Agenda Decision / to Note / Enc./ Agenda Discussion Item Item Description Table / No / Presenter Pres

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Meeting in Common of the North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups’ Primary Care Commissioning Committees – Held in Public Tuesday 5th June 2018, 10.00am – 11.30am The Morston Room, Floor 3, One Smithfield, Hanley, Stoke-on-Trent, ST1 4FA Agenda Decision / To Note / Enc./ Agenda Discussion Item Item description Table / No / Presenter Pres. Informatio n Welcome and Apologies for Absence: 1 North Staffordshire CCG: Stoke-on-Trent CCG: Declarations of Interest North Staffordshire CCG & Stoke-on-Trent CCG : If any member of the Committee or invited attendee has any pecuniary 2 interest, in any contract, proposed contract or other matter under consideration at this meeting he/she shall disclose the fact to the Chairman Verbal To Note and shall not take part in the consideration or discussion of the matter or vote on any question with respect to it unless agreed by the Chairman and PD members of the committee 10.00am Confirmation of Quoracy (following consideration of interests (5 mins) declared pertaining to the agenda) 3 North Staffordshire CCG Stoke-on-Trent CCG Minutes from: Public Meeting In Common Of The North Staffordshire and Stoke- To Note / 4 On-Trent Clinical Commissioning Groups’ Primary Care Enc. 4.1 Decision Commissioning Committee Tuesday 1st May 2018 Enc. 4.2 Action List and Matters Arising 5 Governance 10.05am LM 5.1 Terms of Reference Enc. 5.1 Decision (10 mins)

6 Finance, Performance and Planning 10.15am

LM 6.1 Primary Care 2018/19 Planning To follow Enc. 6.1 Assurance/ To Note (15 mins)

° LC 6.2 360 Ipsos MORI Stakeholder Survey 2018 Enc. 6.2 To Note (10 mins)

6 GP Forward View 10.40am

For LM 7.1 GP Forward View Highlight Report Enc. 7.1 information (10 mins)

10 High Impact Actions – Rolling Programme of Updates Enc. 7.2a LM 7.2  Workload and Resilience To note Enc. 7.2b (15 mins)  Social Prescribing Update

NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes

NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE

7 Standing Agenda Items 11.15am

Primary Care Horizon Scanning ALL 7.1 Enc. 7.1 Information  NHS England Head of Primary Care Update (5 mins)

8 Any Other Business 11.20am

 Questions from the Public Verbal  Any other key issues Verbal Information PD  Committee Effectiveness Enc. 8.1

DATE/TIME OF NEXT MEETING: Date Time Venue Chair

rd 10.00am The Conference Suite, The Bridge Centre, Birches Head Tuesday 3 July 2018 PD Road, Birches Head, ST2 8DD

NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes

NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE

Public Meeting of the North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups’ Primary Care Commissioning Committees held in Common st Tuesday 1 May 2018, 10.00am – 11.30am The Conference Suite, Bridge Centre, Birches Head Road, Birches Head, ST2 8DD

Unconfirmed Minutes

Members: Quoracy 10/04/2018 01/05/2018 03/07/2018 04/09/2018 02/10/2018 06/11/2018 04/12/2018 Present: North Staffordshire CCG Voting Members: Peter Dartford PD Lay Member – Patient and Public Involvement ✓ ✓ (meeting chair) Mike Edgley ME Lay Member ✓ ✓ Neil McFadden NMcF Lay Member – Governance ✓ ✓ Stoke-on-Trent CCG Voting Members: Tim Bevington TB Lay Member ✓ ✓ John Howard JH Lay Member – Governance ✓ ✓ Margy Woodhead MWo Lay Member – Patient and Public Involvement ✓ x North Staffordshire and Stoke-on-Trent CCGs’ Voting Members: Cheryl Hardisty CH Director of Commissioning and Operations x x Zara Jones ZJ Director of Strategy, Planning and Performance x x Lorraine Cook LC Head of Quality x ✓ Alistair Mulvey AM Chief Finance Officer ✓ ✓ Marcus Warnes MWa Accountable Officer ✓ ✓ In attendance: North Staffordshire and Stoke-on-Trent CCGs: Dr Waheed Abbasi WA Clinical Director – Mental Health and Specialist x x Groups Nicola Austerberry NA Primary Care Lead ✓ x Jessica Chaplin JC Executive Assistant (Minutes) ✓ ✓ Dr Lorna Clarson LC Clinical Director – Patient and Public Involvement ✓ ✓ Anna Collins AC Head of Communications and Engagement ✓ x Dr Steve Fawcett SF Medical Director ✓ x Dr John Gilby JG Clinical Director – Primary Care ✓ ✓ Charlotte Harper CHa Project Manager – Care Navigation ✓ x Dr Latif Hussain LH Non-Executive GP Board Member ✓ x Vicky Oxford VO Senior Commissioning Manager ✓ ✓ Alex Palethorpe AP Associate Director – Corporate Services ✓ ✓ Staffordshire Single Leadership Team: Lynn Millar LM Director of Primary Care ✓ ✓ Mark Seaton MS Managing Director x ✓ Sally Young SY Director of Corporate Governance, ✓ x Communications and Engagement NHS England Rebecca Woods RW Head of Primary Care ✓ x Wendy Henson WH Primary Care Lead ✓ ✓ Terry Chikurhune TC Primary Care Lead ✓ ✓ Public/Observers Simmy Aktar SA Healthwatch Stoke-on-Trent x ✓ Jackie Owen JO Healthwatch Staffordshire ✓ ✓

Dr Paul Scott PS North Staffordshire LMC Chair x ✓ Dr Harald Van-Der HVL North Staffordshire LMC Secretary ✓ x Linden

NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes

NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 1

0 members of public/press in attendance 2018/MAY 1. Welcome and Apologies for absence Action /054 PD welcomed members to the public meeting of the North Staffordshire and Stoke-on-Trent CCG Primary Care Commissioning Committees held in Common.

Apologies were duly received and noted as above. 2018/MAY 2. Members’ Declarations of Interest /055 No further declarations of interests made extraordinary to items declared on the CCGs’ Declaration of Interest Register. 2018/MAY 3. Confirmation of Quoracy /056 The meeting was not confirmed as quorate for North Staffordshire CCG and Stoke-on-Trent CCG. It was noted that work needed to take place to review the terms of reference and to refresh the meeting membership to ensure that the Staffordshire CCGs Single Leadership Team were included for Quoracy arrangements. 2018/MAY 4. Minutes, Action Sheet and Matters Arising /057 Minutes from the meeting held on Tuesday 10th April 2018 The North Staffordshire CCG and Stoke-on-Trent CCG Governing Bodies Duly received and approved the minutes of the public session of the North Staffordshire CCG and Stoke-on-Trent CCG Primary Care Commissioning Committees held in common on held on Tuesday 10th April 2018.

Actions from the meeting held on Tuesday 10th April 2018 All other actions complete or on the meeting agenda for discussion.

Matters Arising No matters raised. 2018/MAY 5. Primary Care Risk Register /056 AP presented the meeting with the Primary Care Risk Register for risks rated 12 and above as at 31st March 2018, including details around changes in risk score and approval for respective items to be closed. The paper presented to the Committees also included an update on the alignment of risks across Staffordshire. The Primary Care Commissioning Committees were asked to approve the closure of risks detailed within the paper, to confirm that they were assured with the actions in place to manage risks and to receive and note the contents of the Risk Register. Key details were presented as follows:

The meeting were advised that in line with the CCGs’ Board Assurance Framework, the Committees were asked to review the Public Primary Care Risk Register risks scoring 12 and above.

 PC1 Vulnerability within General Practice (GPs and Practice Nurses). Recruitment and Retention National Crisis – The risk in relation to Vulnerability in General Practice was requested to be reduced from 16-12, due to the following mitigations in place to manage the risk accordingly (1) Staffordshire Primary Care Workforce Plan; (2) International Recruitment scheme in progress; (3) GP Forward View – Workforce workstream.

The Committees engaged in a comprehensive discussion whereby it was requested that PC1 remained at the risk score of 16, as there were still increased workforce pressures within general practice. Furthermore, LC informed the meeting that the STP workforce modelling concluded that there was an approximate 82 GP Vacancies across North Staffordshire and Stoke-on-Trent CCGs, with 16% of the workforce over 60 and 85 GP could retire imminently. It was concluded that a full position, including a clear breakdown of figures across the whole of General Practice Workforce to allow for the Committees to obtain a full understanding of the risk.

ACTION: LM to present the committees with a focussed review on General Practice Workforce to the June meeting, including a breakdown of vacancies across North Staffordshire CCG and Stoke-on-Trent CCG.

NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes

NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 2

 PC2 Lack of clinical and managerial capability in Primary Care to deliver the required and operate Primary Care at Scale – It was requested that PC2 was reduced from 15 to 12 due to the following mitigations in place to manage the risk accordingly; (1) Staffordshire Primary Care Workforce Plan; (2) GP Forward View Staffordshire Improvement Plan; (3) Releasing capacity workstream; (4) Training being provided and; (5) Care Navigation Rollout. The North Staffordshire CCG and Stoke-on-Trent CCG Primary Care Commissioning Committees approved the reduction in risk score for PC2.

 PC9 Lack of provision of a GP Service for a cohort of violent and aggressive patients due to current provider giving notice – The Committees were asked to consider the closure of risk PC9, as alternative arrangements had been sourced, with the service provided on an Enhanced Service Term and arrangements would be reviewed in March 2019. The North Staffordshire CCG and Stoke-on-Trent CCG Primary Care Commissioning Committee approved for the risk to be reduced to a risk score of 2, until a long term plan for future provision of the service is developed.

AP provided a further update in relation to alignment of Risk Registers across the Six Staffordshire CCGs, whereby members were advised that a workshop had taken place on 31st April 2018 and all risks across the CCGs were collated by each respective director. In addition, work was taking place to review the format of the risk registers to ensure that the Registers were aligned where applicable and at the next Risk Management Group, a format would be shared with members for consideration.

LM commented that further work needed to take place, to ensure that mitigations and rationale detailed within the risk register provided robust enough assurances. It was suggested that a workshop could take place, for both directors and commissioners to ensure a common understanding of the Risk Register and best practice when providing mitigation detail.

JH stated that as the CCGs were commencing their transition phase, for aligned working across the Staffordshire CCGs there was a need to ensure that the alignment of the Risk Registers would provide the opportunity to manage and work to reduce risks and to increase the level of assurances provided by the registers. Furthermore JH highlighted the importance that as work took place for another alignment of the registers, which the focus on risk and the quality of content needed to be improved and a refresh of format could provide the opportunity for a full review of how assurances were sought from the risk register and the strength of supporting actions.

MWa commented that there was a wider issue around risk management across the Staffordshire CCGs and the South Staffordshire CCGs’ Audit Committees recognised for the need for a workshop to take place around risk, once the Management of Change process had been concluded. It was noted that discussions had taken place with Pricewaterhouse Cooper to deliver the session for the CCGs. Furthermore, MWa informed members that the CCGs’ Executive Team would have a specific objective focussing on the Risk Registers – recognising that the Risk Register was a key area for the CCGs to obtain assurances.

To conclude, the North Staffordshire CCG Primary Care Commissioning Committee received and noted the Primary Care Risk Register as at 31st March and approved the changes to scoring as detailed above; and Stoke-on-Trent CCG Primary Care Commissioning Committee received and noted the Primary Care Risk Register as at 31st March and approved the changes to scoring as detailed above. 2018/MAY 6.1 Finance Update – Primary Care Delegated Budgets /057 AM presented the Committees with a paper detailing the final outturn position for the CCGs’ Primary Care budgets for 2017/18. The North Staffordshire CCG and Stoke-on-Trent CCG Primary Care Commissioning Committees were asked to receive and note the financial position as at month 12. The report was taken as read by the Committees and key details presented as follows:

The meeting were advised that North Staffordshire CCG and Stoke-on-Trent CCG reported underspend of £284k and £1,197k respectively. North Staffordshire CCG were reporting slightly higher than the month 11 forecast and Stoke-on-Trent CCG were in line with the month 11 forecast. In addition, members were advised that following on from agreement of the allocation of the underspend at the March Committee 2018/19 plans had been amended accordingly with the

NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes

NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 3

agreement of the Committees.

TB requested detail on NHS England involvement in discussions for the Delegated Budgets. AM responded that levels were set and sent to the CCGs. It was noted that in previous years there had been substantial underspend but the CCGs did not have full visibility of the levels of underspend.

To conclude, the North Staffordshire CCG Primary Care Commissioning Committee received and noted the Finance Update - delegated budgets final outturn 2017/18; and Stoke-on-Trent CCG Primary Care Commissioning Committee received and noted the Finance Update – delegated budgets final outturn 2017/18. 2018/MAY 6.2 Primary Care 2018/19 Planning /058 LM provided a verbal update to the meeting in relation to Primary Care Planning for 2018/19. Members were advised that a Primary Care Commissioning Lead had been appointed following on from the Management of Change process. It was noted that the CCGs’ Primary Care Commissioning Lead had commenced work on looking at costings, opportunities and proposals available to support planning. In addition, a meeting would take place with key stakeholders to work through discuss the plan and a full update would be presented to the June meeting.

ACTION: LM to present the June Primary Care Commissioning Committees with a paper LM detailing Primary Care Planning for 2018/19. 2018/MAY 7.1 Primary Care Quality Report /059 VO presented the Committees with the Primary Care Quality Assurance report, the North Staffordshire CCG and Stoke-on-Trent CCG Primary Care Commissioning Committees were asked to receive and note the contents of the report and to agree the frequency of reporting. Details presented as follows:

Members were asked to consider the frequency of reporting for Primary Care Quality, as it was noted that meetings to discuss Primary Care quality assurance and performance were held on a bi-monthly and quarterly basis – including meetings with CQC inspectors and the Primary Care Quality Dashboard Review Group.

The Committees received the current CQC rating for all practices across North Staffordshire and Stoke-on-Trent CCGs. It was highlighted that both Moss Lane Surgery and Talke Pits clinic received focussed revisits to review areas where they had received requires improvement on one indicator. Following on from the revisits, Moss Lane Surgery received a rating of ‘Outstanding’ and Talke Pitts Clinic received a rating of ‘Good’. In addition, members were advised that work was taking place with Orchard Surgery, following on from their rating of ‘Requires Improvement’, to develop an action plan to address the issues highlighted in the CQC report.

Further details were provided to the Governing Bodies in relation to Quality Improvement work that was taking place in-line with the GP Forward View, Family and Friends test results and complaints – with work taking place with NHS England to ensure complaints information was received in a timely way.

MS queried if there were any key themes that the CCGs could support practices with, in relation to common findings from CQC inspections. VO replied that MRMH alerts were an issue in a number of CQC reports where practices had the responsibility to cascade the alerts throughout the practice as appropriate and work was taking place to identify a protocol to support practices looking at best practice and roll out. In addition, it was highlighted that another key theme was in relation to recruitment processes and work would take place to identify support to practices. WH informed the meeting that the quarterly Primary Care Quality Leads Group were working on common themes from inspectors with key themes working in collaboration with CQC inspectors, furthermore NHS England Practice Support Team were also working to see if there were any themes to share and to proactively troubleshoot issues as they arise, using local intelligence also.

TB queried if there was any further detail to be provided around the Family and Friend Test Review. WH responded that the review was still in process and responses were still open and highlighted that the value of Family and Friend Test Data was the qualitative free text data received.

NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes

NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 4

MWa commented that Primary Care had the best performance for CQC across the system and commended the quality of care provided in Primary Care, with the majority of practices rated as good and outstanding across North Staffordshire and Stoke-on-Trent CCGs and formally recognised the achievement. The importance of ensuring a supportive approach was taken with practices in the run up to inspection and it was hoped that the Staffordshire Primary Care Team would help to align the approach taken to support practices.

To conclude, the North Staffordshire CCG Primary Care Commissioning Committee approved for the Primary Care Quality Assurance Report to be reported on a bi-monthly basis to the meeting and received and noted the Primary Care Quality Assurance Report; and Stoke-on-Trent CCG Primary Care Commissioning Committee approved for the Primary Care Quality Assurance Report to be reported on a bi-monthly basis to the meeting and received and noted the Primary Care Quality Assurance Report. 2018/MAY 8.1 10 High Impact Actions – Rolling Programme of Updates /060 LM presented the meeting with an update on the Social Prescribing project, following on from approval from the March meeting to utilise the 2017/18 underspend to support the development of social prescribing across North Staffordshire and Stoke-on-Trent. The North Staffordshire CCG and Stoke-on-Trent CCG Primary Care Commissioning Committees were asked to receive and note the Update. Key details presented as follows:

The meeting were advised that the Social Prescribing Steering Group had met twice since the agreement to fund the project in principle and a Terms of Reference had been agreed to formalise the meeting, a wide range of stakeholders were invited including representatives from Northern Staffordshire Federation, LMC, Voluntary Sector and Local Authorities. Furthermore, a number of task and finish groups had been convened to look at Early Implementer sites, Model to be used an evaluation. It was noted that the proposed model and associated costings would be presented back to the meeting for consideration and approval.

To conclude, the North Staffordshire CCG Primary Care Commissioning Committee received and noted the Social Prescribing project position statement; and the Stoke-on-Trent CCG Primary Care Commissioning Committee received and noted the Social Prescribing project position statement. 2018/MAY 9 Any other Business /061 Questions from the Public No members of public in attendance.

Any other key issues

Primary Care Estates JH requested that an update was provided to a future meeting in relation to primary care estates, in relation to opportunities and issues to highlight to the Committees. PS highlighted concerns in relation to LIFT buildings and associated leases, with a number of disputes for practices taking 2-3 years to resolve. LM acknowledged the issues associated with Primary Care Estates and advised the meeting that South Staffordshire CCG had to underwrite a lease for a practice. The meeting were informed that a review of Primary Care Estates had taken place to provide a baseline position for lease arrangements.

Committee effectiveness 1. Did we achieve what we set out to achieve linking back to the agenda? Yes 2. Was the information presented appropriate/easy to understand? Yes 3. Was the information received in a timely manner prior to the meeting? Yes 4. Do we need to inform our decision? No 5. Are we assured? Yes 6. Do we need any more information/require a further progress report at a later date? Detailed within Mintues 7. Agreed actions captured in the minutes? Yes 8. Were there any risks raised in the meeting that should be captured on the risk register? Risk

NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes

NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 5

Tuesday 1st May 2018 2.30pm – 5.00pm Bridge Centre, Birches Head Road, Birches Head, Stoke- AB on-Trent, ST2 8DD All parties should note that the minutes of the meeting are for record purposes only. Any action required should be noted by the parties concerned during the course of the meeting and actions carried out promptly without waiting for the issue of the minutes. These minutes are signed as being a true record of the meeting, subject to any necessary amendments being made, which will, if any, be recorded in the following meeting’s minutes.

Signed: ...... Position: ...... Date:......

NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes

NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 6

Enclosure 4.2 Action Tracker from May meeting of North Staffordshire and Stoke-on-Trent CCG Primary Care Commissioning Committees’ Public Session

MEETING Responsible REFERENCE AGENDA ITEM Action Outcome / update DATE Officer LM to present the committees with a focussed review on General Practice Item added to meeting 2018/MAY Primary Care Risk 01/05/18 Workforce to the June meeting, including a Lynn Millar agenda under GP Forward /056 Register breakdown of vacancies across North View Update Staffordshire CCG and Stoke-on-Trent CCG. LM to present the June Primary Care 2018/MAY Primary Care 2018/19 01/05/18 Commissioning Committees with a paper Lynn Millar Item on the agenda. /058 Planning detailing Primary Care Planning for 2018/19.

Public Paper

Enclosure: 5.1

Report to North Staffordshire and Stoke on Trent CCG Primary Care Commissioning Committee meeting in Common

Title Terms of Reference revised membership

Meeting Date 5th June 2018

Sponsor Director Lyn Millar, Director of Primary Care and Medicines Optimisation

Action required Decision Y Discussion Y For assurance/For Information Y

Purpose of the paper, key issues, points and recommendations This paper presents a proposed revision of the terms of reference in respect of membership. The amendments are to ensure that • meetings reflect the changes made in regard to membership following the implementation of the single leadership team; and

• meetings are quorate when decisions are being made.

Proposed changes are highlighted in yellow in the attached document, the rationale for the change is detailed below. the committee are also asked to note that a full review of the terms of reference will be undertaken by the 30th September and brought back to the Committee for approval and Governing Body ratification..

Membership Proposed changes to voting members

Removal of Chief Operating Officer - post removed following the decision to have a single leadership team

The following officers are proposed to be removed from the membership, although they still have a right to attend if requested.

• Director of Commissioning, or nominated deputy • Director of Strategy planning and Performance or nominated deputy

The following officers are proposed to be added to the membership as voting members

• Director of Primary Care or nominated Deputy • Managing Director- North Division or nominated Deputy Insert following sentence The Committee can request any member of the single leadership team to attend the meeting, and these will be considered to be a voting member unless they are a GP.

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.

Proposed Change to non-voting members removal of Head of Governance or Deputy; replace with Director of Corporate Services, Governance and Communication or nominated Deputy

Insert the following into the following paragraph *Whilst clinical members cannot be voting members, they are actively encouraged to attend to participate and ensure sufficient clinical input, Therefore a minimum of two are required for quoracy, 1 from each CCG (unless they are appointed across both CCGs i.e. a non-executive GP board member represents both CCGs) . The Committee is asked to i) Approve the proposed changes to membership of the primary care commissioning committee, with the proposal that this is enacted immediately. ii) That the Chair of the Committee takes this to the Governing Body for ratification, retrospectively The Committee is asked to note; th i) A full review of the terms of reference will take place by the 30 September 2018. Which other CCG committee and/or Group has considered this report

Committee/Group Other agreements Director of primary Care

Summary of risks relating to the proposal Without terms of reference reflecting the correct membership, there is the potential meetings would not be not quorate when decisions are required to be made.

Any statutory/ regulatory/legal /NHS constitutional/NHSE assurance / governance implications

Primary Care Commissioning committee has delegated functions from NHSE

Strategic objectives supported by this paper Our shared Goals: Yes No

Empowered Staff 1.

Commissioning Health Outcomes 2.

Seamless Partnerships 3.

Responsible Use of Resources 4. Y

Key Requirements: Yes No

Has a Quality Impact Assessment been completed? 1. N

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.

Has an Equality Impact Assessment been completed? 2. Y

Has Engagement activity taken place with Stakeholders/Practice/Public and Patients 3. Y

Acronyms contained in document

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.

NHS NORTH STAFFORDSHIRE AND NHS STOKE-ON-TRENT CLINICAL COMMISSIONING GROUPS Primary Care Commissioning Committee Meetings Held in Common Terms of Reference

1. Introduction

1.1 The individual Primary Care Commissioning Committee (the Committees) of North Staffordshire and Stoke-on-Trent CCGs are established in accordance with each CCG’s Constitution, Prime Financial Policies and Scheme of Delegation. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of each Committee and shall have effect as if incorporated into each Clinical Commissioning Group’s Constitution and Prime Financial Policies enabling the Committees to meet ‘in common’.

1.2 As per the CCGs constitutions, in the interest of partnership working, the Committees will operate as a ‘committee in common’ with representatives from both CCGs to jointly plan for North Staffordshire and Stoke-on-Trent. In accordance with each CCGs Constitution, the accountability and decision making of the Committees has been delegated to the Committees by each individual Clinical Commissioning Group’s Body.

2. Statutory Framework

2.1 NHS England has delegated to each CCG authority to exercise the primary care commissioning functions set out in schedule 2 of the delegated agreement in accordance with section 13Z of the NHS Act. (see appendix 1 to these terms of reference)

2.2 Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and each 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 14Z1) i) Public involvement and consultation (section 14Z2)

2.4 The North Staffordshire and Stoke-on-Trent CCGs will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:

• Duty to have regard to impact on services in certain areas (section 13O);

1 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

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

2.5 The Primary Care Commissioning committees of NHS North Staffordshire and NHS Stoke-on- Trent CCG Governing Bodies are established as a committee of each Governing Body in accordance with Schedule 1A of the “NHS Act”.

2.6 The members acknowledge that the Committees are subject to any direction made by NHS England or by the Secretary of State.

3. Role of the Committees

3.1 The committees have been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in North Staffordshire and Stoke –on-Trent, under delegated authority from NHS England.

3.2 In performing its role the Committees will exercise its management of the functions in accordance with the agreement entered into between NHS England and NHS North Staffordshire and Stoke-on- Trent CCGs, which will sit alongside the delegation and terms of reference.

3.3 The functions of the Committees 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.

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

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

3.6 The CCGs will also carry out the following activities:

a) To plan, including needs assessment, primary care services in North Staffordshire and Stoke-on-Trent;

b) To undertake reviews of primary care services in North Staffordshire and Stoke-on-Trent ;

c) To co-ordinate a common approach to the commissioning of primary care services generally in North Staffordshire and Stoke-on-Trent;

2 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

d) To manage the budget for commissioning of primary care services in North Staffordshire and Stoke-on-Trent.

3.7 The Committees provide the level of assurance to the Governing Bodies to ensure all matters related to Primary Care are well governed and well managed.

3.8 The Committees are authorised by each Governing Body to investigate any activity within its terms of reference. The Committees are authorised to seek any information it requires from any employee, or interim and temporary members of staff, who are directed to co-operate with any request made by the Committee. The Committee is authorised by the Governing Body to obtain outside legal, or other independent professional, advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary.

3.9 To support the collaborative working across Stoke-on-Trent and North Staffordshire CCGs, the Committee will hold meetings ‘in common’, where appropriate, to discuss items of common interest. This will be agreed in advance with the Chair of each Committee and a Chair’s Report submitted to each CCG Governing Body in line with normal processes.

4. Geographical Coverage 4.1 The Committee will comprise of North Staffordshire CCG and Stoke-on-Trent CCG. It will undertake the function of commissioning primary medical services for both CCGs.

5. Membership 5.1 The Committee shall be appointed by each Governing Body and shall consist of:

Voting Members Joint CCG Posts • Accountable Officer • Chief Operating Officer • Chief Finance Officer, or nominated deputy • Director of Commissioning, or nominated deputy • Director of Strategy, Planning and Performance, or nominated deputy • Director of Nursing and Quality, or nominated deputy • Director of Primary Care or nominated Deputy • Managing Director – North Division or nominated Deputy

The Committee can request any member of the single leadership team to attend the meeting, and these will be considered to be a voting member unless they are a GP.

NSCCG Lay member x 3 (includes Chair*)

Stoke-on-Trent CCG

Lay member x 3 (includes Chair*)

*The role of Chair and Vice Chair must be undertaken by a Lay Member (who is not the Audit Chair and Conflicts of Interest Guardian)

Non-Voting Members 3 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

• Medical Director* • Clinical representatives (to be sourced from Clinical Chairs, Clinical Directors or Non Executive GP Board Members)* • Secondary Care Consultant (x 2)* • Head of Governance (or deputy) Director of Corporate Services, Governance and Communication or nominated Deputy • Head of Primary Care Commissioning or nominated deputy • Representative from NHS England – Head of Primary Care or nominated deputy

*Whilst clinical members cannot be voting members, they are actively encouraged to attend to participate and ensure sufficient clinical input, Therefore a minimum of two are required for quoracy, 1 from each CCG (a non-executive GP board member represents both CCGs) .

5.2 A standing non-voting invitation will be open to the following observers to attend and participate in discussions : • Healthwatch Stoke-on-Trent • Healthwatch Staffordshire • Health and Wellbeing Board Representative (Stoke-on-Trent City Council) • Health and Wellbeing Board Representative (Staffordshire County Council) • LMC

The standing invitation will enable all observers to attend the open and closed section of the meetings. The value of observers contributing to discussions is recognised and valued, however the Chair of the Committees reserves the right to request observers leave the closed meeting should it be required (as set out in section 8.2)

5.3 The Committees may also extend invitations to other personnel with relevant skills, experience or expertise as necessary to enable it to address matters before the Committee or as part of the Committees’ cycle of business to support with the decision making process. These representatives will be noted in the minutes as ‘in attendance’. All other senior managers may be invited to attend by exception, particularly when the Committee are discussing areas of risk or operation within their area of responsibility.

5.4 Development sessions will be put in place, as appropriate, for committee members over the next twelve months so members fully understand its roles and functions.

5.5 Membership will be reviewed regularly to adjust for changes as required by the purpose of the Committee. If at such time the two CCGs have any shared Lay Members, the representation from lay members may be reviewed accordingly.

4 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

6.Quoracy

6.1 The meeting shall be deemed quorate when: • A minimum of two of the three lay members from each CCG (including the Committee Chair) are present (noting that the Chair of the meeting cannot be the Lay Member for Governance); and • A minimum of three executives or their deputy are present • A minimum of 2 GP representatives, 1 from each CCG

Whilst clinical members cannot be voting members, they are actively encouraged to attend to participate and ensure sufficient clinical input, but must not be in the majority.

7. Voting

7.1 Each voting member of the Committees shall have one vote. The Committees 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 Committees will be to achieve consensus decision-making wherever possible.

7.2 Certain items will be pertinent to one CCG only, and will only be voted on by voting members of that CCG.

8. Frequency and Notice of Meetings

8.1 Meetings shall routinely be held on a monthly basis, but not less than nine times a year.

8.2 As a general rule, meetings of the Primary Care Commissioning Committees, including the decision-making and deliberations leading up to the decision, shall

a) be held in public , subject to the application of b) b) the Committees 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.

Examples of where it may be appropriate to exclude the public include:

• Information about individual patients or other individuals which includes sensitive personal data is to be discussed; • Commercially confidential information is to be discussed, for example the detailed contents of a provider’s tender submission; • Information in respect of which a claim to legal professional privilege could be maintained in legal proceedings is to be discussed; • To allow the meeting to proceed without interruption and disruption.

8.3 Members of the Committees have a collective responsibility for the operation of the Committees. 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. 5 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

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

8.5 The Committees may call additional experts to attend meetings on an adhoc basis to inform discussions.

8.6 Members of the Committees, including observers, shall respect confidentiality requirements as set out in the CCG’s constitution and will be required to complete declaration of interest forms

8.7 The Committees will present its minutes to North Midlands Sub-regional Team of NHS England and the North Staffordshire CCG Governing Body and Stoke-on-Trent Governing Body following each meeting for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 8.4 above.

8.8 The CCGs will also comply with any reporting requirements set out in their constitutions.

9 Accountability of the Committees

The Committees have delegated authority from North Staffordshire CCG Governing Body and Stoke-on-Trent CCG Governing Body :

• To carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act • To assist and support NHS England in discharging its duty under section13E of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) so far as relating to securing continuous improvement in the quality of primary medical services. • To work with NHS England to agree rules for areas such as the collection of data for national data sets, equivalent of what is collected under QOF, and IT intra-operability. • To comply with public procurement regulations and with statutory guidance on conflicts of interest • To consult with Local Medical Committee and demonstrate improved outcomes reduced inequalities and value for money when developing a local QOF scheme or DES. • To approve the arrangements for discharging the group’s statutory duties associated with its GP practice commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation.

10. Procurement of Agreed Services 10.1 The below is taken from the Next Steps in primary care co-commissioning document for further guidance on this please see link below. https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2014/11/nxt- steps-pc-cocomms.pdf 10.2 The Committees must comply with public procurement regulations and with statutory guidance on conflicts of interest. The Committees may vary or renew existing contracts for primary care provision or award new ones, depending on local circumstances. If the Committees fail to secure an adequate supply of high quality primary medical care, NHS England may direct the CCG to act. 6 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

10.3 If Committees are found to have breached public procurement regulations and/or statutory guidance on conflicts of interest, NHS Improvement may direct the CCG or NHSE to act. NHS England may, ultimately, revoke the CCG’s delegation. Any proposed new incentive schemes should be subject to consultation with the Local Medical Committee and be able to demonstrate improved outcomes, reduced inequalities and value for money.

11. Decisions

11.1 The Committees will make decisions within the bounds of its remit.

11.2 The decisions of the Committees shall be binding on NHS England and either North Staffordshire CCG or Stoke- on-Trent CCG.

11.3 The Committees will produce an executive summary report which will be presented to NHS North Midlands England and the governing body of each CCG monthly [could be longer period] for information.

12. Appeal Process 12.1 If any practice wishes to appeal against the decision reached by the Committee, they are required to follow the member practice grievance procedure as set out in each CCG’s Constitution (section 16)

Date Approved by Committees:

Date Approved by Governing Bodies:

Review on an annual basis or earlier if required

7 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

Appendix 1 – Schedule 2 from Delegation Agreement between CCG and NHSE Schedule 2 – Delegation Part 1: Delegated Functions: Specific Obligations

1. Introduction

1.1. This Part 1 of Schedule 2 (Delegated Functions) sets out further provision regarding the carrying out of each of the Delegated Functions.

2. Primary Medical Services Contract Management

2.1. The CCG must:

2.1.1. manage the Primary Medical Services Contracts on behalf of NHS England and perform all of NHS England’s obligations under each of the Primary Medical Services Contracts in accordance with the terms of the Primary Medical Services Contracts as if it were named in the contract in place of NHS England;

2.1.2. actively manage the performance of the counter-party to the Primary Medical Services Contracts in order to secure the needs of people who use the services, improve the quality of services and improve efficiency in the provision of the services including by taking timely action to enforce contractual breaches and serve notice;

2.1.3. ensure that it obtains value for money under the Primary Medical Services Contracts on behalf of NHS England and avoids making any double payments under any Primary Medical Services Contracts;

2.1.4. comply with all current and future relevant national Guidance regarding PMS reviews and the management of practices receiving Minimum Practice Income Guarantee (MPIG) (including without limitation the Framework for Personal Medical Services (PMS) Contracts Review guidance published by NHS England in September 2014 (http://www.england.nhs.uk/wp-content/uploads/2014/09/pms-review-guidance- sept14.pdf));

2.1.5. notify NHS England immediately (or in any event within two (2) Operational Days) of any breach by the CCG of its obligations to perform any of NHS England’s obligations under the Primary Medical Services Contracts;

2.1.6. keep a record of all of the Primary Medical Services Contracts that the CCG manages on behalf of NHS England setting out the following details in relation to each Primary Medical Services Contract:

2.1.6.1. name of counter-party;

2.1.6.2. location of provision of services; and

2.1.6.3. amounts payable under the contract (if a contract sum is payable) or amount payable in respect of each patient (if there is no contract sum).

8 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

2.2. For the avoidance of doubt, all Primary Medical Services Contracts will be in the name of NHS England.

2.3. The CCG must comply with any Guidance in relation to the issuing and signing of Primary Medical Services Contracts in the name of NHS England.

2.4. Without prejudice to clause 13 (Financial Provisions and Liability) or paragraph 2.1 above, the CCG must actively manage each of the relevant Primary Medical Services Contracts including by:

2.4.1. managing the relevant Primary Medical Services Contract, including in respect of quality standards, incentives and the QOF, observance of service specifications, and monitoring of activity and finance;

2.4.2. assessing quality and outcomes (including clinical effectiveness, patient experience and patient safety);

2.4.3. managing variations to the relevant Primary Medical Services Contract or services in accordance with national policy, service user needs and clinical developments;

2.4.4. agreeing information and reporting requirements and managing information breaches (which will include use of the NHS Digital IG Toolkit SIRI system);

2.4.5. agreeing local prices, managing agreements or proposals for local variations and local modifications;

2.4.6. conducting review meetings and undertaking contract management including the issuing of contract queries and agreeing any remedial action plan or related contract management processes; and

2.4.7. complying with and implementing any relevant Guidance issued from time to time.

Enhanced Services

2.5. The CCG must manage the design and commissioning of Enhanced Services, including re- commissioning these services annually where appropriate.

2.6. The CCG must ensure that it complies with any Guidance in relation to the design and commissioning of Enhanced Services.

2.7. When commissioning newly designed Enhanced Services, the CCG must:

2.7.1. consider the needs of the local population in the Area;

2.7.2. support Data Controllers in providing ‘fair processing’ information as required by the DPA;

2.7.3. develop the necessary specifications and templates for the Enhanced Services, as required to meet the needs of the local population in the Area;

9 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

2.7.4. when developing the necessary specifications and templates for the Enhanced Services, ensure that value for money will be obtained;

2.7.5. consult with Local Medical Committees, each relevant Health and Wellbeing Board and other stakeholders in accordance with the duty of public involvement and consultation under section 14Z2 of the NHS Act;

2.7.6. obtain the appropriate read codes, to be maintained by NHS Digital;

2.7.7. liaise with system providers and representative bodies to ensure that the system in relation to the Enhanced Services will be functional and secure; and

2.7.8. support GPs in entering into data processing agreements with data processors in the terms required by the DPA.

Design of Local Incentive Schemes

2.8. The CCG may design and offer Local Incentive Schemes for GP practices, sensitive to the needs of their particular communities, in addition to or as an alternative to the national framework (including as an alternative to QOF or directed Enhanced Services), provided that such schemes are voluntary and the CCG continues to offer the national schemes.

2.9. There is no formal approvals process that the CCG must follow to develop a Local Incentive Scheme, although any proposed new Local Incentive Scheme:

2.9.1. is subject to consultation with the Local Medical Committee;

2.9.2. must be able to demonstrate improved outcomes, reduced inequalities and value for money; and

2.9.3. must reflect the changes agreed as part of the national PMS reviews.

2.10. The ongoing assurance of any new Local Incentive Schemes will form part of the CCG’s assurance process under the CCG Assurance Framework.

2.11. Any new Local Incentive Scheme must be implemented without prejudice to the right of GP practices operating under a GMS Contract to obtain their entitlements which are negotiated and set nationally.

2.12. NHS England will continue to set national standing rules, to be reviewed annually, and the CCG must comply with these rules which shall for the purposes of this Agreement be Guidance.

Making Decisions on Discretionary Payments

2.13. The CCG must manage and make decisions in relation to the discretionary payments to be made to GP practices in a consistent, open and transparent way.

2.14. The CCG must exercise its discretion to determine the level of payment to GP practices of discretionary payments, in accordance with the Statement of Financial Entitlements Directions. 10 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

Making Decisions about Commissioning Urgent Care for Out of Area Registered Patients

2.15. The CCG must manage the design and commissioning of urgent care services (including home visits as required) for its patients registered out of area (including re-commissioning these services annually where appropriate).

2.16. The CCG must ensure that it complies with any Guidance in relation to the design and commissioning of these services.

3. Planning the Provider Landscape

3.1. The CCG must plan the primary medical services provider landscape in the Area, including considering and taking decisions in relation to:

3.1.1. establishing new GP practices in the Area;

3.1.2. managing GP practices providing inadequate standards of patient care;

3.1.3. the procurement of new Primary Medical Services Contracts (in accordance with any procurement protocol issued by NHS England from time to time);

3.1.4. closure of practices and branch surgeries;

3.1.5. dispersing the lists of GP practices;

3.1.6. agreeing variations to the boundaries of GP practices; and

3.1.7. coordinating and carrying out the process of list cleansing in relation to GP practices, according to any policy or Guidance issued by NHS England from time to time.

3.2. In relation to any new Primary Medical Services Contract to be entered into, the CCG must, without prejudice to any obligation in Schedule 2, Part 2, paragraph 3 (Procurement and New Contracts) and Schedule 2, Part 1, paragraph 2.3:

3.2.1. consider and use the form of Primary Medical Services Contract that will ensure compliance with NHS England’s obligations under Law including the Public Contracts Regulations 2015/102 and the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013/500 taking into account the persons to whom such Primary Medical Services Contracts may be awarded;

3.2.2. provide to NHS England confirmation as required from time to time that it has considered and complied with its obligations under this Agreement and the Law; and

3.2.3. for the avoidance of doubt, Schedule 5 (Financial Provisions and Decision Making Limits) deals with the sign off requirements for Primary Medical Services Contracts.

4. Approving GP Practice Mergers and Closures

4.1. The CCG is responsible for approving GP practice mergers and GP practice closures in the Area.

11 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

4.2. The CCG must undertake all necessary consultation when taking any decision in relation to GP practice mergers or GP practice closures in the Area, including those set out under section 14Z2 of the NHS Act (duty for public involvement and consultation). The consultation undertaken must be appropriate and proportionate in the circumstances and should include consulting with the Local Medical Committee.

4.3. Prior to making any decision in accordance with this paragraph 4 (Approving GP Practice Mergers and Closures), the CCG must be able to clearly demonstrate the grounds for such a decision and must have fully considered any impact on the GP practice’s registered population and that of surrounding practices. The CCG must be able to clearly demonstrate that it has considered other options and has entered into dialogue with the GP contractor as to how any closure or merger will be managed.

4.4. In making any decisions pursuant to paragraph 4 (Approving GP Practice Mergers and Closures), the CCG shall also take account of its obligations as set out in Schedule 2, part 2, paragraph 3 (Procurement and New Contracts), where applicable.

5. Information Sharing with NHS England in relation to the Delegated Functions

5.1. This paragraph 5 (Information Sharing with NHS England) is without prejudice to clause 9.4 or any other provision in this Agreement. The CCG must provide NHS England with:

5.1.1. such information relating to individual GP practices in the Area as NHS England may reasonably request, to ensure that NHS England is able to continue to gather national data regarding the performances of GP practices;

5.1.2. such data/data sets as required by NHS England to ensure population of the primary medical services dashboard;

5.1.3. any other data/data sets as required by NHS England; and

5.1.4. the CCG shall procure that providers accurately record and report information so as to allow NHS England and other agencies to discharge their functions.

5.2. The CCG must use the NHS England approved primary medical services dashboard, as updated from time to time, for the collection and dissemination of information relating to GP practices.

5.3. The CCG must (where appropriate) use the NHS England approved GP exception reporting service (as notified to the CCGs by NHS England from time to time).

5.4. The CCG must provide any other information, and in any such form, as NHS England considers necessary and relevant.

5.5. NHS England reserves the right to set national standing rules (which may be considered Guidance for the purpose of this Agreement), as needed, to be reviewed annually. NHS England will work with CCGs to agree rules for, without limitation, areas such as the collection of data for national data sets and IT intra-operability. Such national standing rules set from time to time shall be deemed to be part of this Agreement.

12 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

6. Making Decisions in relation to Management of Poorly Performing GP Practices

6.1. The CCG must make decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list).

6.2. In accordance with paragraph 6.1 above, the CCG must:

6.2.1. ensure regular and effective collaboration with the CQC to ensure that information on general practice is shared and discussed in an appropriate and timely manner;

6.2.2. ensure that any risks identified are managed and escalated where necessary;

6.2.3. respond to CQC assessments of GP practices where improvement is required;

6.2.4. where a GP practice is placed into special measures, lead a quality summit to ensure the development and monitoring of an appropriate improvement plan (including a communications plan and actions to manage primary care resilience in the locality); and

6.2.5. take appropriate contractual action in response to CQC findings.

7. Premises Costs Directions Functions

7.1. The CCG must comply with the Premises Costs Directions and will be responsible for making decisions in relation to the Premises Costs Directions Functions.

7.2. In particular, but without limiting the generality of paragraph 7.1, the CCG shall make decisions concerning:

7.2.1. applications for new payments under the Premises Costs Directions (whether such payments are to be made by way of grants or in respect of recurring premises costs); and

7.2.2. revisions to existing payments being made under the Premises Costs Directions.

7.3. The CCG must comply with any decision-making limits set out in Schedule 5 (Financial Provisions and Decision Making Limits) when taking decisions in relation to the Premises Costs Directions Functions.

7.4. The CCG will comply with any guidance issued by the Secretary of State or NHS England in relation to the Premises Costs Directions, including the Principles of Best Practice, and any other Guidance in relation to the Premises Costs Directions.

7.5. The CCG must work cooperatively with other CCGs to manage premises and strategic estates planning.

The CCG must liaise where appropriate with NHS Property Services Limited and Community Health Partnerships Limited in relation to the Premises Costs Directions Functions.

Part 2 – Delegated Functions: General Obligations 13 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

1. Introduction

1.1. This Part 2 of Schedule 2 (Delegated Functions) sets out general provisions regarding the carrying out of the Delegated Functions.

2. Planning and reviews

2.1. The CCG is responsible for planning the commissioning of primary medical services.

2.2. The role of the CCG includes:

2.2.1. carrying out primary medical health needs assessments (to be developed by the CCG) to help determine the needs of the local population in the Area;

2.2.2. recommending and implementing changes to meet any unmet primary medical services needs; and

2.2.3. undertaking regular reviews of the primary medical health needs of the local population in the Area.

3. Procurement and New Contracts

3.1. The CCG will make procurement decisions relevant to the exercise of the Delegated Functions and in accordance with the detailed arrangements regarding procurement set out in the procurement protocol issued and updated by NHS England from time to time.

3.2. In discharging its responsibilities set out in clause 6 (Performance of the Delegated Functions) of this Agreement and paragraph 1 of this Schedule 2 (Delegated Functions), the CCG must comply at all times with Law including its obligations set out in the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013/500 and any other relevant statutory provisions. The CCG must have regard to any relevant guidance, particularly Monitor’s guidance Substantive guidance on the Procurement, Patient Choice and Competition Regulations (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/283505/Su bstantiveGuidanceDec2013_0.pdf).

3.3. Where the CCG wishes to develop and offer a locally designed contract, it must ensure that it has consulted with its Local Medical Committee in relation to the proposal and that it can demonstrate that the scheme will:

3.3.1. improve outcomes;

3.3.2. reduce inequalities; and

3.3.3. provide value for money.

4. Integrated working

4.1. The CCG must take an integrated approach to working and co-ordinating with stakeholders including NHS England, Local Professional Networks, local authorities, Healthwatch, acute and 14 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

community providers, the Local Medical Committee, Public Health England and other stakeholders.

4.2. The CCG must work with NHS England and other CCGs to co-ordinate a common approach to the commissioning of primary medical services generally.

4.3. The CCG and NHS England will work together to coordinate the exercise of their respective performance management functions.

5. Resourcing

NHS England may, at its discretion provide support or staff to the CCG. NHS England may, when exercising such discretion, take into account, any relevant factors (including without limitation the size of the CCG, the number of Primary Medical Services Contracts held and the need for the Local NHS England Team to continue to deliver the Reserved Functions).

15 North Staffordshire & Stoke-on-Trent Clinical Commissioning Groups: Joint Primary Care Commissioning Committee Terms of Reference – revised 5 June 2018 version 5 Ratified by Governing Bodies

Public Paper

Enclosure: 6.2

Report to Meeting in Common of North Staffordshire and Stoke-on-Trent CCGs’ Primary Care Commissioning Committees

Title 360° Ipsos MORI Stakeholder Survey 2018

Meeting Date Tuesday 5th June 2018

Sponsor Director Lorna Clarson, CCGs’ Director of Partnerships and Engagement

Action required Decision Discussion For Information X

Purpose of the paper, key issues, points and recommendations

Clinical Commissioning Groups (CCGs) need to have strong relationships with a range of stakeholders in order to be successful commissioners within their local health and care systems. These relationships provide CCGs with valuable intelligence to help them make the effective commissioning decisions for their local populations. The CCG 360o Stakeholder Survey enables stakeholders to provide feedback about their CCGs. The results of the survey serve two purposes: 1. To provide data for CCGs to help with their ongoing organisational development, supporting them to build strong and productive relationships with stakeholders. The findings can provide a tool for all CCGs to evaluate their progress, and inform the way that they work and make decisions. 2. To help NHS England to assess CCGs’ stakeholder relationships and leadership within their local health and care systems, and how effectively they commission services to improve service quality and health outcomes. The North Staffordshire CCG and Stoke-on-Trent CCG Primary Care Commissioning Committees are asked to:

 Receive and note the contents of the report. Which other CCG committee and/or Group has considered this report

Committee/Group Other agreements N/A N/A

Summary of risks relating to the proposal Detailed within report.

Any statutory/ regulatory/legal /NHS constitutional/NHSE assurance / governance implications

Detailed within report.

Strategic objectives supported by this paper Our shared Goals: Yes No

Empowered Staff 1. x

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.

Commissioning Health Outcomes 2. x

Seamless Partnerships 3. x

Responsible Use of Resources 4. x

Key Requirements: Yes No

Has a Quality Impact Assessment been completed? 1. x

Has an Equality Impact Assessment been completed? 2. x

Has Engagement activity taken place with Stakeholders/Practice/Public and Patients 3. x

Acronyms

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.

360° Ipsos MORI Stakeholder Survey 2018

Summary Report covering Staffordshire and Stoke-on-Trent CCGs April 2018

Slide Numbers Background and Objectives of the Survey 3

Methodology 4

Response Rates 5 - 11

Combined Stakeholders’ Responses 12 - 18

GP Member Practices Responses 19 - 23

Last Year’s Action Plans 24 - 27

Appendix 1: Overall Summary Slides by CCG 28 - 40

The CCG 360o Stakeholder Survey enables stakeholders to provide feedback about their CCGs. The results of the survey serve two purposes:

1. To provide data for CCGs to help with their ongoing organisational development, supporting them to build strong and productive relationships with stakeholders. The findings can provide a tool for all CCGs to evaluate their progress, and inform the way that they work and make decisions.

2. To help NHS England to assess CCGs’ stakeholder relationships and leadership within their local health and care systems, and how effectively they commission services to improve service quality and health outcomes.

• It was the responsibility of each CCG to provide the list of stakeholders to invite to take part in the CCG 360° stakeholder survey. • CCGs were provided with a specification of core stakeholder organisations to be included in their stakeholder list. Beyond this, CCGs had the flexibility to determine which individual within each organisation was the most appropriate to nominate. • CCGs were also given the opportunity to add up to ten additional stakeholders they wanted to include locally. These could include: Commissioning Support Units, Health Education England, lower tier local authorities, MPs, private providers, Public Health England, local care homes, GP out-of-hours providers and others. • Stakeholders were sent an email inviting them to complete the survey online. Stakeholders who did not respond to the email invitation, and stakeholders for whom an email address was not provided, were telephoned by an Ipsos MORI interviewer who encouraged response and offered the opportunity to complete the survey by telephone. There were also follow up calls to some stakeholders by CCG/CSU staff, to request that they complete the survey and reminders in GP newsletters. • Within the survey, stakeholders were asked a series of questions about their working relationship with the CCG. In addition, to reflect each core stakeholder group’s different area of expertise and knowledge, they were presented with a short section of questions specific to the stakeholder group they represented. • Fieldwork was conducted between 15th January and 28th February 2018.

• The response rates for each CCG across all stakeholders are shown on the following six slides

29 of the CCG’s stakeholders completed the survey. The overall response rate was 49%.

39 of the CCG’s stakeholders completed the survey. The overall response rate was 57%.

29 of the CCG’s stakeholders completed the survey. The overall response rate was 43%.

32 of the CCG’s stakeholders completed the survey. The overall response rate was 56%.

34 of the CCG’s stakeholders completed the survey. The overall response rate was 47%.

22 of the CCG’s stakeholders completed the survey. The overall response rate was 55%.

• There were 22 questions which were common to all stakeholders

• The responses to the first of those questions around the views on the effectiveness of the working relationship with each CCG are shown on the following six slides

• The summary findings for each of the CCGs for the questions asked of all stakeholders can be found at Appendix 1 of this report

• The table on the following slide sets out the responses to the 11 questions asked of GP member practices • Where the same question was asked in 2017, that score is also shown

North Staffs % Stoke-on-Trent Cannock SAS SESP East Question Posed Positive Indication % % % % % 2018 2017 2018 2017 2018 2017 2018 2017 2018 2017 2018 2017 To what extent, if at all, do you feel able to A great deal / Fair amount influence the CCG’s decision-making process? 12 6 33 34 21 62 38 31 29 26 43 77 Red = Scores of less

I have confidence in the clinical leadership of the Strongly / Tend to agree than 60% and any 47 50 63 66 64 69 77 62 47 52 79 85 CCG There is clear and visible clinical leadership of Strongly / Tend to agree scores that are lower 53 67 71 92 53 79 the CCG than the score for the The clinical leadership of my CCG has effective Strongly / Tend to agree influence within local partnerships 41 50 57 54 41 71 same question last (STPs/ACSs/other)

Understanding of the financial implications of the Very / Fairly well year 47 61 54 62 43 69 85 54 59 52 71 69 CCG’s plans Understanding of the implications of the CCG’s Very / Fairly well 35 50 50 52 43 77 77 38 65 39 71 85 plans for service improvement Amber = Scores of Understanding of the referral and activity Very / Fairly well 41 50 46 69 57 92 85 62 65 48 71 85 implications of the CCG’s plans more than 60% but The CCG’s plans to improve the health of the lower than for the local population and reduce health inequalities Very / Fairly well 41 58 57 54 71 71 same question in 2017 To what extent do you agree or disagree that value for money is a key factor in decision making when formulating my CCG’s plans and Strongly / Tend to agree 65 72 79 83 79 92 100 77 76 61 79 92 priorities? Green = Scores of

How familiar are you, if at all, with the financial Very / Fairly familiar 71 67 88 69 36 85 100 100 82 74 71 69 60% or above, except position of your CCG? To what extent do you agree or disagree that Strongly / Tend to agree for those worse than representatives from member practices are able to take a leadership role within the CCG if they 71 56 58 72 86 69 85 77 71 74 86 85 last year’s score want to?

Areas of weakness identified in the responses given by GP Member Practices suggest that improved communication and engagement is required in the following areas:

• Feeling unable to influence the CCG’s decision-making process • Lack of confidence that the clinical leadership of their CCG has effective influence within local partnerships (STPs/ACSs/other) • Lack of confidence in the CCG’s plans to improve the health of the local population and reduce health inequalities • Poor understanding of the financial implications of the CCG’s plans • Poor understanding of the implications of the CCG’s plans for service improvement • Poor understanding of the referral and activity implications of the CCG’s plans

Member practices were asked to provide suggestions for how the CCG could strengthen its governance systems and ability to hear the voice of the member practices, including opportunities for representatives from practices to take more of a leadership role in the CCG.

The main themes of responses to that question were as follows:

• Amount of time needed for a GP to take up leadership roles in the CCG / some concerns that those GPs in leadership roles are not always having an impact

• CCG listens when the views expressed back up what it wants to do, but GPs can’t influence strategic direction

• GPs aren’t involved earlier enough in decision making process

• Lack of openness on the part of the CCG

• CCG should hold more practice meetings

The major themes coming from other verbatim comments which appear to be attributable to GPs are similar:

• Grassroots GPs are not being involved in potential changes and their views are not taken into account (from all 6 CCGs)

• GPs not being involved at an early enough stage (from all CCGs except for Stafford and East)

• The CCGs don’t seem to appreciate the pressures on GPs and General Practice or take it into account when making decisions (All CCGs except Cannock and North Staffs)

• Lack of openness on the part of the CCGs (Cannock and North Staffs)

In response to last year’s survey, the following action was taken:

• North – it was decided to focus on the GP Membership and the action plan to address this is shown on slide 24 • South – the Primary Care Team produced a summary report on the survey findings, which contained actions which are shown on slides 25-26 • East – no plan was created last year as ESCCG’s scores for all of the questions posed in the national survey were better than those achieved for the national average, CCG cluster and their DCO, instead there was a drive to improve the response rates by focusing on the initial recruitment/selection of stakeholders and the following up during the fieldwork window with targeted communications

Communications Media Relations Generate pro-active press releases to Comms & Engagement celebrate and share best practice Social Media Generate content to share with Practice Comms & Engagement Facebook accounts and websites

Newsletter Review readership, reach, relevance and Comms & Engagement frequency Intranet Review GPP intranet to meet their needs Comms & Engagement / Primary Care

Committee Highlight Reports, agendas, Send summary from Primary Care Delivery Primary Care / Admin minutes and actions Group, Primary Care Commissioning Committee and Joint Planning Committee to locality leads

Engagement Practice Manager Groups Provide briefings and updates and listen Primary Care and act upon their concerns Members Events To be held bi-annually – agenda shaped Comms & Engagement / Primary Care / based on key messages Execs Localities Meetings Provide briefings and updates and listen Execs Wednesday lunchtimes to be kept free to and act upon their concerns enable this to happen Bi-Annual Visit to each practice To discuss commissioning, finance, plans Meds OP conduct annual visits and to listen Primary Care Quality Visits GP Forward View Comms Plan being developed with NHS E Comms & Engagement Delivery Plans, 10 high impact actions to roll out across system. Comms NHS E National PMO & Comms teams and the difference they will make. guide/toolkit in development. Workshops, theme per month videos etc being prepared.

STP Clinical engagement Dr John James is interim lead. New substantive Primary Care lead to be appointed. Clinical Leaders group to disseminate info and engage with Primary Care

The following actions were contained within the South’s Primary Care Team’s summary report of the 2017 survey:

• Work will continue in prior to the 2018 survey to continue and improve the uptake for the 2018 survey. This will be through a reminder at practice quality visits, which was felt to be a successful mechanism at SaS CCG for the 2017 survey and the result support this, and engagement with practices prior to the survey deadlines. • Most member practices felt engaged by the CCG in the 12 month period from January 2016 to January 2017. The results for Stafford and Surrounds CCG showed a higher level of engagement than that of Cannock and SESSP. A lower percentage of practices however felt satisfied with the way in which the CCG engages and this needs to be an area of focus in the coming twelve months. • In terms of quality practices feel able to raise quality concerns with the CCG. Further work needs to be undertaken in order to address the confidence they have in the CCG acting on feedback and there may be an opportunity to learn from processes in Cannock where practices felt that their concerns were acted upon. The quality team are already working on a soft intelligence report to be presented to Locality and Membership Boards so that practices are aware of what actions are being taken as a result of their information. Cont’d….

…Cont’d • Practices in both Cannock and Stafford felt they knew the CCGs plans and priorities. A slightly less positive result can be found for SES&SP CCG. There is opportunity for member practices to influence and comment on the CCGs plans and priorities in this financial year. The CCG also needs to focus on ensuring that practices in SES&SP feel that plans and priorities have been effectively communicated to them. This could be through practice visits, necessary officers communicating plans at Locality Boards and also through direct communication to practices.

• There are varying results by CCG with a focus needing to be taken around how we feed back to practices about how the CCG acted upon information provided by patients and the public. The results in SES&SP CCG are significantly lower than Cannock and Stafford and this needs to be understood further. Ensuring that information on engagement is shared with the membership may help to increase the percentages.

• In Cannock practices understand the CCGs plans to improve the health of the local population however further work needs to be undertaken in both SES&SP and Stafford around this agenda.

• It is really positive that practices feel that they are able to take a leadership role within the CCG and the CCG is keen to develop this further to ensure further clinical engagement with the organisation.

Appendix 1 - Overall Summary Slides

• On the following pages are the overall summary slides for each of the CCGs • These show the results at CCG level for the questions asked of all stakeholders - including the direction of travel comparisons where available

Cannock Chase Clinical Commissioning Group North Staffordshire Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group East Staffordshire Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group 28 Summary North This report presents the results from North Staffordshire CCG’s 360° Stakeholder Survey 2017-18. The annual CCG 360° Stakeholder Survey, which has been conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships with Staffs (1) their CCG. The results are used to support CCGs’ ongoing development and feed into improvement and assessment conversations with NHS England.

The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 2017 and 2016.

Base = all stakeholders except CQC (2018; 29, 2017; 30, 2016; 47) unless otherwise stated Overall Engagement 2018 2017 2016

Overall, how would you rate the effectiveness of your working relationship with the CCG? 69% 50% 70%

% very/fairly good

How satisfied or dissatisfied are you with how the CCG involves patients and the public?* 45% - -

% very/fairly satisfied

Commissioning services 2018 2017 2016

The CCG involves the right individuals and organisations when commissioning/decommissioning 45% 50% 55% services % strongly/tend to agree

The CCG provides adequate information to explain the reasons for the decisions it makes when 48% - - commissioning/decommissioning services % strongly/tend to agree

I have confidence the CCG’s plans will deliver high quality services that demonstrate value for money 52% - - % strongly/tend to agree

I have confidence in the CCG to commission/decommission services appropriately 45% - -

% strongly/tend to agree

The CCG demonstrates it has considered the views of patients and the public when making commissioning decisions* 48% - - % strongly/tend to agree

North Staffordshire CCG *Base = all stakeholders (2018; 29, 2017; 30, 2016; 47)

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 29 Summary cont. Leadership of the CCG 2018 2017 2016 North How effective, if at all, do you feel your CCG is as a local system leader? 62% 70% 53% % very/fairly effective Staffs (2) The leadership of the CCG has the necessary blend of skills and experience* 34% 60% 62% % strongly/tend to agree There is clear and visible leadership of the CCG* 48% 63% 64% % strongly/tend to agree I have confidence in the leadership of the CCG to deliver its plans and priorities* 45% 50% 57% % strongly/tend to agree

The leadership of CCG is delivering high quality services within the available resources* 45% - - % strongly/tend to agree I have confidence in the leadership of the CCG to deliver improved outcomes for patients* 45% 47% 49% % strongly/tend to agree The leadership of the CCG is contributing effectively to local partnership arrangements (including Sustainability Transformation Partnerships (STPs), Accountable Care Systems (ACSs) where 55% - - applicable and/or other local partnership arrangements)* % strongly/tend to agree Monitoring and reviewing services 2018 2017 2016

I have confidence that the CCG monitors the quality of the services it commissions in an 52% 77% 64% effective manner % strongly/tend to agree If I had concerns about the quality of local services I would feel able to raise my concerns within 76% 73% 83% the CCG % strongly/tend to agree I have confidence in the CCG to act on feedback it receives about the quality of services 59% 50% 66% % strongly/tend to agree Plans and priorities 2018 2017 2016

69% 70% 62% How much would you say you know about the CCG’s plans and priorities? % a great deal/fair amount

I have been given the opportunity to influence the CCG’s plans and priorities 34% 33% 49% % strongly/tend to agree

When I have commented on the CCG’s plans and priorities I feel that my comments have been 38% 43% 43% considered (even if the CCG has not been able to act on them) % strongly/tend to agree

The CCG has effectively communicated its plans and priorities to me 45% 53% 53% % strongly/tend to agree

North Staffordshire CCG Base = all stakeholders except CQC (2018; 29, 2017; 30, 2016; 47) unless otherwise stated

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 30 Summary Stoke- This report presents the results from Stoke on Trent CCG’s 360° Stakeholder Survey 2017-18. The annual CCG 360° Stakeholder Survey, which has been conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships with their on-Trent CCG. The results are used to support CCGs’ ongoing development and feed into improvement and assessment conversations with NHS England.

(1) The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 2017 and 2016.

Base = all stakeholders except CQC (2018; 39, 2017; 42, 2016; 35) unless otherwise stated Overall Engagement 2018 2017 2016

Overall, how would you rate the effectiveness of your working relationship with the CCG? 67% 71% 80%

% very/fairly good

How satisfied or dissatisfied are you with how the CCG involves patients and the public?* 56% - -

% very/fairly satisfied

Commissioning services 2018 2017 2016

The CCG involves the right individuals and organisations when commissioning/decommissioning 31% 64% 46% services % strongly/tend to agree

The CCG provides adequate information to explain the reasons for the decisions it makes when 41% - - commissioning/decommissioning services % strongly/tend to agree

I have confidence the CCG’s plans will deliver high quality services that demonstrate value for money 49% - - % strongly/tend to agree

I have confidence in the CCG to commission/decommission services appropriately 44% - -

% strongly/tend to agree

The CCG demonstrates it has considered the views of patients and the public when making commissioning decisions* 38% - - % strongly/tend to agree

Stoke on Trent CCG *Base = all stakeholders (2018; 39, 2017; 42, 2016; 35)

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 31 Summary cont. Leadership of the CCG 2018 2017 2016

How effective, if at all, do you feel your CCG is as a local system leader? 62% 69% 74% % very/fairly effective Stoke- The leadership of the CCG has the necessary blend of skills and experience* 46% 64% 60% % strongly/tend to agree on-Trent There is clear and visible leadership of the CCG* 51% 62% 66% (2) % strongly/tend to agree I have confidence in the leadership of the CCG to deliver its plans and priorities* 46% 57% 60% % strongly/tend to agree

The leadership of CCG is delivering high quality services within the available resources* 51% - - % strongly/tend to agree I have confidence in the leadership of the CCG to deliver improved outcomes for patients* 46% 50% 54% % strongly/tend to agree The leadership of the CCG is contributing effectively to local partnership arrangements (including Sustainability Transformation Partnerships (STPs), Accountable Care Systems (ACSs) where 44% - - applicable and/or other local partnership arrangements)* % strongly/tend to agree Monitoring and reviewing services 2018 2017 2016

I have confidence that the CCG monitors the quality of the services it commissions in an 49% 62% 57% effective manner % strongly/tend to agree If I had concerns about the quality of local services I would feel able to raise my concerns within 72% 74% 83% the CCG % strongly/tend to agree I have confidence in the CCG to act on feedback it receives about the quality of services 38% 64% 63% % strongly/tend to agree Plans and priorities 2018 2017 2016

74% 67% 77% How much would you say you know about the CCG’s plans and priorities? % a great deal/fair amount

I have been given the opportunity to influence the CCG’s plans and priorities 51% 52% 49% % strongly/tend to agree

When I have commented on the CCG’s plans and priorities I feel that my comments have been 41% 43% 51% considered (even if the CCG has not been able to act on them) % strongly/tend to agree

The CCG has effectively communicated its plans and priorities to me 51% 57% 51% % strongly/tend to agree

Stoke on Trent CCG Base = all stakeholders except CQC (2018; 39, 2017; 42, 2016; 35) unless otherwise stated

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 32 Summary

This report presents the results from Cannock Chase CCG’s 360° Stakeholder Survey 2017-18. The annual CCG 360° Stakeholder Survey, which has been conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships with their CCG. The results are used to support CCGs’ ongoing development and feed into improvement and assessment conversations with NHS England.

Cannock The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of Chase (1) stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 2017 and 2016.

Base = all stakeholders except CQC (2018; 29, 2017; 31, 2016; 35) unless otherwise stated Overall Engagement 2018 2017 2016

Overall, how would you rate the effectiveness of your working relationship with the CCG? 72% 74% 80%

% very/fairly good

How satisfied or dissatisfied are you with how the CCG involves patients and the public?* 55% - -

% very/fairly satisfied

Commissioning services 2018 2017 2016

The CCG involves the right individuals and organisations when commissioning/decommissioning 41% 45% 60% services % strongly/tend to agree

The CCG provides adequate information to explain the reasons for the decisions it makes when 52% - - commissioning/decommissioning services % strongly/tend to agree

I have confidence the CCG’s plans will deliver high quality services that demonstrate value for money 48% - - % strongly/tend to agree

I have confidence in the CCG to commission/decommission services appropriately 48% - -

% strongly/tend to agree

The CCG demonstrates it has considered the views of patients and the public when making commissioning decisions* 52% - - % strongly/tend to agree

Cannock Chase CCG *Base = all stakeholders (2018; 29, 2017; 31, 2016; 35)

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 33 Summary cont. Leadership of the CCG 2018 2017 2016

How effective, if at all, do you feel your CCG is as a local system leader? 69% 74% 74% % very/fairly effective The leadership of the CCG has the necessary blend of skills and experience* 55% 68% 69% Cannock % strongly/tend to agree Chase (2) There is clear and visible leadership of the CCG* 52% 74% 71% % strongly/tend to agree I have confidence in the leadership of the CCG to deliver its plans and priorities* 48% 58% 66% % strongly/tend to agree

The leadership of CCG is delivering high quality services within the available resources* 52% - - % strongly/tend to agree I have confidence in the leadership of the CCG to deliver improved outcomes for patients* 59% 58% 54% % strongly/tend to agree The leadership of the CCG is contributing effectively to local partnership arrangements (including Sustainability Transformation Partnerships (STPs), Accountable Care Systems (ACSs) where 59% - - applicable and/or other local partnership arrangements)* % strongly/tend to agree Monitoring and reviewing services 2018 2017 2016

I have confidence that the CCG monitors the quality of the services it commissions in an 52% 65% 63% effective manner % strongly/tend to agree If I had concerns about the quality of local services I would feel able to raise my concerns within 83% 81% 74% the CCG % strongly/tend to agree I have confidence in the CCG to act on feedback it receives about the quality of services 59% 68% 66% % strongly/tend to agree Plans and priorities 2018 2017 2016

48% 65% 60% How much would you say you know about the CCG’s plans and priorities? % a great deal/fair amount

I have been given the opportunity to influence the CCG’s plans and priorities 34% 48% 51% % strongly/tend to agree

When I have commented on the CCG’s plans and priorities I feel that my comments have been 41% 58% 57% considered (even if the CCG has not been able to act on them) % strongly/tend to agree

The CCG has effectively communicated its plans and priorities to me 41% 61% 49% % strongly/tend to agree

Cannock Chase CCG Base = all stakeholders except CQC (2018; 29, 2017; 31, 2016; 35) unless otherwise stated

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 34 Summary This report presents the results from Stafford and Surrounds CCG’s 360° Stakeholder Survey 2017-18. The annual CCG 360° Stakeholder Survey, which has been conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships Stafford & with their CCG. The results are used to support CCGs’ ongoing development and feed into improvement and assessment conversations with NHS England. Surrounds The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of (1) stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 2017 and 2016.

Base = all stakeholders except CQC (2018; 32, 2017; 31, 2016; 27) unless otherwise stated Overall Engagement 2018 2017 2016

Overall, how would you rate the effectiveness of your working relationship with the CCG? 81% 71% 67%

% very/fairly good

How satisfied or dissatisfied are you with how the CCG involves patients and the public?* 66% - -

% very/fairly satisfied

Commissioning services 2018 2017 2016

The CCG involves the right individuals and organisations when commissioning/decommissioning 63% 55% 44% services % strongly/tend to agree

The CCG provides adequate information to explain the reasons for the decisions it makes when 63% - - commissioning/decommissioning services % strongly/tend to agree

I have confidence the CCG’s plans will deliver high quality services that demonstrate value for money 59% - - % strongly/tend to agree

I have confidence in the CCG to commission/decommission services appropriately 63% - -

% strongly/tend to agree

The CCG demonstrates it has considered the views of patients and the public when making commissioning decisions* 44% - - % strongly/tend to agree

Stafford and Surrounds CCG *Base = all stakeholders (2018; 32, 2017; 31, 2016; 27)

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 35 Summary cont. Leadership of the CCG 2018 2017 2016

How effective, if at all, do you feel your CCG is as a local system leader? 81% 74% 63% % very/fairly effective The leadership of the CCG has the necessary blend of skills and experience* 69% 74% 78% Stafford & % strongly/tend to agree Surrounds There is clear and visible leadership of the CCG* 72% 84% 85% (2) % strongly/tend to agree I have confidence in the leadership of the CCG to deliver its plans and priorities* 56% 61% 67% % strongly/tend to agree

The leadership of CCG is delivering high quality services within the available resources* 66% - - % strongly/tend to agree I have confidence in the leadership of the CCG to deliver improved outcomes for patients* 59% 48% 44% % strongly/tend to agree The leadership of the CCG is contributing effectively to local partnership arrangements (including Sustainability Transformation Partnerships (STPs), Accountable Care Systems (ACSs) where 66% - - applicable and/or other local partnership arrangements)* % strongly/tend to agree Monitoring and reviewing services 2018 2017 2016

I have confidence that the CCG monitors the quality of the services it commissions in an 66% 58% 48% effective manner % strongly/tend to agree If I had concerns about the quality of local services I would feel able to raise my concerns within 91% 87% 78% the CCG % strongly/tend to agree I have confidence in the CCG to act on feedback it receives about the quality of services 59% 61% 59% % strongly/tend to agree Plans and priorities 2018 2017 2016

78% 74% 63% How much would you say you know about the CCG’s plans and priorities? % a great deal/fair amount

I have been given the opportunity to influence the CCG’s plans and priorities 47% 45% 37% % strongly/tend to agree

When I have commented on the CCG’s plans and priorities I feel that my comments have been 66% 48% 41% considered (even if the CCG has not been able to act on them) % strongly/tend to agree

The CCG has effectively communicated its plans and priorities to me 66% 65% 41% % strongly/tend to agree

Stafford and Surrounds CCG Base = all stakeholders except CQC (2018; 32, 2017; 31, 2016; 27) unless otherwise stated

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 36 Summary This report presents the results from South East Staffordshire and Seisdon Peninsula CCG’s 360° Stakeholder Survey 2017-18. The annual CCG 360° Stakeholder Survey, which has been conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships with their CCG. The results are used to support CCGs’ ongoing development and feed into improvement and assessment South conversations with NHS England. East The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of Staffs stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 2017 and 2016. (1) Base = all stakeholders except CQC (2018; 34, 2017; 35, 2016; 34) unless otherwise stated Overall Engagement 2018 2017 2016

Overall, how would you rate the effectiveness of your working relationship with the CCG? 85% 77% 76%

% very/fairly good

How satisfied or dissatisfied are you with how the CCG involves patients and the public?* 68% - -

% very/fairly satisfied

Commissioning services 2018 2017 2016

The CCG involves the right individuals and organisations when commissioning/decommissioning 50% 54% 56% services % strongly/tend to agree

The CCG provides adequate information to explain the reasons for the decisions it makes when 41% - - commissioning/decommissioning services % strongly/tend to agree

I have confidence the CCG’s plans will deliver high quality services that demonstrate value for money 56% - - % strongly/tend to agree

I have confidence in the CCG to commission/decommission services appropriately 59% - -

% strongly/tend to agree

The CCG demonstrates it has considered the views of patients and the public when making commissioning decisions* 50% - - % strongly/tend to agree

South East Staffordshire and Seisdon Peninsula CCG *Base = all stakeholders (2018; 34, 2017; 35, 2016; 34)

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 37 Summary cont. Leadership of the CCG 2018 2017 2016

How effective, if at all, do you feel your CCG is as a local system leader? 62% 66% 65% % very/fairly effective South East The leadership of the CCG has the necessary blend of skills and experience* 47% 63% 68% Staffs (2) % strongly/tend to agree There is clear and visible leadership of the CCG* 53% 57% 74% % strongly/tend to agree I have confidence in the leadership of the CCG to deliver its plans and priorities* 59% 63% 68% % strongly/tend to agree

The leadership of CCG is delivering high quality services within the available resources* 50% - - % strongly/tend to agree I have confidence in the leadership of the CCG to deliver improved outcomes for patients* 50% 54% 68% % strongly/tend to agree The leadership of the CCG is contributing effectively to local partnership arrangements (including Sustainability Transformation Partnerships (STPs), Accountable Care Systems (ACSs) where 47% - - applicable and/or other local partnership arrangements)* % strongly/tend to agree Monitoring and reviewing services 2018 2017 2016

I have confidence that the CCG monitors the quality of the services it commissions in an 71% 60% 68% effective manner % strongly/tend to agree If I had concerns about the quality of local services I would feel able to raise my concerns within 91% 89% 88% the CCG % strongly/tend to agree I have confidence in the CCG to act on feedback it receives about the quality of services 71% 69% 76% % strongly/tend to agree Plans and priorities 2018 2017 2016

65% 66% 79% How much would you say you know about the CCG’s plans and priorities? % a great deal/fair amount

I have been given the opportunity to influence the CCG’s plans and priorities 44% 51% 68% % strongly/tend to agree

When I have commented on the CCG’s plans and priorities I feel that my comments have been 56% 49% 65% considered (even if the CCG has not been able to act on them) % strongly/tend to agree

The CCG has effectively communicated its plans and priorities to me 44% 51% 56% % strongly/tend to agree

South East Staffordshire and Seisdon Peninsula CCG Base = all stakeholders except CQC (2018; 34, 2017; 35, 2016; 34) unless otherwise stated

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 38 Summary This report presents the results from East Staffordshire CCG’s 360° Stakeholder Survey 2017-18. The annual CCG 360° Stakeholder Survey, which has been conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships with East their CCG. The results are used to support CCGs’ ongoing development and feed into improvement and assessment conversations with NHS Staffs (1) England.

Base = all stakeholders except CQC (2018; 22, 2017; 20, 2016; 33) unless otherwise stated Overall Engagement 2018 2017 2016

Overall, how would you rate the effectiveness of your working relationship with the CCG? 64% 85% 82%

% very/fairly good

How satisfied or dissatisfied are you with how the CCG involves patients and the public?* 73% - -

% very/fairly satisfied

Commissioning services 2018 2017 2016

The CCG involves the right individuals and organisations when commissioning/decommissioning 68% 80% 61% services % strongly/tend to agree

The CCG provides adequate information to explain the reasons for the decisions it makes when 68% - - commissioning/decommissioning services % strongly/tend to agree

I have confidence the CCG’s plans will deliver high quality services that demonstrate value for money 68% - - % strongly/tend to agree

I have confidence in the CCG to commission/decommission services appropriately 68% - -

% strongly/tend to agree

The CCG demonstrates it has considered the views of patients and the public when making commissioning decisions* 68% - - % strongly/tend to agree

East Staffordshire CCG *Base = all stakeholders (2018; 22, 2017; 20, 2016; 33)

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 39 Summary cont. Leadership of the CCG 2018 2017 2016

How effective, if at all, do you feel your CCG is as a local system leader? 73% 85% 76% % very/fairly effective The leadership of the CCG has the necessary blend of skills and experience* 64% 85% 73% East Staffs % strongly/tend to agree (2) There is clear and visible leadership of the CCG* 68% 80% 85% % strongly/tend to agree I have confidence in the leadership of the CCG to deliver its plans and priorities* 68% 75% 76% % strongly/tend to agree

The leadership of CCG is delivering high quality services within the available resources* 68% - - % strongly/tend to agree I have confidence in the leadership of the CCG to deliver improved outcomes for patients* 68% 75% 70% % strongly/tend to agree The leadership of the CCG is contributing effectively to local partnership arrangements (including Sustainability Transformation Partnerships (STPs), Accountable Care Systems (ACSs) where 73% - - applicable and/or other local partnership arrangements)* % strongly/tend to agree Monitoring and reviewing services 2018 2017 2016

I have confidence that the CCG monitors the quality of the services it commissions in an 82% 85% 64% effective manner % strongly/tend to agree If I had concerns about the quality of local services I would feel able to raise my concerns within 86% 100% 85% the CCG % strongly/tend to agree I have confidence in the CCG to act on feedback it receives about the quality of services 73% 90% 73% % strongly/tend to agree Plans and priorities 2018 2017 2016

64% 85% 82% How much would you say you know about the CCG’s plans and priorities? % a great deal/fair amount

I have been given the opportunity to influence the CCG’s plans and priorities 41% 80% 61% % strongly/tend to agree

When I have commented on the CCG’s plans and priorities I feel that my comments have been 64% 70% 61% considered (even if the CCG has not been able to act on them) % strongly/tend to agree

The CCG has effectively communicated its plans and priorities to me 55% 75% 76% % strongly/tend to agree

East Staffordshire CCG Base = all stakeholders except CQC (2018; 22, 2017; 20, 2016; 33) unless otherwise stated

CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public Fieldwork: 15th January - 28th February 40

Public Paper

Enclosure: 7.1

Report to Public Meeting in Common of the North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups’ Primary Care Commissioning Committees

Title GP Forward View Highlight Report

Meeting Date 5th June 2018

Sponsor Director Lynn Millar, CCGs’ Director of Primary Care and Medicines Optimisation

Action required Decision Discussion For assurance/For Information Yes

Purpose of the paper, key issues, points and recommendations

This paper sets out an update on the overall position of each GP Forward View workstreams and specific progress made since the last period across the Staffordshire and Stoke-on-Trent CCGs. The report sets out priorities for action in the next period and any new / carried forward risks or issues identified requiring attention of the relevant governance group(s). The report covers the following areas:

• Access • Workload (including Resilience Funding) • Workforce (including Practice Managers Funding) • Nursing Framework including Nurse Recruitment and Retention • Infrastructure (including Estates and Technology Transformation Fund (ETTF) and Digital) • Models of Care

The Board is asked to note : I. Progress, current activity and future activity in relation to the GP Forward View. II. Issues, risks and mitigations identified. Which other CCG committee and/or Group has considered this report

Committee/Group Other agreements

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.

Summary of risks relating to the proposal • Detailed within report.

Any statutory/ regulatory/legal /NHS constitutional/NHSE assurance / governance implications

Strategic objectives supported by this paper Our shared Goals: Yes No

Empowered Staff 1. Yes

Commissioning Health Outcomes 2. Yes

Seamless Partnerships 3. Yes

Responsible Use of Resources 4. Yes

Key Requirements: Yes No

Has a Quality Impact Assessment been completed? 1. N/A

Has an Equality Impact Assessment been completed? 2. N/A

Has Engagement activity taken place with Stakeholders/Practice/Public and Patients 3. N/A

Acronyms (Please see the Abbreviation Key in the report).

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.

GPFV Highlight Report – Staffordshire

Update Bundle: May 2018 (v2)

Purpose of this Report Bundle

This report bundle provides a concise update on the overall position of each work stream and specific progress made in the last period. It sets out priorities for action in the next period and any new risks or issues identified and requiring the attention of the STP governance group(s) The bundle includes individual papers as follows:

Mark Rayne / 1. Access Kirsten Owen / Victoria Oxford Sarah Jeffery / 2. Workload including Resilience Funding Nicola Austerberry / Kirsten Owen Rebecca Woods / Workforce including Practice Manager funding 3. Julie Downie

Nursing Framework including nurse recruitment and Lynn Millar / Tracey 3.1 retention Cox Andy Hadley / Infrastructure: Estates and Technology Transformation Phil Brenner / 4. Fund (ETTF) and Digital Laurence Wadlow

5. Models of Care Lynn Millar

Cannock Chase Clinical Commissioning Group East Staffordshire Clinical Commissioning Group North Staffordshire Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group Risk Scoring Key Probability 1. Rare The event may only occur in exceptional circumstances (<1%) 2. Unlikely The event could occur at some time (1-5%) 3. Possible Reasonable chance of occurring at some time (6-20%) 4. Likely The event will occur in most circumstances (21-50%) 5. Almost certain More likely to occur than not (>50%)

Impact 1. Insignificant No impact on GPFV outcomes, insignificant cost or financial loss, no media interest 2. Minor Limited impact on GPFV, moderate financial loss, potential local short-term media interest 3. Moderate Moderate impact on GPFV outcomes, moderate loss of reputation, moderate business interruption, high financial loss, potential local long-term media interest 4. Major Significant impact on GPFV, major loss of reputation, major business interruption, major financial loss, potential national media interest 5. Severe Severe impact on patient outcomes, far reaching environmental implications, permanent loss of service or facility, catastrophic loss of reputation, multiple claims, parliamentary questions, prosecutions, highly significant financial loss

5 5 10 15 20 25

4 4 8 12 16 20

3 3 6 9 12 15

IMPACT 2 2 4 6 8 10

1 1 2 3 4 5

1 2 3 4 5 Probability Progress Status Key On schedule Behind schedule with Behind schedule mitigating actions in place

Abbreviation Key GPFV General Practice Forward View STP Sustainability and Transformation Plan PM Practice Manager ETTF Estates and Technology Transformation Fund DCO Director of Commissioning Organisation CEPN Community Education Provider Network SRO Senior Responsible Officer

Work Stream Extended Primary Care Access Month covered May 2018

Author Mark Rayne Status Green Impact if Not

Achieved Summary status:

Update following the 2018/19 planning guidance requires GP extended access from the 1st October, rather than the 31st October 2018.

Currently 2 Prime Minister Challenge Funded pilots offering extended access in various models and approaches.

Task and finish group and steering group and CCG working groups have been established and a service specification is in development in line with the procurement timeframes and procurement rules.

Local procurement timeline plans to have services in place by start of October 2018.

Lynn Millar has formally responded to Soyuz Shrestha (NHSE) in respect of potential opportunities for earlier implementation and has identified a number of current pilots that could potentially be expanded to work towards delivery of the 7 core requirements, at varying stages, to ensure full service from 1st October. In terms of mobilisation of the pilots, we would need to commence more formal conversations with the providers to agree the milestones to achieve the 7 core requirements.

Activities and updates from the last period 1. 2. Procurement options paper and legal framework completed Presented to East Governing Body (29th March) for their decision on the procurement approach 3. All governing bodies agreed to an intention for a direct award for extended access 4. Development of the robust governance process to manage the process going forward 5. Review of TOR for task and finish and steering groups following meet with legal team to meet requirements moving forward 6. Further development of the specification and start of localisation specifications to be shared at task and finish group on 11th April. Core specification to be reviewed to ensure they are clinically robust and contain required transformation requirements by steering group on 18th April. 7. Refresh of the project plans in line with commissioning approach agreed 8. Development of IMT requirements gap analysis and development plan to be taken to steering group 11th April 9. Risks and issues log reviewed and updated following meeting with the legal team 10. Meetings to start financial modelling against allocations with Finance manager 11. QIA signed off by assurance panel 12. Task and finish group delivered 13. Steering group delivered

Actions planned for next period 1. Development of financial modelling and options paper to Steering group 18th April 2. Develop an assurance approach with legal team 3. Finalise our CCG specific service model templates informed by the survey, demographic information, the previous engagement events and existing pilots 4. Engagement on potential service models starts with providers 5. Finalise service specification ready for this to be considered by the appropriate governance forums to be agreed and signed off 6. Share specification with legal team following steering group meeting on 18th April to develop questions and proforma and assurance process to start engagement with providers in may 7. Development of the non-conflicted panel 8. Development of IMT requirements gap analysis and development plan taken to steering group 11th April 9. 10. IMT requirements paper to steering group 18th April 11. intention to directly award publicised on CCG websites 12. A next stage communications and engagement approach commenced with legal team and communications and engagement team 13. Risks and issues log reviewed and updated following meeting with the legal team 14. Task and finish group 11th April 15. Steering group 18th April 16. Further development of the specification and start of localisation specifications were shared at task and finish group on 11th April. Core specification to be reviewed to ensure they are clinically robust and contain required transformation requirements by steering group on 18th April.

Recommendations for the relevant governance group(s)

New risks and issues that need input from the relevant governance group(s) – what do we need the group(s) to do to help mitigate risks?

Risk No. New risk / issue Mitigation support requested rating If elements of the earlier implementation (such as expansion of current pilots) and working towards the 7 core 1 requirements could not be progressed there will be a lot more to do towards the end of the project timeline A commissioning options paper was developed with support from the Commissioning Support unit (CSU) Procurement Team, and was presented to the North Staffordshire procurement panel, North, South and East Staffordshire CCG internal Governance Ensuring the decision made on the Committees in order for those groups to review and commissioning route by The Governing make their individual recommendations on the 2 Bodies is informed by Procurement 12 commissioning route. A commissioning options Team, CCG internal Governance paper with a recommendation for a commissioning Committees and Legal Advice. route together with a legal framework paper was presented by the Executive Director of Primary Care (as SRO for this programme) and the legal team to each Governing Body for their individual decision on the commissioning route The ONS weighting formula for financial This risk and the resulting impact to the successful 3 12 allocations used by NHS England is less delivery of the programme have been regularly

than the raw practice population figures reported to the Extended access steering group. and the capitated weighted population North, East and South Programme managers have figures used by the CCG. As a result, responded to NHS England in respect of the formula the ONS weighting formula used would used for the financial allocations and shared not provide the £3.34 and £6 a head of modelling undertaken of practice population numbers practice population funding initially (raw and weighted capitation) against proposed ONS proposed by NHS England. This would weighting to formally report the funding gap. NHS produce a funding shortfall England have acknowledged this as a National issue and discussing options to minimise the impact. Regular updates are being requested from NHS England Links have been established with the Workforce programme and its initiatives for recruitment and GP Workforce remains a significant risk retention. Extended access and workforce as across the whole of Staffordshire with programmes within the GP Forward view are both 4 particular issues around recruitment and 12 discussed at NHS England checkpoint meetings retention within Stoke on Trent and which is the main forum to discuss the parts of North Staffordshire. interdependency that extended access has on the workforce programme and in order to receive updates on initiatives for recruitment and retention. Digital Lead has been asked to develop an options There are Information technology paper regards how to move forward and also to requirements for delivering extended review the specification in terms of requirements for access at scale, remotely and out of extended access at scale. Urgent care team hours, specifically interoperability and 5 12 Colleagues have been asked to review extended systems integrating together. There is a access interoperability with NHS 111. They have risk that national solutions will not be been asked to identify the requirements from where available to support developments NHS 111 is now to the full integration and if possible locally booking appointments • A clear communication and engagement strategy will be developed and implemented in early May. There is a risk that providers do not fulfil • Engagement sessions will be planned and the requirements in order to be coordinated with potential providers recommended for direct award. If this • The specification together with the proforma and 6 occurs, there will be a need to go out to 12 criteria / requirements and timeframes to be shared in procurement to ensure there is early may population coverage for extended • Support will be available to answer questions and access identify early concerns during May and June • Adequate time will be made available for providers to complete their proposals by mid-June Lack of Senior level managerial and This risk and the resulting impact to the successful organisational leads to undertake the delivery of the programme has been regularly individual programmes of work within reported to the Extended access steering group each CCG post April 2018 (EAST) 11 (most recently at the 22nd March meeting and will be May (SOUTH). There are currently two formally recorded in the meeting notes together with interim management consultants an update of this risk log for the programme. As working on this programme, the East senior level leadership and managerial input for this 7 20 Programme lead finishes 27th April and programme may not be in place for the East the South Programme lead, who has Programme Manager leaving on 27th April and the also been acting as key coordinator South Programme Manager leaving on 11th May due across Staffordshire leaves on 11th to the management of change process, to request the May. The current Management of SRO identify key individuals as an interim Change process is not scheduled to be arrangement to receive a handover of the programme concluded by at least the 31st May in order to provide ongoing programme management. 5

meaning that there will be a significant Meeting is in the process of being arranged in April gap in senior level leadership and with Executive Director of Primary care and Primary managerial input for this programme Care team Colleagues to formalise the handover which will cause the programme to stop. arrangements. Handover packs will be developed Making the lack of resource a show and all project materials will be accessible on a stopper for this programme. shared drive to primary Care Colleagues The current management of change process is seriously impacting upon programme delivery. The process is taking capacity of key individuals who Discuss and Review current risk and impact at April are not able to attend the steering and task and finish group (11th) and steering group (18th) task and finish groups or provide regular meetings. Continue to attempt to secure key 1-1 supervision. This is resulting in 8 20 individuals' involvement and decisions on programme manager’s inability to programme areas via email and with support of PAs discuss key programme areas and and EAs in the absence of 1-1 meetings and receive information required on key individuals attendance at meetings decisions required to progress the programme. This is resulting in a slippage of programme milestones and a risk to successful programme delivery.

Work Stream Workload including Resilience Funding Month covered May 2018 Sarah Jeffery / Nicola Austerberry / Author Status Green Kirsten Owen Impact if Not

Achieved Summary status:

Active Signposting: • Care Navigation we have 255 receptionists trained in Stoke and 230 in North Staffordshire. • Cannock Town & Villages localities launched active signposting on 1st November 2017, this includes 12 practices. In readiness for this launch, up to 125 Practice Staff Members have undertaken active signposting training to help signpost patients and carers to the right care first time. A workshop across the two localities is scheduled for May 2018 to reflect on progress, share learning and further embed in practices. • Training is ongoing across all practices in the Stafford Primary Health Care Alliance, South Stafford General Practice Network, Stone & Eccleshall locality and Rugeley locality, in preparation for implementation. • South East Staffordshire & Seisdon Peninsula CCG localities are considering their preferred approach in terms of taking forward active signposting and workflow optimisation. • East Staffordshire CCG held a GP and PM awareness session for Active Signposting on the 8th March to promote this with local practices. The CCG will commission a series of training events during 2018/19.

Brighton and Hove Workflow Optimisation: • In North Staffordshire and Stoke-on-Trent, 46/77 practices have received workflow optimisation training to release GP capacity • Awaiting further information about the online learning approach to enable further practices to participate • In South Staffordshire, 9 training sessions have taken place so far on workflow optimisation, which have been centrally organised. Discussions are ongoing with the training provider on e-learning places in order to ensure opportunities are available for all practices to undertake workflow optimisation training. Remaining places and scheduling to be jointly considered. Localities are considering the opportunity to hold further workflow optimisation training. • To date, 75 South Staffordshire Practice Staff Members have been trained on workflow optimisation across 51 practices, with the opportunity to cascade the training once they have been signed-off from a practice perspective, where possible. • In East Staffordshire 5 practices have had HERE training during 2017/19. The CCG will be looking to train a further 6 practices in quarter 1 of 2018/19. 7 practices have advised that they do not wish to participate in HERE training. • Evaluation of the impact of the training undertaken to date to be planned, with opportunities to align evaluation activities across CCGs to be explored.

PGP Quickstart Programme • 10 practices in North Staffordshire and Stoke on Trent have completed the programme and a further 11 practices started in January to complete by March 2018. • Work is ongoing to complete evaluation and develop a repository of resources to maintain practices and support other practices.

Resilience Funding: • DCO North Midlands 2016/17 Outcomes Report has been produced. • Across the STP, 38 practices have been supported across all CCGs. • Deep dive on resilience funding to be completed. • Case studies to be produced by practices on the use and impact of resilience funding for 2017/18. • PMO to advise the CCGs and practices on the emerging national approach.

Activities and updates from the last period

1. Practices across Stafford & Surrounds CCG and Rugeley locality are continuing their training. 2. Cannock Town & Villages have undertaken a review of progress to date and planned a further workshop for practice staff members. 3. Discussions are ongoing within South East Staffordshire & Seisdon Peninsula CCG practices on taking forward active signposting and workflow optimisation. 4. Continued roll out of navigation training and Brighton and Hove model 5. Discussions are ongoing with HERE on remaining workflow optimisation e-learning training places in the South. 6. 11 Practices across North Staffordshire and Stoke-on-Trent are continuing the PGP Quickstart Programme due to complete in March 2018. 7. Work is ongoing to complete evaluation and develop a repository of resources for the PGP Quickstart Programme. This continues into the next period. 8. DCO North Midlands 2016/17 Outcomes Report has been produced 9. East Staffordshire CCG held a GP and PM awareness session for Active Signposting on the 8th March attendance from practices was good. 10. East Staffordshire is hosting 5 active signposting seminars between April, May and June with the capacity for up to 150 delegates. Actions planned for next period 1. Dashboard is being finalised in North Staffordshire and Stoke on Trent to monitor evaluate the progress of Care Navigation. 2. Relevant South Staffordshire localities to continue to develop training plans with their chosen provider and commence implementation. 3. Remaining South Staffordshire localities to consider training options. 4. The number of Brighton & Hove e-learning remaining training spaces for South Staffordshire CCGs to be agreed. 5. The number of Brighton & Hove e-learning remaining training spaces for East Staffordshire CCGs to be agreed. 6. Commission a number of Active Signposting and care navigation training sessions for East Staffordshire CCG. 7. Explore opportunities to evaluate workflow optimisation training undertaken to date – ongoing. 8. Relevant practices to continue PGP Quickstart Programme. 9. Evaluation and repository of resources development for PGP Quickstart Programme ongoing. 10. Deep dive and case studies collation in relation to the use of resilience funding to commence. Recommendations for the relevant governance group(s) 1. New risks and issues that need input from the relevant governance group(s) – what do we need the group(s) to do to help mitigate risks?

Risk No. New risk / issue Mitigation support requested rating

Workforce including Practice Manager Work Stream Month covered May 2018 funding

Author Rebecca Woods / Julie Downie Status Amber Impact if Not

Achieved Summary status:

GP practices and localities in our three CCG’s have started to embrace new workforce models. Cannock town have piloted a number of roles in primary care and are currently measuring the impact. Examples include a primary care based Musculoskeletal specialist. Trials of well-being workers have been ongoing who support patients who do not necessarily have a medical need but frequently attend general practice. A number of practices are jointly working together to employ clinical pharmacists offering support on medication reviews, reviewing safety, and ensuring optimum support to patients on regular medication. Three localities have recruited Physicians Associates a new role to general practice. These roles are due to start imminently and then will be measured/evaluated. One locality has recruited an Urgent Care Practitioner to see patients who need home visits or are in need of urgent on the day appointments. Important to note: urgent care practitioner and physicians associates are GP supervised roles.

Refreshed Workforce Plan submitted on schedule, to date no feedback has been received. Activities and updates from the last period

International Recruitment (IR):- Third IR bid was submitted for an additional 12 recruitments on the 28th February 2018, results of the bid still pending. Task to Finish Group has now been established. • 100 International GPs required to close the GP Workforce gap. • £20,000 available to the newly formed Staffordshire training Hub to engage with practices to collate expressions of interest to be delivered by May 2018. • International Recruitment Agencies procured to facilitate the delivery of the programme. • Staffordshire identified as a wave 2 site, recruitment programme to start in July 2018. • Delivery of the programme to be closely monitored operationally through the training hub and assurance through the monthly GPFV Checkpoint meetings. • Significant risks identified, for the success of this programme, co-ordinated and managed through the Regional Workforce 2020 meetings. • Local strategy to achieve maximum possible benefit from the programme but to mitigate the risks by continually working with practices to develop multi-disciplinary team working.

GP Retention:- North Staffs GP Federation successful in becoming one of the 11 national GP Career Plus Pilot sites. • GP Retention scheme has been advertised twice with no uptake. • To target Locum GP’s they have been highlighted as vulnerable group through the GP Careers plus. • Suggested Paid Locum Network Group. • Implement a GP Locum group two hour session per month, one hour networking and one hour CPD. • Scoping exercise undertaken to collate drivers making GPs leave and gain ideas as to what would make them stay. • Anticipated funding to bid against to implement and learn from the findings of the scoping exercise. • On-going work with the Staffordshire Training Hub to submit bids and co-ordinate activities around this scheme.

Physicians Associates:- Additional 12 Physicians Associates have now been recruited and 12 secondary placements have now been secured. Confirmation has been received that nine Physicians Associates have successfully qualified; they will be included in the commencement of cohort 2 starting week commencing 12th March 2018. Five will be allocated to North Staffordshire and four will be allocated to South Staffordshire.

Clinical Pharmacists:- Successful recruitment of Clinical Pharmacists for the subsequent Cannock bid. • No bids received for the Phase 2 Wave 5 submission deadline of Friday 13th April 2018. • Snr Clinical Pharmacist/Ambassador advert to be placed by the end of April 2018. • Snr Clinical Pharmacist/Ambassador recruitment scheduled for the end of May 2018.

Practice Management:- GPFV money allocated to CCGs for Practice Management Development. A meeting took place on Wednesday 7th March with key personnel to look at three key areas as follows:- • Local initiatives and hard to reach areas. • Mentoring and Coaching. • Networking and Appraisal. • Staffordshire training Hub to submit plan, this was received, now on-going discussions regarding funding and delivery of the plan. It was felt that the LMC, and federations, could help in terms of distributing information and encourage practices to engage.

GP Medical Assistants:- Meeting with Joe Ryan and Sarah Laing regarding developing a new apprentice role and develop a specific job description. There is a levy of 90% training funded to General Practice. Further development around this project.

Local Nurse Redeployment:- Ongoing work around nurse redeployment into General Practice. • Training package established with Staffordshire University. • Briefing paper submitted to LMC ongoing discussions with LMC members.

GPN Ten Point Plan:- GPN Ten Point Action Plans now received further workshop to discuss action plans submitted now scheduled for 16th April 2018.

Actions planned for next period Continue with recruitment process for clinical pharmacists and GP retainer scheme.

A draft workforce strategy has been developed for Staffordshire and partially assured by NHSE

Recommendations for the relevant governance group(s) 1. New risks and issues that need input from the relevant governance group(s) – what do we need the group(s) to do to help mitigate risks?

Risk No. New risk / issue Mitigation support requested rating Inability to recruit to new workforce model 1 continues to be ongoing risk.

Nursing Framework including nurse Work Stream Month covered May 2018 recruitment and retention Author Lynn Millar / Tracey Cox Status Amber Impact if Not Amber Achieved Summary status:

Draft Staffordshire wide implementation and delivery plan submitted to NHS England on 14th March in relation to the GPN 10 point plan. This includes key deliverables and milestones with appropriate leads and timescales. The plan was jointly developed by CCG Primary Care and Quality and had significant contribution/input from the Staffordshire Training Hub (formally CEPN) and nurse facilitators

Activities and updates from the last period

1. Draft Staffordshire wide GPN implementation and delivery plan submitted to NHS England for review. 2. Developing a locality based model for implementation of the GPFV 3. Good progress being made on the use of IT to support Primary Care

Actions planned for next period

1. To receive feedback in relation to the draft Staffordshire wide GPN plan and work towards the milestones and deliverables 2. Further follow up meeting was to be arranged by NHS England following the last workshop held on 6th February (as per Cheryl Sherratt e-mail on 9th February) for 6-8 weeks’ time

Recommendations for the relevant governance group(s) N/A

New risks and issues that need input from the relevant governance group(s) – what do we need the group(s) to do to help mitigate risks?

Risk No. New risk / issue Mitigation support requested rating

Infrastructure: Estates and Technology Work Stream Month covered May 2018 Transformation Fund (ETTF) and Digital Andy Hadley / Author Status Amber Phil Brenner / Laurence Wadlow Impact if Not

Achieved Summary status:

IM&T

From the additional £771k which was secured under ETTF to fund enhanced practice IT, we have now rolled out approx. 1600 monitors to practices. These are setting up clinicians and back office functions with dual screens to support the workforce optimisation programme and clinical/practice teams to work more efficiently.

Majority of Staffordshire localities are now actively utilising the EMIS clinical system (Clinical Services/Remote Consultations) which is supporting practices to share records, enhancing delivery of care across the area.

An approach for online consultations roll out has been agreed with key stakeholders – 24/158 practices committed interest to be a pilot site for either EMIS Online Triage or eConsult. Orders now placed with suppliers and roll out to commence in April, with expected completion mid-May on current trajectory. Programme lead reviewing other suppliers who have emerged on to the market to ensure area is piloting products that suit the objectives of the programme. Suppliers committed to running Webinars for practices to understand more about the products.

Estates Funding approved for two developments – Longton South in Stoke on Trent and Greenwood House in South Staffordshire.

The Longton programme timescales continue to slip whilst the site remains outside of control via exclusivity.

Activities and updates from the last period From an IM&T perspective, planned activities are continuing and potential risks continue to be monitored.

From an Estates perspective;

Longton South: The concept design work with GPS continues however in readiness to apply once site agreement obtained. Risk register is in place for Longton Project - risks identified, with mitigating actions, owners and timescales identified.

Actions planned for next period IM&T: • Commence activities for online consultation pilots • Redefine programme plan and how teams will deliver against detail in bid. • Assess recruitment options for programme team to support programme lead to deliver against bid/programme plan • Continue to engage with NHS England Patient Online team about how Online Consultations programme will align moving forwards – both programmes to support one another to ensure online activities are improved. • Align Primary Care and Urgent Care pilots of online apps to ensure a links moving forwards.

Estates: Actions planned to commence: • Development concept & massing & phase potential • Options appraisal

Recommendations for the relevant governance group(s)

New risks and issues that need input from the relevant governance group(s) – what do we need the group(s) to do to help mitigate risks?

Risk No. New risk / issue Mitigation support requested rating

Work Stream Models of Care Month covered May 2018

Author Lynn Millar Status Green Impact if Not

Achieved Summary status: Development of Locality Hubs/Primary Care at Scale

A glossary of terms has been developed of the different terminologies. The integrated care hubs are being mapped across the locality areas.

Locality Development Programme A Locality development Programme is underway to support networks of practices to work together. The first phase will be a ‘diagnostic’ phase to understand the readiness of practices to work at scale and to identify a programme of support which is tailored to the needs of each geographical area. The Programme has been commissioned from the CSU Strategy unit who will use a process of appreciative enquiry to identify best practice, risks and blocks to development and OD requirements.

Locality agreements As part of the locality agreements in South Staffordshire, all nine localities have signed and returned a memorandum of understanding to agree to work together at scale. Most of the localities have a formal meeting structure in place where they agree objectives. The localities also meet with mental health and community providers to ensure effective integration of community teams into primary care. Community teams have been aligned to localities and the majority of individual GP practices also have a named nurse from the community team. Three localities have agreed on a clinical area they will focus on improving clinical outcomes for patients as part of their locality agreements. All nine localities have been sent a clinical data pack from the CCG primary care analyst which identifies disease specific prevalence, any trends in outpatient and inpatient activity as well as opportunities to support the right care programme.

Within East Staffordshire the 18 practices have formed a single working group to develop working at scale across East Staffordshire. East Staffordshire Primary Care Partnership has been established a CIC, meets formally on a regular basis and a formalized governance structure. The ESPCP has an organisational development plan and is supporting practices to ensure sustainability of general practice and build resilience.

The programme recognizes the different phases of development across the 23 localities as well as support from GP Federations.

Nursing Homes Several localities have developed new innovative ways of working with nursing homes, such as zoning (one GP looking after one nursing home) and recruiting a joint nurse / Advance Nurse Practitioner to work with the local nursing homes. Monitoring to understand the impact of these innovative schemes is ongoing.

Complex Care A number of localities still deliver multi-disciplinary team meetings with the community provider clinicians despite no longer being paid to deliver this through a directly enhanced service. These meetings provide an opportunity to discuss and case manage the most complex and frail patients who may be at greater risk of being admitted to hospital.

Activities and updates from the last period As outlined in the above status.

Actions planned for next period Actions planned include:

1. Refresh estates and branch surgery review 2. Staffordshire GPIT plan – 2018/19 3. Develop an outcomes based commissioning framework – Alliance Agreement 4. Refresh integrated team plan including baseline exercise

Recommendations for the relevant governance group(s)

New risks and issues that need input from the relevant governance group(s) – what do we need the group(s) to do to help mitigate risks?

Risk No. New risk / issue Mitigation support requested rating

Public Paper

Enclosure: 7.2b

Report to Primary Care Commissioning Committees held in Common

Title Social Prescribing Project Position Statement

Meeting Date 5th June 2018

Sponsor Director Lynn Millar, CCGs’ Director of Primary Care and Medicines Optimisation

Action required Decision Discussion For Information X

Purpose of the paper, key issues, points and recommendations

This paper provides a position statement on the development of the Social Prescribing Project. The aim of the project is to build on and develop work that is already in place where this is a feasible option. The successful Care Navigation project has already seen a saving of over 1,000 GP hours and works closely with the Voluntary Community Services (VCS) Hub. The development lead for the hub is piloting some of the elements which it is planned to include in the local model. The aims of the hub are:

 Support ‘active’ signposting – within primary and secondary care  Enable connection to the most appropriate professional/support source  Facilitate referrals and access to non-medical support services  Connect to services that help and that increase the ability to ‘self-care’ and to maintain independence Referrals into the service are increasing and are made by GPs, members of the GP practice team and also some self- referral. The service is identifying gaps relating to the following areas: Befriending

 Housing Needs  Low level Mental Health needs  Practical Home Support  Benefits Support  Physical/Learning Disability support: particularly for those of working age The steering group have discussed and agreed that the areas the project will focus on below, will address these gaps:

 Finance- including debt, housing , benefits.  Lifestyle- diet, weight management, exercise,  Wellbeing-low level MH, social isolation, befriending , volunteering etc. In order to develop the project, a draft model has been developed (see attached document) and from this task and finish groups were set up to develop the areas which will enable the model to be delivered. These groups have met and provided feedback at the last steering group on the 15th April 2018 with the following outcomes: Early Implementer Sites Members

 Nicola Austerberry, CCG Primary Care Lead,  Dr Paul Roberts, GP, Director North Staffs GP Federation  Gill O’Hare, Transformation Manager – Younger Adults, Adult Social Care – Learning Disability, Public Health and Adult Social Care

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.

 Margaret Hurley, VCS HUB Development Lead - Social Prescribing Following discussion, three areas were identified as potential early implementer sites and fast follower/control sites. The aim is to provide datasets for and specific needs of these areas to substantiate the reason for identification. The areas are:

 Stoke North to include Middleport and Burslem  Stoke South to include Longton, Meir, Normacot  Newcastle to include Silverdale and Chesterton A fourth site will be Leek. A significant piece of work is already being implemented through the fire and rescue service and the plan would be to work alongside this project. The group meet again 7th June 2018 Model to be used Members

 Charlotte Bennett VAST  Andrew Thompson Chief Executive Officer, VAST  John Larkham Service Manager, Age UK The group had completed a robust literature search of social prescribing models already in place and the role of the link worker or equivalent resource within each model. Models which became the focus were: Rotherham – the model provides a universal offer and includes a link worker. There has been a reduction of 20% A&E attendances and NELs Newcastle – Ways to wellness has a focus on LTC within the 40-74 year age group and includes a link worker Kensington, Chelsea – the model provides to levels – 1) a universal offer and 2) over 65 years. The model includes link workers. The group will meet again (date to be confirmed) to develop a role description for a link worker to enable this to be costed and subsequently shared for recruitment to the roles in the identified areas. Evaluation Members

 Nicola Austerberry, CCG Primary Care Lead,  Dr Paul Roberts, GP, Director North Staffs GP Federation  Peta Curno Senior Health Improvement Specialist, Public Health and Adult Social Care, Stoke on Trent City Council  Melanie Dunne Staffordshire Housing The group met on 20th April and 15th May. At the initial meeting, the expressions of interest received were discussed and it was agreed to do further literature review in order to provide more clarity in what was required of the evaluation. At the second meeting, additional literature was discussed and it was agreed to take this to the steering group after which a specification will be developed and shared with the three providers interested in providing the evaluation. The providers will be asked to resubmit their proposal which will then have a more focused approach. A further meeting is being planned to complete this work. Date to be agreed. Steering Group Meeting 15th May 2018 The three task and finish groups fed back and agreed to the next steps as described above. Further feedback will be received by the group at the next meeting 13th June 2018 after which it is anticipated a more robust model and plans for implementation will be developed. This will be presented to the next PCCC in July.

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.

The Committee is asked to:

 Note the content of the report

Which other CCG committee and/or Group has considered this report

Committee/Group Other agreements N/A N/A

Summary of risks relating to the proposal

Any statutory/ regulatory/legal /NHS constitutional/NHSE assurance / governance implications

Social Prescribing are within the Ten High Impact Actions of the General Practice Forward View

Strategic objectives supported by this paper Our shared Goals: Yes No

Empowered Staff 1. X

Commissioning Health Outcomes 2. X

Seamless Partnerships 3. X

Responsible Use of Resources 4. X

Key Requirements: Yes No

Has a Quality Impact Assessment been completed? 1. X

Has an Equality Impact Assessment been completed? 2. X

Has Engagement activity taken place with Stakeholders/Practice/Public and Patients 3. X

Acronyms

We commission safe, accessible, high quality services to improve the health outcomes and meet the clinical needs of the people of Stoke-on-Trent and North Staffordshire.