NHS Coventry and Warwickshire CCG Primary Care Commissioning Committee - Public to be held on Thursday 27 May 2021
13:30 - 15:00
Via Microsoft Teams A G E N D A
No Time Item Presenter Enclosure Purpose 1. Standing Items
1.1 13.30 Welcome Chair Verbal Apologies Received: Sarah Matthews, Jenni Northcote, Jo Galloway, Adrian Stokes
1.2 Confirmation of Quoracy Chair Verbal Confirm (From proposed Terms of Reference): The quorum necessary for the transaction of business by the Committee shall be three of the voting members and a Lay and executive majority.
1.3 Declarations of Interest: Chair Enclosure A Confirm Where possible, any conflict of interest should be declared to the Chair of the meeting in advance of the meeting. See guide below.
2. Legacy Primary Care Commissioning Committee items
2.1 13.35 Minutes of the last Meeting Chair Enclosures B Approve - Enc B1 03/02/2021 (CR) - Enc B2 24/02/2021 (SW) - Enc B3 11/03/2021 (WN)
2.2 13.40 Primary Care Commissioning Committee Andy Wilkins Enclosure C Approve Terms of Reference
2.3 13.45 Committee Schedule of Business Andy Wilkins Enclosure D Approve 2021/22
No Time Item Presenter Enclosure Purpose 3. Agenda Items
3.1 13.50 Primary Care Financial Planning Report Chris Lonsdale Enclosure E Decision
3.2 14.05 Expansion Fund Proposal Alison Cartwright Enclosure F Decision
3.3 14.15 Primary Care Quality Report Rebecca Bartholomew Enclosure G Note
3.4 14.30 Primary Care Update Reports Alison Cartwright Enclosures H Note - Enc H1 Coventry and Rugby - Enc H2 North Warwickshire - Enc H3 South Warwickshire
4. Other
4.1 14.45 Matters to be reported to the Governing Chair Governance Body Reporting
5. 14.50 Any Other Business
6. 14.55 Questions from the Public
Future meetings: Date Time Venue 27 May 2021 13:30-15:00 Microsoft Teams 14 July 2021 09:30-11:00 Microsoft Teams 8 September 2021 09:30-11:00 Microsoft Teams 10 November 2021 09:30-11:00 Microsoft Teams 12 January 2022 09:30-11:00 Microsoft Teams 9 March 2022 09:30-11:00 Microsoft Teams
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Declarations of Interest
Under the Health and Social Care Act 2012, there is a legal obligation to manage conflicts of interest appropriately. Where possible, any conflict of interest should be declared to the Chair of the meeting as soon as it is identified in advance of the meeting. Where this is not possible, it is essential that at the beginning of the meeting a declaration is made if anyone has any conflict of interest to declare in relation to the business to be transacted at the meeting. An interest relevant to the business of the meeting should be declared whether or not the interest has previously been declared.
Type of Description Interest
Financial This is where an individual may get direct financial benefits from the consequences of a Interests commissioning decision. This could include being:
• A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations; • A shareholder (of more than 5% of the issued shares), partner or owner of a private or not for profit company, business or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. • A consultant for a provider; • In secondary employment; • In receipt of a grant from a provider; • In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and • Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider). Non- This is where an individual may obtain a non-financial professional benefit from the Financial consequences of a commissioning decision, such as increasing their professional reputation Professional or status or promoting their professional career. This may include situations where the Interests individual is:
• An advocate for a particular group of patients; • A GP with special interests e.g., in dermatology, acupuncture etc. • A member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared); • An advisor for CQC or NICE; • A medical researcher. Non- This is where an individual may benefit personally in ways which are not directly linked to Financial their professional career and do not give rise to a direct financial benefit. This could include, Personal for example, where the individual is: Interests • A voluntary sector champion for a provider; • A volunteer for a provider; • A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation; • A member of a political party; • Suffering from a particular condition requiring individually funded treatment; • A financial advisor. Indirect This is where an individual has a close association with an individual who has a financial Interests interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). This should include: • Spouse / partner; • Close relative e.g., parent, [grandparent], child, [grandchild] or sibling; • Close friend; • Business partner.
Enclosure A Declarations of Interest Coventry & Warwickshire CCG - Primary Care Committee Current position (s) held- i.e. Governing Body, Member Declared Interest- (Name of the organisation and nature of Title First Name Surname Type of Interest Date of Interest practice, Employee or other business)
Declared To
Indirect
Interests
Interests Interests
Personal
Financial
Professional
Non-Financial Non-Financial Ms Rebecca Bartholomew Director of Nursing and Quality Nil Current Shareholder of Applied Geology (can undertake site/ground Ms Alison Cartwright Chief Planning and Performance Officer Jun-13 Ongoing investigations for NHS organisations) ✓ Practice Member of the Governing Body (South Warwickshire Dr Sukhdeep Dhesi 1. GP Partner at Croft Medical Centre, Leamington Spa Mar-08 Ongoing Place) ✓ Practice Member of the Governing Body (South Warwickshire 2. Croft Medical Centre is a Member of South Warwickshire GP Dr Sukhdeep Dhesi Mar-15 Ongoing Place) Federation ✓ Practice Member of the Governing Body (South Warwickshire Dr Sukhdeep Dhesi 3. CD of Leamington South PCN May-19 31/03/2021 Place) ✓ Practice Member of the Governing Body (South Warwickshire Dr Sukhdeep Dhesi 4. Director of Dhesi Medical Ltd Jan-15 Ongoing Place) ✓ Practice Member of the Governing Body (South Warwickshire Dr Sukhdeep Dhesi 5. Husband is a Dental Surgeon Jan-15 Ongoing Place) ✓ Practice Member of the Governing Body (South Warwickshire Dr Sukhdeep Dhesi 6. CEO of NEC in Birmingham, relative. Jan-07 Ongoing Place) ✓ Practice Member of the Governing Body (South Warwickshire Dr Sukhdeep Dhesi 7. Chief Information Officer at McKesson UK, brother in law. Jan-18 Ongoing Place) ✓ Ms Jo Galloway Chief Nursing Officer Nil Current Mr Andrew Harkness Executive Lead for Coventry Place Spouse is Managing Director of East Staffordshire CCG ✓ 2017 Current Ms Roma Holland Information Sharing Programme Manager Bank Nurse, South Warwickshire Foundation Trust ✓ 2017 Current 1. Member of Chartered institute of Public finance Accountants Mr Phillip Johns Accountable Officer Dec-20 Current (CIPFA) ✓ 2. Member of Healthcare and financial management association Mr Phillip Johns Accountable Officer Dec-20 Current (HFMA) ✓ Mr Phillip Johns Accountable Officer 3. Wife is director of Seren Melyn - providing OT services ✓ Dec-20 Current Mr Phillip Johns Accountable Officer 4. Wife is employee at SWGHFT ✓ Dec-20 Current Mr Zubair Khan Governing Body Lay Member 1. Lay Member Tribunals Ministry of Justice ✓ Mar-21 Current 2. Lay Manager Birmingham and Solihull Mental Health NHS Mr Zubair Khan Governing Body Lay Member ✓ Mar-21 Current Foundation Trust (honorary agreement) Mr Zubair Khan Governing Body Lay Member 3. Lay Chair Gate Medical Centre ✓ Mar-21 Current Mr Zubair Khan Governing Body Lay Member 4. Consultants Recruitment AAC Panel ✓ Mar-21 Current Mr Chris Lonsdale Interim Chief Finance Officer Nil Current Mrs Mary Mansfield Deputy Director of Nursing and Quality Nil Current Jointly appointed - George Eliot Hospital (Director of Strategy, Ms Jenni Northcote Executive Lead for Warwickshire North Place Nov-19 Current Service Improvement and Primary Care) Mr Andrew Olbort-Wilkins Head of Governance and Corporate Affairs 1. Partner is a Hospital Doctor ✓ May-16 Current Mr Andrew Olbort-Wilkins Head of Governance and Corporate Affairs 2. Director of Warts and all Theatre ✓ Jul-16 Current Mr Adrian Stokes Interim Chief Finance Officer Director of Flexible Health Solutions ✓ 2014 Current Mrs Nicola Templerley-Smith Head of Primary Care Commissining Nil Current Dr Deepika Yadav Practice Member of the Governing Body (Coventry Place) 1. GP Partner, Willenhall Primary Care Centre ✓ Jun-20 Current Dr Deepika Yadav Practice Member of the Governing Body (Coventry Place) 2. Husband is GP, Locum in Coventry and Warwickshire ✓ Sep-14 Current Dr Deepika Yadav Practice Member of the Governing Body (Coventry Place) 3. Member of Coventry LMC ✓ Apr-16 Current Dr Deepika Yadav Practice Member of the Governing Body (Coventry Place) 4. Resident in local area with children who go to school locally ✓ Mar-04 Current 5. Director future aesthetics LTD, providing aesthetics treatments Dr Deepika Yadav Practice Member of the Governing Body (Coventry Place) (No longer current as at March 2021, to be removed in September ✓ Apr-19 Mar-21 2021) Dr Deepika Yadav Practice Member of the Governing Body (Coventry Place) 6. RCGP Midlands tutor ✓ Sep-20 Current 7. Clinical Director of Integrated care - University Hospitals Coventry Dr Deepika Yadav Practice Member of the Governing Body (Coventry Place) Apr-20 Current and Warwickshire (UHCW) and the CCG. ✓ Dr Deepika Yadav Practice Member of the Governing Body (Coventry Place) 8. Joint role as Clinical Director for Strategic partnerships CWPT ✓ Oct-20 Current Mr Ghulam Vohra Governing Body Lay Member 1. Grandson employed by UHCW ✓ Oct-19 Current Mr Ghulam Vohra Governing Body Lay Member 2. Trustee - Umar Education Welfare Trust ✓ 2012 Current Mr Ghulam Vohra Governing Body Lay Member 3. Treasurer - Hillfields Muslim Association ✓ 2002 Current Mr Ghulam Vohra Governing Body Lay Member 4. Vice Chairman - Coventry Muslim Forum ✓ 2010 Current Mr Ghulam Vohra Governing Body Lay Member 5. Co-Chair Coventry Community Forum (IAG) ✓ 2016 Current Mr Ghulam Vohra Governing Body Lay Member 6. Chair of Governors - Lyng Hall Secondary School ✓ 2016 Current Mr Ghulam Vohra Governing Body Lay Member 7. Vice Chair - Eden Girls Secondary School ✓ 2014 Current Mr Ghulam Vohra Governing Body Lay Member 8. Board Member - Faith Strategic Partnership Group - WMCA ✓ 2021 Current Mr Ghulam Vohra Governing Body Lay Member 9. West Midlands Police Scrutiny Board ✓ 2015 Current PRIMARY CARE COMMISSIONING COMMITTEE (PUBLIC) Enc B 1 UNCONFIRMED MINUTES OF THE MEETING HELD ON
WEDNESDAY 3 FEBRUARY 2021 15:00-16:00
HELD VIRTUALLY BY MICROSOFT TEAMS 1
PRESENT Voting Members Graham Nuttall (GN) Coventry and Rugby CCG Lay Member Primary Care, and interim and Warwickshire North CCG Committee Chair Gemma Nistorica-David Coventry and Rugby CCG Lay Member Patient and Public (GND) and Warwickshire North CCG Engagement and Committee and Committee Vice Chair Jenni Northcote (JN) Coventry and Rugby CCG Chief Strategy and Primary Care and Warwickshire North CCG Officer Chris Lonsdale (CL) Coventry and Rugby CCG Acting Chief Finance Officer and Warwickshire North CCG Rebecca Bartholomew (RB) Coventry and Rugby CCG Director of Nursing and Warwickshire North CCG Dr Deepika Yadav (DY) Coventry and Rugby CCG GP Clinical Lead and Governing Body Member Dr Pradeep Bahalkar (PB) Coventry and Rugby CCG GP Clinical Lead and Governing Body Member Dr Kiran Mandhyan (KM) Coventry and Rugby CCG GP Clinical Lead and Governing Body Member
IN ATTENDANCE Chris Stainforth (CS) Coventry and Rugby CCG Lay Member Audit and Governance Ed De Vane (EDV) Healthwatch Coventry Healthwatch Representative and fellow at the Parliamentary Office of Science and Technology (Health and Social Care) Nikkie Temperley-Smith (NTS) Coventry and Rugby CCG Head of Primary Care Commissioning Dr Sarah Matthews (SM) Coventry LMC Representative Coventry LMC Secretary Dr Lesli Davies (LD) Warwickshire LMC Warwickshire LMC Representative Andrew Wilkins (AW) Coventry and Rugby CCG Head of Governance and Corporate and Warwickshire North CCG Affairs Jackie Webster (JW) Coventry and Rugby CCG Minute Taker
APOLOGIES Jo Galloway Coventry and Rugby CCG Chief Nursing Officer and Warwickshire North CCG Dr Sarah Raistrick Coventry and Rugby CCG Coventry CCG Chair
ACTION 1. WELCOME AND APOLOGIES – Chair These were noted as above.
2. QUORACY CHECK DURING COVID-19 PANDEMIC – Chair The meeting was declared quorate.
3. DECLARATIONS OF INTEREST – Chair Declarations of Interest were detailed in Enclosure A. No other conflicts of interest were declared. 1
4. MINUTES OF PREVIOUS MEETING – Chair Minutes of the meeting held on 2 December 2020 were approved.
5 ACTION TRACKER – Chair There were no outstanding actions.
6. PRIMARY CARE FINANCE REPORT – Chris Lonsdale A report was presented to advise Members of the reported financial position in relation to the delegated GP Services budget and also related CCG budgets as at Month 9.
The Committee was asked to NOTE the Primary Medical Care (Delegated) reported position and risk of underspend in 2020/21 therefore not meeting NHS England requirements, to NOTE that the retrospective adjustment for month 6 is now completed, to NOTE risk of programme slippage and ability to carry forward funding due to the current financial framework, and APPROVE the proposals to use delegated underspends should carry forward not be permissible thereby achieving the NHSE requirement to break even as in previous years.
The following was highlighted:
Primary Care Delegated Budget: • The report outlined risks and potential for slippage (of up to £3.6m) and the need to mitigate these towards the end of the financial year. • Discussions are taking place with NHSE regarding how to mitigate Primary Care Additional Roles underspend. • Other potential slippage relates to discretionary funds, particularly new shared care pathways, and some underperformance in other areas. • Table 3 outlined the proposal for non-recurrent transfer from primary care budgets to delegated to achieve a year-end break-even position. • Carry forward opportunities, including PMS Funding, is yet to be confirmed with NHSE. • Delegated budget was reported as spent for this financial year.
GP related budgets: • Prescribing - Full year reporting to date showed an overall overperformance.
GP Forward View: • Current position was outlined in the paper – the CCG will look to secure allocations going forwards.
GPIT Allocation: • Confirmation of budget allocation has only been received for N365 upgrade at this stage. Flexibility is being sought so that spend against delegated authorities can be achieved.
Feedback and responses: • PMS funding is ring-fenced for Primary Care and further value for money scheme ideas from Primary Care colleagues is being encouraged. • Separate funding has been made available from NHSE for care homes schemes. • On Table 1 reporting of underspend of £304k for GMS services was related to a number of variables including practice list sizes. • SM expressed concern that the reported £3.6m underspend may not be retained 2
for Primary Care locally in view of the CCG merger in April 2021, and queried if the underspend could be used for items such as ARRS roles.
The Committee NOTED the Finance Report for month 9 and APPROVED the proposal to use delegated underspends to mitigate any risk of carry forwards not being permissible and in order to achieve budget break even at year end.
7. PRIMARY CARE QUALITY REPORT – Sarah Weir-Smith A report was presented to provide the Primary Care Committee with information and assurance on the quality of care across GP practices, in the period since the last report. The following was highlighted in relation to the Covid vaccination programme:
• All eligible residents in care homes should have received their Covid vaccination by 7 February 2021.
• The Covid vaccination programme for care homes is being supported by CCG nurses who will then move to support the Roving Team for housebound patients and PCN vaccination sites.
• Further internal admin support is now in place in the CCG’s Quality Team to manage Primary Care reporting of all incidents, including vaccination programme incidents, through the Datix system. Of the 151,100 vaccinations delivered locally as at 2 February 2021, only 11 incidents had been reported of minor side effects from the vaccine which equates to 0.0007% incident rate.
The Committee NOTED the Quality Report as presented and was ASSURED regarding the monitoring of quality of care in GP Practices.
8. PRIMARY CARE ASSURANCE REPORT – Nikkie Temperley-Smith A report was presented to provide the Committee with ASSURANCE on the work streams in progress as part of the CCGs delegated functions relating to GP Primary Care Commissioning. The following was highlighted:
• Covid Vaccination Sites – All now established and working well. Refocussing of work to support the Covid response has resulted in a slowing of progress in some other work streams under Primary Care commissioning.
• GP Surgeries – All practices remain open and are offering a digital first (telephone and video) service for initial triaging of patients to assess the urgency and method for treating individuals. This method is designed to keep patients and healthcare staff safe during the Covid response. All essential GMS services such as screening and other immunisations continues. All non-essential services and face to face appointments remain available in line with clinical need.
• Seasonal Flu Vaccination Programme – This winter there is a drive to increase uptake to offer protection against flu during the Covid pandemic. Latest data shows a significant increase in uptake rate from 69.2% last year to 78.5% this year.
• Foleshill New Development – Work is progressing well and the CCG continues to work with the incumbent provider to ensure this facility is operational as soon as construction has been completed. Intercoms, dividing doors and partitions are being included as part of the construction as safety measures for staff and patients in pandemic situations. 3
• SAS (Special Allocations Scheme) – Due to the present situation regarding the pandemic, the frequency of reporting from the current Providers has been paused to ensure continuity of service and to enable Providers to respond to patients’ needs throughout the pandemic. The Review Panel continues to meet to review new referrals to the scheme.
The Committee NOTED the content of the Primary Care Assurance Report and was ASSURED regarding the work being undertaken in Primary Care.
9. PRIMARY CARE CONTRACT REPORT – Nikkie Temperley-Smith A report was presented to request that the Committee NOTE the following applications for a variation to contract:
• M86034 Woodside Medical Centre – application to remove Dr David Gillmer from the GMS Contract. This is a practice with 3 Clinical Partners applying to remove 1 Partner from the Contract. There are no known quality concerns and it is anticipated that there will be no impact on the practices’ ability to continue to deliver quality patient services as a result of this contract variation.
The Committee NOTED the above contract variation submission.
10. ANY OTHER BUSINESS None.
DATE OF NEXT PUBLIC MEETING:
Wednesday 12 May 2021, 9.30-11.00 am
4
Enc B 2
PRIMARY CARE COMMITTEE
Draft Minutes of the Primary Care Committee meeting held on Wednesday 24 February 2021 (09.30am – 10.30am) via Microsoft Teams Present:
Robin Verso Lay Member (Chair) RV
Dr Richard Lambert Assistant Clinical Chair RL
Rodney Pitts Lay Member RP
Dr David Spraggett CCG Chair DS
Alison Cartwright Chief Delivery Officer AC
Dr Ian Allwood GP Member IA
In attendance
Anna Hargrave Chief Strategy Officer AH
Liz Flavell-Smith Deputy Chief Finance Officer LFS
Sue Phillips Head of Primary Care Commissioning SP
Sarah Johnson Primary Care Contracts Manager SJ
Rachel James Primary Care Development Manager RJ
Hannah Willetts Head of Planning and Policy HW
Wendy Gault Strategise (Consultancy) WG
Vicki Vernon Minute Taker VV
Ref Note Action
1. RV reminded all that no recording of the meeting was permitted.
2. Apologies
2.1 Apologies were received from Alison Walshe, Oliver Lawton, Phil Johns and Steven Waweru.
3. Declarations of Interest
3.1 The Chair reminded all in attendance of their obligation to declare any interests.
Primary Care Committee – 24 February 2021 Page 1 of 4
Enc B 2 3.2 None were declared.
4. Minutes of the Previous Meeting (Enc 01)
4.1 Apart from a minor typographical error the minutes of the previous meeting held on 9 December 2020 were accepted as a true and accurate record.
5. Matters Arising from Previous Meeting
5.1 There were no matters arising from the previous minutes.
6. Action Log (Item 6, Enc 02)
6.1 Action 65 – Not due until year end (May 2021). Action remains Open.
7. Questions from the Public
7.1 There were no questions from the member of the Public.
8. 2020/21 Financial Position at Month 9, December 2020 (Item 8, Enc 03)
8.1 LFS outlined the key points in the report.
8.2 RL queried the £0.5m additional Locum costs and where they appeared in Table 1. LFS confirmed that the increase was an expected overspend measured against last year and the costs were included in the ‘Other’ section in Table 1.
8.3 RV questioned the Actual Dispensing figure at the month end compared to the forecast outturn. LFS responded she would follow up outside of the meeting to confirm the difference.
8.4 Subsequently LFS has reported: NHSEI have provided an overall bottom line budget for prescribing within the CCG programme allocation. This has been pro-rated over the original planned individual categories and actual costs reported year-to-date at that detailed level. However, the
forecast position has only been estimated bottom line, and is expected to be break-even.
The forecast spend was reported as matching budget on the individual lines, whereas in reality there will be variation between individual budget lines, albeit break-even overall. This approach will be reviewed for the next report so the forecast on an individual budget line reflects the anticipated position at year-end line-by-line.
8.5 The Primary Care Committee noted the contents of the report.
9. Primary Care Update (Item 9)
9.1 AC advised that SWCCG had achieved an excellent flu uptake being top in 5 out of 6 categories in the Midlands region and congratulated all concerned in achieving those targets.
9.2 Covid Vaccinations continue at pace and as at 15 February, Coventry and Warwickshire had to date vaccinated 296,000. Currently the aim is to achieve high numbers in Cohort 6 before moving on to Cohort 7. Second doses will start to be given next week initially at UHCW and then at the Local Vaccination Sites.
9.3 Further slides summarised the situation with PCN’s and GP Contracts.
Primary Care Committee – 24 February 2021 Page 2 of 4
Enc B 2
9.4 RV thanked all those involved in delivering the Covid programme.
10. Stretched QOF 2019-20 (Item 10, Enc 04)
10.1 The incentive scheme for GP practices to improve quality of care was extended to September 2020 due to the Covid Pandemic. AC advised that all 32 Practices received additional payments.
10.2 AC applauded the improvement of the number of diabetics treated with Statins and the increase in the number of patients with Heart Failure treated with an ACE-1/ARB.
10.3 AC advised that the need to focus on Covid-19 resulted in a decision not to run a Stretched QOF scheme for the remainder of 2020-21.
10.4 RL asked if the Committee could clarify the figures circulated yesterday. RJ responded that the information had been reviewed and correct payments identified for all practices.
10.5 The Primary Care Committee noted the contents of the report.
11. General Practice Estates Planning – Locality Position Updates (Item 11, Enc 05)
11.1 AH presented the report and advised that the ongoing actions would be picked up by the new merged CCG going forward. She expressed her thanks to Hannah Willetts and Wendy Gault for their hard work.
11.2 RV asked about the Kings Hill place development. AH advised that discussions had taken place with C&R and WN CCGs and with WDC reference Section 106 funding. It will be picked up by the new CCG.
11.3 RV asked about the figures in paragraph 2.5. AH advised that they are based on a consistent method of estimating using industry averages.
11.4 RL questioned if Equity and Diversity was considered in the planning. AH assured that consideration is given to available information including current and future work practices and space needed based on population. Modelling is based on many factors.
11.5 DS commented that any building needs to be fit for the future. AH advised that space standards are considered to provide future flexibility for use. DS suggested that there should be a nationally agreed method.
11.6 RV asked if all these issues had been considered and taken into account? AH advised that this is very early stages and due to the changes in operating systems for many practices that have come about during the past year, all estimates are reduced to 80% of the norm to account for lower footfall but also maintaining a safe working space for staff and patients.
11.7 The Primary Care Committee noted the contents of the report.
12. North Leamington Spa – New Practice Development (Cubbington Road Surgery M84029) (Item 12, Enc 06)
12.1 AH outlined the reasons for this development and assessment of need. £2.8m has been allocated through WDC Infrastructure Funding. SWFT is the developer on this project and would meet any capital shortfall. AH asked for the Committee’s confirmation that this could move to a Business Case.
Primary Care Committee – 24 February 2021 Page 3 of 4
Enc B 2 12.2 RV commented that it was good to see public sector money going into the project.
The Primary Care Committee noted the contents of the report and confirmed its approval.
13. Budbrooke Medical Centre Improvement Project (Item 13, Enc 07+07a)
13.1 AH outlined the background and purpose of the report and asked the Committee to approval the planned improvement works and leased new build space.
The Primary Care Committee noted the contents of the report and confirmed its approval.
14. Any Other Business
10.1 No other business was raised.
10.2 The Chair thanked all members of the Committee and its officers and wished all well in the new merged CCG. He declared the meeting finished and moved on to the Confidential session of the meeting.
Date of next meeting: This was the final SWCCG PCC meeting.
Confirmed as a true and accurate record of the meeting:
Signature of Chair:
Print Name: Date:
Primary Care Committee – 24 February 2021 Page 4 of 4
Enc B 3 PRIMARY CARE COMMISSIONING COMMITTEE (PUBLIC) MEETING UNCONFIRMED MINUTES OF THE MEETING HELD ON THURSDAY 11 MARCH 2021 – 11:00– 11:45 VIRTUAL BY MS TEAMS
PRESENT Voting Members Graham Nuttall (GN) - Chair Warwickshire North CCG Lay Member Primary Care and Acting Committee Chair Gemma Nistorica-David Coventry Rugby & Warwickshire Lay Member Patient & Public (GND) North CCGs Engagement and Committee Vice Chair Jenni Northcote (JN) Coventry Rugby & Warwickshire Chief Strategy and Primary Care Officer North CCGs Kay Speed-Andrews (KSA) Coventry Rugby & Warwickshire Deputy Director of Finance and North CCGs nominated deputy for Acting Chief Finance Officer Sarah Weir-Smith (SWS) Coventry Rugby & Warwickshire Primary Care Lead Nurse for Quality and North CCGs nominated deputy for Chief Nursing Officer
Non-Voting Members Dr Arshad Khan (AKh) Warwickshire North CCG GP Clinical Lead
IN ATTENDANCE Dr Amar Kachhia (AKa) Warwickshire LMC Assistant LMC Secretary Roma Holland (RH) Warwickshire North CCG Head of Primary Care Commissioning Jean Thomas (JT) Chair of PPG, Pear Tree Surgery Member of the public Jackie Webster (JW) Coventry Rugby & Warwickshire Primary Care Administrator (Minutes) North CCGs
APOLOGIES Jo Galloway Coventry Rugby & Warwickshire Chief Nursing Officer North CCGs Chris Lonsdale Coventry Rugby & Warwickshire Acting Chief Finance Officer North CCGs Rebecca Bartholomew Coventry Rugby & Warwickshire Director of Nursing & Quality North CCGs Andrew Wilkins Coventry Rugby & Warwickshire Head of Governance and Corporate North CCGs Affairs
ACTION 1. WELCOME AND APOLOGIES – Chair These were noted as above including one member of the public who joined the meeting.
2. QUORACY CHECK – Chair The meeting was declared quorate. New quoracy for approvals during the Covid-19 pandemic period was noted as one Lay Member Chair and one CCG Manager.
3. DECLARATIONS OF INTERESTS – Chair Declarations of Interest were noted in the Register of Interests. No other Conflicts of Interest were reported.
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4. MINUTES OF PREVIOUS MEETING – Chair Minutes of the meeting held on 14 January 2021 were approved.
5. ACTION TRACKER – Chair There were no outstanding actions.
6. PRIMARY CARE FINANCE REPORT – Kay Speed-Andrews A report was presented to advise Members of the reported and underlying financial position in relation to the delegated GP Services budget and related CCG budgets as at Month 10 and to seek retrospective APPROVAL for proposals in order to meet the statutory breakeven target for delegated budgets should carry forward of funding not be permissible under the current financial framework. The following was highlighted:
• Reporting of underspend for the current financial year is due to the circumstances of the pandemic, prudent budget setting in the first half of the year, and the new financial framework. • Under a normalised position the CCG would be reporting an overperformance on Primary Care budgets for this financial year based on spend. • Budget setting prior to Covid was outlined in the paper under Appendix 2 for comparison purposes.
Delegated Primary Medical Care Budget • Reported to be performing in line with plan based on proposals being approved in order to meet delegated duties. • Many actions and mitigations to reduce the underspend risk highlighted at month 8 have been completed and outcome based on expected performance for the remaining months indicate that the budget will underspend by c.£1m, therefore not meeting NHSE requirements to breakeven. • Efforts have been made to confirm whether budget carry forwards are permitted to meet future financial commitments, but as this may not be possible, approval for flexibility was being sought to resolve any underspend in line with previous years.
GP Related Budgets • Full year forecast is £39.3m resulting in a forecast underspend of £2.4m. • A contributory factor to the underspend relates to prescribing which are higher than in 2019/20 but lower than initially predicted based on the significant pressures in the first 4 months of this year.
GPIT Capital – NHSE has confirmed capital requirements including funding for N365, BAU Capital for Enterprise Domain, and Covid capital costs.
The Committee NOTED the Primary Care Finance Report, the risk of underspend and programme slippage, and APPROVED the proposal to use delegated underspends to achieve breakeven should carry forwards not be permissible.
7. PRIMARY CARE QUALITY REPORT – Sarah Weir-Smith A report was presented to the Committee for INFORMATION and ASSURANCE regarding the quality of care across GP practices. The following was highlighted:
• Care Quality Commission (CQC) – Two new inspectors have been appointed to support and cover inspections and any concerns raised by any Coventry, Rugby and Warwickshire North practices. No inspections are taking place other than those where concerns have been raised - no concerns have been raised for local practices. CQC are planning how inspections are to take place post-Covid.
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• Incident Reporting – Practices continue to use the Datix system for reporting incidents. Themes are mainly related to poor discharge from medical settings and medication incidents. • Cytology – Reporting of results back into GP Practices remains within the 14 day trajectory. The new ICE system for ordering is now live in practices. • Covid Vaccination – The vaccination programme continues throughout Primary Care. Initial focus was on Care Homes and use of the roving team to assist in vaccinating the most vulnerable. First vaccinations for all care homes has been completed and second doses will commence imminently with mutual aid and Quality Team supporting effective delivery. • Flu Vaccination – The flu season has now ended. Public Health has reported no confirmed cases of flu in hospitals this year with suggestions that Covid barriers and increase in the flu roll out programme to also cover 50-64 year olds suggested as possible contributory factors. Uptake for the flu vaccination across all vulnerable age groups and also CCG staff was very good. Confirmation is awaited from NHSE regarding the age groups to be included in the 2021/22 winter flu roll out plan.
The Committee NOTED the Primary Care Quality Report and was ASSURED regarding work programmes in place to support quality improvements in Primary Care.
8. PRIMARY CARE ASSURANCE REPORT – Roma Holland A report was presented to provide the Committee with ASSURANCE on the work streams in progress that relate to GP Primary Care Commissioning, as part of the CCG’s delegated functions. The following was highlighted:
• APMS Contracts Re-Procurement – Plans to mobilise service delivery under the new contractor are progressing smoothly with expected completion of plans on target for the new contractor Spirit Healthcare to commence on 1 April 2021. • Contract Variation – Application from Atherstone Surgery for the removal of Dr Cosgrove from the GMS partnership. Submitted to the Committee for noting. • Covid Vaccination Programme – On 26 February Coventry and Warwickshire was publicly commended by Matt Hancock, Government Health Secretary, as the first area nationally to vaccinate 95% of its over 65s population. Vaccinations are progressing through lower age groups as per Government guidance, and also second vaccinations as they are due. Venues for vaccinations include some community pharmacies local vaccination sites, and a large national vaccination centre at Stoneleigh. A clinic with specialised staff is being offered on Saturdays at the Bedworth Civic Centre for people
with a learning disability or issues relating to mental health. • Hot Hub Activity – Set up to assess Covid-19 patients safely, the site in Galley Common remains operational with an average of 5 patients being seen daily. An additional site at Polesworth remains ready to go live if needed in the event of another surge in cases. The situation is continually being monitored to determine stand up or stand down requirements. • Learning Disability Annual Health Checks – The number of health checks completed are expected to rise when they are offered in quarters 3 and 4. Additional funding through the Expansion Fund has been made available to practices to help them increase their workforce to deliver these. • Primary Care Network Funds – Local action plans are being developed across PCNs to move towards a more collaborative approach across Place with the aim of pooling investment to achieve economies of scale. Remote monitoring and self care is also a particular focus for PCNs. • Care Homes – The Warwickshire North digital Docobo project for Remote Care Monitoring has progressed to wave 5 care homes having mobilised and received training. The CCG’s Quality Lead for care homes and Out of Hospital community
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teams are helping care homes to utilise the technology. Presentations to appropriate meetings and vulnerable groups are planned to encourage engagement in other care homes. • GPIT/Digital – NHS Digital has ensured that arrangements are in place for IT contracts to continue throughout the pandemic until such time that new procurements can proceed; the programme of choice for GPs, AccuRX, has been mobilised for GPs to carry out on-line consultations. Training is available for practices on bulk text messaging. JN also mentioned proposals to link the GPIT programme of work with delivery work at Place. • COVID Oximetry at Home – A successful service for patients to monitor their oxygen levels at home and receive treatment earlier if needed.
The Committee NOTED the Primary Care Assurance Report and was ASSURED regarding work programmes in place to support Primary Care and commissioning of services.
9. ANY OTHER BUSINESS – Chair
Jean Thomas gave the following comments: - Some improvement in accessing her GP practice by telephone had been seen. - Positive feedback on the vaccine programme which was well co-ordinated.
10. DATE AND TIME OF NEXT PUBLIC MEETING:
Wednesday 12 May 2021, 09:30-11:00
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NHS Coventry and Warwickshire Clinical Commissioning Group Enc C
Report To: Primary Care Commissioning Committee (Public) Meeting
Report Title: Committee Terms of Reference
Report From: Andy Wilkins, Head of Governance and Corporate Affairs
Author: Julie Seaborne, Governance and Corporate Affairs Officer
Date: 27th May 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: ✓ Assurance: Information: Confidential
Purpose of the Report: To present the 2020/21 Terms of Reference for the Primary Care Commissioning Committee to consider for approval.
Key Points: • The purpose of the Primary Care Commissioning Committee is to function as a corporate decision-making body for the management of the delegated functions as given to the CCG by NHS England.
• The Committee will have unlimited authority to make decisions in relation to primary medical care commissioning in accordance with the Delegation Agreement as reflected in the CCG’s Scheme of Reservation and Delegation and the CCG’s Constitution.
• The Terms of Reference and the effectiveness of the Committee will be reviewed at least annually and earlier if required and any proposed amendments to the Terms of Reference will be submitted to the CCG’s Governing Body for approval. Changes will not be implemented until after an application to NHS England to vary the constitution has been agreed.
• The Committee will provide assurance by presenting its minutes and an executive summary report to the CCG’s Governing Body and NHS England for each of its meetings held.
• Procurement decisions will be reported to the CCG Governing Body through the Committee’s reports.
Recommendation: Members are asked to: • NOTE the Terms of Reference and RECOMMEND the Terms of Reference for approval and adoption by the Governing Body.
Implications
Committee Terms of Reference Page 1 of 2 Primary Care Committee 27 May 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc C
Objective(s) / Plans supported by this Compliance with duties as set out in the CCG Constitution and Terms of Reference. report: Conflicts of Interest: None identified Non-Recurrent Expenditure: N/A Recurrent Expenditure: N/A Financial: Is this expenditure included within the CCG’s Financial Yes No N/A ✓ Plan? (Delete as appropriate) Performance: N/A Quality and Safety: N/A General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any decision that is finalised without being influenced by appropriate due regard could Equality and Diversity: be deemed unlawful. Has an equality impact assessment been Yes No N/A ✓ undertaken? (Delete as (attached) appropriate) Patient and Public N/A Engagement: Clinical Engagement: N/A Risk and Assurance: N/A
Committee Terms of Reference Page 2 of 2 Primary Care Committee 27 May 2021
Primary Care Commissioning Committee NHS Coventry and Warwickshire CCG Primary Care Commissioning Committee Terms of Reference 1. Purpose
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 below to NHS Coventry and Warwickshire CCG (the CCG).
1.2. The CCG has established the Primary Care Commissioning Committee (the Committee). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.
2. Statutory Framework
2.1. NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out below in accordance with section 13Z of the NHS Act.
2.2. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the CCG.
2.3. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including: a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2).
2.4. The CCG will also, in respect of the delegated functions from NHS England, specifically exercise the functions in accordance with the duties set out below: a) Duty to have regard to impact on services in certain areas (section 13O); b) Duty in respects of variation in provision of health services (section 13P).
2.5. The Committee is established as a committee of the Governing Body of the CCG in accordance with Schedule 1A of the “NHS Act”.
2.6. The Committee is subject to any directions made by NHS England or by the Secretary of State.
3. Role of the Committee
3.1. The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services 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 agreements entered into between NHS England and the CCG, which will sit alongside the delegation and terms of reference.
3.3. In performing its role, the Committee will ensure that appropriate engagement is undertaken with relevant stakeholders.
3.4. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.
3.5. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act.
3.6. This includes the following: a) Managing GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing breach/remedial notices, and removing a contract);
b) Managing the design and commissioning of enhanced services (“Local Enhanced/Incentive Services” and “Directed Enhanced Services”);
c) Design of local incentive schemes in addition to or as an as an alternative to the national framework, including the Quality Outcomes Framework (QOF);
d) Decision making on whether to establish new GP practices in an area;
e) Approving practice mergers and closures; and
f) Making decisions on ‘discretionary’ payments (e.g. returner/retainer schemes).
4. Geographical Coverage
4.1. The Committee will cover the CCG area of NHS Coventry and Warwickshire CCG.
5. Membership
5.1. The Committee will, in accordance with NHS England guidance, be so constituted so as to ensure that the majority is held by Lay and executive members.
5.2. The Chair, Deputy Chair and members of the Committee will be appointed by the Governing Body.
5.3. The Chair of the Governing body and the Audit Committee Chair will not be members but may, at the invitation of the Committee Chair, attend meetings.
5.4. The Chair and Deputy Chair of the Committee will be Lay Members.
5.5. The Committee will include the following members: a. Two Lay Members
b. The Accountable Officer (or their Nominee);
c. Chief Finance Officer (or their nominee);
d. The director with responsibility for primary care (or their nominee);
e. Two further members, at least one of which will be a GP drawn from the Governing Body members other than the Chair.
5.6. In addition to the list of members above, the following individuals will receive a standing invitation to attend meetings of the Committee. With the agreement of the Chair of the Committee, they may be invited to take part in discussion but they will not be entitled to vote: a. Up to 4 GPs who sit on the Governing Body
b. A representative from NHS England
c. A representative from HealthWatch;
d. the Director of Public Health or their nominee;
e. Local Medical Committee representative(s).
5.7. The Committee may call additional experts to attend meetings and contribute to the discussions as required.
6. Meetings and Voting
6.1. The Committee will operate in accordance with the CCG Standing Orders. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member no later than seven days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.
6.2. Each member of the Committee 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 consensus decision-making wherever possible.
7. Quorum
7.1. The quorum necessary for the transaction of business by the Committee shall be three of the voting members and a Lay and executive majority. A duly convened meeting of the Committee at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
8. Arrangements for Meetings
8.1. Meetings of the Committee shall be held as a minimum bi-monthly, with further meetings being held as and when required.
8.2. Meetings of the Committee shall: a) be held in public, subject to 8.2 b;
b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.
8.3. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.
8.4. The Committee may delegate tasks, to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the CCG's scheme of delegation and standing orders. Any subcommittees must be governed by terms of reference that are published in the CCG Governance Handbook and reflect appropriate arrangements for the management of conflicts of interest and transparency.
8.5. The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs or any successor document will apply at all times and members of the committee will at all times comply with the CCG policy and procedure in respect of interests and managing conflicts of interest.
8.6. Members of the Committee shall respect confidentiality requirements as set out in the CCG Constitution and approved policies.
8.7. The Committee should ensure an appropriate level of patient participation and engagement, and take account of patient experience.
9. Reporting Arrangements
9.1. The Committee will present its minutes to the Governing Body and NHS England meetings for information, including the reports of any sub-committees to which responsibilities are delegated.
9.2. The Committee will produce and executive summary report which will be presented to NHS England and the Governing Body after each meeting.
9.3. The Committee will also comply with any Committee reporting requirements set out in its constitution and standing orders.
10. Decisions
10.1. The Committee will make decisions within the bounds of its remit.
10.2. The decisions of the Committee shall be binding on NHS England and the CCG.
11. Accountability of the Committee
11.1. The Committee will have unlimited authority to make decisions in relation to primary medical care commissioning in accordance with the Delegation Agreement as reflected in the CCG’s Scheme of Reservation and Delegation and the CCG’s Constitution. The Committee’s authority extends to primary medical care healthcare and non-healthcare investments.
11.2. Procurement decisions will be reported to the CCG Governing Body through the Committee’s report. A record of all procurement decisions will be kept in accordance with the Standards of Business Conduct Policy.
11.3. For the avoidance of doubt, in the event of any conflict between the Terms of Reference and the Scheme of Reservation and Delegation, Standing Orders, or Standing Financial Instructions of the CCG, the terms of the Delegation Agreement will prevail.
11.4. Where required, consultation will take place with members of the public and/or other CCGs.
12. Procurement of Agreed Services
12.1. The detailed arrangements regarding procurement are set out in the Delegation Agreement.
13. Review
13.1. These terms of reference and the effectiveness of the Committee will be reviewed at least annually and earlier if required.
13.2. All reviews will be logged in the Terms of reference review log which is published in the Governance Handbook.
13.3. Any proposed amendments to the terms of reference will be submitted to the Governing Body for approval. Changes will not be implemented until after an application to NHS England to vary the constitution has been agreed.
Date of approval:
Schedule 1: Delegation
NHS Coventry and Warwickshire Clinical Commissioning Group Enc D
Report To: Primary Care Commissioning Committee (Public) Meeting
Report Title: Committee Schedule of Business 2021-22 – Public Meetings
Report From: Andy Wilkins, Head of Governance and Corporate Affairs
Author: Julie Seaborne, Governance and Corporate Affairs Officer
Date: 27th May 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: ✓ Assurance: Information: Confidential
Purpose of the Report: To present the 2020/21 Schedule of Business for the Primary Care Commissioning Committee meeting.
Key Points: The proposed 2021-22 Schedule of Business sets out the yearly work plan of the Committee detailing which papers the Committee will receive at each meeting and the frequency of regular reports. This will be used to inform agendas of the meetings throughout the year.
The schedule may be updated during the year as new items emerge or existing items are no longer required and the timing of some items may change.
Recommendation: Members are asked to: • REVIEW and APPROVE the 2021-22 Schedule of Business for the Primary Care Commissioning Committee meeting.
Implications
Objective(s) / Plans supported by this Compliance with duties as set out in the CCG Constitution and Terms of Reference. report: Conflicts of Interest None identified Non-Recurrent Expenditure: N/A Financial: Recurrent Expenditure: N/A
Committee Schedule of Business - Public Page 1 of 2 Primary Care Committee 27 May 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc D
Is this expenditure included within the CCG’s Financial Yes No N/A ✓ Plan? (Delete as appropriate) Performance: N/A Quality and Safety: N/A General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any decision that is finalised without being influenced by appropriate due regard could Equality and Diversity: be deemed unlawful. Has an equality impact assessment been Yes No N/A ✓ undertaken? (Delete as (attached) appropriate) Patient and Public N/A Engagement: Clinical Engagement: N/A Risk and Assurance: N/A
Committee Schedule of Business - Public Page 2 of 2 Primary Care Committee 27 May 2021
Enclosure D1
Primary Care Commissioning Committee (public) - Schedule of Business
Contents (in line with the Committee Terms of Activity Purpose Frequency Lead/Author May July September November Janaury March Reference set for each CCG)
Meetings Bi Monthly Chair ✓ ✓ ✓ ✓ ✓ ✓
Welcome and Apologies Received Bi Monthly Chair ✓ ✓ ✓ ✓ ✓ ✓
Confirmation of Quoracy Bi Monthly Chair ✓ ✓ ✓ ✓ ✓ ✓
Declarations of Interests Bi Monthly Chair ✓ ✓ ✓ ✓ ✓ ✓
Minutes of previous meeting Approve Bi Monthly Chair ✓ ✓ ✓ ✓ ✓ ✓
Matters Arising/Action Schedule Note Bi Monthly Chair ✓ ✓ ✓ ✓ ✓ ✓
Question from the public Bi Monthly Chair Performance:
Primary Medical Services' Performance and Quality Report (historically SW) Bi Monthly Formerly Alison Walshe ✓ ✓ ✓ ✓ ✓ ✓
Reporting
Review of Schedule of Business (historically CR/WN) Annual Governance
Committee effectiveness review to Audit Committee (CR/WN) Annual Governance
Issues to report to Governing Body (historically CR/WN) Bi Monthly Chair ✓ ✓ ✓ ✓ ✓ ✓
Terms of Reference
Committee Terms of Reference Review (historically CR/WN) Annually Governance
Other
GP IT (historically CR/WN) Quarterly
Premises updates (historically CR/WN) Quarterly
Workforce (historically CR/WN) Quarterly
Primary Care Network Report (historically CR/WN) Quarterly
Special Allocations Scheme (historically CR/WN) Bi-annually
Primary Care Finance Report (historically SW) Bi Monthly Paul Sheldon ✓ ✓ ✓ ✓ ✓ ✓
Financial plan & Budget Approval Bi-annually
Financial Update ( statutory Audit) (historically CR/WN) Quarterly
General Practice Forward View Progress Update (historically SW) Bi Monthly Anna Hargreave ✓ ✓ ✓ ✓ ✓ ✓
Estates and Technology Transformation Fund Update (historically SW) Bi Monthly Anna Hargreave ✓ ✓ ✓ ✓ ✓ ✓
Start Point budgets for Primary Care 20/21 (historically SW) Annual LFS? ✓
Primary Care Prescribing Incentive Scheme Proposal (historicallySW) Annual Formerly Alison Walshe ✓
Primary Care Strategy (historically CR/WN) Annual Jenni Northcote ✓
Jenni Northcote/Nikkie Internal Audit Report (historically CR/WN) Note Annual ✓ Temperley-Smith Jenni Northcote/Nikkie Primary Care Contract Report (historically CR/WN) Note Bi-monthly ✓ ✓ ✓ ✓ ✓ ✓ Temperley-Smith Jo Galloway/Sarah Weir- Primary Care Quality Report (historically CR/WN) Note Bi-monthly ✓ ✓ ✓ ✓ ✓ ✓ Smith Jenni Northcote/Nikkie Primary Care Assurance Report (historically CR/WN) Note Bi-monthly ✓ ✓ ✓ ✓ ✓ ✓ Temperley-Smith NHS Coventry and Warwickshire Clinical Commissioning Group Enc E
Report To: Primary Care Commissioning Committee (Public) Meeting
Report Title: 2021/22 Primary Care Financial Plan & Budget approval (H1)
Report From: Chris Lonsdale, Director of Finance
Author: Michael Hau & Martin Smith
Date: 27th May 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: ✓ Assurance: Information: Confidential
Purpose of the Report: To note the opening revenue budget for Primary Care 2021/22 and to approve the level of funding for discretionary schemes and PMS Premium.
Key Points: • Planning guidance published on 25 March 2021 set out the financial arrangements for the first 6 months of the year (H1). The confirmed system wide funding envelope for delegated primary care is confirmed as £75.9m which includes growth and other non-recurrent allocations. This is an increase of £4.9m. • Updates to the GP contract agreed in 2020/21 arrangements and the financial implications of these have been assessed as £4.6m and incorporated into start point budgets. • There is no requirement to set a contingency in 2021/22 compared to previous year’s 0.5% of allocation. Based on the level of in-year risk and additional investment required as part of restoration of primary care services, it is proposed that a continency is not set within the current funding envelope. • Recurrent PMS budgets are based on historical amounts agreed as part of the PMS transitional process undertaken at a National level by NHS England. • Discretionary expenditure has been locally agreed by respective Primary Care Committees and the proposal is to continue to fund these from the Delegated budget as these have direct benefits for Primary care and are within affordability limits. • Core Primary Care budgets for April 2021 to September 2021 are £86.5m • Further System Development Funding (SDF) of £4.6m has been confirmed for primary care in the first 6 months and schemes are already in place to invest this in primary care.
Recommendation:
CWCCG Primary Care Committee Members are asked to: • NOTE & APPROVE the 2021/22 Financial Plan/revenue Budget as presented for H1. • NOTE & APPROVE the planned investment in Primary Care, PMS and Discretionary funds.
Implications
Primary Care Financial Plan and Budget Report Page 1 of 9 Primary Care Committee 27 May 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc E
[Details of which corporate objective, strategy or plan this report supports: Objective(s) / Plans 1. Achievement of Financial Duties supported by this report: 2. Delivery of the CCGs Primary Care Strategy 3. Delivery of GPFV commitments and GP Contract Conflicts of Interest: None identified. The proposed budget makes provision for Non-Recurrent Expenditure: anticipated non-recurrent expenditure. The proposed budget makes provision for Recurrent Expenditure: Financial: anticipated recurrent expenditure. Is this expenditure included within the CCG’s Financial Yes ✓ No N/A Plan? (Delete as appropriate) The Plan seeks to be explicit as to the level of investment set aside to secure Performance: improvement against GPFV and other relevant national must dos. The proposed budget is expected to be adequate to secure acceptable levels of Quality and Safety: quality and service in commissioned GP services. General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any Equality and Diversity: decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A ✓ (attached) (Delete as appropriate) Patient and Public No immediate requirements identified in addition to the CCG’s ongoing engagement Engagement: activities. Clinical engagement across primary care will be essential to securing improved use Clinical Engagement: of resources. [MEDIUM – changes to the assumptions around restoration of services may affect of the viability of the budget. Note also that no contingency has been set due to Risk and Assurance: affordability. Whilst the resultant pressure will fall on the CCG’s core budget, the Primary Care Committee will wish to understand the implications of their decisions on overall system affordability.
Primary Care Financial Plan and Budget Report Page 2 of 9 Primary Care Committee 27 May 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc E
1.0 Introduction
The purpose of this report is to outline the 2021/22 financial assumptions for Primary Care and present to the Committee an opening and balanced revenue budget for period from April 2021 to Sep 2021 (H1).
2.0 Financial Plan Overview & Affordability
The notified GP Medical Services allocation in the first 6 months of 2021/22 is £75.9m and includes growth and additional non recurrent allocations in support of the commitments made in ‘General Practice Forward View’ (GPFV). The overall planning assumptions is that the CCG is expecting to deliver a breakeven position for H1.
Appendix 1 provides a breakdown of the CCGs allocation.
Table 1 below provides a summary of the planned delegated expenditure of £75.9m to deliver a breakeven position.
20/21 Price Activity Contract Other 21/22 21/22 Delegated Plan (H1) Reference Startpoint uplift growth Changes Changes Budget Increase £000s £000s £000s £000s £000s £000s £000s Primary Care Co-Commissioning General Practice - GMS 44,667 0 278 1,971 0 46,916 2,250 Section 4 General Practice - APMS 2,239 0 66 68 0 2,373 134 Section 4 Premises Cost Reimbursement 5,610 87 0 0 105 5,803 193 Section 5 Other premises costs 11 0 0 0 15 26 15 Section 5 Enhanced services 904 12 13 0 2 931 27 Section 5 QOF 6,059 192 0 547 0 6,798 739 Section 4 Other GP Services 2,502 10 67 0 54 2,634 131 Section 5 PCN DES 1,601 0 0 704 0 2,305 704 Section 4 PCN Additional Roles 2,188 3 0 1,353 0 3,544 1,356 Section 4 Extended Access 598 0 0 5 0 602 5 PMS Premium 1,077 0 0 0 0 1,077 0 Discretionary Schemes 2,872 34 21 0 0 2,927 55 Section 8
Sub total - Primary Care Co- 70,328 339 445 4,648 176 75,936 5,608 Commissioning
3.0 National Overview
Delegated primary care allocations for the CCG in 2021/22 will see an overall increase Nationally to reflect the commitments first made in 2016 as part of the review of Primary Care services1. The review pledged to invest an extra £2.4bn a year in Primary Care over 5 years including the GP contract, workforce, infrastructure and digital transformation.
The agreed changes to the GP contract were set out as part of the ‘Investment and evolution’ document in 2019 and builds on the commitments made in the GPFV review. These included investments to GP workforce, Quality and Outcomes Framework (QOF), GP access, digital transformation and the creation of Primary Care Networks.
4.0 Summary of 2021/22 GMS Contract Changes
The changes in the GP contract in 2021/22 reflect the overarching agreements already reached with the BMA in 2020. A list of the key changes underpinning the GMS/APMS budgets are shown in Appendix 2.
1 General Practice Forward View Apr 2016 Primary Care Financial Plan and Budget Report Page 3 of 9 Primary Care Committee 27 May 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc E
The financial implication of these changes is included within the opening budgets for H1 and summarised below.
Details £000s Comments DDRB (GP Review Body) Uplift 2,039 Based on 2.1% pay & expenses uplift QOF New Indicators 547 Equivalent to increase in 68 points for SMI/VI Impact and Investment Fund (IIF) 491 Increase from £0.67 to £2.47 per patient Additional Roles Funding (ARRS) 1,353 Increase from £7.13 to £12.31 per weighted patient Care Home Premium 218 FYE of 2020/21 funding CWCCG Total 4,648 Overall increase in GP Contract
5.0 Other Planning Assumptions
A summary of other planning assumptions around inflation, efficiency and growth used to arrive at the overall expenditure plan is shown in Table 3 below.
Non Demographic Demographic Details Inflation Efficiency growth growth Directed Enhanced Services 0.00% 0.00% 3.49% 0.51% Premises 2.70% 0.00% 0.00% 0.00% Dispensing & Prescribing Fees 0.00% 0.00% 4.00% 0.51% PCO Payments 2.00% 0.00% 1.00% 1.00% Discretionary Schemes 2.00% 0.00% 2.00% 0.00%
There have not been any changes to other Directed Enhanced Services other than the Network DES. All prices remain the same as in previous years. The planned expenditure for Directed Enhanced Services is £0.9m in H1 2021/22 and includes overall growth estimates of 4%.
Where services that have been impacted by COVID and income protection measures were not in place, then provisions have been made for the costs of restoring these to pre pandemic levels.
6.0 Personal Medical Services (PMS) Premium
The full year PMS Premium available for investment in H1 2021/22 is £0.8m (Coventry & Rugby) and £0.3m (South). North historically did not have any PMS practices. Several schemes have already been earmarked as recurrent having previously been approved by respective Committees. Further details of full year recurrent investments in 2021/22 are included in Appendix 3. The balance of funding has been set aside for ringfenced investment at individual place level. This allows the Committee to assess additional requests for funding.
7.0 Discretionary Expenditure
Table 4 – Summary of Discretionary Primary Care schemes funded through Delegated budgets
Place H1 (£000's) H2 (£000's) Total (£000's) Coventry & Rugby 2,241.5 2,241.5 4,483.0 North 685.5 685.5 1,371.0 CW CCG Total 2,927.0 2,927.0 5,854.0
A further breakdown of schemes previously approved by respective Committees in shown in Appendix 4
Primary Care Financial Plan and Budget Report Page 4 of 9 Primary Care Committee 27 May 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc E
8.0 Risks
A number of risks have been identified as part of setting the budget and with a proposal to not put in place a specific contingency need to be noted within a tighter budget:
• Activity growth – not normally a material risk to the budget. • Restoration of services and investment in new services - the take up and timing could result in higher performance levels than budgeted. This is additionally an area for potential slippage that could mitigate over performance in other areas. • The delegated budget in relation to South place continues to face financial challenges due to unavoidable/contractual cost pressures - An element of these challenges has been mitigated with recurrent solutions within the budget. Anticipated slippage in Coventry, Rugby and North places are anticipated to mitigate the remainder in-year.
The recurrent affordability position is dependent on restoration and take up of service levels in Coventry, Rugby and North place. Plans are in place to review this on a quarterly basis and update the Committee of any material changes.
9.0 Core Primary Care Expenditure
The Core Primary Care budget is £86.5m and covers all other Primary Care budgets. The opening budget is based on 2020/21 M12 outturn adjusted for non-recurrent spend and allocations before applying uplifts for pricing, activity and other assumptions around service restoration where applicable.
• Prescribing The planned prescribing budget for 2021/22 is £75.5m for H1. The pricing concessions seen in 2020/21 relate to supply issues which cause wholesale prices to increase which have the effect of a downward pressure on Pharmacy margins. Whilst non recurrent, this expected to again have an impact on costs for the year. In line with National assumptions, the increase in cost (tariffs) are assumed to be a 0.68% on 2020/21 prices.
• Local Enhanced Services The planned budget for enhanced services is £1.8m for H1 and includes £0.8m for PCN Core support funding. Funding is based on existing enhanced service agreements being extended or rolled over and previously approved services being rolled out during the year.
• GP I.T Revenue Budgets have been set on known existing commitments and factoring in the recurrent costs of digital transformation with Primary Care. This includes investments in the integration of GP records, remote working and other practices systems that allow to work smarter and become more informed.
Table 5 – Summary of Primary Care budgets based on latest submission of CCG plan.
Primary Care Financial Plan and Budget Report Page 5 of 9 Primary Care Committee 27 May 2021
NHS Coventry and Warwickshire Clinical Commissioning Group Enc E
Underlying Activity Additional Service Area Price uplift H1 Budget startpoint growth Investment £000s £000s £000s £000s £000s
Central Drugs 2,048 71 21 0 2,141
Commissioning Schemes (COVID) 0 0 0 554 554
Local Enhanced Services 1,755 63 4 0 1,822
Out of Hours 2,610 83 93 0 2,787
GP Forward View 1,036 0 0 0 1,036
Oxygen 530 1 15 10 555
Prescribing 71,060 142 343 4,010 75,554
Primary Care IT 1,632 53 20 92 1,798
Primary Care Investments 251 0 0 0 251 Sub total - Primary Care 80,923 412 497 4,667 86,498
10.0 System Development Funding (SDF)
System development funding (SDF) and Covid expansion support funding totalling £4.6m for 2021/22 has been confirmed for Q1 with a further £0.3m being available conditionally. A breakdown of total funding available is shown in Appendix 5.
The CCG already has existing contracts in place for extended access and training and plans are in place to work with practices and PCNs across the CCG to maximise the use of the remaining funds.
11.0 GP I.T Capital
The CCG GP I.T Capital budget for 2021/22 has been confirmed as £1.9m for the full year. A prioritisation process is in place to assess schemes that are being jointly developed with IT partners in line with the CCGs GP IT Strategy. It is anticipated that PIDS will be submitted by Q1 after which a further update will be provided.
12.0 Recommendations
The Primary Care Committee Members are asked to:
• NOTE the 2021/22 Financial Plan/revenue Budget as presented for H1, contingency and risks
• NOTE & APPROVE the planned investment in Primary Care, PMS and Discretionary funds.
Primary Care Financial Plan and Budget Report Page 6 of 9 Primary Care Committee 27 May 2021
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Appendix 1
GP Services (Delegated growth)
50% funded in H1 £0.84p £120 per bed Capitation Capitation FY additional FY additional allocation: FY additional allocation: FY additional Investment allocation: Increase in allocation : and Impact Care home practice New QOF Total £000s Raw List Care Beds Fund (IIF) premium funding indicators Allocations Growth Total
CR 539,060 3062 £ 226 184 88 361 £ 859 £ 1,694 £ 2,553 SW 300,605 2770 £ 126 166 49 201 £ 543 £ 945 £ 1,487 WN 195,258 1539 £ 82 92 32 131 £ 337 £ 614 £ 951 1,034,923 7371 £ 435 448 169 693 1739 3,252 £ 4,991
Appendix 2
• Global Sum will increase to £97.28 an increase of £3.82 (4.1%). This allows for an increase of 2.1% to pay and expenses.
• APMS contracts to increase by £2.87 per weighted patient
• Qof point value will increase to £201.16 an increase of £6.33 (3.3%)
• Minimum Practice Guarantee (MPIG) and Seniority payments ceased in 2020/21. The reinvestment in global sum in 2021/22 are in respect of deductions made in the previous year.
• New QOF indicators relating to severe mental illness (SMI) and public health immunisations worth a combined £92m Nationally. This is estimated to increase QOF ceiling by a further 9% and is funded through additional non recurrent allocations and is worth £0.7m for the year.
• The Impact and Investment Fund element of the PCN DES increased from £0.67 per patient to £2.47 per patient; an increase of £1.8m for the CCG. £0.84p is funded in plans with the remainder being held centrally.
• Enhanced Nursing & Care Homes (ENCH) premium payment to increase from £60 per bed to £120 per bed and reflects the full year cost of this element of the PCN DES.
• Additional Roles Reimbursement Scheme (ARRS) funding increased from £7.13 to £12.31 per patient. This addition of £5.3m investment in Primary and brings the total investment in ARRS Nationally to £746m as set out in the GP contract. The CCG has planned for the equivalent of £6.85 per patient with the remainder being held centrally.
Primary Care Financial Plan and Budget Report Page 7 of 9 Primary Care Committee 27 May 2021
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Appendix 3
PMS Premium Schemes Funding
Details Place H1 (£000s) H2 (£000's) Total (£000's) Child Safeguarding Coventry & Rugby 225.0 225.0 450.0 Adult Safeguarding Coventry & Rugby 240.5 240.5 481.0 DOAC Initiation Coventry & Rugby 24.5 24.5 49.0 Paramedic Visiting Service Coventry & Rugby 168.0 168.0 336.0 Notes Summarising Coventry & Rugby 200.0 200.0 400.0 Sub-Total Coventry & Rugby 858.0 858.0 1,716.0 Enhanced Services Bundle South 126.5 126.5 253.0 SMS Costs South 17.5 17.5 35.0 Prescribing Incentive Scheme South 99.5 99.5 199.0 Sub-Total South 243.5 243.5 487.0 CW CCG Total 1,101.5 1,101.5 2,203.0
Appendix 4
Discretionary Funding
Scheme Details Place H1 (£000's) H2 (£000's) Total (£000's) Care Homes Enhanced Support (CHESS) Existing scheme Cov/Rug 152.5 152.5 305.0 Choose & Book Team Existing scheme Cov/Rug 76.0 76.0 152.0 GP Tutors Existing scheme Cov/Rug 33.0 33.0 66.0 LES Treatment room Existing scheme Cov/Rug 734.5 734.5 1,469.0 LES Anti- Coagulation Existing scheme Cov/Rug 31.0 31.0 62.0 HSCN & COIN Network Costs Existing scheme Cov/Rug 165.5 165.5 331.0 GP Academic Funding Existing scheme Cov/Rug 77.0 77.0 154.0 GP Resilience MOU Existing scheme Cov/Rug 125.0 125.0 250.0 Dementia diagnosis Existing scheme Cov/Rug 15.0 15.0 30.0 Admiral Nursing Existing scheme Cov/Rug 155.0 155.0 310.0 Out Of Hours Existing scheme Cov/Rug 677.0 677.0 1,354.0 Coventry & Rugby Total 2,241.5 2,241.5 4,483.0 24 hr ECG Existing scheme North 79.5 79.5 159.0 Anti Coagulation Existing scheme North 23.0 23.0 46.0 GP Nursing Home LES Existing scheme North 23.5 23.5 47.0 Insulin Initiation Existing scheme North 21.0 21.0 42.0 Ear Syringing Existing scheme North 77.5 77.5 155.0 Minor Injury Existing scheme North 71.0 71.0 142.0 Warfarin Existing scheme North 104.5 104.5 209.0 Shared Care Existing scheme North 90.5 90.5 181.0 Spirometry Existing scheme North 27.0 27.0 54.0 Treatment Room LES Existing scheme North 105.0 105.0 210.0 Federation MOU Existing scheme North 48.0 48.0 96.0 Dementia diagnosis Existing scheme North 15.0 15.0 30.0 North Total 685.5 685.5 1,371.0 CR CCG Total 2,927.0 2,927.0 5,854.0
Primary Care Financial Plan and Budget Report Page 8 of 9 Primary Care Committee 27 May 2021
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Appendix 5 (SDF)
Primary Care System Development Funding
H1 H1 conditional Details confimed(£000's) (£000's) H2 (£000's) Total (£000's) Workforce: Training Hubs 51 51 102 204 Primary Care Networks - development and support systems 125 125 249 499 Practice resilience programme - local 36 36 72 144 Online consultation software systems (local) 68 68 135 271 GP IT Infrastructure and Resilience (revenue) - central and systems 55 55 111 221 Improving Access 2,124 2,124 4,248 Primary Care - Covid Support 2,048 0 2,048 Diabetes Transformation 122 122 244 CW CCG Total 4,629 335 2,915 7,879
Primary Care Financial Plan and Budget Report Page 9 of 9 Primary Care Committee 27 May 2021
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Report To: Primary Care Commissioning Committee (Public) Meeting
Report Title: Expansion Fund Proposal for April to September 2021
Report From: Alison Cartwright, Chief Planning and Performance Officer (Interim)
Author: Sue Phillips, Head of Primary Care Commissioning SW
Date: 27th May 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: ✓ Assurance: Information: Confidential
Purpose of the Report: To gain agreement for the proposed allocation of the April to September 2021 Primary Care Expansion Fund as per the guidance issued by NHS England on 19th March 2021.
Key Points: • NHS England (NHSE) established a new General Practice Capacity Expansion Fund to support the expansion of general practice capacity up to the end of March 2021. This fund has been continued with a further £2.048m being allocated to Coventry and Warwickshire April to September 2021.
• NHSE detailed the expectations and 8 priority goals for the use of the Expansion fund. Appendix 1 details the funding proposal against these 8 goals.
Recommendation: The proposal has been considered by the Primary Care Clinical Advisory Group and they recommend that Primary Care Committee approve the expansion fund payments.
Implications
Objective(s) / Plans 1. Delivery at Place supported by this 2. Supporting general practice report: 3. Ensuring patient care and supporting staff wellbeing Conflicts of Interest: N/A This is non recurrent expenditure against a non recurrent allocation from NHS England Non-Recurrent Expenditure: to support general practice recover and Financial: restore services as well as support their workforce Recurrent Expenditure: N/A
Expansion Fund report Page 1 of 4 CWCCG Primary Care Committee 27th May 2021
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Is this expenditure included within the CCG’s Financial Yes No N/A ✓ Plan? (Delete as appropriate) As stated this will allow general practice to commence the restoration of services and return to some form of business as usual. It will also support Performance: practices to allow staff holidays etc following the Covid pandemic and for many high levels of engagement with the Covid vaccination programme This will support the delivery of services and thereby improve the patient Quality and Safety: experience General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non-discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis Equality and Diversity: or due regard. Any decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A ✓ (attached) (Delete as appropriate) Patient and Public N/A Engagement: This proposal has been presented and approved at the Primary Care Clinical Engagement: Clinical Advisory Group Risk and Assurance: N/A
Expansion Fund report Page 2 of 4 CWCCG Primary Care Committee 27th May 2021
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Background
1.1 In November 2020 NHS England (NHSE) established a new General Practice Capacity Expansion Fund to support the expansion of general practice capacity up to the end of March 2021 and Coventry and Warwickshire received an additional £2.53m.
1.2 In March 2021 NHSE confirmed a continuation of the Expansion Fund to support the continued response to the pandemic and the delivery of the Covid vaccination programme and a further non recurrent £2.048m has been received by the CCG to support general practice from April to September 2021.
Expansion Fund Requirements
2.1 NHSE detailed the expectations for the use of the Expansion fund and these included some key principles that the funding is ringfenced exclusively for use in general practice to increase capacity with a focus on simplicity and speed of deployment. The fund should continue to support all GP recruitment and retention schemes and to increase current salaried staff capacity.
2.2 NHS detailed 8 priority goals to deliver, these were:
1. Increasing GP numbers and capacity;
2. Establishment of COVID oximetry@home model;
3. Identifying and supporting patients with Long COVID;
4. Support clinically extremely vulnerable and maintain shielding list;
5. Continue to make inroads into backlogs of routine work including chronic disease management and routine vaccinations and immunisations;
6. Make significant progress on delivering learning disability health checks;
7. Improve ethnicity data recording in GP records;
8. Backfill for staff absences where agreed by CCG where not able to work remotely.
2.3 Any payment is conditional that GP practices and PCNs continue to complete national appointment and workforce data in line with existing contractual requirements
2.4 Appendix 1 details the proposed allocation of the expansion fund against these priority goals. This proposal has been considered by the Primary Care Clinical Advisory Group (CAG) and they recommend its approval.
Recommendation
3.1 Primary Care Committee are asked to approve the Expansion Fund proposal as detailed in Appendix 1.
Expansion Fund report Page 3 of 4 CWCCG Primary Care Committee 27th May 2021
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Appendix 1: Expansion Fund 2021/22 Proposal
Expansion Fund report Page 4 of 4 CWCCG Primary Care Committee 27th May 2021
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Report To: Primary Care Commissioning Committee (Public) Meeting
Report Title: Primary Care Quality Report
Report From: Rebecca Bartholomew, Director of Nursing and Quality
Author: Sarah Weir-Smith Quality Lead Nurse for Primary Care
Date: 27th May 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: Assurance: ✓ Information: ✓ Confidential
Purpose of the Report: To provide the Primary Care Committee with information and assurance on the quality of care across GP practices.
Key Points: • Care Quality Commission (CQC) - No concerns have been raised by CQC, all Routine CQC inspections work is suspended currently due to Covid-19 response, and annual reviews are no longer being completed, response currently is to concern, or escalation of concerns
• Incident Reporting- The most common type of incident themes in practice are Administrative errors, IG Breaches and Immunisation and Vaccination errors.
• Cytology Update- Reporting continues to be within the 14-day trajectory currently, ICE system ordering has now gone live in practices.
• A meeting is being organised for the Primary Care team across Coventry and Warwickshire CCG to harmonise approaches to Quality, Clinical outcomes, performance and QOF. This will inform this paper to the committee going forward.
Recommendation: The Primary Care Committee are asked to note the contents and actions in place to gain assurance and improve the quality of patient care and service delivery in primary care.
Implications
Objective(s) / Plans supported by this Quality and safety of services and sustainability in Primary Care report: Conflicts of Interest: N/A Financial: Non-Recurrent Expenditure: N/A Primary Care Quality Report Page 1 of 8 NHS Coventry and Warwickshire CCG Primary Care Committee
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Recurrent Expenditure: N/A Is this expenditure included within the CCG’s Financial Yes No N/A ✓ Plan? (Delete as appropriate) Performance: Quality assurance in relation to performance issues Assurance regarding actions being taken to address the quality and safety in Quality and Safety: primary care General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any Equality and Diversity: decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A ✓ (attached) (Delete as appropriate) Patient and Public Feedback from patient survey will inform quality improvement offer to primary care Engagement: Clinical Engagement: N/A Measures in place to monitor and support the practices where there are quality Risk and Assurance: and/or safety concerns
Primary Care Quality Report Page 2 of 8 NHS Coventry and Warwickshire CCG Primary Care Committee
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Introduction
1. Information within the Quality in Primary Care report provides assurance of the Quality in service delivery and patient care in Primary Care and the overview of monitoring in place.
Background
2. Coventry and Warwickshire CCG has a statutory duty to assist and support NHS England with quality of services in primary care. Whilst Practices as providers are accountable for the quality of services and required to have their own quality monitoring processes in place, NHS England and CCGs as commissioners have a shared responsibility for quality assurance. The principle is to be supportive and enhance quality and prevent harm to patients. NHS Coventry and Warwickshire CCG is committed to improving the quality of care for our patients and therefore assessing, measuring and benchmarking quality is a key focus. Quality in the NHS can be defined in 3 dimensions to quality that must be present to provide a high-quality service (Darzi, 2008):
• Patient Safety
• Clinical Effectiveness
• Experience of patients
Care Quality Commission (CQC)
3. All GP practices across Coventry, Rugby and Warwickshire North (WN) Places continue to be CQC rated as ‘Good or Outstanding’. Since the last report, there have been no formal CQC inspections, due to the Covid-19 response and a pause of all inspection activity, direct updates continue to provide assurance, CQC are re-starting their inspections in May and are currently developing an inspection model that will allow for ongoing considerations for distancing and population needs. Responses to concerns continue, and a working partnership of discussion continues between CQC identified managers and the Quality Lead for Primary Care.
Table one: CQC ratings of Coventry, Rugby and Warwickshire North Places (please see table on page 4)
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Patient Safety
4. Patient safety and concerns are currently monitored for themes and trends from user reports on Datix. Work is ongoing in order to develop a strategy for Datix monitoring which will include a monthly theme, in order to identify trends and escalation of concern.
GP Incident Reporting 5. The following information is collated from incidents reported across the places via Datix.
The incidents reported are a mixture of internal practice incidents and incidents from external providers.
* Please note the number indicated below may differ from the number reviewed at quality meeting as more than one theme may arise from one incident report.
Table two: GP Incidents reported by month
Table three: GP Feedback received by month
GP Internal Incident Reporting For internal GP incidents the most common emerging themes are relating to admin error, Information Governance breaches and immunisation and vaccination errors.
Primary Care Quality Report Page 5 of 8 NHS Coventry and Warwickshire CCG Primary Care Committee
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Diagram one: Pie chart – GP Practice internal incidents
GP’s reporting incident about other providers (external incidents) The most common type of incident themes; transference of workload, prescriptions and medication and referrals.
Diagram two: Pie Chart – Reported provider themes
The following information relates to the actions of the CCG Quality and Patient Safety Representatives that have been taken related to reported incidents.
Diagram three: Actions taken by the CCG in relation to providers
Primary Care Quality Report Page 6 of 8 NHS Coventry and Warwickshire CCG Primary Care Committee
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Patient Satisfaction
6. Friends and Family Test (FFT) Currently paused and last available data relates to February 2020 – information to recommence when reporting restarts.
Cytology
7. HPV Screening services and cervical cytology services at Royal Wolverhampton continue, there are no reported delays with reporting and turnaround within the 2-week trajectory currently.
ICE electronic ordering has now commenced in practices and enables the user to order the HPV screening test in the same way as they request blood tests. A query has been raised with RWH Screening services in relation to the request for ICE form and Open Exeter information to accompany the samples, increasing time for printing and organisation of samples. Awaiting further confirmation from NHSE/I Screening Team regarding sample taker information and audit to ensure assurance of sample takers across places.
Conclusion and Recommendation
The Primary Care Committee are asked to note the contents and actions in place to gain assurance and improve the quality of patient care and service delivery in primary care.
Primary Care Quality Report Page 7 of 8 NHS Coventry and Warwickshire CCG Primary Care Committee
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Blank page
End of Report
Primary Care Quality Report Page 8 of 8 NHS Coventry and Warwickshire CCG Primary Care Committee
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Report To: Primary Care Commissioning Committee (Public) Meeting
Report Title: Primary Care Update Report – Coventry and Rugby
Report From: Alison Cartwright, Chief Planning and Performance Officer (Interim)
Author: Nikkie Temperley-Smith, Head of Primary Care Commissioning.
Date: 27th May 2021
Previously Considered by: n/a
Action Required (delete as appropriate)
Decision: Assurance: Information: ✓ Confidential
Purpose of the Report: To provide the Committee with assurance on the work streams in progress as part of the CCGs delegated functions relating to GP Primary Care Commissioning.
Key Points: • The current position and progress updates in relation to activities undertaken to deliver the delegated functions and supporting work streams under full delegation for GP Primary Care Commissioning.
• The key operational and strategic activities and developments being taken forward and co- ordinated by the Primary Care Team relevant to Primary Care Commissioning functions and duties. This includes updates in relation to all current and emerging work streams as part of the management of GP Primary Care delegated functions, strategic developments and implementation of the GPFV and other relevant projects.
• To outline emerging issues and highlight areas of potential and actual risk to the delivery of GP primary care services across the CCG area.
Recommendation: The content of this paper is for assurance and information and therefore, Members are asked to note the report.
Implications
[Details of which corporate objective, strategy or plan this report supports: Objective(s) / Plans 1. GP Forward View supported by this report: 2. Primary Care Estates Strategy 3. Wider Primary Care Strategy including the Long Term Plan Conflicts of Interest in relation to this report should already be included on the Conflicts of Interest: register of interests. If any are identified through presentation of the paper, these should be raised for noting in line with the requirements of the meeting. Financial: Non-Recurrent Expenditure: Not applicable
Primary Care Update Report – Coventry/Rugby Page 1 of 4 Primary Care Committee 27 May 2021
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Recurrent Expenditure: Not applicable Is this expenditure included within the CCG’s Financial Yes No N/A ✓ Plan? (Delete as appropriate) Performance: Provides assurance against milestones where these apply. Provides assurance in relation to quality and safety associated with the various Quality and Safety: workstreams included. General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any Equality and Diversity: decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A ✓ (attached) (Delete as appropriate) Patient and Public Not applicable Engagement: Clinical engagement as part of the programmes of work included in this report is Clinical Engagement: undertaken through the Primary Care Development Group where appropriate. Risks associated with the workstreams included within this report are managed Risk and Assurance: locally as part of the project plans and the Primary Care Risk Register and will, if required be escalated and included in the CCG Corporate Risk Register.
Primary Care Update Report – Coventry/Rugby Page 2 of 4 Primary Care Committee 27 May 2021
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Introduction
1.1. This report aims to provide further updates and appropriate assurances to the Committee in relation to the undertaking and delivery of delegated functions for the commissioning of GP Primary Care. This also includes the identification of emerging risks and associated mitigation actions in place to deliver these delegated functions.
1.2. The report is also intended to summarise progress to date against key work streams currently being managed through the Primary Care Team to ensure information is shared with the Committee at the earliest opportunity.
Commissioning and procurement of primary medical services
2.1 Rugby Homeless service (for information only): The CCG are continuing to progress the work to develop a service to be provided to Rugby patients considered homeless or vulnerably housed with input having been sought from Warwickshire LMC and Warwickshire Public Health. This service is being progressed in line with the procurement undertaken for the Coventry based service as the Invitation to Tender (ITT) set out. 2.2 Discussions have taken place with the Provider of the Homeless Service contract and further meetings have taken place in order to establish a suitable and safe service for the provision of GP Primary Care service model for the patients in Rugby.
2.3 The drafting of appropriate contractual arrangements is now underway as is the infrastructure requirements for the clinical room to be occupied for the delivery of the service at the Hope4 centre, Rugby. Due to the development of the service from an operational perspective and the contractual arrangements that need to be in place. The CCG will be working closely with local practices in Rugby in relation to this over the coming months and also with Hope4 and Warwickshire Healthwatch colleagues.
2.4 Foleshill New Developments: The new development building has been underway following a successful FBC (Full Business Base) and governance process continue to be progressed with Partners with NHSE as Project Lead, with the final amendments and iterations of the FBC are now underway. Risks identified in relation to this development continue to be managed through the Estates Programme Board and escalated via the Risk Register as appropriate. A further progress update is expected by mid-February and the outcomes of this will be shared with Committee.
2.5 Alternative Provider Medical Services (APMS) Contracts (WN): The procurement for a new practice and contract for the delivery of GMS services within North Nuneaton is underway and is anticipated to deliver the contract from premises as an interim solution in terms of location from April 2022. Details of the process and procurement will be shared with the Committee at the appropriate juncture and in line with procurement guidance. Members are asked to note that this is progressing and that a Project Group and Assurance Board are in place to ensure appropriate plans are in place and timelines achieved.
Contract Performance and Management
3.1 Committee Members are asked to note that there are currently no contractual performance monitoring issues to be reported.
3.2 No practices have been party to any contractual performance visits or assessments during this reporting period. Where any such intervention is required, the basis upon which the CCG might be required to manage performance, an application for approval of contractual measures will be presented to the Committee and monitored in line with the contract and based upon the concerns identified in terms of the management approach.
Primary Care Update Report – Coventry/Rugby Page 3 of 4 Primary Care Committee 27 May 2021
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3.3 This will be undertaken with LMC engagement and involvement where possible and as appropriately requested by the Contract Holders concerned.
3.4 Contract Mergers: No new applications to merge contracts have been received prior to the Committee. The ongoing merger of the 4 contracts previously approved is progressing well against the project plan with regular assurance meetings to monitor progress and identify and manage any risks associated with the merge.
3.5 Contract Variations: Contract variations have been received from a number of practices requesting a change to their partnerships due to retirements, general leavers and joiners. These are subject to the standard regulations and checks within the team from an operational perspective.
GP Forward view and Enabling Workstreams
4.1 Workforce the CCG was previously required, as part of an STP submission to update the Workforce Strategy to ensure the information, progress, risks and mitigations are outlined and in hand as part of the ongoing work concerning the workforce requirements in GP Primary Care as required to meet the needs of the local population.
4.2 In addition, a structured approach to delivering the various schemes as part of the Workforce Strategy and are outlined below:
- Practice Resilience - GP Retention - Reception and Clerical - First Five Scheme - Welcome back to work - Medical Education and Peer Support - Portfolio Careers - HEE – Primary Care Workforce Development - Workforce training hubs - Fellowship Core Offer (New to practice - Fellowship Aspiring Leaders (New to practice)
4.3 Plans are already developed for the above areas and are progressing through the appropriate routes
4.4 Extended Access remains as a requirement for all CCGs to have in place access to GP Primary Care from 6.30pm to 8.00pm Monday to Friday, and a level of access at weekends available to all patients in their respective CCG area.
4.5 Workload - GP Resilience Fund (GPRF): The CCG continues to work with GP Practices wishing to submit applications against this funding which enables support for those practices that are experiencing specific difficulties that meet the defined eligibility criteria.
4.6 The CCG continues to deliver the locally approved Primary Care GP IT Strategy and the digital requirements of The NHS Long Term Plan. To support this a Digital Dashboard is being developed to provide assurance and support delivery of local projects and the digital requirements in the NHS Long Term Plan.
Conclusion and Recommendation
The content of this paper is for assurance and information and therefore, Members are asked to note the report.
End of report.
Primary Care Update Report – Coventry/Rugby Page 4 of 4 Primary Care Committee 27 May 2021
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Report To: Primary Care Commissioning Committee Meeting (Public) Meeting
Report Title: Primary Care Update Report – North Warwickshire
Report From: Alison Cartwright, Chief Planning and Performance Officer (Interim)
Author: Roma Holland - Head of Primary Care WN and Rugby
Date: 27th May 2021
Previously Considered by: N/A
Action Required (delete as appropriate)
Decision: Assurance: Information: ✓ Confidential
Purpose of the Report: To provide the Committee with assurance on the work streams in progress that relate to GP Primary Care Commissioning, as part of the CCG’s delegated functions.
Key Points:
To provide the Primary Commissioning Committee with assurance on key areas of work and items of business that relate to delegated primary care work, covering the following areas:
• The current position and progress updates in relation to activities undertaken to deliver the delegated functions and supporting work streams under full delegation for GP Primary Care Commissioning;
• The key operational and strategic activities and developments being taken forward and co- ordinated by the Primary Care Team relevant to Primary Care Commissioning functions and duties. This includes updates in relation to all current and emerging work streams as part of the management of GP Primary Care delegated functions, strategic developments and implementation of the GPFV and other relevant projects;
• To outline emerging issues and highlight areas of potential and actual risk to the delivery of GP primary care services across the CCG area.
It is anticipated that this will provide a consistent update to the Committee on the delegated functions, to include both on-going and expected future areas of work.
Recommendation: The Primary Care Commissioning Committee is asked to note the report for INFORMATION and ASSURANCE.
Implications
Objective(s) / Plans CCG Primary Care Strategy & GP Forward View supported by this report: Conflicts of Interest: No conflicts of interest have been identified Financial: Non-Recurrent Expenditure: Not applicable
Primary Care Update Report – North Warwickshire Page 1 of 7 Primary Care Commissioning Committee Meeting – 27th May 2021
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Recurrent Expenditure: Not applicable Is this expenditure included within the CCG’s Financial Yes No N/A ✓ Plan? (Delete as appropriate) Performance: Not applicable Quality and Safety: Not applicable General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any decision that is finalised without being influenced by appropriate due regard could Equality and Diversity: be deemed unlawful. Has an equality impact assessment been Yes No N/A ✓ undertaken? (Delete as (attached) appropriate) Patient and Public Not applicable Engagement: Clinical Engagement: Not applicable Risk and Assurance: Not applicable
Primary Care Update Report – North Warwickshire Page 2 of 7 Primary Care Commissioning Committee Meeting – 27th May 2021
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1. Introduction
1.1 This report aims to provide the Committee appropriate assurances in relation to the undertaking of delegated functions for the commissioning of GP Primary Care, including emerging risks and associated mitigation actions in place to deliver the delegated functions.
2. Commissioning and Procurement of Primary Medical Services
2.1 From the 1st April 2021, Spirit Health Care commenced providing services from Satis House, Chaucers Surgery and Camp Hill Health Care.
2.2 The CQC registration documents have now been received by all three practices, 7th May 2021.
2.3 The NHS Property Services lease agreement is six months behind due to the impact of covid on service delivery. This is recorded on the issue log and continue to be pursued. The new provider has provided written assurances to the CCG that this will not affect patient care.
3. Primary Care Flu Plan
3.1 This item is covered within Sarah Weir-Smith’s Quality Report.
4. WN Covid Vaccination Programme
4.1 Three of the four Local Vaccination Sites (LVS) have progressed to the nationally commissioned Covid-19 Enhanced Service Stage Two. Three sites are in Warwickshire North, Atherstone, Hazelwood and Polesworth. These sites will deliver the vaccinations to cohorts 10 – 12.
4.2 The Nuneaton site (Abbeygate) will be decommissioned on completion of the second vaccine doses to cohorts 1 – 10.
4.3 Covid vaccine coverage for the two Nuneaton PCN’s, Bedworth and Bulkington PCN area will be provided by Bedworth Civic Centre, three community pharmacies and the National Vaccination Site (Stoneleigh). The CCG is assured that the offer will provide enough capacity to serve this population.
4.4 The LVS have continued to delivery vaccinations at pace and are currently delivering first doses of vaccine to the cohort 10 group (40 to 49).
4.5 The cohort 1 – 9 recall for second dose vaccines is being achieve against the national plan of 84 days
4.6 CCG continues to monitor the delivery of both first and second doses supporting sites with delivery schedules, data penetration analysis by age, ethnicity and cohort to ensure an equitable service is available.
4.7 CCG continues to work in collaboration with Public Health and Local Authorities to strengthen public communication and increase uptake in vulnerable and diverse communities by extending its reach which includes sharing of business intelligence data to develop delivery strategy.
5. Hot Hub Activity
5.1 The CCG fully funded service provision for Covid symptomatic patients within the Warwickshire North area continues to be provided by the GP Alliance (GPA) from the Galley Common location.
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5.2 The agreed escalation point to increase appointment capacity remains at 75%. Activity is monitored by the Warwickshire North Area Vaccine Response Team.
5.3 The commissioned service is currently maintained in line with the NHSE Primary Care Standard Operating Procedure.
5.4 WN experienced an outbreak amongst the schools in Polesworth and Dordon which saw an increase in Hot Hub activity following the Easter school holidays. The CCG worked in partnership with Public Health to contain the outbreak to this area with no impact on hospital admission.
5.5 The CCG continues to attend the WN Incident Management Team meeting chaired by Local Authorities and has membership from key community organisations.
5.6 Utilisation report has been provided (see appendix A).
Enc E - WNCCG Hub Utilisation 13th April 2021.pdf
6. Learning Disability Health Checks
6.1 NHSE/I recently released practice level data for Learning Disability (LD) Annual Health Checks (AHC) for 2020/21. This confirms significant progress in relation to delivery of LD AHCs, the figures present positive performance with 75.6% of people on Warwickshire North LD registers having received a check during 2020/21, much higher than in 2019/20 when 47%. This performance figure exceeds the local target (52%) and national target (67%).
6.2 A summary of PCN level data is provided in the table below:
Full LD LD AHCs completed % as at end Register 2020/21 of Q3 PCN (Denominator)* (Numerator) 2020/21 WARWICKSHIRE NORTH PCN 108 68 63% WARWICKSHIRE RURAL PCN 148 82 51.6% BEDWORTH & BULKINGTON PCN 182 171 94% NUNEATON_NORTH PCN 262 200 76.3% NUNEATON_SOUTH PCN 235 194 85.6% NHS WARWICKSHIRE NORTH 946 715 CCG 75.6%
*Please note that the definition used by NHSE for the CCG level performance indicator uses the all age QOF LD register figure as denominator, rather than the reduced 14+ LD register figure applied to the IIF PCN measure*
6.3 The target for 21/22 has been set nationally as 70% and all systems are expected to strive to exceed this. Practices are requested to continue to prioritise annual health checks for people with a learning disability and to consider offering checks to anyone who may not have been offered a check during 20/21 within the current quarter of 21/22. The additional £30 incentive for completion of LD AHCs has been extended until 30th September 2021 increasing the overall payment per LD AHC to £170.
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7. Primary Care Network Funds 20/21
7.1 Bedworth and Bulkington Primary Care Network (PCN) have re-elected the Clinical Director and Co-ordinator posts following the announcement from the two incumbent post holders to stand down. The posts will transfer on the 1st June 2021.The Clinical Director is a Nurse Prescriber and will be the first elected Clinical Director that is not a GP.
7.2 All PCNs across WN have submitted local action plans including:
➢ Recruitment intentions based on ARRS budgets for the coming year. ➢ The additional roles, PCN can recruit to this year are: Mental Health Practitioner (50% funded by local MH Provider), paramedics and advance practitioners for Clinical Pharmacists, First Contact Physio, Dietician, Podiatrist, OT, Paramedic. ➢ Role limits for First Contact Physios and Pharmacy Techs have been removed.
7.3 Based on a national population of 60,616,648 (updated from 60,334,866 in 2020/21) for 2021/22 the Additional Roles Reimbursement Sum will be calculated using £12.314 per PCN weighted patient as at 1 January 2021 (2020/21 was £7.131 per PCN weighted list size as at 1 Jan 2020).
7.4 Due to COVID 19 pandemic, the Extended Access & Extended Hours specification will be released in the summer.
7.5 Plans associated with integrated working should be linked to Place priorities and Local PCN population health needs through tools such as the Joint Strategic Needs Assessment (JSNA). Further considerations around developing the MDTs; developing greater levels of inter-practice working; establishing PCN/Place level hubs for enhanced services; maybe designing a PCN/Place home visiting service; developing local patient forums at a PCN level; being very clear what services should be provided at practice, PCN or Place level etc.
7.6 Accelerate the use of digitally enabled services/ remote service offers e.g. remote monitoring and self-care. Again, linking to partnership working with OOH providers and Acute partners.
7.7 A link to the local JSNA and local clinical knowledge to continue to tackle health inequalities. This could include a link to the new Additional Roles such as the Social Prescribing Link Worker, Health and Wellbeing Coaches and the Mental Health workers, linking into Place health inequality priorities.
7.8 A revised maturity matrix.
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7.9 The CCG are working with PCNs to develop actions plans to ensure key milestones are achieved.
8. Care Homes
8.1 The Covid vaccination programme in care homes is now complete. There are currently 5 providers in an outbreak situation however none of the outbreaks affect residents and currently affect a small number of staff. We continue to work with providers to increase the uptake of carers accessing the vaccination.
8.2 Quality monitoring in conjunction with Warwickshire County Council has now recommenced.
8.3 Warwickshire North place has successfully rolled out Docobo to 22 Care Homes for older people.
8.4 We are continuing to work with providers who are coming in later onto the project.
8.5 Docobo has been identified as an area of good practice by NHSX and will be rolled out across 4 STP’s in the West Midlands.
8.6 Locally in the Coventry and Warwickshire places NHSX have commissioned to fund a further 100 Docobo equipment sets to care homes in Coventry and South Warwickshire.
Governance and Reporting
9. Special Allocation Scheme (SAS)
9.1 There are currently thirteen patients on the Special Allocation Scheme in Warwickshire North Place.
9.2 Panel meetings are planned to resume in May 2021.
9.3 The Special Allocations Scheme panel continue to review all new referrals onto the scheme on a monthly basis, in line with the Terms of Reference. This is to meet the required 28-day review period for new referrals and to ensure that all patients registered on the scheme have access and continuity of care.
9.4 Panel reviews continue to be completed virtually due to Covid 19. SAS providers continue to review all patients currently registered under the scheme 6 monthly and to complete a review report for any who are considered suitable to return to mainstream practice. This was to reduce the reporting requirements to enable providers to respond to patients needs throughout the pandemic. . 10. Extended Access
10.1 Warwickshire North Extended Access service for 2021/22 has been commissioned to be delivered by Coventry and Rugby GP Alliance (CRGPA).
10.2 Extended Access 95 hours per week which provides 448 appointments for the Warwickshire North registered population.
10.3 The CRGPA Extended Access service model will be ➢ a centralised Hub from Camp Hill for three Primary Care Networks (Bedworth and Bulkington, Nuneaton South, Nuneaton North) ➢ a PCN service delivery for North Warwickshire PCN and Rural PCN
10.4 The CCG has considered the impact on patient access by moving the service delivery site from Chancery Lane Surgery to Camp Hill Medical Centre to be very low as this site has previously provided the out of hours walk-in service. Camp Hill is situated near Harts Hill and is an area of
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low deprivation, is recorded on the national data source as an area where there is low car/ transport ownership per household and is in close proximity to the previous site Chancery Lane.
10.5 Discussions continue with the three PCNs to support their transition to a PCN based model by July 2021
Conclusion and Recommendation
Committee members are asked to note the content of this report.
End of Report
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North Warwickshire Hot Hub Utilisation Compiled data as at 12pm 13/04/2021
North Warwickshire Place Hot Hub Utilisation North Warwickshire Place Hot Actuals based on MDS returns, and supplementary summary information from Galley Common Hub Utilisation 13 12 11 13Total 10 Galley Common 591 9 Foleshill GPA32 348 8 Arbury Medical Centre32 7 Pear Tree 13 6
Patients Old Mill 8 5 348 4 591 3 2 1 0
Galley Common Foleshill GPA
13/04/2020 20/04/2020 04/05/2020 11/05/2020 25/05/2020 01/06/2020 15/06/2020 22/06/2020 06/07/2020 13/07/2020 27/07/2020 03/08/2020 17/08/2020 24/08/2020 07/09/2020 14/09/2020 28/09/2020 05/10/2020 19/10/2020 26/10/2020 09/11/2020 16/11/2020 30/11/2020 21/12/2020 11/01/2021 01/02/2021 22/02/2021 15/03/2021 05/04/2021 27/04/2020 18/05/2020 08/06/2020 29/06/2020 20/07/2020 10/08/2020 31/08/2020 21/09/2020 12/10/2020 02/11/2020 23/11/2020 07/12/2020 14/12/2020 28/12/2020 04/01/2021 18/01/2021 25/01/2021 08/02/2021 15/02/2021 01/03/2021 08/03/2021 22/03/2021 29/03/2021 06/04/2020 Arbury Medical Centre Pear Tree Old Mill
4 Of patients recorded Of patients recorded Of patients recorded on on the MDS, what 37 the MDS, what is 108 82 on the MDS, REFERRAL_SOURCE2Totalare the referral sources? AGE_BANDING Totalwhat is the age profile? the ethnicity split? 111 108 0-18 275 275 ETHNIC2 Total 69 252 GP 759 111 19-59 404 0-18 White British 252 White WMAS 1 60-69 69 19-59 Other 10 British GP Other 3 70-79 82 60-69 Unknown 609 Other 80+ 37 WMAS 70-79 Blank 4 10 759 80+ 609 Unknown Other 404 Blank NHS Coventry and Warwickshire Clinical Commissioning Group Enc H
Report To: Primary Care Commissioning Committee (Public) Meeting
Report Title: Primary Care Update Report - South Warwickshire
Report From: Alison Cartwright, Chief Planning and Performance Officer (Interim)
Author: Sue Phillips, Head of Primary Care Commissioning.
Date: 27th May 2021
Previously Considered by: n/a
Action Required (delete as appropriate)
Decision: Assurance: Information: ✓ Confidential
Purpose of the Report: To provide the Committee with assurance on the work streams in progress as part of the CCGs delegated functions relating to GP Primary Care Commissioning.
Key Points: • The current position and progress updates in relation to activities undertaken to deliver the delegated functions and supporting work streams under full delegation for GP Primary Care Commissioning.
• The key operational and strategic activities and developments being taken forward and co- ordinated by the Primary Care Team relevant to Primary Care Commissioning functions and duties. This includes updates in relation to all current and emerging work streams as part of the management of GP Primary Care delegated functions, strategic developments and implementation of the GPFV and other relevant projects.
• To outline emerging issues and highlight areas of potential and actual risk to the delivery of GP primary care services across the CCG area.
Recommendation: The content of this paper is for assurance and information and therefore, Members are asked to note the report.
Implications
[Details of which corporate objective, strategy or plan this report supports: Objective(s) / Plans 1. GP Forward View supported by this report: 2. Primary Care Estates Strategy 3. Wider Primary Care Strategy including the Long Term Plan Conflicts of Interest in relation to this report should already be included on the Conflicts of Interest: register of interests. If any are identified through presentation of the paper, these should be raised for noting in line with the requirements of the meeting. Financial: Non-Recurrent Expenditure: Not applicable
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Recurrent Expenditure: Not applicable Is this expenditure included within the CCG’s Financial Yes No N/A ✓ Plan? (Delete as appropriate) Performance: Provides assurance against milestones where these apply. Provides assurance in relation to quality and safety associated with the various Quality and Safety: workstreams included. General Statement: The CCG is committed to fulfil its obligations under the Equality Act 2010, and to ensure services commissioned by the CCG are non- discriminatory on the grounds of any protected characteristics. Policies/decisions may need to be adjusted in line with any equality analysis or due regard. Any Equality and Diversity: decision that is finalised without being influenced by appropriate due regard could be deemed unlawful. Has an equality impact Yes assessment been undertaken? No N/A ✓ (attached) (Delete as appropriate) Patient and Public Not applicable Engagement: Clinical engagement as part of the programmes of work included in this report is Clinical Engagement: undertaken through the Primary Care Development Group where appropriate. Risks associated with the workstreams included within this report are managed Risk and Assurance: locally as part of the project plans and the Primary Care Risk Register and will, if required be escalated and included in the CCG Corporate Risk Register.
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Introduction
1.1 This report aims to provide further updates and appropriate assurances to the Committee in relation to the undertaking and delivery of delegated functions for the commissioning of GP Primary Care. This also includes the identification of emerging risks and associated mitigation actions in place to deliver these delegated functions.
1.2 The report is also intended to summarise progress to date against key work streams currently being managed through the Primary Care Team to ensure information is shared with the Committee at the earliest opportunity.
Commissioning and Procurement of Primary Medical Services
2.1 Priory Medical Centre New Build - the new build for the practice continues on plan, with GMS services due to commence on site from 28th June 2021. The primary care ICT provider will be working with the practice in the proceeding weeks to ensure that a full service is up and running from 9am on the day of opening.
2.2 Primary Care Network (PCN) - Fenny Compton Surgery has now officially joined the Warwickshire East PCN, meaning that all 32 practices are now part of a network.
Contract Performance and Management
3.1 Committee Members are asked to note that there are currently no contractual performance monitoring issues to be reported.
3.2 Contract Variations - A contract variation has been received from a practice requesting a change to their partnership due to a partner introduction. This is subject to the standard regulations and checks within the team from an operational perspective.
GP Forward View and Enabling Workstreams
4.1 Workforce - the CCG has submitted its workforce plans for 2021/22 via the recent Operating Plan. The focus remains the recruitment and retention of all roles but with a focus on retention of GPs and nurses and the recruitment of additional roles into GP practices to support delivery of the PCN Directed Enhanced Service and provide workforce resilience.
4.2 Wellbeing is a key area of focus following a challenging 16 months. We are working with system partners to develop and implement a wellbeing programme for all including the general practice workforce.
4.3 In addition, a structured approach to delivering the various schemes as part of the Workforce Strategy and are outlined below:
• GP Retention • GP Workforce Lead • GP Mentoring • First Five Scheme and Next Gen scheme (supporting GPs in the first 5/7 years of their careers) • Phoenix Scheme (supporting mid career GPs) • LMC Exit interviews • Fellowship Core Offer (New to practice) • Fellowship Aspiring Leaders (New to practice) • Coventry and Warwickshire Training Hub • Nurse Development Lead
4.4 Plans are already developed for the above areas and are progressing through the appropriate routes
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4.5 GP Resilience Fund: The CCG will work with the LMC to decide on the best use of these funds going forward and direct them towards practices which meet the eligibility criteria set out by NHSE.
4.6 ICT – The CCG has concluded a number of IT priorities over the last couple of months in order to meet the Primary Care GP IT Strategy. The priorities over the next few months include:
• Video consultation procurement • Digitalisation of patient notes • Completion of CCG GP IT Contracts • Business process review and learning for on-line consultations • Updating the Digital Dashboard to include new projects to provide oversight and assurance • A replacement WIFI solution for practices and the implementation of further Office 365 functionality ‘One Drive’ which will increase the ability for the general practice workforce to work remotely and increase practice resilience
Conclusion and Recommendation
5.1 The content of this paper is for assurance and information and therefore, Members are asked to note the report.
End of report.
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