated on Joint Strategic Needs Analysis, • CCG operational plan and Commissioning Plans prepared, which documents the health needs of North Tyneside CCG approved by the Council of Practices and published  population • Active public and patient engagement in planning, commissioning • Value Based Commissioning Policy on CCG website; Medical and service review Director identified as CCG decision maker; reported at Clinical  Executive • Clinical Leaders bring direct experience of patient contact to CCG • Reports from public and patient engagement in major service  decision making reviews (e.g. maternity services review, urgent care review) Risk that the CCG fails to • Mechanisms in place for patients to contact the CCG formally and • Committee reports and minutes show that Clinical Leaders - focus on the needs of Executive Director Head of informally nurses and GPs - are involved in all aspects of CCG decision  patients and fails to 16/11/2015 540 of Nursing & Chief Improvement & S 3 4 12 making, 3 3 9 15/09/2017 9 2 commission the right, Operating Officer Development • North Tyneside Health and Wellbeing Board priorities inform CCG • CCG website shows a number of ways to contact the CCG cost effective services to plans including 'contact us' , complaints and compliments, opportunity to  meet those needs meet Governing Body members informally prior to meetings • Quality Review Groups in place, joint with other CCGs, to support • Internal Audit review 2014/15 of Patient Experience NTC4805 the delivery of high quality healthcare services provided significant Assurance with no issues of note (issued May  2015) • Service planning and service redesign, including QIPP plans, • Minutes of Quality Review Groups and reports to Quality and  based on clinical evidence Safety Committee • Referral Management System being implemented to support • Plans for service redesign, including QIPP plans, maternity adherence to good clinical practice. services, urgent care, include reference to available clinical  evidence • Communication and Engagement group within Patient Forum • Advice of Clinical Senate sought on paediatric care pathway and  which provides a direct link with Governing Body. on urgent care plans • CCG Patient Forum Comms & Engagement Group working with • Internal Audit review of Strategic Planning NTC 1617/02 provided Save the Children to engage with children and young people and significant Assurance with no issues of note  their parents to develop healthcare fit for the future. • External assurance from Andy Mills, Consultation Institute on  urgent care process (at Governing Body 28.6.16) • Contract management meetings with variances against planned • CCG need to recruit to • Notes of contract management meetings and 14 Day reviews Robust data awaited • s256 agreement to be contract activity scrutinised forecast out turn summaries updated permanent Director of and actions arising from those from NHCFT following signed Contracting & Commissioning  cyber attack.

• Finance Committee to oversee investigation into priority areas, • s256 agreements not in • Minutes of Finance Committee and QIPP Programme Assurance Detailed review of M2 supported by QIPP Programme Assurance Committee (QPAC) place Committee (QPAC), including deep dives  data on receipt from NHCFT • Detailed finance and contract report and quality and performance • Finance and contract reports and quality and performance report presented to Clinical Executive, Finance Committee and reports to Clinical Executive, Finance Committee and Governing  Governing Body to enable triangulation of information Body with exceptions highlighted and actions reported

• Medicines Optimisation Services purchased from NECS - • Minutes of Medicines Optimisation Committee, medicine Medicines Optimisation Committee in place optimisation SLA with NECS and medicine optimisation QIPP  Risk of activity or schemes contract performance • Robust CHC assessment processes in place, benchmarked • CHC assessment processes and reports to Clinical Executive Director of increasing over Chief Finance against other CCGs nationally, robust CHC decision making and Finance Committee  30/11/2015 545 Contracting & contracted or formally 4 5 4 4 15/09/2017 Officer processes and budget forecasts Commissioning planned levels, bringing • High cost CHC packages remain under close scrutiny • CHC Policy  C additional, unplanned 20 16 8 2 • CHC Policy approved by Clinical Executive February 2015 sets • BCF s75 agreement; signing reported to Governing Body financial pressures  out CCG's role in commissioning CHC • BCF Board ToR and meeting papers  • Metrics and KPIs agreed for each scheme in the BCF • Review by Internal Audit NTC16/17/1 Medicines Management  provided substantial assurance • BCF Board in place to oversee monitoring against plan and • Review by Internal Audit NTC16/17/12Contract Monitoring -  initiate corrective action if required substantial assurance • Referral Management System in place • Internal Audit report NTC 1617/15 Key Financial Controls -  substantial assurance • Discussions with NHCFT regarding risk mitigation of specific • Review by Internal Audit NTC16/17/09 QIPP Assurance gave t  activity increases in Accident and Emergency substantial assurance with no issues of note ) • CCG has advertised for a Director of Contracting & • Review by Internal Audit NTC 1617/10 Performance Commissioning (February 2017). Appointment expected in June Management gave substantial assurance with no issues of note  2017

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• Provision of suitable financial reserves in the plan • Reduction in elective activity  • Contractual agreement with NHCFT.  • Appointment of Interview for Director of Commissioning and Demand management paper submitted to Governing Body - 25 Contracting June 17 

• Identification of further QIPP • QIPP list rationalised and agreed by Clinical Executive • Robust data awaited • Ongoing identification schemes to address risk in 13/01/2016. from NHCFT following of new QIPP schemes FRP  cyber attack. by director team and staff •Appointment of COO March 2016 with specific objective to deliver the QIPP scheme • STP requires completion • QIPP plan monitored by the QIPP Programme Assurance • Further work on STP

and implementation Committee; QPAC formally reports to Clinical Executive and  to determine how plan provides updates to the Finance Committee. will be delivered.

• Supply of financial data from • Signed contract with providers Detailed review of M2 NHCFT is not robust due to  data on receipt from cyber attack NHCFT • Monthly meeting with NHS England Team to scrutinise and • Resolve urgent care •QIPP Projects developed with support of Business Intelligence validate credibility of QIPP across NCCG and NTCCG  procurement through and Finance to test the robustness of assumptions made. legal process • Urgent care procurement  process is not on schedule •PMO assurance of QIPP projects  •PMO fortnightly monitoring, reporting and escalation of QIPP • Reports to Finance Committee and Clinical Executive Committee  progress •QPAC receives QIPP monitoring reports and directs remedial • QPAC Tracker/QPAC minutes  actions (where appropriate) •Finance Committee receives regular reports of QIPP and • Internal Audit NTC1617/09 substantial assurance 16/17  QIPP plans, including challenges underperformance •Each QIPP project has a project plan, savings target, KPIs, • NECS/ Deloitte review of QIPP target contract values,  are not delivered and/or Quality and Equality Impact Assessments Chief Finance Chief Finance •Monthly monitoring of CCG FRP implementation by NHS England • Joint cost reduction approach with NHCFT. Minutes 09/11/2016 554 C there is increased 4 4 16  4 4 16 15/09/2017 8 2 Officer Officer expenditure, causing the Team CCG to breach its control total •Monthly contract management meetings • Contracts with Acute Trusts include QIPP within value. •Systemwide STP (Sustainable Transformation Plan) being developed that includes N CCG, NT CCG and NHCFT to identify joint QIPP programme - 5 year plan. 13 work streams identified • NTW contract signed. • NUTH contract agreed • £risks and mitigations being tracked on an ongoing basis to inform position • Financial expenditure controls • QIPP schemes (including block contracts) • Joint cost reduction approach with NHCFT. Minutes

• FRP refreshing during 16/17 • Urgent care procurement process

• Model designed in collaboration with Clinical Senate, which • Consultation process audited by The Consultation Institute and involved extensive consultation, and engagement at Chief Officer found to be consistent with recognised standards of best practice level with key stakeholders and Legal advice • Seek agreement from current contract  • Legal challenge from holders to extend Northumbria Healthcare NHS contracts in order to FT has resulted in the ensure continuity of contract award being delayed. service provision.

• Work with providers to coproduce a service solution which takes account of system • Current contracts come to changes including GP an end 30.09.2017 extended hours, streaming at NSECH and is in line with Risk that the delay in the • In collaborative dialogue with stakeholders (current contract clinical model and is launch of the new Urgent holders) to ensure continuity service provision post September cognisant with Care Centre Service 2017 procurement law.

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S C Care Centre Service NEW Director of creating system • NHCFT has indicated they Commissioning 558 Contracting and C uncertainty, potential 4 5 20 would not support another 4 4 16 08/09/2017 4 3 Manager 07/06/2017 Commissioning pressure on other provider utilising the Rake services, reputational Lane site and therefore the damage and financial public preferred option is not risk. secure at this time.

• Commissioning Plans informed by JSNA to ensure focus on • Commissioning Plans developed and published  health needs and health improvement • Regular reports to Clinical Executive and Governing Body on • Regular integrated quality and performance reports to Clinical progress against health outcomes data set Executive and Governing Body; minutes of those meetings and  results of 'deep dives' Risk of the work of the • Regular Performance Reviews with the NHS England Area Team • Notes of Quarterly Performance Reviews with the NHS England  Executive Director Deputy Director of CCG and its partners not Area Team 07/05/2013 138 of Nursing & Chief Nursing, Quality & S improving the health of 4 3 12 • Joint working with CCG and Local Authority Public Health • Public Health work plan 4 2 8 09/08/2017 8 4 Operating Officer Safety the population in line with department, including Consultant Public Health (Medical) working  statutory duties within the CCG 2 days per week • Progress on health improvement reported year-on-year in CCG • CCG Annual Report against CCG health outcomes data set  Annual Report • Review by Internal Audit of Performance Management (NTC 1516/08) gave significant assurance with no issues of note (issued  Jan 16). • CCG an active partner in the North Tyneside Health and • Failure to agree funding for • North Tyneside Health and Wellbeing Board and Overview and • Meetings between Wellbeing Board the Local Authority in 16/17 Scrutiny Committee meeting papers and minutes LA/NTCCG to align (difference of £750k between spending and planning budget and LA expectation) assumptions results in potential  decommissioning of social care services to that value.

• CCG attends the Overview and Scrutiny Committee, as required, Failure to agree funding for • Minutes and papers of committees of the Health and Wellbeing • Report to CCG and to present and discuss the work of the CCG the LA in 17/18 relating to Board, Integration Board, Turnaround Board, Urgent Care Board, Council on service   BCF. Potential difference of Primary Care Commissioning Committee and meetings with MPs implications of £2m. spending plans • CCG has regular formal and informal meetings with North • Communications and engagement strategy Tyneside Council, local NHS Foundation Trusts, HealthWatch,  local MPs Risk of failure to engage • Stakeholder engagement plan in place, as part of • Communications and engagement plan for key pieces of work with partners and communications and engagement strategy, with specific targeted including for example, FRP, commissioning plan, urgent care  Director of Planning & stakeholders in line with plans for identified initiatives 20/05/2013 193 Contracting & Commissioning S CCG statutory duties, 3 4 12 3 3 9 09/08/2017 6 4 • CCG complies with formal duty to consult • Reports to CCG Governing Body on plans to consult and Commissioning Manager resulting in misalignment outcome of consultation, including, for example, maternity services  of plans across the and urgent care health economy • CCG actively engages with stakeholders, public and patients, • Formal agreement with the Community Health Care Forum including commissioning the Community Health Care Forum to  facilitate the patient forum • There are regular communication channels between CCG and • Internal Audit review of Strategic Planning NTC 1617/02 provided Voluntary Sector significant assurance with no issues of note (issued May 2016) 

• Process designed for the development of Commissioning • Internal Audit review of Partnership Arrangements - Governance Intentions NTC 1516/04 provided significant assurance with issues of note  (issued Nov 2015) • Operational Plan 16/17 complete and available of CCG website • Operational Plan 16/17 signed off by Clinical Executive, Governing Body and Council of Practices, available on CCG  website. • STP (final version submitted (21/10/16)  • CCG has engaged with the NTW Sustainable Transformation Plan governance arrangements and are planning systemwide financial control targets for 17/18 • CHC restitution team and processes reviewed in line with 2015 • Report to Q&S committee, Clinical Executive and Governing 'Previously Unassessed Periods of Care' (PUPoC) guidance Body on requirements of 2015 'Previously Unassessed Periods of  Care' (PuPoC) guidance and CCG action taken

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• Action plan in place to close gap between current and required • PuPoC Action plan monthly trajectory to ensure national timetable met

Risk closed as there is an effective local process  which has been tested by the independent review panel upholding CCG Risk of CHC Restitution decisions. Therefore processes failing to meet residual risk score Executive Director Deputy Director of national standards, 21/05/2013 195 of Nursing & Chief Nursing, Quality & S 3 5 15 changed to 6 3 2 6 09/08/2017 6 4 resulting in untimely or • Plans made to transfer responsibility for CHC restitution back to • Report to Q&S committee, Clinical Executive regarding transfer Operating Officer Safety inappropriate decisions neighbouring CCGs to enable NTCCG to concentrate on own CHC restitution work back to neighbouring CCGs to enable  cases NTCCG to concentrate on own cases - transfer complete • CHC Restitution allocation tracker and progress monitoring • CHC Restitution progress reports to Clinical Executive, including process in place to report on progress and to track this against benchmarking, included in quarterly CHC report  national timetable requirements • Benchmarking against national figures from other CCGs • Monthly reports from Restitution team to Finance Committee  • CHC restitution costs calculated and accounted for in CCG • CHC restitution budget and continuing national risk share  financial plans • National risk share in place to manage the financial impact of • Monthly returns to Area Team  restitution claims • Agreed process in place to deal effectively with complaints that • PuPOC cases completed by September 16 deadline  may arise from CHC restitution cases • All cases completed within due date • Robust organisation processes in place, including suitably • Clear staff reporting arrangements; job descriptions, appraisal qualified and trained staff, a range of policies and procedures, processes, objectives and work plans, Staff statutory and  clear work plans, agreed HR processes and agreed IG processes mandatory training up to date, monitoring arrangements for the SLA with NECS including HR and IG • CCG Constitution in place, with Scheme of Delegation and clear • CCG Constitution is current and on CCG website; committee governance structures ToR regularly reviewed and reported in Annual Governance  Statement • Service Level Agreement with Commissioning Support Unit in • CSU service user reports received by Audit Committee and  place referenced in the CCG Annual Report • CCG capacity to deliver FRP and maintain all other essential • IG toolkit level 2 attained in 2013/14, 2014/15 and 15/16 reported  business reviewed and staff team strengthened and adjusted to Q&S committee. • CCG Major Incident & Business Continuity Management Plan in • Internal Audit review 2013/14 NTC3816 Emergency Planning  place gave significant assurance (29 July 2014) • CCG complies with Emergency Planning, Resilience and • Internal Audit review 2013/14 NTC3817 Business Continuity  Response (EPRR) requirements under Civil Contingencies Act Planning gave significant assurance (29 July 2014) Risk of inadequate • Urgent Care Working Group/System Resilience Group in place to • 2015/16 EPRR self assessment completed operational resilience, or  monitor capacity and direct investment as required. Director of Commissioning organisational capacity • Membership of Urgent Care Group includes all relevant • Local A&E Delivery Board 13/08/2014 534 Contracting & Manager/Head of S and infrastructure, 4 4 16  4 2 8 09/08/2017 8 4 Commissioners and Providers Commissioning Governance leading to a failure to • Winter plans in place • Clinical Executive papers and minutes  respond to local • Clinical Executive reviews capacity plans as necessary; plans healthcare needs • Lifting of special measures reflecting the strengthening   also subject to review by partners and by NHS England leadership. • Permanent appointments to Chief Officer and Chief Finance Officer posts.

• System to monitor capacity and pressure in place. • Winter plans including documented system to monitor capacity  and pressure • Daily teleconference between Commissioners, Acute Providers • Notes of Daily teleconference over the winter period  and NEAS to manage pressures over winter period • Report received from ECIST (Dec 2016) with recommendations • A&E Delivery Boards minutes to Clinical Executive how to improve system resilience and urgent care system.  Response being co-ordinated by Local A&E Delivery Board. • Establishment of A&E Delivery Boards for the NNT footprint • NHS England CCG assurance (Amber Feb 17) • Reported results of EPRR self assessment to Governing Body on 27/9/16 (full compliance) • Appointment of Interview for Director of Commissioning and • Standards of Business Conduct policy in place, with clear conflict • Standards of Business Conduct policy, quarterly review of conflict • In the future options of Interest management arrangements in line with current of interest declarations, over seen by Audit Committee appraisal of the CCG's guidance and good practice form and function include ACO as an  option

• Deloitte review of QIPP • PMO arrangements identified as best practice • Deliver FRP 17/18 to  ensure directions lifted in Autumn 2017 Risk of a lack of • Robust contracting and procurement process in place • Minutes of Governing Body where procurement decisions made confidence in the CCG  Head of as a result of reputational and recorded 19/08/2014 535 Chief Officer S 4 4 16  4 2 8 09/08/2017 4 4 Governance damage, inhibiting the • CCG has access to legal advice • Reference to legal advice in committee reports • NHS England actively supporting the CCG to consider and • Governing Body Meetings held in public, with papers posted in CCG’s role as a system  leader develop sustainable options for the future advance of the meeting • Robust consultation and engagement processes • Internal Audit report NTC 1516/14 on Governance Structures  gave Significant Assurance (issued 17 March 2016) • Proactive media relations to promote openness and transparency • CCG Annual Reports and Annual Governance Statements  on financial position and actions being taken published for 2013/14, 2014/15 and 2015/16

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• NHSE approved changes to constitution November 2016 - now • Internal Audit report NTC 1516/05: Primary Care Co-  v13. Commissioning gave Significant Assurance (issued 3 Nov 2015) • Improvement Plan in response to Directions completed • CCG removed from special measures



• Governing Body members maintain both an external and internal • Minutes of Health and Wellbeing Board, CCG Accountable • Establish joint focus, working with key stakeholders and partners Officers and Chairs meeting, Primary Care Commissioning   committee with other Committee, Integration Board CCGs • CCG Directors and Senior Managers participate in region wide • Terms of Reference, papers and minutes of Professional  groups and fora meetings e.g. health care acquired infection partnership • CCG chairs and leads meetings, acting as system wide leader • Terms of reference for Urgent Care working group, practice Executive   Risk of the CCG lacking nurse forum, QRGs, Medicines Optimisation Director of 16/11/2015 542 Chief Officer S capacity to provide 4 4 16 • Permanent appointments to Chief Officer and Chief Finance 4 2 8 09/08/2017 8 4 Nursing & Chief system wide leadership Officer posts. Operating Officer



• Joint Management arrangements project team, project plan and • Quarterly NHSE assurance • Lifting of Legal Risk closed as Director risk register in place and delivered Directions of CC appointed.  Therefore residual score reduced to 4.

The transition to joint • Substantial stability within Governing Body as Chair, Lay • FRP performance reports management members, Executive Director of Nursing & Transformation and  Executive arrangements impacts Medical Director remain in post Director of 16/02/2017 556 Chief Officer C on the delivery of 4 4 16 • Extension of current Chief Operating Officer interim post until • CCG performance reports 4 1 4 09/08/2017 4 4 Nursing & Chief  NTCCG corporate Director of Contract & Commissioning post filled Operating Officer objectives, FRP and • Continued weekly staff briefing and briefing of members by the agreed priorities Chair • Revised Organisational structure approved. • Compliance with existing delivery arrangements, policies and processes • Appointment of Interview for Director of Commissioning and Contracting

• Tripartite Primary Care Strategy developed and agreed by CCG • 1 Further Locality Director • Primary Care Strategy approved by Governing Body May 16 • Urgent Care/Primary • Appointment of a GP Federation and LMC. required Care changing further 1 Locality landscape has Director  introduced uncertainty to discharging of previously agreed plans.

• Monitoring of progress again Tripartite Primary Care Strategy by • Primary Care Committee ToR and minutes to Governing Body • Directors to agree Primary Care Committee strategy to manage Capacity in Primary Care  and system support for impact of changing NEW Executive Director Commissioning & new ways of working landscape 557 of Nursing & Chief Performance C 4 3 12 4 3 12 4 4 challenges the delivery of • Primary Care Quality Committee • NHS England approval of Level 3 submission. 06/06/2017 Operating Officer Manager  sustainable Primary Care Services. • 2 Locality Directors in post • Quarterly assurance meetings with NHS England 

• Council of Practices

• CCG has 3 Clinical Directors, Medical Director and Chair who are Primary Care Practitioners • Support from NHS England in the management of primary care issues

Overall financial control environment including: specific system Internal audit reports and opinion Await result of 17/18 controls; budgetary control system; internal audit; counter fraud  audit of Financial & services; external audit review of financial statements; and CCG Strategic Planning policies as outlined below: HR07:Disciplinary Policy Counter fraud updates and annual report  Fraud undermines the HR35: Whistleblowing policy External audit opinion  Chief Finance financial CO06:Anti-Fraud Policy CCG policies  NEW 3/7/17 559 Chief Finance Officer C 2 2 4 2 1 2 2 2 Officer position/reputation of the CO13:Procurement Policy Budget reports  CCG CO19:Standards of Business Conduct Reconciliations 

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• Business Continuity Plan v3.1 approved by Quality & Safety • SAR reports Audit Committee is Map assurances and Committee 2/5/17 unclear the extent and identify gaps in CCG IT systems at risk • Monitoring of Business Continuity Planning incidents, responses source of assurances assurance Executive of cyber attack, and lessons learned by Quality & Safety Committee received Executive Director of Director of jeopardising day to day • Business Impact Assessment (BIA) undertaken for IT date New 14/7/17 560 Nursing & Chief C 4 4 16 24/4/17  4 4 16 6 1 Operating Officer Nursing & Chief operations and impacting Operating Officer on service delivery and • Monitoring by IM&T Sub Committee patient safety •NECS IT Contingency Plan (as per BIA) •NECS IT Disaster Recovery Plan (as per BIA)

2017/18 Corporate Objectives Risk Assurance Framework - Definition

1. Commission high quality care for patients, that is safe, value for money and in line with the NHS Constitution Strategic Risk is a risk that undermines the CCG’s ability to meet its statutory duties. These are identified as ‘strategic risks’ on the Risk Assurance Framework. They will remain on the Risk Assurance Framework permanently to provide assurance that the risks are effectively managed.

2. Deliver the Financial Recovery Plan, leading to the achievement of the CCG’s statutory financial duties and future sustainability Corporate Risk refers to a risk that is transient in nature and once managed to an acceptable level will be closed. These are identified as ‘corporate risks’ on the Risk Assurance Framework.

3. Work collaboratively with partners and stakeholders to develop health and social care fit for the future in North Tyneside Risk Assurance Framework is a document which consolidates the Corporate Risk Register (see corporate risks) and Assurance Framework (see strategic risks) into one document.

4. Continue to develop North Tyneside CCG as a patient focused, clinically led commissioning organisation with a continuous learning culture

Three Lines of Defence

1. the first line of defence – functions that own and manage risk (assurance from functions that own and manage risk ) 2. the second line of defence – functions that oversee or specialise in risk management, compliance (e.g. PMO, CCG financial and performance reporting, Governing Body, Audit Committee, external organisations e.g. QRG, LSCB, A&E Board, Health & Wellbeing Board) 3. the third line of defence – functions that provide independent assurance ….. (internal audit, external audit, CQI, NHSE Assurance).

Source: Chartered Institute of Internal Auditors (brackets by CCG)

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Report to: Governing Body Date: 25 July 2017 Agenda item: 13.2 Title of report: Conflicts of Interest: Revised Guidance Sponsor: Irene Walker, Head of Governance, NTCCG Author: Shelagh Cockburn, Programme Management Officer, NTCCG Purpose of the report and action required: This report summarises Managing conflicts of interest: Revised statutory guidance for CCGs 2017, issued 16 June 2017. This supersedes the June 16 statutory guidance.

Members are asked to note the changes and actions required.

Members are asked to agree that the Primary Care Committee be delegated the commissioning and contract management of new care models and to approve the updated Primary Care Committee Terms of Reference accordingly. Executive summary: The statutory guidance for the management of conflict of interests was updated in June 17. The following indicates key changes for CCGs and provides an indication of when the CCG will achieve compliance.

The key changes are as follows:

• Register of Interests: CCGs to have systems in place to satisfy themselves that, as a minimum on an annual basis that their registers of interest are accurate and up-to-date, and that decision making staff only are included on the published register;

• Gifts from suppliers or contractors: In line with the NHS –wide guidance, gift of low value (up to £6), such as promotional items, can now be accepted;

• Gifts from other sources: In line with wider NHS guidance, gifts under £50 (rather than £10) can be accepted from non-suppliers and non-contractors, and do not need to be declared; and gift with a value of over £50 can now be accepted on behalf of an organisation, but not in a personal capacity;

• Hospitality – meals and refreshments: Thresholds have been amended in that hospitality under £25 does not need to be declared. Hospitality between £25 and £75 can be accepted, but must be declared, and hospitality over £75 should be refused unless senior approval is given.

• New care models: A new annex to provide further advice on identifying, declaring and managing conflicts of interest in the commissioning of new care models.

An action plan is provided at Appendix 1. Page 1 of 2

OFFICIAL New Care Models The revised statutory guidance includes specific reference to managing conflicts of interest relating to the commissioning of new care models. In this context, new care models means any Multi-speciality Community Provider (MCP), Primary and Acute Care Systems (PACS) or other arrangements of a similar scale or scope that (directly or indirectly) includes primary medical services. The guidance suggests that where a CCG has full delegation for primary medical services, CCGs could consider delegating the commissioning and contract management of the entire new care model to its Primary Care Commissioning Committee. This Committee is constituted with a lay and executive majority, and includes a requirement to invite a Local Authority and Healthwatch representative to attend.

Governance and Compliance

1. Links to corporate objectives

2. Consultation and engagement No consultation required.

3. Resource implications No resource implications.

4. Risks This paper identifies the action required to ensure the CCG is compliant with new statutory guidance – issued June 17.

5. Equality assessment Not applicable

6. Environment and sustainability assessment Not applicable Page 2 of 2

OFFICIAL Appendix 1 Action Plan v2 Managing conflicts of interest: Revised statutory guidance for CCGs 2017, issued 16 June 2017

Action Gap Action Taken By who By when Status No. 1. Rationalisation of current Head of Governance August 2017 published Registers of Interest to

include decision makers (committee members) only 2. As appropriate, update the CCG’s Head of Governance On next revision Constitution to reflect the

changes to the statutory guidance 3. Review and update the Conflicts Head of Governance August 2017 of Interest templates

4. Review and update CCG CO19: North of England Commissioning Circa September Standards of Business Conduct Support (NECS) 2017

Policy 5. Communications to all staff E mail to all NTCCG Staff sent 5 July 17 Head of Governance July 2017 E mail to Practice Managers/GPs 6 July 17 COI Guardian informed 11 July 17 Lay members informed 11 July 17 Healthwatch informed 11 July 17 6. Revise Primary Care Committee Paper prepared for Governing Body to Head of Governance July 2017 (PCC) terms of reference to approve PCC TOR on 25 July 17 delegate commissioning & contracting of new care models to PCC.

S:\Corporate\Committees & Meetings\Governing Body and Committees\Governing Body (move to Committees)\2017-18\05 - July 2017\Public\13.2b App 1 Action Plan CoI v2.docx

KEY Not yet implemented In progress Completed

OFFICIAL Appendix 1

Action Gap Action Taken By who By when Status No. 7. Amend the Training Needs Head of Governance/ Once available Analysis for the CCG to include Transformation Facilitator

Conflicts of Interest training once available

S:\Corporate\Committees & Meetings\Governing Body and Committees\Governing Body (move to Committees)\2017-18\05 - July 2017\Public\13.2b App 1 Action Plan CoI v2.docx

KEY Not yet implemented In progress Completed

OFFICIAL

North Tyneside Primary Care Committee Terms of Reference

1. Introduction

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

1.2 The Governing Body has established the North Tyneside Primary Care Commissioning Committee (the Committee). The Committee will function as a corporate decision-making body for the management of delegated functions and the exercise of the delegated powers in line with North Tyneside CCG’s Constitution and Scheme of Delegation.

2. Statutory Framework

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

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

2.3 Arrangements made under sections 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 Chaper 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 (section14Q)

d) Duty as to improvement in quality of services (section 14R)

e) Duty in relation to quality of primary medical services (section 14S)

f) Duty as to reducing inequalities (section 14T) Page 1 of 10

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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 consultations (section 14Z2)

2.4 The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:

a) Duty to have regard to the impact on services in certain areas (section 13O)

b) Duty as respects variation in provision of health services (section 13P)

2.5 The Committee has been established as a committee of the Governing Body in accordance with Schedule 1A of the NHS Act.

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

3. Role of the North Tyneside Primary Care Committee

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

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

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

3.4 The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act, as set out in section 4.1 below.

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4. Responsibilities of the Primary Care Commissioning Committee

4.1 This includes the following activities:

a) Decisions in relation to General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Providers of Medical Services (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);

b) Decisions in relation to newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”);

c) Decisions in relation to design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

d) Decision making on whether to establish new GP practices in an area;

e) Planning new primary care estate;

f) Decisions on practice closures;

g) Approving practice mergers and de-mergers; and

h) Making decisions on ‘discretionary’ payment (e.g. returner/retainer schemes).

i) Commissioning and contract management of new care models (new care models means any Multi-speciality Community Provider (MCP), Primary and Acute Care Systems (PACS) or other arrangements of a similar scale or scope that (directly or indirectly) includes primary medical services.

4.2 The CCG will also carry out the following activities:

a) To plan primary medical services, including Primary Care needs assessments;

b) To undertake reviews of primary medical care services;

c) To co-ordinate a common approach to the commissioning of primary care services generally;

d) To manage the budget for commissioning primary care medical services in North Tyneside;

e) Develop and monitor the delivery of the Primary Care Strategy (approval is by Governing Body).

5. Geographical coverage

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The North Tyneside primary care committee will comprise the area covered by North Tyneside CCG.

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6. Membership

6.1The Committee shall consist of:

a) Committee Chair: CCG Deputy Lay Chair (or in his/her absence the lay member for Patient and Public Engagement1) (voting member/s)

b) A Director from North Tyneside CCG or deputy (voting member)

c) The CFO from North Tyneside CCG or deputy (voting member)

d) A Director from NHS England (non-voting member)

e) A minimum of one nominated GP (non-voting member)

f) Clinical Director (non-voting member)

In attendance:

a) The CCG Designated lead for Primary Care

6.2 To ensure effective management of actual or potential conflicts of interest, the circulation of meeting agenda and papers will be circulated to ensure committee members do not receive papers on items they are conflicted on and GPs will withdraw from the meeting as requested to do so by the Chair of the committee. These arrangements do not preclude GP participation in strategic discussions on primary care issues, subject to appropriate management of conflicts of interest.

6.3A standing invitation will be made to specified partners in a non-voting capacity, namely:

a) A representative from HealthWatch North Tyneside; and

b) A representative from the North Tyneside Health and Wellbeing Board.

6.4 Other CCG Governing Body members, GPs, officers, employees and practice representatives may be invited to attend all or part of meetings of the committee to provide advice or support particular discussion from time to time. Those invited to attend will not be entitled to vote, but will be an integral part of all discussions.

6.6Those invited in a non-voting capacity will not be entitled to attend the meetings in private session, unless specifically invited to do so by the Chair for a particular item.

6.7The membership will meet the requirements of the CCG’s Constitution.

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6.8The CCG Director will be the lead officer for the committee.

7. Meetings and Voting

7.1 The Committee shall adopt the Standing Orders of NHS North Tyneside CCG insofar as they relate to the:

a) Notice of meetings; b) Handling of meetings; c) Agendas; d) Circulation of papers; and e) Conflicts of interest

7.2 Each member of the Committee (except the non-voting members) shall have one vote. 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 a consensus decision-making wherever possible.

8. Quoracy

8.1 The quoracy for the committee is two voting members one of which must be a lay member and the other a substantive director with voting rights.

9. Frequency and operation of meetings

9.1 The committee will meet monthly (as required to discharge the responsibilities of the committee) but must meet a minimum of 4 times per year in public.

9.2 In exceptional circumstances, an extraordinary meeting of the committee may be required and can be called by the Chair by providing members with a minimum of five working days’ notice. The quoracy for this meeting is the same as that set out above.

9.3 Meetings of the Committee shall:

a) Be held in public, subject to the application of 9.3(b) (below);

b) The Committee may resolve to exclude the public from a meeting that is open to the public (whether during 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.

9.4 Declarations of Interest will be a standing agenda item. All potential conflicts of interest will be declared and dealt with in accordance with the

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CCG’s Constitution and CCG policies and procedures for Standards of Business Conduct and Declarations of Interest.

9.5 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.

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

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

9.8 Members of the Committee shall respect confidentiality requirements as set out in the CCG Standing Orders unless separate confidentiality requirements are set out for the committee in which event these shall be observed.

9.9 The Committee will make decisions within the bounds of its remit. The decisions of the committee shall be binding on NHS England and the CCG.

9.10The Committee will produce and executive summary report which will be presented to NHS England and the CCG governing body for information no less than annually.

10 Review of Terms of Reference

10.1 These terms of reference will be formally reviewed on an annual basis, or as required reflecting experience of the Committee in fulfilling its functions or changes to guidance or legislation.

11 Accountability of the Committee

11.1 The Committee is responsible for all decisions relating to the functions set out in schedule 6 of the delegation agreement and associated budget except those decisions that are reserved to Governing Body as shown in the CCG’s Scheme of Delegation. The CCG has reviewed its Standing Financial Instructions and Standing Orders to ensure consistency with these Terms of Reference.

11.2 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.

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12 Procurement of Agreed Services

12.1 The detailed arrangements regarding procurement are set out in the delegation agreement.

13 Decisions

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

13.2 The decisions of the Committee shall be binding on NHS England and North Tyneside CCG.

13.3 The Committee will produce an executive summary report which will be presented to Cumbria and North East area team of NHS England and the governing body of North Tyneside CCG annually for information.

Schedule 1 – Delegation Schedule 2 – Delegated functions Schedule 3 – List of Members

Date approved by CCG Governing Body: 28 March 2017 TBC 25 July 2017 Due for review: March 2018 July 2018

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SCHEDULE 1

Delegation Agreement

1718 Delegation Agreement - North Ty

SCHEDULE 2

Delegated functions

1718 Delegation - North Tyneside.pdf

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LIST OF MEMBER PRACTICES

Practice Representative’s Signature & Practice Name Address Date Signed 49 Marine Avenue 49 Marine Avenue, Whitley Bay Letter signed by Dr Justine Norman, dated 12th November 2012 Appleby Surgery Hawkeys Lane North Shields Letter signed by Dr A Bates, dated 6th November 2012 Battle Hill Health Centre Battle Hill Health Centre, Belmont Close, Letter signed by Gill Coulson, dated 12th Wallsend November 2012 Beaumont Park Hepscott Drive, Whitley Bay Letter signed by Dr A McMenzie, dated 7th December 2012 Bewicke Medical Centre 51 Tynemouth Road Wallsend Letter signed by Dr Thornton, dated 12th November 2012 Collingwood Surgery Hawkeys Lane North Shields Letter signed by Dr Dave Tomson, dated 5th November 2012 Earsdon Park Surgery Shiremoor Resource Centre, Earsdon Letter signed by Gill Coulson, dated 12th Road, Shiremoor November 2012 Forest Hall Medical Centre Station Road, Forest Hall Letter signed by Dr David Reid Milligan, dated 14th November 2012 Garden Park Surgery Denbigh Avenue Howdon Wallsend Letter signed by Ann Crosby, dated 8th November 2012 Lane End Surgery 2 Manor Walk Letter signed by Dr Caroline Sprake, dated 6th November 2012 Mallard Medical Practice (formerly Drs Killingworth Health Centre Citadel East Letter signed by Dr Mark Preston, dated 6th Preston and Austin) Killingworth November 2012 Marine Avenue Medical Centre Marine Avenue, Whitley Bay Letter signed by Dr Clare Robson, dated 12th November 2012 Monkseaton Medical Centre Cauldwell Avenue, Monkseaton Letter signed by Dr Nick Lawson, dated 9th November 2012 Nelson Health Group Cecil Street North Shields Letter signed by Dr Atoosa McNamara, dated 7th November 2012 Northumberland Park Medical Group Shiremoor Resource Centre, Earsdon Letter signed by Dr Simon Young, dated 12th (formerly Dr Young & Partners) Road, Shiremoor November 2012 Park Parade Surgery 69 Park Parade, Whitley Bay Letter signed by Dr C J Lee, dated 13th November 2012 Park Road Medical Practice 93 Park Road Wallsend Letter signed by Dr Kate Carding, dated 12th November 2012 Portugal Place Portugal Place, Wallsend Letter signed by Dr Angus McColl, dated 7th November 2012 Priory Medical Group 19 Albion Road, North Shields Letter signed by J B Roberts, dated 12th November 2012 Redburn Park Medical Centre 15 Station Road, Percy Main North Letter signed by Dr Sharon Gandy, dated Shields 11th November 2012 Bridge Medical (formerly Shiremoor Medical Shiremoor Resource Centre, Earsdon Letter signed by Dr A Chalmers, dated 7th Group - formerly Dr Smith & Partners) Road, Shiremoor November 2012 Spring Terrace Health Centre Spring Terrace North Shields Letter signed by Dr Clare Scarlett, dated 12th November 2012 Swarland Avenue Surgery 2 Swarland Avenue Benton Letter signed by Dr Clare Mears, dated 8th November 2012 Village Green Surgery The Green, Wallsend Letter signed by Dr Jane Riddle, dated 9th November 2012 Wellspring Medical Practice Killingworth Health Centre Citadel East Letter signed by Dr SallyAnn Ritchie, dated Killingworth 17th December 2012 West Farm Surgery 31 West Farm Avenue Letter signed by Dr Rob Morrison, dated 11th November 2012 Whitley Road Health Centre Whitley Road Whitley Bay Letter signed by Mrs L Dodgson , dated 9th November 2012 Wideopen Medical Centre Great North Road Wideopen Letter signed by Dr Chris May, dated 9th November 2012 Woodlands Park Medical Centre Canterbury way, Woodlands Park, Letter signed by Dr Shaun Lackey, dated Wideopen 12th November 2012

Extract from Constitution (v14)

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Report to: Governing Body Date: 25 July 2017 Agenda item: 13.3 Title of report: Quality & Safety Committee Terms of Reference Author: Irene Walker, Head of Governance NTCCG Purpose of the report and action required: Governing Body is asked to approve the Terms of Reference for Quality & Safety Committee. Executive summary:

The Quality & Safety Committee Terms of Reference was last approved by Governing Body on 28 March 2017. Since that date Internal Audit has completed an audit of conflicts of interest and noted that the CCG has not clearly identified which committee is responsible for ensuring compliance with the required standards.

The Terms of Reference have been updated at paragraph 6.27 to include: “To oversee arrangements for the effective management of conflicts of interest and compliance with statutory guidance.”

Following review of the draft Terms of Reference by Quality & Safety Committee (4 July 17) the membership list was also updated.

Governing Body is asked to approve the Terms of Reference for Quality & Safety Committee.

Governance and Compliance

1. Links to corporate objectives

2017/18 corporate objectives Item links to objectives √ 1. Commission high quality care for patients, that is safe, √ value for money and in line with the NHS Constitution 2. Deliver the Financial Recovery Plan, leading to the achievement of the CCG’s statutory financial duties and future sustainability 3. Work collaboratively with partners and stakeholders to develop health and social care fit for the future in North Tyneside 4. Continue to develop North Tyneside CCG as a patient focused, clinically led commissioning organisation with a continuous learning culture

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2. Consultation and engagement Quality & Safety Committee (4 July 2017) has been consulted on the Terms of Reference.

3. Resource implications N/A

4. Risks N/A

5. Equality assessment N/A

6. Environment and sustainability assessment N/A

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Quality and Safety Committee Terms of Reference

1. Introduction

The Quality and Safety Committee (the committee) is established as a committee of the CCG Governing Body, in accordance with constitution, standing orders and scheme of delegation.

These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the CCG constitution and standing orders.

2. Principal Function

The Quality and Safety Committee is responsible for ensuring the appropriate governance systems and processes are in place to commission, monitor and ensure assure the delivery of high quality safe patient care in commissioned services.

In achieving this, the committee will seek to promote a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness and patient experience, to secure public involvement, to promote research and the use of research and to provide assurance to the Governing Body about the quality, safety and risks of the services being commissioned, and the overall risks to the organisation’s strategic and operational plans.

The Committee will, as delegated by the Governing Body, provide oversight and scrutiny of arrangements for supporting NHS England in relation to securing continuous improvement in the quality of primary medical services.

Quality and Safety Committee has responsibility for oversight of the CCG’s arrangements for the discharge of its safeguarding duties, clinical governance and corporate governance, unless reserved to Governing Body, as reflected in the scheme of delegation.

The Committee will recommend for approval to Governing Body arrangements for risk management; handling complaints; for business continuity and emergency planning. It has delegated authority to approve policies (unless otherwise stated in the scheme of delegation); arrangements for handling Freedom of Information requests; conflicts of interest, information governance arrangements; and equalities & diversity arrangements.

3. Accountability

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4. Membership

Membership of the Committee is:

• A Lay Member of the Clinical Commissioning Group (Chair of the Committee) • Secondary Care Specialist Doctor • Medical Director • Chief Operating Officer & Executive Director of Nursing and Transformation • Member Practice GP representative • Member Practice GP Practice manager • Head of Governance • Deputy Director of Nursing, Quality and Patient Safety • Head of Safeguarding: Designated Nurse Safeguarding Children - Designated Nurse for Safeguarding • Performance & Commissioning Manager • Head of Planning & Commissioning

The Chair has the responsibility to ensure that the Committee obtains appropriate advice in the exercise of its functions.

Officers, employees, and practice representatives of the CCGs and other appropriate individuals may be invited to attend all or part of meetings of the committee to provide advice or support particular discussion from time to time. This may include, for example, representatives from the Commissioning Support service.

5. Authority

5.1 The CCG Governing Body authorises the Committee to pursue any activity within these Terms of Reference including to:

a) Seek any information it requires from CCG employees, in line with its responsibility under these terms of reference and the Scheme of Reservation and Delegation;

b) Require all CCG employees to co-operate with any reasonable request made by the Committee, in line with its responsibility under these terms of reference and the Scheme of Reservation and Delegation;

c) Review and investigate any matter within its remit and grants freedom of access to the organisation’s records, documentation and employees. The Committee must have due regard to the Information Governance Policies of the CCG, regarding personal health information and the CCG’s duty of care to its employees when exercising its authority.

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5.2 In discharging its responsibilities the Committee will comply with the CCG’s Standing Orders and Prime Financial Policies and Standards of Business Conduct Policy.

6. Roles and responsibilities

Clinical Governance

6.1 To review the CCG’s vision for commissioning services ensuring that plans are safe, high quality and clinically effective

6.2 Approve arrangements, including supporting policies, to minimise clinical risk, maximise patient safety and to secure continuous improvement in quality and patient outcomes.

6.3 Approval of clinical, quality and safety strategies and policies.

6.4 To receive reports on the quality of commissioned services, to review risks arising and monitor progress in implementing recommendations and action plans.

6.5 To receive reports on clinical risks, incident reporting, serious incidents, ‘Never Events’, CQUIN development, complaints, claims and safety alerts; and monitor progress in implementing recommendations and action plans.

6.6 To oversee development of a Patient Safety Assurance Framework with systems for monitoring quality and safety of care, with reference to a range of indicators which might include Care Quality Commission ratings and reviews, Monitor ratings and any other relevant sources of external assurance.

6.7 To ensure a clear escalation process, including appropriate trigger points, is in place to enable appropriate engagement of external bodies in relation to areas of concern, with a view to an external review being carried out.

6.8 To receive and scrutinise independent investigation reports relating to patient safety issues and agree publication plans.

6.9 To seek assurance on the performance of NHS provider organisations in terms of the Care Quality Commission, Monitor and any other regulatory bodies. (Note that the Monitor’s compliance framework relies on assurance from third parties, including local commissioners of services).

6.10 To receive and review the Quality Accounts of NHS Foundation Trusts which, as a minimum, will include those relating to the Foundation Trusts which provide local acute services, community health care services and mental health and learning disabilities services to the North Tyneside population.

6.11 To receive reports on the management of infection control performance, especially health care acquired infections.

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6.12 To receive reports on Medicines Management by exception, as advised by the Medical Director.

6.13 To ensure that appropriate strategies and training plans are in place for safeguarding of children and vulnerable adults, receiving appropriate reports pertaining to the CCG’s safeguarding duties.

6.14 To ensure that the CCG promotes research and the use of research.

6.15 To ensure that agreements and processes in place with the CCG’s members to secure improvements in the quality of primary medical services in terms of clinical effectiveness, patient safety, risk, safeguarding and patient experience in GP practices.

Corporate Governance

6.16 To recommend risk management arrangements for the CCG, including risk policy, to the Governing Body.

6.17 Review risks, assurance and controls relevant to the Quality & Safety Committee’s remit (and as aligned to corporate objectives).

6.18 Review and recommend to Governing Body, human resources policies for employees and for other persons working on behalf of the Group.

6.19 Recommend for approval to Governing Body, the Group’s arrangements for business continuity and emergency planning.

6.20 Recommend for approval to Governing Body, the Group’s arrangements for handling complaints.

6.21 Approve the Group’s arrangements for Information Governance, ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data.

6.22 Approving arrangements for handling Freedom of Information requests.

6.23 To ensure that all systems are in place and operating effectively for the identification, assessment and prioritisation of potential risk relating to this committee’s remit i.e. quality and patient safety, financial risk (as it affects quality & safety) including regarding QIPP, health and safety, emergency preparedness, business continuity, information governance and sustainable development, and to report on any major strategic issues and any associated financial implications to the Governing Body and to other external agencies as appropriate including the National Reporting and Learning System.

6.24 To approve policy, strategy and practice in respect of equality, diversity and human rights (supported through the Equality Delivery System), including the Equality Diversity and Human Rights Annual Report to ensure the statutory and legal obligations of the CCG are met. Page 4 of 6

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6.25 To approve all polices except those specifically reserved to the Governing Body or other committee (Schedule D of Constitution).

6.26 To review and recommend for approval to the Audit Committee the Group’s counter fraud and security management arrangements.

6.27 To oversee arrangements for the effective management of conflicts of interest and compliance with statutory guidance.

7. Administration

The Deputy Director of Nursing, Quality & Safety will ensure that a minute of the meeting is taken and provide appropriate support to the Chair and Committee members.

8. Quorum

The quorum shall be four members of the committee, including at least two clinical members (doctor or nurse).

9. Decision Making

Generally it is expected that decisions will be reached by consensus. Should this not be possible then a view of members will be required. In the case of an equal vote, the person presiding (i.e. the Chair of the meeting) will have a second, and casting vote.

10. Frequency and notice of meetings

Meetings will be held at such interval as the Chair shall judge necessary to discharge the responsibilities of the Committee, but shall be at least six times per year.

11. Attendance at meetings

11.1 The members of the Committee are required to provide information to progress and inform the agreed agenda items.

11.2 The Committee members are required to attend each meeting or if apologies are made any information they are expected to contribute must be supported either through a deputy or in writing to the Chair.

11.3 In addition to the core membership the Committee may co-opt additional members as appropriate to enable it to undertake its role.

12. Reporting Arrangements

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The Chair of the committee shall draw to the attention of the Governing Body any issues that require disclosure to the Governing Body, or require executive action. The committee will report to the Governing Body, at least annually on its work.

13. Conduct of the committee

All members of the committee and participants in its meetings will comply with the Standards of Business Conduct for NHS Staff, the NHS Code of Conduct and the CCG’s Policy on Standards of Business Conduct and Declarations of Interest which incorporate the Nolan Principles.

The committee will review its performance, membership and these Terms of Reference at least once per financial year. It will make recommendations for any resulting changes to these Terms of Reference to the Governing Body for approval.

No changes to these Terms of Reference will be effective unless and until they are agreed by the Governing Body.

Date reviewed: 20 June 2014; agreed by Governing Body 23 September 2014 Date reviewed: 7 April 2015: agreed by Governing Body 25 August 2015 Date reviewed: 5 April 2016: agreed by Governing Body May 2016 Date approved by Governing Body: 27 September 2016 Date approved by Governing Body: 28 March 2017 Date approved by Governing Body: 25 July 2017 TBC

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North Tyneside CCG Clinical Executive Meeting (Part One) Wednesday, 22 March 2017, 1.30pm – 2.00pm Hedley Court

Present: Mark Adams Newcastle Gateshead CCG Chief Officer Ruth Evans Commissioning Clinical Director Philip Horsfield Practice Manager, Village Green Surgery Paul James Interim Chief Finance Officer John Wicks Interim Chief Operating Officer Irene Walker Head of Governance Martin Wright Medical Director (Chair) Lesley Young-Murphy Executive Director of Nursing & Transformation

In Attendance: Tracy Charlton Note Taker

Apologies: John Matthews Clinical Chair Janet Soo-Chung Interim Chief Officer

Agenda Item, Discussion & Agreed Actions Action

NTCE/17/023 Welcome & Apologies: Agenda Item No. 01

Martin Wright (MW) welcomed everyone to the meeting and apologies were noted above.

NTCE/17/024 Register of Interest: Agenda Item No. 02

The standard Register of Interests form was attached to the agenda.

A declaration of interest was declared by John Wicks (JW), Paul James (PJ) and Philip Horsfield (PH) in relation to Agenda Item 09, Intermediaries Legislation Briefing.

NTCE/17/025 Quoracy: Agenda Item No. 03

The meeting was confirmed quorate.

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NTCE/17/026 Minutes of Previous Part 1 - Meeting held on 22 February 2017: Agenda Item No. 04

NTCE/17/021 – Any Other Business

PJ reported this item was inaccurate and requested the sentence, “PJ requested that quoracy be addressed in terms of the impact of decision making”, be deleted from the draft minutes.

NTCE/17/027 Matters Arising from the Part 1 Previous Minutes held on 22 February 17 : Agenda Item No. 05

There are no matters arising from the previous minutes.

NTCE/17/028 Action Log – Part 1: Agenda Item No. 06

NTCE/17/008 – Matters Arising from Committees

PH reported that this is an on-going issue, moving from 3 to 5 years. PH explained this is an ongoing concern for Practice Managers. PH advised NECS IT will be attending the next Practice Manager meeting.

Complete.

NTCE/17/018 – Integrated Quality & Performance Report

Complete.

NTCE/17/029 Integrated Quality & Performance Report: Agenda Item No. 07

Lesley Young-Murphy (LYM) advised the committee that the performance identified within the report showed minor changes.

In terms of the ambulance handover delays the numbers continue to be an issue.

The A&E delivery board are overseeing and seeking assurance through the CCG. The CCG are considering intervention.

LYM explained that in December both Northumbria and Newcastle FTs fell short of the 95% threshold for 4 hour waits. The ECIP review identified areas of improvement and cross-organisational actions have been agreed to combat the issues highlighted.

In terms of Category ‘Red’ LYM reported that some improvement has been identified. The 19 minute transportation time 95% threshold was being met until recently.

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A discussion was held in relation to the NHS Outcomes Framework between LYM and RE in terms of the 3 GP patient experience indicators showing under performance and rated as amber. Further funded work is planned with GP practices to review current capacity and demand and put in place practice level plans to improve access.

LYM advised the committee of the measures in the Quality Premium. Currently 4 out of 8 measures are on target, however data for one measure is not currently available for 2016/17.

LYM reported there were no issues of note at either Northumbria or Newcastle FT. LYM advised that to avoid Never Events, and organisations failing to comply, a comprehensive action plan has been devised.

PJ expressed a priority in terms of ensuring NSECH model is being challenged and optimised as this impacted on service and finance.

LYM agreed the need to identify some local and national indicators with a view to being proactive and to compile an action plan.

Action 1: LYM to compile an action plan in relation to the Quality LYM Premium/Other Quality Measures.

NTCE/17/030 Intermediaries Legislation Briefing: Agenda Item No. 08

LYM explained the purpose of the report was to highlight the proposed changes to IR35 legislation, which will now take effect from 6 April 2017.

LYM advised the committee that from 6 April 2017, the liability for paying the appropriate taxes for off-payroll workers will move to the organisation paying the worker and deductions will have to be made at source. This applies to Clinical Leads and any contracts with practices. LYM explained there were previous issues experienced with HMRC; but in order to assist HMRC an online tool has been released. LYM explained in detail the new process.

JW reported he had completed the tool and, whilst it is relatively straightforward, there are some areas of interpretation.

LYM advised that any new appointments eg. Locality Directors, will need to complete the on-line tool. In order to achieve a successful outcome, LYM advised that she has written to Practice Managers to advise of the new process and support would be provided. Upon full completion of the assessment tool a certificate will be issued.

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NTCE/17/031 Medical Optimisation Committee Terms of Reference: Agenda Item No. 09

MW explained the purpose of the report is to seek approval for the updated Terms of Reference (ToR) for the Medicines Optimisation Committee (MOC). Members were asked to approve the updated ToR for the MOC.

MW highlighted the bullet points within the Executive Summary and requested any comments or issues.

The committee approved the updated papers.

NTCE/17/032 Matters Arising from Committees: Agenda Item No. 10

MW requested the committee members individually report Matters Arising from Committees.

PJ reported that in terms of Finance Committees, Contract Finance and Performance and QPAC, some previous meetings had been cancelled due to negotiations with Northumbria. Internal audit identified these cancelled meetings and PJ was able to provide an explanation.

PH reported that the JSC had previously organised for a member to attend Practice Manager meetings bi-monthly. This has proven to be successful. PH to liaise with Dianne Effard to confirm future requirements. PH

LYM reported that Medicines Optimisation rolled out a demonstration that is going live across North Tyneside. The demonstration was to Optimise RX new prescribing decision tool. LYM explained that this links in with coding and notes, and that both herself and IW scrutinised this. Both reported they accepted the new approach.

MW updated the committee in relation to Medicines Optimisation. MW reported £350,000 saving on top of QIPP. PJ expressed his thanks to MW.

NTCE/17/033 Quality & Risk Verbal Update: Agenda Item No. 11

LYM reported that an Ofsted inspection has taken place over the last fortnight. LYM will provide results from the Ofsted report in due course.

NTCE/17/034 Any Other Business: Agenda Item No. 12

There was no other business to discuss.

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NTCE/17/035 Date and Time of Next Meeting: Agenda Item No. 13

Wednesday, 26 April 2017 1.30 pm – 2.15 pm, NTCCG, Longsands Meeting Room, Hedley Court

OFFICIAL Part 1 Agenda Item 4

Quality and Safety Committee Part 1

Minutes of the Quality and Safety Committee Meeting held on 02 May 2017, at Hedley Court, 09:00 – 11:30

Present: Mary Coyle Deputy Lay Chair (Chair) Maureen Grieveson Deputy Director of Nursing, Quality & Patient Safety Dr James Lunn Nominated GP James Martin Contracts & Performance Manager Anya Paradis Head of Planning & Performance Irene Walker Head of Governance Dr Martin Wright Medical Director Lesley Young-Murphy Executive Director of Nursing & Chief Operating Officer (arrived 10.00)

In attendance: Julie Bee Clinical Quality Manager, NECS Gregor Miller Senior Clinical Quality Manager, NECS Andrea Ormond Minute Taker (NTCCG) Clare Scarlett NTCCG Clinical Lead Learning Disabilities Welcome Mrs Coyle welcomed everyone to the meeting. Dr Clare Scarlett was in attendance for the first time and therefore full introductions were made.

NTQS1/17/035 Agenda Item 1: Apologies for Absence

Apologies for absence were received from Alice Southern, Nominated Practice Manager and Jan Hemingway, Designated Nurse Safeguarding Children. Mrs Coyle advised that due to diary commitments, Dr Young-Murphy would be arriving late.

NTQS1/17/036 Agenda Item 2: Declarations of Conflict of Interest

It was noted that all declarations of conflict of interests were recorded in the register of interests on the public website and as shown on the enclosed register. There were no additional declarations relating to the Part 1 Agenda.

NTQS1/17/037 Agenda Item 3: Quoracy of Meeting

The Committee was confirmed as quorate.

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OFFICIAL NTQS1/17/038 Agenda Item 4: Minutes of Previous Part 1 Meeting held on the 04 April 2017

The Committee accepted the minutes of the last meeting held on the 04 April 2017 as a true and accurate record.

NTQS1/17/039 Agenda Item 5: Matters Arising from Previous Part 1 Minutes held on the 04 April 2017

NTQS1/17/30 Action 9 At the NuTHFT QRG Mrs Grieveson to request a written response and action plan by a specified date from the trust to address the increase in theatre never events. If no response is received then the Quality and Safety Committee will draft a formal letter to the trust.

Update 02.05.2017 Mrs Grieveson advised that never events have been discussed at the NuTHFT QRG and the Lead Commissioner which is Newcastle and Gateshead CCG is proposing an independent and external review. Due to the number of previous reviews already carried out the Trust is reluctant to have another review. It is thought that NHS England/NHS Improvement are in discussions with the Trust offering support and guidance.

Status – Complete

Patient Quality & Safety

NTQS1/17/040 Agenda Item 6: Integrated Governance Report

Mrs Bee presented the Integrated Governance Report to the Committee. Serious Incidents 12 Serious Incidents (SIs) were reported in March 2017 relating to North Tyneside CCG (NTCCG) patients. Newcastle upon Tyne FT reported one Never Event in March 2017, relating to surgical/invasive procedures.

Complaints A total of six formal complaints and three concerns were received during March 2017. 25 Freedom of Information Act requests were received in March 2017.

Quality Review Groups (QRG)

Newcastle Upon Tyne Hospitals Foundation Trust E-referrals – Preliminary information suggests there has been an improvement in performance. Never Events –one was reported in March relating to a patient’s nerve block being inserted on the wrong side and was noticed as the patient moved from anaesthesia to theatre. Patient safety – the Trust continues to exceed the 95% harm free care target. Based on full year numbers there has been a reduction in total number of falls by 5%; a reduction in serious harm from falls by 19% and a reduction in falls graded as major (resulting in a fracture) by 30% compared to the same period last year.

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OFFICIAL Performance - it was noted that the Trust did not meet the A&E 4 hour wait target. The trajectory will be revised initially to 93% then to 95% in 2018/19. Progress will be monitored through the contract sub-group. Mr Martin advised the committee that NHS Improvement look at trajectories and there is a dip around the winter period. In comparison to the national underperformance against the standard, 93% is in line with the rest of the country.

Northumbria Healthcare Hospitals Foundation Trust  Serious incident reporting – compliance with its 60-day and 2-day reporting performance targets remains an area of concern and an action plan has been requested for May’s QRG meeting. Dr Young-Murphy confirmed that a formal letter has been sent and an improvement action plan has been requested to provide assurance.  Pressure ulcers as SIs–following an analysis of their reporting rates compared to safety thermometer data and discussion of potential problems of under-reporting at the Trust Safeguarding Committee, the Trust is undertaking a review of reporting rates.  Falls – these continue to be an area of focus for the Trust. Following a presentation at the QRG, the Trust has been asked to provide a further update at May’s meeting. Mrs Grieveson raised concerns in relation to falls as the same issues continue to appear and from a commissioning point of view the CCG is not assured that the learning is being implemented.

Northumberland, Tyne and Wear NHS Foundation Trust The next QRG is due to be held on 3 May 2017 and an update will be provided in a future report.

North East Ambulance Service NHS Foundation Trust  Workforce – recruitment is ongoing and a visit to Poland will be taking place to recruit internationally. It was reported that 13 applications have been received for recruitment into the clinical hub.  Serious incidents - Eight SI reports are awaited and one is overdue. Improvements regarding reporting are ongoing.  Patient Safety – ‘Dispatch’ remains the highest cause of patient safety incidents however it was reported this is also a national issue.

Friends and Family Test:  Response rates remain well below the national and regional average for A&E and inpatients for both NHCFT and NUTHFT, however NHCFT has improved its inpatient response rates.  Although NTWFT remains below the national average for percentage recommended for Mental Health, it has increased its percentage to 84% which is the highest the Trust has reported since April 2016.  NuTHFT A&E response rate has fallen to 2% and continues to be significantly below the England average of 12.7%. The committee noted the very low response rate of 2%.

Healthcare Acquired Infections:  NTCCG reported three cases of C-Difficile in March 2017. Of the 24 cases of C-Difficile reported to date, 22 are community related. The CCG has the lowest report rate of C-Difficile per 100,000 populations in the North East and Cumbria region. Page 3 of 6

OFFICIAL  NuTHFT reported three cases of MRSA and no cases of C-Difficile.  NHCFT reported no cases of MRSA and two cases of C-Difficile and the Trust remains within trajectory.

National Reporting and Learning System (NRLS) Mrs Bee advised the committee that the data within the main report relates to the period March 2016 to September 2016.  NuTHFT – The Trust continues to be within the lowest 25% of reporters. The Trust is the 6th lowest reporter out of 136 Trust.  The committee queried the decline and Mr Miller advised there is no real reason has been given for this decline from the Trust. It appears that there is a cultural issue as staff are reluctant to recognise that no harm or near misses are reportable. Mr Miller confirmed that the Trust is aware of the relapse. NTW – The Trust is in the middle 50% of reporters. The number of self- harming behaviour incidents remains significantly higher than other Trusts and significantly less no harm incidents. The committee queries the figures and Mr Miller advised that organisations do not always apply the coding in a consistently which makes comparisons difficult. The committee noted the long standing and type of patients admitted to the Trust and that the Trust is a good reporters. Mr Miller advised that the Trust has a new staff online direct reporting system which is making it easier to submit reports and therefore numbers are likely to increase. NHCFT – The trust is now in the lower of the middle 50% of reporters for the period September 15 to March 16. The Trust is the third highest reporter amongst the Cumbria and North East Trust. NEAS – An improvement has been seen from the previous data reports. The number of treatment/procedure incidents continues to be higher than other ambulance rust.

NHS Safety Thermometer NuTHFT has again risen above the national average in reported new pressure ulcers. NHCFT and NTWFT reported slightly above the national average for rates of falls with harm. NHCFT reported above the national average for UTI rates for the first time since December 2016.

Mrs Coyle asked the committee members for questions and comments.

Mrs Walker commented that there appears to be no improvement with regard to NHCFT implementing learning from SIs. Mrs Grieveson confirmed that a formal letter has been issued and an improvement action plan has been requested and the committee will continue to be updated on a regular basis.

There were no further questions and Mrs Coyle thanked Mrs Bee for the report.

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OFFICIAL Corporate Quality and Safety

NTQS1/17/041 Agenda Item 7: Death under Deprivation of Liberty Safeguards (DoLS)

Mrs Grieveson presented the Death under Deprivation of Liberty Safeguards (DoLS) report to the committee. Mrs Grieveson advised that there is a change of purpose to this report as it is for information only a she is unable to provide assurance for the Coroners Office.

In summary, if a death on or after 03 April 2017, where the deceased was subject to DoLS, the coroner will no longer have a duty to conduct an inquest in all cases. The coroner only needs to be informed where the cause of death is unknown or where there are concerns that the cause of death was unnatural or violent, including where there is any concern about the care given having contributed to the persons death. People who die expectedly do not now need to be referred to the coroner. The death of a loved one is a very emotional time and this will prevent further distress to families through unwarranted referral to the Coroner, although referral can still be made if there are any concerns surrounding the death.

Dr Wright advised the committee that he feels this is a good move for families.

The committee received the report for information.

NTQS1/17/042 Agenda Item 8: CQC Published Reports

Mrs Grieveson gave a verbal summary of the report provided by Mrs Marshall regarding the CQC report for Princes Court, part of Akari Care. Mrs Grieveson pointed out that CQC inspection is in relation to the Nursing Home part of Princes Court and not the Intermediate Care Unit.

The overall outcome of the report was rated as ‘requiring improvement’. All five areas as detailed below require improvement:-

Is the service safe? Requires Improvement Is the service effective? Requires Improvement Is the service caring? Requires Improvement Is the service responsive? Requires Improvement Is the service well-led? Requires Improvement

The CQC require an action plan as to how Akari are going to make improvements. The CQC and the CCG will be monitoring the action plan to ensure improvements are made.

Following the inspection and ongoing concerns Prince Court was placed in organisational safeguarding. Their improvement action plan is monitored by the Local Authority and CCG Clinical Quality Lead Nurse.

Mrs Coyle asked if the CCG were offering support to Princes Court. Mrs Grieveson confirmed that the CCG continue to work with Akari Care, and regular meetings and joint monitoring visits with the Local Authority are taking place. Mrs Grieveson confirmed that the home is under a lot of scrutiny.

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OFFICIAL

The committee discussed a number of issues including the rapid turnover of staff and lack of leadership within the home. It was noted that there is a complex case mix within the home which is different to wards in hospitals.

NTQS1/17/043 Agenda Item 9: Risk Management Policy

Mrs Walker advised that the Risk Management Policy v5 was approved by the Governing Body on the 28 March 2017. Following an internal audit, the policy has been updated to v5.1 to clarify risk management training arrangements and this is the only change to the policy.

The training required to comply with this policy is key to the successful implementation of this policy and embedding a culture of risk management in the organisation. Staff and members will receive practical advice on the implementation of this policy from the Head of Governance. Risk management training will be included in in the corporate staff induction programme.

The committee approved Risk Management Policy v5.1.

NTQS1/17/044 Agenda Item 10: Any Other Part 1 Business

There was no other business raised for Part 1 of the meeting.

Date and Time of Next Meeting

06 June 2017 9.00 a.m. to 11.30 a.m. Hedley Court 04 July 2017 9.00 a.m. to 11.30 a.m. Hedley Court

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Notes of the meeting of the North Tyneside CCG Patient Forum held on 11 May 2017 held at The Linskill Centre, Linskill Terrace, North Shields, 11am – 1pm

Present: The meeting was chaired by Eleanor Hayward

Practice Representatives: Beaumont Park Victoria Mayes Earsdon Park Surgery Ann Appleby Priory Medical Group Susan Dawson Wellspring Practice Gillian Bennett Val Telfer 49 Marine Avenue Pat Bottrill MBE Park Road Medical Practice George Mitchell CBE Marine Avenue Jon Routledge Park Parade Ray Calboutin Northumberland Park David Hall Forest Hall Medical Group Judith McSwain Battle Hill Health Centre Dean Stewart Collingwood Health Group Phil Howells Swarland Avenue Steve Cattle Nelson Medical Group Sylvia Hall Whitley Bay Health Centre Philip Lowe PhD

In attendance: NHS North Tyneside CCG Lesley Young-Murphy Chair Eleanor Hayward NHS North Tyneside CCG Jon Connolly NHS North Tyneside CCG Wally Charlton NHS North Tyneside CCG` Marc Rice NHS North Tyneside CCG Anne Timmins Community & Health Care Forum Michele Spencer Community & Health Care Forum Carole Reed Community & Health Care Forum Paula Peart (Note taker)

Not in attendance: West Farm Surgery Patsy Lemin Nelson Health Group Linda Scott Portugal Place Health Centre Tina Trowbridge Lesley Rycroft Spring Terrace Gillian Rayne Wideopen Surgery Craig Harold West Farm Surgery Andrew Fothergill West Farm Surgery Grace Foggin Bewicke Medical Centre Diane Blackham Wellspring Practice Anne Lawson

Apologies for absence: Wideopen Surgery Eric Landau Village Green Surgery Bill Critchlow Lane End Surgery Steve Manchee Monkseaton Medical Centre John Tanner Beaumont Park Mark Hoggan Priory Medical Group Anne Carlile Sandra Gillings 49 Marine Avenue Hazel Parrack Whitley Bay Health Centre Heather Carr Lane End Surgery Steve Roberts Colin Thomson Collingwood Health Group Wendy Johnson Bewicke Medical Centre Sonia Bradley

1. Welcome and introductions: Eleanor Hayward welcomed members to the Patient Forum and thanked everyone for taking the time to attend and introduced Jon Connolly, Director of Finance.

2. Apologies: Apologies for absence were received as above.

3. Confirmation of quoracy: The meeting was confirmed as quorate.

4. Declarations of interest: Everyone was encouraged to declare their interest if relevant.

5. Notes of the previous meeting dated 16 March 2017: The notes were agreed as a true record.

Actions were discussed, concluded or to follow.

6 Matters arising GP Access Extended Hours - Dr Lesley Young-Murphy The Primary Care Strategy brings together a National Strategy which is included in the CCG 5 year plan. The public will be involved in each part of the delivery of the plan by way of consultation across the whole of North Tyneside. The Patient Forum will always be involved in helping the CCG shape primary care and community services together. Dr John Matthews agreed there could have been more engagement with the Patient Forum regarding the Primary Care Strategy and GP Access Extended Hours and this will be taken on board for the future.

The Shared Decision Making presentation will be uploaded to the CCG website and sent to all GP surgeries

The CCG’s intentions are always to move services closer to people in the community; some surgeries are better equipped for this than others but will work together in localities. If some surgeries have to close and team up together then this will go out to consultation.

7. CCG Update Dr Lesley Young-Murphy It has been a challenging couple of years but the CCG is now delighted to have Jon Connolly with his wealth of experience as the new permanent Director of Finance.

The CCG has only 1 interim member of staff left and this post will go out to secondment next week.

Urgent Care Conversations are still ongoing between the potential provider and the CCG and the CCG will make an announcement when they are in a position to sign the contract.

Member Questions/Comments Q. Why are inappropriate referrals being made to the Referral Management System (RMS) in certain practices?

A. Some practices do really well, others not so well. RMS has saved £1.8m. Feedback is given to GPs from RMS and the CCG looks at this feedback and puts in training where necessary.

Financial Recovery Plan (FRP) – Jon Connolly Jon Connolly advised the Forum that he has 10 years experience in working in finance in the NHS and is very pleased to be working for the CCG. He advised the group that the CCG has achieved their financial plan for the first time and that the 2017/18 plan is very deliverable on what needs to be done so will continue on the progress already made.

8. Development Session Are they working? Do we need to re-align? Do we need to create new groups? What do you feel the big issues are for the CCG in the next 12 months?

The Forum split into groups to reflect on the success of the Forum and to discuss the way forward for the working groups, all comments were then fed back to the group. Marc Rice and Anne Timmins will collate the responses for the next Forum meeting.

9. Any other business Dr Lesley Young-Murphy advised that that the CCG will continue to build on their successes; they have had presentations from providers and have looked at their accounts which will be published on the CCG website

There has been a lot of good work in nursing homes which will be shared with the Caring for Older People working group.

The CCG and Public Health will form a Falls Prevention Strategy and raise public awareness and the Patient Forum members will be invited to contribute to this strategy.

North Tyneside CCG Patient Forum Action Log

Date Action Action Person Responsible Target Status No. Date 11.05.17 1 Hugo is hoping to put a Michele Spencer working group together re GP Access Extended Hours, Michele will send out expression of interest

11.05.17 2 Shared Decision Making Marc Rice presentation to be uploaded to the CCG website and sent to all GP Practices

11.05.17 3 Development Session Wally Charlton feedback to be discussed at next Patient Forum

Primary Care Committee (Public)

Minutes of the Primary Care Committee Meeting held on Thursday, 30 March 2017 2017, 2.30pm - 4pm, at Hedley Court, NTCCG

Present: Mary Coyle CCG Deputy Lay Chair, NTCCG (Chair)(MC) Denise Jones Primary Care Commissioning Manager (GP) NHS England (DJ) John Matthews Clinical Chair NTCCG (JM) Lesley Young-Murphy Executive Nurse and Chief Operating Officer, NTCCG (LYM)

In Attendance: James Martin Commissioning & Performance Manager, NTCCG (JMt) Shelagh Cockburn Programme Officer, NTCCG (SC) Margaret Hall Cabinet Member, Member of Health and Wellbeing Board, NTLA (MH) Tracy Charlton PA, Interim Director of Commissioning and Contracting, Medical Director (TC)

Apologies: Christine Keen Director of Commissioning, NHS England Iain Kitt Board Member, Healthwatch

Agenda item, Discussion & Agreed Actions Action

NTPCC/17/001 Welcome & Apologies for absence: Agenda Item 1

Mrs Mary Coyle (MC) welcomed all to the Primary Committee and apologies were noted as above.

NTPCC/17/002 Confirmation of Quoracy: Agenda Item 2

The meeting was confirmed to be quorate.

NTPCC/17/003 Declarations of Interest: Agenda Item 3

The Register of interest was checked for up-to-date accuracy.

Tracy Charlton (TC) to make amendments to the declaration of interest and include the members in attendance.

There were no declarations of interest.

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NTPCC/17/004 Minutes of the previous meeting : Agenda Item 4

The minutes from the meeting held on 15 December 2016, were agreed as a true record.

NTPCC/17/005 Actions from the previous meeting : Agenda Item 5

JMt reported that all items have been successfully completed.

There were no other actions arising.

NTPCC/17/006 Woodlands Park Health Centre: Agenda Item 6

Denise Jones (DJ) explained the purpose of the report was to inform the Primary Care Co-Commissioning Committee of an application from Woodlands Park Health Centre to:

• Permanently close the practice’s branch surgery located at Dinnington Health Centre, which would include the cessation of the provision of a dispensing service, and;

• Notification that the main practice will cease also dispensing from the site located on Canterbury Way, Wideopen, Newcastle upon Tyne.

The committee were informed that dispensing would cease at both the main practice site and branch surgery, from 01 April 2017. DJ advised that the request was outside the 3 month regulatory notification period.

DJ provided further information on the number of patients using both the branch practice and the dispensary services and the alternative options available. She explained that the implications for the closure of the Dinnington Branch were explained in detail in sections 1-10. DJ described the options available to the committee. She advised that option 2 would be the recommendation of NHS England. Option 2: Agree to the branch closure subject to the following:

• The practice addresses concerns raised by patients in relation to the branch closure. The practice is to provide information on what actions have been taken, including timescales;

• The practice submitting a communication plan for patients and stakeholders;

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• The practice confirming the date that they will exit the premises; • The practice submitting evidence to show notice on the lease has been given.

The committee were asked to consider if any action was required regarding the request of the cessation of dispensing at both sites outside of the 3 month regulatory notification period.

DJ suggested that a letter strongly advising the practice to abide by the contract, as oppose to serving a breach notice. The committee agreed that there would be little benefit in serving a breach notice.

MC thanked DJ for a thorough briefing prior to asking members for any additional comments or feedback.

The committee agreed that their main concern was that patients in Dinnington continued to have access to health services. DJ referred to the report highlighting that another GP Practice provided services from Dinnington Health Centre. Woodlands Park were happy to continue to provide health services to patients previously using the Dinnington branch from the main site and that there are several local pharmacy’s in the area who provide a delivery service for patients residing in Dinnington.

The committee requested confirmation of the financial implications of the changes for the CCG. DJ advised that costs were slightly higher for new GP Practice patients, however this would not be additional cost for North Tyneside CCG.

The committee agreed Option 2 and that the practice would be asked to provide the information within 30 days.

Action: NHS England to write to the practice to notify them of the decision and the conditions

NTPCC/17/007 Operational update – Agenda Item 7

JMt advised the committee of the recent decisions made outside of the public Primary Care Committee. JMt explained that on occasion decisions were required within a specific timescale. Since the last public Primary Care Committee there has been a need to make a decision on the 2 items. However, there remained a need for the CCG to ensure transparency in its decision making. JMt advised the following decisions had been made:

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Closure of the breach at Bridge Medical

JMt explained Bridge Medical Practice had been issued with a contractual breach because of the ‘Inadequate’ rating by the Care Quality Commission (CQC). The practice has made significant improvements and completed their remedial action plan. The CQC has revisited Bridge Medical and the service was now rated as ‘Good’. The committee noted this to be positive and a credit to the practice, and the work they have undertaken, to achieve this.

Primary Care Committee – Terms of Reference amendments

LYM advised the committee the Terms of Reference for the Primary Care Committee have been updated to reflect the CCG’s successful application to NHSE for delegated primary medical services commissioning (level 3).

LYM explained the main changes relate to the change in decision making process from being a joint decision between NHS England and North Tyneside CCG to one made by the CCG alone.

JMt provided a detailed explanation in terms of the difference in the 3 levels. • Level 1, NHS England commissioned Primary Care (GP) services. • Level 2, the CCG jointly commissioned Primary Care Services (GP) with NHS England. • Level 3, the CCG will be responsible and accountable whilst the NHSE will carry out the assurance function ensuring that the CCG carries out its duties whilst staying within the allocated budget.

Discussion took place around Section 106 payments whereby GP Practices can apply for funding from the Local Authority (LA) to develop healthcare services in areas of urban development. LYM highlighted the importance of the Primary Care Committee liaising with local authorities to maintain an oversight of the future plans.

MC highlighted the importance of formally recording these decisions in the minutes of the public facing committee.

NTPCC/17/008 Level 3 Delegated Commissioning: Agenda Item 8

This item was discussed within Agenda Item 7.

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NTPCC/17/009 Strategy Update: Agenda Item 9

JMt provided the committee with an update in the progress being made in the implementation of the Tripartite Primary Care Strategy.

Projects currently being initiated, are;

DVT Pathway A GP-led pathway in primary care for the diagnosis, treatment and ongoing monitoring of those suspected of having DVT, avoiding the need to travel to the ambulatory care centre in Cramlington. A GP practice in each locality was identified to be the specialist practice in that locality. The benefits include improved patient experience, reduced travel, improved patient safety, reduced workload and reduced cost.

Menorrhagia Pathway This proposal sees the transfer in to primary care of treatment for Menorrhagia, currently carried out in secondary care. LYM explained that a number of practices do not currently have the skills within their practice to provide this service and therefore refer patients into secondary care for treatment. The new service will allow inter-practice referrals to practices that currently provide this treatment for their own patients. This will reduce patient travel, the clinician treating the patient will have access to the full patient notes, will improve sustainability, and reduce cost.

Care Navigators JMt explained that this scheme covers the forthcoming introduction of the Care Navigators service in North Tyneside. An initial cohort of 25 receptionists will receive training and accreditation to be able to direct patients to the most appropriate source of help or advice. JMt advised that this would; reduce GP workload and reduce demand for GP appointments.

Online GP consultations This proposal introduced the concept of online consultations within North Tyneside, making use of funds allocated via the GP Forward View. JMt explained that this will allow practices to offer initial GP consultations online, either via a standard questionnaire online or via bespoke questions that relate to the specific patient’s condition.

Following further explanation, it was agreed amongst the committee that value for money be reviewed on completion of the pilot.

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Extended GP Access JMt explained, the first ‘pillar’ in the strategy relates to increasing access to GP practices. In addition, CCGs are mandated to provide a set increase in the number of hours that patients can access services in evenings and on weekends. Cllr Margaret Hall (MH) questioned where extra opening hours would be available. JMt advised that a business case was to be developed to confirm the delivery model. It was concluded that the vision be clearly articulated to residents within North Tyneside.

MC appreciated this update and thanked JMt for the report.

NTPCC/17/010 Quality Update - Agenda Item 10

JMt explained that the Primary Care Quality Group was a sub-committee of the CCGs Quality and Safety Committee. The report outlines the business discussed at the Primary Care Quality meeting on 14 February 2017.

The group were informed that an expression of interest had been received regarding the position of Locality Director.

JMt advised that the committee had found it difficult to draw conclusions on the overall level of quality at individual practices from the data provided by NHS England due to the limited measures available and the varying historic nature of the data provided. The CG has started a piece of work with the Business Intelligence Unit, North of England Commissioning Support (NECS) to weight the different measures and provide an overall rating for each practice. DJ offered the assistance of NHS England.

LYM informed the committee that there had been an article in the HSJ which highlighted that North Tyneside CCG had the highest number of GP Practices rated as ‘Outstanding’ or ‘Good’ by the CQC. MC commented that this was a significant achievement by practices and the CCG staff who had assisted.

NTPCC/17/011 Primary Care Self-Assessment – (Tabled) - Agenda Item 11

Members were asked to note the collated results of the self- assessment questionnaire.

SC advised that the completion of the self-assessment survey had been offered to all Primary Care Commissioning members.

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5 of 7 members responded to the questionnaire although 1 member felt unable to answer the questions due to the small number of times they had attended the committee (4 respondents answered the self-assessment survey).

The survey highlighted that one respondent was not clear about the committees Terms of Reference (ToR). Two of the respondents only partly agreed that the committee members had an appropriate balance of skills and knowledge to ensure responsibilities were managed effectively and two members partially agreed that the papers and information provided were in the right format and at the right time. A further comment was received in relation to the papers ‘some late changes to papers/agendas reduce the time to prepare’.

The Primary Care Committee was thanked for their responses.

NTPCC/17/012 Any Other Business - Agenda Item 10

10.1 – Urgent Care Centre

Cllr MH asked if a decision has been agreed in terms of the procurement of the new Urgent Care Centre. LYM explained that the CCG were following due process and was currently in a standstill period of 10 days to allow for challenge in the system. LYM concluded that the CCG will announce this publically to all North Tyneside Stakeholders in due course.

Following this agenda item, the meeting was closed.

MC thanked the committee members for their attendance and contribution.

NTPCC/17/013 Date and time of the next meeting - Agenda Item 11

2.30 pm – 4.00 pm on Thursday, 15 June 2017 NTCCG, Longsands Meeting Room, Hedley Court

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Notes of the Meeting of the North Tyneside CCG Council of Practices held on Wednesday 15 March 2017, at The Rising Sun Country Park, 1.35-3.30pm

Present: The meeting was chaired by Dr John Matthews, Clinical Chair

Practice Representatives:

49 Marine Avenue Dr Julia Fisher Battle Hill Health Centre Dr Susannah Thompson Beaumont Park Dr Angela McMenzie Bewicke Medical Centre Dr Kristin Richardson Bridge Medical Centre Dr Simon Young/Dr Reshimi Salam Collingwood Surgery Dr Dave Tomson Earsdon Park Surgery Dr Rebecca Keogh Forest Hall Medical Centre Dr James Lunn Garden Park Surgery Dr Cathy Allison Monkseaton Medical Centre Dr Sarah Hartley Nelson Medical Group Dr Will Tufton Northumberland Park Dr Simon Young Park Parade Surgery Dr Chris Lee Park Road Medical Practice Dr Kate Carding Portugal Place Dr Fraser Dickson Priory Medical Group Dr Andrew Duggan Redburn Park Medical Centre Dr Mark Tones Spring Terrace Health Centre Dr Sheevaun Chaudhri Swarland Avenue Surgery Dr Clare Mears Village Green Surgery Dr Mark Westwood West Farm Surgery Dr Joanne Lee Whitley Road Health Centre Dr David Colvin Wideopen Medical Centre Dr Chris May Woodlands Park Medical Centre Dr Shaun Lackey

In attendance:

Yvonne Scotland Battle Hill Health Centre) Jo Reynolds Forest Hall Medical Centre Lara-Anna Hills Nelson Medical Practice Philip Horsfield Village Green Surgery Christine Davidson West Farm Surgery Sharon Fox Wideopen Medical Centre Darren Berry Woodlands Park Medical Centre

Janet Soo-Chung Interim Chief Officer Lesley Young-Murphy Director of Transformation and Executive Nurse Dr Martin Wright Medical Director Dr Ruth Evans Clinical Director Paul James Interim Chief Finance Officer John Wicks Interim Chief Operating Officer Page 1 of 7

Mary Coyle Deputy Lay Chair Irene Walker Head of Governance Mark Adams Chief Officer, Newcastle Gateshead CCG

1 Welcome and Apologies

Apologies were subsequently noted from Dr Rachel Firth, Appleby Surgery and Dr Richard Scott, Marine Avenue Medical Centre.

Dr Matthews welcomed members to the meeting and introduced Mr Mark Adams to his first meeting of North Tyneside CCG’s Council of Practices. Mr Adams is the new Accountable Officer for NTCCG, also AO for Newcastle Gateshead CCG (NGCCG), and a North Tyneside resident.

Dr Matthews welcomed Ms Mary Coyle to the meeting who will present agenda item 6, Approval of Appointments to the Governing Body.

There had been some concern about the format of the papers sent out for this meeting, as they were sent as a combined PDF. If anyone had a problem with the combined PDF version in the future, the individual documents can be supplied on request and were posted on GP TeamNet as individual documents.

2 Register of Interests and Declarations of Conflicts of Interest

There were no additional declarations of interest.

3 Notes of Previous Meeting: 18 January 2017

Dr Matthews advised that information related to action points 2 and 3 had been circulated following that meeting.

It was noted that Darren Berry was incorrectly shown as being in attendance at the last meeting. Subject to that change, the minutes were agreed as an accurate record.

4 Chair’s Report

Dr Matthews presented his report and invited questions from members. He highlighted a number of areas.

The CCG had been taken out of special measures in January 2017, which was a significant achievement as it was the first CCG to have been taken out of special measures. Dr Matthews said that this was due to the efforts of the whole team, and represented a significant level of confidence in the CCG by NHS England.

The IAPT service has been selected as an early implementer for patients with long term conditions, which was a vote of confidence in our local IAPT service and an important extra resource for North Tyneside residents. An engagement event is to take place next Thursday and Dr Matthews hoped practices would be able to attend.

5 North Tyneside CCG Constitution

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Ms Walker presented the report relating to Primary Care Commissioning which had been discussed at the January meeting when it was agreed to move to delegated commissioning, level 3. This had been approved by NHS England and the Constitution now needed Council of Practices approval.

Ms Walker advised of the opportunity to make further edits to the Constitution: • Standards of Business Conduct: Between versions 12 and 13 some paragraphs had been omitted, and these were now included in the current version, 14. • Member Practices: The list has been updated. • Standing Orders: Due to conflicts there have been instances where the Chair and other GP members have been able to participate only in discussions, and excluded from decision making. When those members were excluded, this meant the meeting had not been quorate, so when members returned to the meeting they had to ratify the decision that had been made. Enquiries had been made with other CCGs who have an alternative quoracy. A draft had been sent to NHS England, who confirmed their agreement. • Scheme of Delegation: Last updated July 2016. Some items delegated to the Governing Body for decision had been taken from the Quality & Safety Committee and Clinical Executive. This had resulted in some double handling. Quality & Safety Committee, which has a strong membership, will now recommend items relating to the approval of policies to the Clinical Executive for approval. Audit Committee receives minutes from the Quality & Safety Committee for assurance about the effectiveness of the committee.

Members were invited to approve version 14 of the Constitution. A show of hands from a majority of members confirmed this.

Dr Colvin from Whitley Bay Health Centre did raise concerns about the legitimacy of a public ballot involving a show of hands. He suggested that in the future if members are asked to vote a secret e-mail ballot would be fairer and more likely to represent views of member practices.

6 Approval of Appointments to Governing Body

Ms Coyle presented the report detailing appointments to the Governing Body.

Ms Coyle noted that the HSJ had carried a report on NTCCG being taken out of special measures, and is the first CCG to do so. The CCG was still under Directions from NHS England, which was likely to continue until around September 2017.

Ms Coyle advised that the CCG’s Remuneration Committee, which consisted of the lay members, Ms Coyle, Mrs Hayward and Mr Willis, had met to consider key appointments to the posts of Chair, Lay member for Public Engagement, Secondary Care Clinician, Chief Officer, Chief Operating Officer and Chief Finance Officer. She reported on two appointments in particular.

Secondary Care Clinician: Advice was still awaited from NHS England on this position and the person named in the report is still being considered. He has been Secondary Care Clinician with Newcastle Gateshead CCG (NGCCG) from establishment. If he was confirmed for NTCCG he would also continue in that role for NGCCG as a separate appointment. A member felt that it was important to have someone in post who was knowledgeable about Northumbria Healthcare FT (NHCFT). Dr Matthews confirmed that Page 3 of 7

the candidate knows the Trust, and does one session per week for them in Alnwick. Mr Adams also advised that the person had worked at the former SHA working with FTs. Ms Coyle noted that it had not been easy to get someone for the role, and Dr Han’s term of office had been extended while the CCG tried to find a successor.

Chief Finance Officer: NHS England had agreed to the secondment of one of their Finance Directors, Mr Jon Connolly, to the post of Chief Finance Officer for NTCG. For the last six months, Mr Connolly has worked with NTCCG and understands the CCG financial position.

Ms Coyle asked members for their approval to the appointment of Mrs Eleanor Hayward to the role of Lay Member for Patient & Public Involvement, and this was agreed.

Ms Coyle asked members for their approval to the appointment of Mr Mark Adams to the role of Chair, and this was agreed.

Ms Coyle asked members for their approval to the appointment of Dr Lesley Young- Murphy to the role of Chief Operating Officer, and this was agreed.

Ms Coyle asked members for their approval to the appointment of Dr Cunliffe to the role of Secondary Care Clinician, subject to advice being received from NHS England, and this was agreed.

Ms Coyle asked members for their approval to the secondment of Mr Jon Connolly to the role of Chief Finance Officer, and this was agreed.

Dr Matthews advised that the CCG had intended to have a joint Chief Finance Officer with NGCCG, but it was felt NTCCG was in a stronger position to have its own CFO, and would benefit from the strength of Mr Connolly’s experience. He also welcomed Mr Adams formally to the CCG now that his appointment had been confirmed.

Mc Coyle offered her warmest congratulations to the new appointees.

Dr Matthews also advised that Dr Dave Thomson from North Shields had now been appointed as the first Locality Director, and congratulations were offered. It was hoped to recruit Directors to the other localities in time.

7 North Tyneside Care Closer to Home: Developing Our Strategy

Dr Wright gave a presentation outlining the need for the separate strands of community based care development (tripartite primary care strategy. Care Plus, Urgent Care Redesign, community services and enhanced care in care homes) to be seen as a unified strategy with a common vision. The different strands complemented each other and an overarching delivery plan and a timetable was proposed.

Dr Young Murphy gave some background information following Dr Wright’s presentation. The CCG was actively encouraged to apply for two Vanguards. One centred on primary care homes and enhancing primary care to get the right amount of community services to care for patients better and closer to home. The second, the Nursing Care Vanguard, built on the good work that has been done over the last few years. If the application is successful the CCG will benefit from pump priming money to support the development of community services, GP practices and Tynehealth Federation, voluntary sector Page 4 of 7

organisations and patients.

It was noted that Care Plus had achieved a reduction of 19% of patients going to A&E and 22% reduction in admissions, although this only covered 200 patients. The CCG’s results compared well with areas which have had Vanguard funding. This showed that good outcomes could be achieved with limited resources, and should be celebrated. Dr Colvin cautioned against simplistic interpretation of limited data with the NHS having a history of using poor and inaccurate data leading to flawed policy making. He asked that assessment of new systems should be robust and as scientific as possible especially when it might lead to changing policy and use of taxpayers’ money.

With regard to multi-disciplinary working and bringing in different specialists, Mr Horsfield queried social care and social services. His practice had robust links with social workers, but understood social workers were having to apply for their own jobs, as there will only be 21 social workers in the future, rather than 36 currently. This will have an impact on care in the community. It was noted North Tyneside Council were in a challenging economic environment and the CCG was working closely with the LA leads.

Dr Thomson reported that for the first time his practice had texted 7,000 patients to ask if they wanted to be involved in volunteering for named nursing homes, despite only needing 30 volunteers they received 550 positive responses. All agreed that this was an excellent response. These were people who had felt they had received good service and wanted to help in the community. This emphasised how relationships in localities were very important.

Dr Wright asked members to now have discussions in their locality groups and feed back their ideas.

Wallsend: There was concern about the challenges to be faced and how the locality would have input into the process. Different areas had different priorities and each locality might want to put a different emphasis on the different strands. Regarding community nursing teams and their work, there was concern that secondary care costs are increasing but there was a need to transfer resources into the community to support patients to stay in their homes. Discussions were needed with providers and stakeholders. There were ongoing concerns about resources being in the right place. Would STPs help to move that on? They were keen to ensure support for patients with social workers and the voluntary sector involved.

Whitley Bay: Increased support was needed in caring for nursing home patients. There should be easier access to community geriatricians and domiciliary visits. Community services such as district nursing and health visiting should come back to primary care, rather than stay with secondary care.

North West: There needed to be home visits and resources for GP time. There was disproportionate workload in practices, which was difficult to manage with fluctuations in staff. There was a need to manage demand better in localities. There needed to be services in the community and patient transport to get patients to appropriate services, to get people to right place at right time, and develop triage to get patients to the right people. It was difficult to ensure that people were signposted. There was difficulty in recruiting when Page 5 of 7

older people leave the service.

North Shields: Care Plus should be thought of as a most valued colleague and treated as such. There needed to be a review of what is being done in practice, what is useful and what is not. Frail people were being left. There needed to be better integration. There should be a move to directly employing the majority of community staff within a primary care organisation, as it makes a difference who people are employed by. People were needed who understand primary care and will work with us. Regarding the 111 service, we need more clinical triage. It was felt that 111 is not a service which has enhanced patient competence or knowledge. The extended hours conversation should be progressed and the primary care home Vanguard should be explored.

Dr Wright thanked members for their feedback and more work will be done on this. He asked members to think again about becoming Locality Directors, as each locality needed leadership.

8 Transition and Future Options Update

Ms Soo-Chung reminded members that discussions on transition and future options had begun at the January 2017 meeting of the Council of Practices, and had since been discussed with the Governing Body. She took members through the context and her presentation.

The original paper had proposed a set of criteria against which options were judged. These could be reviewed in time to see how the new arrangements have compared against them.

Mr Adams commented that he had been struck by the work that has been done in North Tyneside and congratulated the CCG on coming out of special measures. He stressed that then momentum needed to be maintained, and thanked Ms Soo-Chung, Mr James and Mr Wicks for their work.

He thanked members for endorsing the appointments and said that moving forward, the CCG needed to build on the substantive team to support the direction of travel for services to be delivered and developed. In the future he felt there will be more CCGs coming together, and the STP will see more CCGs working together to deliver service change and transformation. CCGs needed to learn from one another to help deliver services for patients and the public. He stressed the joint working between NTCCG and NGCCG was not a takeover by NGCCG. Mr Adams advised he is the STP lead for NTWND footprint and felt STPs were here to stay.

9 Any Other Business

Dr Matthews noted that this was the last Council of Practices meeting with Ms Soo-Chung in attendance as Interim Chief Officer and Mr James as Interim Chief Finance Officer. He thanked them for the work they had done to get the CCG to where it was now. He also paid tribute to Dr Young-Murphy who has been at the centre of the CCG and is the CCG’s corporate memory, and welcomed her appointment as Chief Operating Officer.

10 Date and Time of Next Meeting:

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Wednesday 17 May 2017, 1.30m-3.30pm The Rising Sun Country Park, Whitley Road, Benton, NE12 9SS

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