Meeting in Public of the Mid Essex, North East Essex & NHS England

Meeting in Public of the Mid Essex, North East Essex & NHS England Primary Care Commissioning Committee

Wednesday, 11 January 2017, 3.00 pm – 4.30 pm

Aspen House, Stephenson Road, Severalls Business Park Colchester CO4 9QR

Part I AGENDA

Item Title Lead/Author Action Page No. No 1. Welcome, Introductions and apologies Chair To note -

2. Register of Interests Chair To note 1 – 6

3. Questions from the Public Chair To note Verbal

4. Minutes of previous meeting held on 16 Chair To note 7 – 12 November 2016 and Action Log

5. Matters Arising Chair To note Verbal

Joint Issues 6. Period 8 Finance Report for North East NHS To note 13 – 21 Essex CCG and Mid Essex CCG England 7. IT and Premises Update NHS To note 22 – 23 England 8. Primary Care Strategy – GP 5 Year P Green / Verbal - Forward View submissions M Crass 9. DES and LES Update NHS Verbal - England / CCGs 10. Guidance Note for GP Practices serving NHS To note 24 - 39 Atypical Populations England North East Essex CCG Operational Issues 11. Proposed merger of Abbey Field Medical A Cowie / For 40 – 44 Centre and the Hawthorn Surgery P Green decision

12. Exercise of Emergency Powers NHS To 45 – 47 England / P endorse Green Mid Essex CCG Operational Issues None Business Issues 13. Any Other Business, including:

i) Frequency of future meetings Chair For Verbal ii) Cover sheet for reports decision 48 – 49

14. Date, Time and Venue of next meeting Chair To note 1 Feb 2017 or 1 March 2017

Name Current Declared Interest Type of Interest Is the Nature of Date of Interest Action taken to position (s) interest Interest mitigate risk (Name of the held i.e. direct or organisation and Governing nature of indirect Body member; business) ?

Committee From To member; Member practice; CCG Financial Financial - employee or - Interest other Professional Non Non Personal Interest Financial Interest Director of Melanie Primary Care & NIL N/A N/A N/A N/A None required Crass Resilience, MECCG Director of Viv Corporate NIL N/A N/A N/A N/A None required Barnes Services, MECCG PPE Lay Anne- Member, Marie MECCG NIL N/A N/A N/A N/A None required Garrigan

Director of Pam Transformation NIL N/A N/A N/A N/A None required Green & Strategy, NEECCG

1 Name Current Declared Interest Type of Interest Is the Nature of Date of Interest Action taken to position (s) interest Interest mitigate risk (Name of the held i.e. direct or organisation and Governing nature of indirect Body member; business) ?

Committee From To member; Member practice; CCG Financial Financial - employee or - Interest other Professional Non Non Personal Interest Financial Interest Chair, Care UK (Health  Indirect Son is IT Lead Ongoing Usual confidentiality NEECCG and social care at this company requirements will apply provider)

SHEL (non-profit-  Direct Director / Chair Ongoing making subsidiary GS to not be involved in of Essex LMC any decisions, or supporting failing discussions leading up Gary practices) to decisions, relating to Sweeney any services which are or may be provided by SHEL

Essex LMC (local  Direct Member Ongoing Confidentiality require- representative ments to be noted in committee for respect of Part II NHS GPs) business.

2 Name Current Declared Interest Type of Interest Is the Nature of Date of Interest Action taken to position (s) interest Interest mitigate risk (Name of the held i.e. direct or organisation and Governing nature of indirect Body member; business) ?

Committee From To member; Member practice; CCG Financial Financial - employee or - Interest other Professional Non Non Personal Interest Financial Interest Locality Simon Director, NHS Evans- England (East) NIL N/A N/A N/A N/A None required Evans

Head of Alison Commissioning, NIL N/A N/A N/A N/A None required Cowie NHS England (East)

Contract David Manager, NHS NIL N/A N/A N/A N/A None required Barter England (East)

Contract Jackie Manager, NHS NIL N/A N/A N/A N/A None required Bidgood England (East)

3 Name Current Declared Interest Type of Interest Is the Nature of Date of Interest Action taken to position (s) interest Interest mitigate risk (Name of the held i.e. direct or organisation and Governing nature of indirect Body member; business) ?

Committee From To member; Member practice; CCG Financial Financial - employee or - Interest other Professional Non Non Personal Interest Financial Interest

Office of the Independent Lay member Alan Police and Crime Joint Audit Usual confidentiality (commercial),  Direct 01/03/15 31/03/19 Hubbard Commissioner for Committee requirements will apply MECCG Essex member Agreed with line manager to declare an RLE Health interest and withdraw Management from the process in Interim Primary Solutions Limited, event of being privy to Robert Care provider of advice  Direct Owner / Director 18/4/12 Ongoing any decision-making Evans Commissioning and support to processes and/or Lead, MECCG healthcare financial authorisations organisations. involving RLE Health Management Solutions Limited Non-voting member of Chair and PCCC; will withdraw Caroline elected GP Danbury Medical  Indirect Salaried GP 1/9/15 Ongoing from proceedings if Dollery member, Centre issues relevant to own MECCG practice are discussed.

4 Name Current Declared Interest Type of Interest Is the Nature of Date of Interest Action taken to position (s) interest Interest mitigate risk (Name of the held i.e. direct or organisation and Governing nature of indirect Body member; business) ?

Committee From To member; Member practice; CCG Financial Financial - employee or - Interest other Professional Non Non Personal Interest Financial Interest East of England Strategic Clinical Chair and Network for Caroline elected GP Usual confidentiality Mental Health,  Direct Clinical Director 1/4/12 Ongoing Dollery member, requirements will apply Learning MECCG Disability and Neurology

Managing Carol Director, NIL N/A N/A N/A N/A None required Anderson MECCG

Elizabeth Direct GP Partner 1/8/03 Ongoing Non-voting member of Courtauld  PCCC; will withdraw Surgery (incorp. from proceedings if Anna Clinical Lead, North Chelmsford issues relevant to own

Davey MECCG Health Centre) practice are discussed

Coggeshall  Direct Long term 31/3/16 Ongoing As above Surgery locum

5 Name Current Declared Interest Type of Interest Is the Nature of Date of Interest Action taken to position (s) interest Interest mitigate risk (Name of the held i.e. direct or organisation and Governing nature of indirect Body member; business) ?

Committee From To member; Member practice; CCG Financial Financial - employee or - Interest other Professional Non Non Personal Interest Financial Interest Anna Clinical Lead, Edgemead Davey MECCG Medical Services Ltd (Limited Company for  Direct Director 31/3/16 Ongoing As above receipt of income generated from above roles only) Phil Assistant Head Cherry of Finance, NHS England NIL N/A N/A N/A N/A None required

6 Mid Essex CCG & North East Essex CCG & NHS England Primary Care Commissioning Committee Meeting

Date: 16 November 2016 Time: 3.00pm to 4.30pm Location: Wren House, Hedgerows Business Park, Colchester Road, Chelmsford

Members:

Name Initials Role Alison Cowie AC Head of Commissioning, NHS England (East) Mat Thorpe MT Head of Finance, NHS England (East) Anne-Marie Garrigan AMG PPI Lay Member, Mid Essex CCG (Chair) Melanie Crass MC Director of Primary Care & Resilience, Mid Essex CCG Viv Barnes VB Director of Corporate Service, Mid Essex CCG Gary Sweeney GS Chair, North East Essex CCG Pam Green PG Director of Transformation & Strategy, North East Essex CCG

In attendance:

Phil Cherry PC Assistant Head of Finance, NHS England (East) Robert Evans RE Primary Care Commissioning Lead, Mid Essex CCG Mike Bailey MB GP Board member & Clinical Lead, Mid Essex CCG Anna Davey AD Clinical Lead, Mid Essex CCG

Item Agenda Item Actions No

1 Welcome and Introductions

Members were welcomed to the meeting and introductions provided.

2 Apologies for absence

Apologies for absence were noted from Simon Evans-Evans, NHS England, Carol Anderson, Mid Essex CCG and Dr Brian Balmer, Essex Local Medical Committee.

3 Declarations of interest

Members reviewed the Register of Interests for the Committee and confirmed there were no changes to the declared interests. A nil declaration was confirmed by Phil Cherry.

Declarations declared by members of the Primary Care Commissioning Committee are listed in Mid and North East Essex CCG’s Registers of Interests. The Register is available via the secretary to the governing body of each CCG.

Declarations of interest from sub committees

N/A.

Declarations of interest from today’s meeting 7

AD declared an interest in relation to the Beaulieu Park item as a member of the GP practice that holds the APMS contract for the nearby North Chelmsford Healthcare Centre. It was agreed that she would vacate the meeting when this item was discussed.

4 Questions from the Public

Ms Maureen Hennessy, a member of the public, raised a number of queries about the Beaulieu Park development in relation to why the timelines were so short, whether the development process would satisfy procurement legislation, and whether there was still an opportunity to influence the design of the proposed healthcare facility.

AC advised that the first two of these points would be addressed when this item was presented to the Committee. Commenting on the third of the above queries, MC advised that there were clearly defined requirements for the design of health buildings including the room sizes and the overall size of the building in relation to local population size. All new build designs were now very generic which meant that they could be multi- purpose in their use. Ms Hennessy asked whether the developer would pay for the build if the development fell under a section 106 agreement, in response to which MT advised that this was dependent upon the size of the development.

Mrs Eve Haigh, a member of the public, queried why Danbury Medical Centre appeared on the finance report but not Mountbatten House Surgery. MT acknowledged that some of the practice names were out-of- date and that the entry in the report should be named ‘Mountbatten Health’ to reflect the merger of these two practices.

Ms Hennessy raised a further question about consultation with patients prior to considering the proposed merger of Abbey Field Medical Centre and the Hawthorn Surgery. AC advised that this point would be addressed when the report was presented to the Committee. As a follow- up question, Ms Hennessy asked whether accessibility was always taken into account when considering a practice merger. AC advised that this was not relevant in this case because the expectation was that patient services would not be affected by the merger. MB noted that there might be occasional exceptions in such a situation, for example if a patient was asked to consult with a GP based in another surgery because of his/her expertise in a particular medical specialty.

5 Minutes of the last meeting and matters arising

The minutes of the previous meeting held on 5 October 2016 were agreed as an accurate record.

Resolved: the PCCC approved the minutes of the meeting held on 5 October 2016.

6 Action Log

Completed actions were noted. MC and PG advised that a meeting was taking place on 24 November 2016 to discuss the reporting format for primary care quality/vulnerable practices. This action was therefore rolled forward until the next meeting. 8

PG advised that a proposed cover sheet had now been sent to VB for incorporating in future PCC reports.

6 Finance Report

MT presented the Primary Care Medical Financial Performance report for period 6. He explained that he had expanded the report in the light of feedback from the last meeting but it still needed some further modification.

Summarising the month 6 position, MT advised that NEE CCG was showing a deficit of £60,000 and ME CCG a deficit of £283,622. Unallocated budgets, earmarked reserves and contingencies were not currently shown within the year to date position, however it was hoped that these would be available from period 7 onwards. Currently no year- end overspend was anticipated against practice budgets and no expected pressure against those not allocated at a practice level. MT also drew attention to the period 6 expenditure summary and explained that the overspends were mainly due to the treatment of old year payments against accruals which would be adjusted for period 7.

A summary was provided of year to date expenditure for Local Enhanced Services by scheme type. MC commented that this information should be available at a practice level and offered to discuss outside the meeting MC with MT.

MC advised that a ME CCG practice had been notified by its district council that it would receive a significant refund following an over-payment of business rates. AC confirmed that NHS England had made practices aware that they would be required to return these refunds, as the cost of business rates was included in their total contract sum.

MT concluded his report by advising that he had now met with both CCGs’ finance teams to discuss the budgets not held at practice level and that these figures would be included in future finance reports.

Resolved: the Committee noted the Primary Care Medical Financial Performance report.

7 Primary Care Workforce Development

MC advised that a number of work programmes were underway to help with the workforce issues in primary care, such as the recruitment programme to encourage 20 European Union GPs to come and work in Essex. Currently the practices in Mid Essex were waiting for more information about this scheme before signing up. An NHS England Workforce Group was also being established under the GP 5 Year Forward View.

PG advised that work was also taking place with all the Essex commissioners and the LMC on the baseline assessment of workforce and training needs for the next 10 years which encompassed all practice staff as well as GPs.

MB noted that the ARU Medical School was another welcome development, albeit a much longer term one. 9

8 Operational Issues

i) Proposed merger of Abbey Field Medical Centre and the Hawthorn Surgery

AC advised that a request to merge had been received from the Abbey Field Medical Centre and Hawthorn Surgery and a copy of the application was appended to the report. Both NHS England and NEE CCG were supportive of the proposed merger, as the Hawthorn surgery was quite a vulnerable practice and the proposal fitted in with the local strategy of developing bigger and more sustainable practices. Both practices had been encouraged to commence engagement with their patients on their plans, however feedback had not yet been received. It was therefore proposed to approve the merger in principle subject to positive feedback from patients and an assurance from the practices that they would continue to deliver the full range of patient services.

PG confirmed her agreement with these comments and the importance of maintaining equity of access.

Resolved: NHS England and North East Essex CCG approved a merger of Abbey Field Medical Centre and the Hawthorn Surgery in principle, subject to positive feedback from patients and an assurance from the practices that they would continue to deliver the full range of patient services.

ii) Beaulieu Park

AD vacated the meeting during discussion of this item.

AC thanked RE for preparing the report on the proposed healthcare development at Beaulieu Park but noted that some of the timescales outlined in the report were slightly ambitious. She therefore suggested that the Committee focused at today’s meeting on whether to support the developer’s offer to build a bespoke healthcare facility in this location. If this was supported, further engagement would need to be undertaken and providers would need to be given an opportunity to develop their proposals for this facility. A decision about the form of contract required would then be made at a subsequent meeting.

Commenting upon the developer’s offer, AC advised that there had been a lot of housing development in this area and there was clear evidence of more growth to come. The GP practices in the area were unable to cope with the resulting increase in demand for primary medical care and therefore NHS England was supportive of an additional healthcare facility at Beaulieu Park. She went on to state that if the other members of the Committee agreed with this recommendation, a dialogue could commence with providers about the nature of the contract that might be procured for this service.

GS asked what information there was about future developments in the area. MC advised that a feasibility study had been undertaken by Community Health Partnerships and so there was a thorough understanding of current and future needs. In response to a further question from GS, AC advised that the CCG would need to determine whether any services additional to GMS/PMS were required in view of the growth in the local population. MC explained that an options appraisal would be undertaken of the type of build that was needed and confirmed 10 that the developers did not require instructions at this point on the likely size of the development.

In response to questions from the public AD advised that, as a third party development, the premises would be owned by the developer, who would either lease them to the NHS provider or sell them to a third party who would become the landlord. AC acknowledged that further development was underway in the area and confirmed that the latest building developments and population projections would be taken into account in the options appraisal.

Resolved: NHS England and Mid Essex CCG agreed to support the development of a purpose-built healthcare facility at Beaulieu Park.

9 Any other business

i) Delegated Commissioning

MC advised that the Mid Essex CCG Board had agreed to explore the feasibility of a move to fully delegated primary care (medical) commissioning in terms of the required practice engagement, governance requirements, financial implications, and the CCG’s capacity and capability to take on this function. Once these issues had been clarified, a further decision by the CCG Board was expected on 1 December 2016.

PG advised the NEE CCG had discussed delegated commissioning at its September Board meeting and was currently engaging with practices, undertaking due diligence, and discussing the resource offer recently made by NHS England. A final decision was anticipated by 29 November 2016. GS noted that this decision would be dependent upon the outcome of the GP ballot and might also be subject to the full completion of due diligence.

10 Date and time of the next meeting

It was agreed to defer the meeting scheduled for 14 December 2016 and meet again in January 2017. VB advised that a schedule of proposed dates for 2017 would be circulated to members shortly. VB

11 Meeting Agenda Action Lead Deadline for Outcome/Update Date Item Completion 30/8/16 5 ii) Cover sheet: Completed. To be shared with NEE CCG report cover sheet to be Pam Green ASAP members for comments. shared with ME CCG 5/10/16 7) Quality Dashboard: Pam Green 16 November 2016 MECCG draft Quality Dashboard Outline dashboard to be developed for Melanie Crass to be discussed at Part II meeting consideration at next PCCC meeting. Alison Cowie on 11 January 2017 prior to wider publication. 5/10/16 10) Meeting Planner: Anne-Marie 7 December 2016 On agenda Meeting frequency to be reviewed after Garrigan December meeting. 16/11/16 6) Finance Report: Inclusion of practice level data for CCG Melanie Crass ASAP Local Enhanced Services to be discussed with NHS England 16/11/16 10) Dates of future meetings: Schedule of proposed meeting dates Viv Barnes ASAP Completed for 2017 to be circulated to members.

NHS England, MECCG and NEECCG Primary Care Commissioning Committee Meeting of 11 January 2017

Period 8 Primary Care Medical Financial Performance Report for Mid Essex and North East Essex CCGs

1. Background

1.1. Joint Commissioning Budget Update 1.2. In 2016/17 joint commissioning arrangements are limited to general practice services. The following report provides an overview of the budgets associated with the CCG and the context within the overall Primary Care Medical financial position. Future period reporting will focus on information around year to date and year end forecasts. All detail is dependent upon the accuracy of the coding within the financial system. 1.3. The Following Table summarises the Primary care medical budget allocated to the CCG.

2015-16 2016-17 2017-18 2018-19 Baseline Including Final Allocation Allocation after Allocation after adjustments and after Place Based Place Based Pace of Place Based Pace previous BCF Funding Pace of Change Change of Change Mid Essex CCG 45,106,014 46,693,014 47,543,015 48,462,015

North East Essex CCG 44,061,108 45,611,346 46,517,934 47,715,397 89,167,122 92,304,360 94,060,949 96,177,412

1.4. The majority of the GP contracting budgets within East are allocated at specific practice level therefore it is possible to reflect these accurately at a CCG level. Where this is not the case or relates to non-GP providers which are not directly linked to geographical areas apportionment methodologies have had to be adopted the majority of which is based upon contractor weighted populations.

1.5. Contractual contains General Practice GMS, PMS and other list based services relate to contract, list size driven budgets allocated to practice level. They include global sum, MPIG, contract values, PMS premium/growth and seniority budgets. These budgets, with the exception of the PMS premium treatments are driven by contractual obligations.

1.6. Premises include budgets for rent, rates and water charges. Premises budgets are also allocated on a contractual basis and have very little scope for local influence other than through commissioner decisions around investments in buildings or estate rationalisation.

13 1.7. Enhanced Services are budgeted on the basis of historic achievement for the ad- hoc smaller payments or recognising the potential full achievement for those which are list size/patient driven for the practices that have signed up to the particular SLAs, eg extended hours and avoiding unplanned admissions. Payment is based upon achievement so variances can exist from budget. Practices had a deadline of the end of June to register for 2016-17 enhanced services.

1.8. Quality outcomes Framework (QOF) aspiration payments are based upon 70% of the previous year’s achievement adjusted for year on year points and price changes. Budgets are set in line with this and pro rata to reflect final forecast achievement. As payment is based upon achievement this means that the CCG may have a financial risk or benefit depending on future practice achievement.

1.9. Material items which are not easily identifiable at a practice level because they are paid direct to other organisations are as follows. For these items assumptions have been made around apportionment methodologies. • Clinical Waste • Discretionary Payments • Other GP Related services such as Occupational Health contracts • Procurement Support • GP Suspension Budget • Translation services

1.10. Through the year budgets are reviewed and virements actioned to better reflect financial plans this will result in transfers between the budget lines not allocated at practice level and those which are.

1.11. QIPP targets associated with GP contracting are contained within the current indicative figures where appropriate and delivery will form part of future monitoring reports.

2. Period 8 Budget Monitoring

2.1. For future meetings the board can expect to receive a finical performance summary detailing year to date variances. Identifying at practice level; risks, mitigations and forecast out-turn positons. This will be taken from the most recently available budget monitoring reports.

2.2. This report provides an update on the financial performance against Primary Care Medical budgets of member practices as at Period 8 (November 2016). The following provides a summary of the expenditure to date versus the detailed budgets associated with Mid Essex and North East Essex CCGs GP Practices.

14 Essex General Practice Financial Performance at Period 8 Sum of YTD Sum of YTD Sum of YTD Sum of Annual Forecast (£) Forecast Budget (£) Actual (£) Variance (£) Budget (£) Variance (£)

Total Mid Essex CCG 29,627,945 29,852,997 225,052 45,628,700 45,730,700 102,000 Total North East Essex CCG 27,578,912 27,543,530 (35,382) 42,476,200 42,476,200 0 Other Essex CCGS 68,749,803 68,454,745 (295,058) 106,083,440 106,083,440 0 Other Essex not practice specific 947,676 267,902 (679,774) 13,586,913 9,433,913 (4,153,000) 126,904,336 126,119,174 (785,162) 207,775,253 203724253 (4,051,000) 2.3. The CCG has been allocated shares of budgets not held at practice level, earmarked reserves and contingencies. Whilst these budgets are contained within the above table they are currently not shown within the detailed year to date position below.

2.4. There is currently no anticipated year-end over spend against practice budgets and no expected pressure against those not allocated at a practice level. The Forecast underspend within the Essex General Practice cost centre reflects the position released nationally. This is predominantly made up 2015/16 year end expenditure not materialising and the release of reserves

2.5. Appendix 1 details further the current month and year to date position and practice level forecast out-turn, providing an explanation of the significant variations form plan. A number of the current month variances are the result of ledger adjustments which have corrected a issues accumulated over a recent months, the expectation is these will smooth in future periods. Work is underway to improve the reporting of these as a direct request from the CCG. The financial information is presented on a practice level basis and then broken down by expenditure type. A summary for the CCG is as follows.

Expenditure Summary for Mid Essex CCG For period 8 - 2016 - 17

Row Labels Sum of Sum of YTD Sum of Sum of YTD Sum of Sum of YTD Comments budget (£) Actual (£) Variance (£) Contractual 21,114,384 21,352,166 237,782 predominently pressures associated with required contract reconciliations associated with list changes Enhanced services 1,292,196 1,302,681 10,485 Other - GP Services 1,607,538 1,518,596 (88,942) Premises cost reimbursements 3,570,100 3,698,070 127,970 Premises development resulting in additional non recurrent support to practice QOF 2,043,727 1,953,670 (90,057) TPS and Pension 0 (0) (0) Grand Total 29,627,945 29,852,997 225,052 2.6. Within Mid Essex the year to date overspend is predominantly the result of profiling and budget coding adjustments required for the three Virgin practices following their move to a permanent APMS Contract from caretaking arrangements earlier in the year and required reconciliations associated with GMS contract list growth, these will be actioned in time for M9 reports. It also contains some NR dual running costs following a premises move 102k and some NR Prior year enhanced Service claim payments. Some Vulnerable Practice and Improvement grant allocations awaited from the centre 36k

Expenditure Summary for North East Essex For period 8 - 2016 - 17

Row Labels Sum of YTD budget (£) Sum of YTD Actual (£) Sum of YTD Variance (£) Comments Contractual 20,384,223 20,418,829 34,606 Enhanced services 1,116,241 1,077,655 (38,586) Underclaimed enhanced services from a number of practices Other - GP Services 1,171,557 1,157,361 (14,196) Premises cost reimbursements 2,868,904 2,841,528 (27,376) Business rate reductions QOF 2,037,989 2,047,799 9,810 TPS and Pension 0 361 361 Grand Total 27,578,914 27,543,532 (35,382)

2.7. Within North East Essex the month 8 underspend is mainly the result of profiling of professional fees budgets against expenditure, a reduction of business rates following appeal for some practices and a non-recurrent recovery of historic notional rent overpayments.

3. CCG Local Enhanced Services position

3.1. The following information has been provided by CCG finance and represents the planned summary expenditure for Local Enhanced Services. It is intended to include practice level detail with future period reporting.

Mid Essex CCG Local Enhanced services M8 ytd Expenditure and Estimated outturn

Type Q1 pay Q2 pay YTD Total Pay Annual Forecast Budget outturn Minor Injuries 320 1,279 1,599 5,484 5,484 Zoladex 3,024 3,214 6,238 13,786 13,786 Phlebotomy 69,938 71,755 141,693 307,747 307,747 INRs 146,548 158,776 305,324 680,965 680,965 Shared Care 41,233 42,667 83,900 182,993 182,993

261,063 277,692 538,755 1,190,975 1,190,975

16 Figures reported in NEECCG Forecast month 8

16/17 16/17 Forecast Annual M8 Forecast Outturn LOCAL ENHANCED SERVICES Budget Outturn variance Minor Injury Services 23,547 38,711 15,164 LES Anti-coagulation 860,452 897,669 37,217 LES Complex Wound Care 176,160 158,348 -17,812 LES DVT 29,659 84,728 55,069 D Dimers 34,626 3,001 -31,625 LES Care of Homeless 3,178 3,270 92 LES Medicine Management 229,709 207,899 -21,810 LES Shared Care 14,799 16,057 1,258 North COLCHESTER Health Center 316 526 210 Carpaltunnel syndrome 4,182 3,611 -571 Headache clinic 54,384 64,350 9,966 LES Total (Workbook) 1,431,012 1,478,170 47,158 Medical fees 9,645 8,968 -677 Referral refinement 6,646 5,811 -835 Total All LES schemes 16,291 14,779 -1,512 YE bal 0 1,649 1,649 GRAND TOTAL LES 1,447,303 1,494,598 47,295

4. Recommendation

4.1. The Joint Committee is asked to note the Month 8 financial performance position.

Mat Thorpe Head of Finance (Direct Commissioning) NHS England – Midlands and East – East

Appendix 1 - Year to Date Financial Performance for Mid Essex and North East Essex CCGs

Practice for Mid Essex CCG For period 8 - 2016 - 17

Sum of In Sum of In Sum of In Sum of YTD Sum of YTD Sum of YTD Sum of Forecast (£) Forecast Comments month budget month month budget (£) Actual (£) Variance (£) Annual Variance (£) (£) actual (£) variance (£) budget (£)

PMS F81020 - THE FRESHFORD PRACTICE 100,316 101,897 1,581 762,775 774,466 11,691 1,173,800 1,173,800 0 F81105 - LITTLE WALTHAM & GT NOTLEY SURGERY 170,246 177,183 6,937 1,388,850 1,445,518 56,668 2,147,700 2,147,700 0 YTD Overspend due to contractual variances where budgets need recoding and a budget aligned to match Q1 expenditure F81126 - BURNHAM SURGERY CM0 8SJ 89,352 135,047 45,695 714,532 696,528 (18,004) 1,104,200 1,104,200 0 F81149 - THE LAURELS SURGERY 122,319 143,322 21,003 984,317 1,025,946 41,629 1,504,000 1,504,000 0 YTD Overspend due to more budget required contractually under the baseline subjective F81721 - BRICKFIELDS SURGERY 48,159 49,080 921 387,741 391,431 3,690 596,000 596,000 0 PMS Total 530,392 606,529 76,137 4,238,215 4,333,890 95,675 6,525,700 6,525,700 0 GMS F81011 - KELVEDON & FEERING HEALTH CENTRE 43,550 43,683 133 350,269 350,435 166 535,100 535,100 0 F81022 - LONGFIELD MEDICAL CENTRE 134,058 137,523 3,465 1,079,832 1,100,647 20,815 1,678,200 1,678,200 0 F81024 - DICKENS PLACE 48,062 53,443 5,381 386,031 383,280 (2,751) 589,900 589,900 0 F81030 - FERN HOUSE SURGERY 144,993 127,115 (17,878) 1,149,409 1,142,369 (7,040) 1,781,700 1,781,700 0 F81035 - MOULSHAM LODGE SURGERY 54,768 58,977 4,209 447,839 449,473 1,634 700,700 700,700 0 F81040 - STOCK SURGERY 51,818 52,632 814 421,163 431,054 9,891 645,800 645,800 0 F81057 - WHITLEY HOUSE 111,378 120,001 8,623 916,909 907,614 (9,295) 1,397,000 1,397,000 0 F81068 - THE ELIZABETH COURTAULD SURGERY 142,106 155,155 13,049 1,175,401 1,168,434 (6,967) 1,804,900 1,804,900 0 F81071 - RIVERMEAD GATE MEDCTR 109,681 111,189 1,508 925,449 914,352 (11,097) 1,384,400 1,384,400 0 F81074 - MELBOURNE HOUSE SURGERY 57,870 74,177 16,307 457,548 477,616 20,068 708,400 708,400 0 F81076 - THE TOLLESBURY PRACTICE 37,300 40,107 2,807 295,918 306,090 10,172 457,900 457,900 0 F81083 - BEAUCHAMP HOUSE 97,544 98,017 473 801,564 795,593 (5,971) 1,231,100 1,231,100 0 F81087 - MOUNT CHAMBERS 171,410 167,713 (3,697) 983,545 1,016,170 32,625 1,502,900 1,502,900 0 YTD Overspend due to premises payment awaiting budget 28,800 along with manual payments for enhanced services F81098 - THE WRITTLE SURGERY 75,022 67,013 (8,009) 595,959 607,014 11,055 919,400 919,400 0 F81099 - BLACKWATER MEDICAL CENTRE 126,790 128,007 1,217 1,023,420 1,031,095 7,675 1,588,700 1,588,700 0 F81100 - DANBURY MEDICAL CENTRE 172,743 201,956 29,213 1,457,832 1,583,547 125,715 2,214,700 2,316,700 102,000 Overspend due to invoice of 102000 for premises one off payment

F81114 - BADDOW VILLAGE SURGERY 116,610 119,775 3,165 977,470 1,002,440 24,970 1,490,700 1,490,700 0 F81119 - THE PUMP HOUSE SURGERY 84,774 85,945 1,171 695,243 686,975 (8,268) 1,061,600 1,061,600 0 F81122 - TENNYSON HOUSE SURGERY 78,450 88,028 9,578 644,068 644,283 215 987,600 987,600 0 F81127 - HUMBER ROAD SURGERY 82,801 83,914 1,113 671,424 687,601 16,177 1,036,800 1,036,800 0 F81130 - WILLIAM FISHER MEDCTR 58,311 68,054 9,743 472,824 470,491 (2,333) 738,900 738,900 0 F81132 - BLANDFORD MEDICAL CENTRE 155,546 133,800 (21,747) 1,272,450 1,269,678 (2,772) 1,944,700 1,944,700 0 F81138 - HILTON HOUSE 36,527 37,990 1,463 287,733 291,709 3,976 453,800 453,800 0 F81162 - CASTLE HEDINGHAM SURGERY 0 0 0 0 (7,978) (7,978) 0 0 0 F81170 - KINGSWAY SURGERY CM3 5QH 36,392 42,035 5,643 292,658 296,795 4,137 446,300 446,300 0 F81173 - DOUGLAS GROVE SURGERY 59,250 63,020 3,770 484,069 520,781 36,712 738,300 738,300 0 17,000 vulnerable practice funding & 27,800 Improvement grant funding required F81183 - TILLINGHAM MED CENTRE 60,494 58,130 (2,364) 498,938 497,782 (1,156) 771,100 771,100 0 F81193 - WITHAM HEALTH CENTRE 42,234 43,594 1,360 327,190 326,450 (740) 516,700 516,700 0 F81635 - COLLINGWOOD ROAD SURGERY 18,178 18,417 239 148,060 146,704 (1,356) 230,700 230,700 0 F81665 - CHELMER VILLAGE SURGERY 26,805 27,019 214 226,173 226,089 (84) 346,200 346,200 0 F81674 - WYNCROFT SURGERY 21,410 31,547 10,137 178,044 188,980 10,936 274,700 274,700 0 F81683 - BLYTHS MEADOW SURGERY 80,477 79,550 (927) 671,881 656,715 (15,166) 1,007,100 1,007,100 0 F81730 - THE COGGESHALL SURGERY 51,480 57,656 6,176 415,170 420,619 5,449 645,200 645,200 0 F81738 - BRIMPTON HOUSE 22,372 24,521 2,149 195,607 193,477 (2,130) 291,600 291,600 0 F81751 - THE TRINITY MEDICAL PRACTICE 31,359 34,994 3,635 247,492 246,345 (1,147) 386,700 386,700 0 Y00293 - THE CASTLE SURGERY 50,273 53,163 2,890 405,436 410,138 4,702 635,600 635,600 0 Y00589 - GREENWOOD SURGERY 33,076 38,431 5,355 265,124 273,038 7,914 411,700 411,700 0 GMS Total 2,725,912 2,826,288 100,376 21,845,142 22,113,895 268,753 33,556,800 33,658,800 102,000 APMS 0V1096 - VIRGIN CARE PROVIDER SERVICES LTD 253,125 0 (253,125) 2,025,000 1,012,701 (1,012,299) 3,037,500 3,037,500 0 YTD underpend due to budgets not being aligned correctly. To be corrected in M9 F81014 - STLAWRENCE MEDICAL PRACTICE 34,740 150,158 115,418 270,469 737,801 467,332 453,200 453,200 0 YTD Overspend due to budgets not being aligned correctly. To be corrected in M9 F81117 - SUTHERLAND LODGE SURGERY 48,382 139,824 91,442 379,507 679,183 299,676 591,400 591,400 0 YTD Overspend due to contract payments not having the correct budget aligned. To be corrected in m9 F81185 - THE PRACTICE SOUTH WOODHAM FERRERS 46,716 50,409 3,693 359,028 344,236 (14,792) 624,700 624,700 0 Y02611 - NORTH CHELMSFORD NHS HCC 58,475 58,755 280 460,549 408,929 (51,620) 754,200 754,200 0 NR Underspend due to YE accruals and no matching payments Y05023 - SILVER END SURGERY 7,842 47,609 39,767 50,035 170,157 120,122 85,200 85,200 0 Overspend due to contract payments fro April & May paid with no budget to match. Budgets need looking into and correcting in M9

APMS Total 449,280 446,755 (2,525) 3,544,588 3,353,007 (191,581) 5,546,200 5,546,200 0

- 06QCCG - NHS MID ESSEX CCG 0 (99,647) (99,647) 0 52,205 52,205 0 old year corrections #N/A Total 0 (99,647) (99,647) 0 52,205 52,205 0 Grand Total 3,705,584 3,779,924 74,340 29,627,945 29,852,997 225,052 45,628,700 45,730,700 102,000

18 Practice Expenditure Summary for Mid Essex CCG For period 8 - 2016 - 17

Contractual Enhanced services Other - GP Services Premises cost reimbursements QOF TPS and Pension Total Sum of YTD budget (£) Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of YTD YTD Actual YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD Actual YTD budget (£) (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget (£) (£) Variance (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) APMS F81014 - STLAWRENCE MEDICAL PRA 58,335 632,464 574,129 40,348 24,589 (15,759) 10,129 391 (9,738) 75,528 58,777 (16,751) 86,129 21,581 (64,548) 270,469 737,801 467,332 F81117 - SUTHERLAND LODGE SURGE 180,150 526,223 346,073 29,599 24,809 (4,790) 21,335 4,541 (16,794) 87,629 61,735 (25,894) 60,794 61,874 1,080 0 (0) (0) 379,507 679,183 299,676 F81185 - THE PRACTICE SOUTH WOOD321,205 309,387 (11,818) 14,100 12,976 (1,124) 0 (150) (150) 1,729 0 (1,729) 21,994 22,022 28 0 0 0 359,028 344,236 (14,792) Y05023 - SILVER END SURGERY 24,671 138,731 114,060 9,700 7,107 (2,593) 0 (16) (16) 0 19,000 19,000 15,664 5,336 (10,328) 50,035 170,157 120,122 Y02611 - NORTH CHELMSFORD NHS H 442,470 410,301 (32,169) 8,750 8,287 (463) 0 778 778 9,329 (10,437) (19,766) 460,549 408,929 (51,620) 0V1096 - VIRGIN CARE PROVIDER SER2,025,000 1,001,851 ######## 0 10,850 10,850 2,025,000 1,012,701 ######## APMS Total 3,051,831 3,018,957 (32,874) 102,497 77,767 (24,730) 31,464 5,544 (25,920) 164,886 150,362 (14,524) 193,910 100,376 (93,534) 0 (0) (0) 3,544,588 3,353,007 (191,581) GMS F81193 - WITHAM HEALTH CENTRE 272,120 273,439 1,319 21,948 22,010 62 2,993 864 (2,129) 30,129 30,137 8 0 0 0 327,190 326,450 (740) F81099 - BLACKWATER MEDICAL CEN 747,779 758,570 10,791 53,548 54,085 537 76,929 74,834 (2,095) 68,564 67,033 (1,531) 76,600 76,572 (28) 0 0 0 1,023,420 1,031,095 7,675 F81100 - DANBURY MEDICAL CENTRE 927,505 945,244 17,739 72,249 82,922 10,673 135,558 106,347 (29,211) 225,521 352,012 126,491 96,999 97,023 24 0 0 0 1,457,832 1,583,547 125,715 F81132 - BLANDFORD MEDICAL CENT 845,653 843,333 (2,320) 48,498 48,710 212 68,000 70,254 2,254 212,564 209,678 (2,886) 97,735 97,702 (33) 0 (0) (0) 1,272,450 1,269,678 (2,772) F81011 - KELVEDON & FEERING HEAL 266,599 266,982 383 12,848 13,203 355 2,329 698 (1,631) 43,693 44,756 1,063 24,800 24,797 (3) 0 (0) (0) 350,269 350,435 166 F81022 - LONGFIELD MEDICAL CENTR 801,599 816,816 15,217 52,647 63,649 11,002 52,065 47,055 (5,010) 97,057 96,669 (388) 76,464 76,459 (5) 0 0 0 1,079,832 1,100,647 20,815 F81024 - DICKENS PLACE 291,625 291,752 127 20,048 20,259 211 3,800 2,430 (1,370) 44,364 42,647 (1,718) 26,194 26,193 (1) 0 0 0 386,031 383,280 (2,751) F81035 - MOULSHAM LODGE SURGER 341,020 339,967 (1,053) 28,349 31,715 3,366 2,800 2,450 (350) 40,200 39,844 (357) 35,470 35,496 26 0 0 0 447,839 449,473 1,634 F81040 - STOCK SURGERY 234,865 235,173 308 12,698 11,914 (784) 97,336 107,861 10,525 50,664 50,492 (172) 25,600 25,615 15 0 0 0 421,163 431,054 9,891 F81057 - WHITLEY HOUSE 634,204 629,676 (4,528) 40,148 39,688 (460) 3,464 (242) (3,706) 182,564 181,953 (611) 56,529 56,539 10 0 0 0 916,909 907,614 (9,295) F81071 - RIVERMEAD GATE MEDCTR 592,264 600,649 8,385 54,563 30,080 (24,483) 5,664 1,363 (4,301) 215,293 224,622 9,329 57,665 57,637 (28) 0 0 0 925,449 914,352 (11,097) F81074 - MELBOURNE HOUSE SURGER 373,975 399,365 25,390 30,150 26,425 (3,725) 3,329 1,728 (1,601) 12,100 12,100 0 37,994 37,999 5 0 (0) (0) 457,548 477,616 20,068 F81076 - THE TOLLESBURY PRACTICE 201,369 207,830 6,461 12,898 12,785 (113) 37,329 39,990 2,661 25,657 26,786 1,129 18,665 18,700 35 0 (0) (0) 295,918 306,090 10,172 F81083 - BEAUCHAMP HOUSE 575,474 574,746 (728) 36,698 36,129 (569) 8,129 5,196 (2,933) 114,064 112,345 (1,719) 67,199 67,177 (22) 0 (0) (0) 801,564 795,593 (5,971) F81087 - MOUNT CHAMBERS 710,018 709,755 (263) 33,797 45,462 11,665 53,271 60,013 6,742 101,600 116,067 14,467 84,859 84,873 14 0 0 0 983,545 1,016,170 32,625 F81098 - THE WRITTLE SURGERY 440,665 441,956 1,291 20,000 23,638 3,638 43,000 48,774 5,774 49,229 49,574 345 43,065 43,072 7 0 0 0 595,959 607,014 11,055 F81114 - BADDOW VILLAGE SURGERY 628,533 625,166 (3,367) 34,750 34,373 (377) 46,264 62,111 15,847 197,929 210,800 12,871 69,994 69,989 (5) 0 0 0 977,470 1,002,440 24,970 F81119 - THE PUMP HOUSE SURGERY 417,929 418,554 625 20,149 13,440 (6,709) 76,800 76,378 (422) 137,100 135,320 (1,780) 43,265 43,283 18 0 0 0 695,243 686,975 (8,268) F81122 - TENNYSON HOUSE SURGERY 463,454 466,669 3,215 34,462 35,027 565 4,129 1,338 (2,791) 94,629 93,869 (760) 47,394 47,380 (14) 0 (0) (0) 644,068 644,283 215 F81127 - HUMBER ROAD SURGERY 518,468 516,703 (1,765) 34,298 54,970 20,672 5,600 3,473 (2,127) 60,329 59,716 (613) 52,729 52,738 9 0 0 0 671,424 687,601 16,177 F81130 - WILLIAM FISHER MEDCTR 341,119 346,439 5,320 25,748 27,934 2,186 38,000 41,292 3,292 33,628 20,488 (13,140) 34,329 34,339 10 0 0 0 472,824 470,491 (2,333) F81170 - KINGSWAY SURGERY CM3 5Q 219,385 223,297 3,912 14,050 13,531 (519) 200 1,224 1,024 39,029 38,760 (269) 19,994 19,983 (11) 0 0 0 292,658 296,795 4,137 F81173 - DOUGLAS GROVE SURGERY 316,433 314,412 (2,021) 16,349 14,582 (1,767) 2,929 17,888 14,959 111,829 109,527 (2,302) 36,529 36,559 30 0 0 0 484,069 520,781 36,712 F81183 - TILLINGHAM MED CENTRE 294,274 311,608 17,334 27,877 25,373 (2,504) 86,064 72,337 (13,727) 60,458 58,178 (2,280) 30,265 30,287 22 0 0 0 498,938 497,782 (1,156) F81635 - COLLINGWOOD ROAD SURG 111,704 112,361 657 6,999 5,889 (1,110) 1,000 393 (607) 16,693 16,397 (296) 11,664 11,663 (1) 0 0 0 148,060 146,704 (1,356) F81665 - CHELMER VILLAGE SURGERY 181,810 183,239 1,429 0 0 0 1,600 293 (1,307) 25,764 25,540 (224) 16,999 17,017 18 0 0 0 226,173 226,089 (84) F81674 - WYNCROFT SURGERY 118,160 120,131 1,971 7,597 11,786 4,189 17,865 23,112 5,247 23,763 23,264 (499) 10,659 10,688 29 0 0 0 178,044 188,980 10,936 F81683 - BLYTHS MEADOW SURGERY 446,359 444,541 (1,818) 32,800 23,007 (9,793) 2,529 917 (1,612) 153,064 151,101 (1,963) 37,129 37,150 21 0 0 0 671,881 656,715 (15,166) F81738 - BRIMPTON HOUSE 139,644 139,368 (276) 9,099 8,109 (990) 9,000 7,612 (1,388) 30,464 31,004 540 7,400 7,384 (16) 0 0 0 195,607 193,477 (2,130) F81751 - THE TRINITY MEDICAL PRACT 181,585 184,100 2,515 13,150 13,583 433 16,864 13,828 (3,036) 16,564 14,608 (1,956) 19,329 20,226 897 0 (0) (0) 247,492 246,345 (1,147) Y00293 - THE CASTLE SURGERY 274,535 275,239 704 18,949 10,861 (8,088) 74,866 70,992 (3,874) 15,693 31,615 15,922 21,393 21,430 37 0 0 0 405,436 410,138 4,702 Y00589 - GREENWOOD SURGERY 192,784 193,720 936 16,148 18,537 2,389 1,464 677 (787) 33,264 33,398 134 21,464 26,706 5,242 265,124 273,038 7,914 F81030 - FERN HOUSE SURGERY 814,489 815,888 1,399 39,999 43,419 3,420 84,729 73,172 (11,557) 118,128 117,842 (286) 92,064 92,048 (16) 0 0 0 1,149,409 1,142,369 (7,040) F81138 - HILTON HOUSE 204,470 205,914 1,444 8,599 7,823 (776) 31,735 34,618 2,883 21,464 21,873 409 21,465 21,481 16 0 0 0 287,733 291,709 3,976 F81162 - CASTLE HEDINGHAM SURGE 1 0 (1) 0 (5,078) (5,078) (1) 0 1 0 (2,900) (2,900) 0 (7,978) (7,978) F81730 - THE COGGESHALL SURGERY 304,180 304,628 448 20,698 26,365 5,667 14,735 14,634 (101) 41,493 40,911 (582) 34,064 34,081 17 0 0 0 415,170 420,619 5,449 F81068 - THE ELIZABETH COURTAULD 804,224 804,708 484 68,749 68,039 (710) 5,600 1,803 (3,797) 215,758 212,804 (2,954) 81,070 81,079 9 0 0 0 1,175,401 1,168,434 (6,967) GMS Total 15,230,274 15,341,939 111,665 1,001,557 1,014,243 12,686 1,117,968 1,087,707 (30,261) 2,930,177 3,073,593 143,416 1,565,166 1,568,601 3,435 0 0 0 21,845,142 22,113,895 268,753 PMS F81105 - LITTLE WALTHAM & GT NOT 860,774 936,114 75,340 74,248 69,475 (4,773) 199,200 184,376 (14,824) 166,029 166,950 921 88,599 88,603 4 0 (0) (0) 1,388,850 1,445,518 56,668 F81721 - BRICKFIELDS SURGERY 298,334 305,991 7,657 19,449 16,448 (3,001) 3,000 1,880 (1,120) 39,893 40,030 137 27,065 27,082 17 0 0 0 387,741 391,431 3,690 F81126 - BURNHAM SURGERY CM0 8S 508,460 509,401 941 31,449 64,299 32,850 57,800 6,521 (51,279) 58,629 58,090 (539) 58,194 58,217 23 0 0 0 714,532 696,528 (18,004) F81149 - THE LAURELS SURGERY 726,196 775,851 49,655 32,599 30,366 (2,233) 35,135 30,160 (4,975) 116,793 115,962 (831) 73,594 73,607 13 0 0 0 984,317 1,025,946 41,629 F81020 - THE FRESHFORD PRACTICE 438,515 463,913 25,398 30,397 30,083 (314) 162,971 150,203 (12,768) 93,693 93,084 (609) 37,199 37,183 (16) 0 0 0 762,775 774,466 11,691 PMS Total 2,832,279 2,991,270 158,991 188,142 210,672 22,530 458,106 373,141 (84,965) 475,037 474,115 (922) 284,651 284,693 42 0 (0) (0) 4,238,215 4,333,890 95,675 #N/A - 06QCCG - NHS MID ESSEX CCG 0 52,205 52,205 0 52,205 52,205 #N/A Total 0 52,205 52,205 0 52,205 52,205 (blank) 19 - (blank) (blank) Total

Financial Performance by Practice for North East Essex For period 8 - 2016 - 17

Actual Contractor Sum of In Sum of In Sum of In Sum of YTD Sum of YTD Sum of YTD Sum of Forecast Forecast Comments Practice Weighted month budget month month budget (£) Actual (£) Variance Annual (£) Variance (£) Population Population (£) actual (£) variance (£) (£) budget (£)

PMS 7,401 9,090 F81018 - GREAT CLACTON MEDICAL PARTNERSHIP 77,816 48,886 (28,930) 615,777 584,655 (31,122) 962,200 962,200 0 9,144 10,485 F81212 - OLD ROAD SURGERY 77,756 94,101 16,345 618,398 703,628 85,230 961,800 961,800 0 YTD Overspend due to contractual budgets that need realigning to correspond with actual payments that have changed with national uplifts for M9 reports. 4,620 4,820 F81221 - FRONKS RD FAMILY SURGERY 45,322 30,435 (14,887) 344,709 312,247 (32,462) 518,500 518,500 0 YTD Underspend caused by contractual budgets needing to be realigned with actual payments for M 9 reports 5,179 5,928 F81741 - CRUSADER SURGERY 51,124 54,542 3,418 418,390 430,854 12,464 642,500 642,500 0 PMS Total 252,018 227,963 (24,055) 1,997,274 2,031,383 34,109 3,085,000 3,085,000 0 GMS 8,700 8,474 F81091 - EAST HILL SURGERY 74,295 75,501 1,206 593,544 582,897 (10,647) 922,900 922,900 0 YTD underspend mainly down to practice not claiming for Q2 extended hours 24,610 22,934 F81042 - CASTLE GARDENS MEDICAL CENTRE 208,610 207,866 (744) 1,664,568 1,661,307 (3,261) 2,578,900 2,578,900 0 15,288 15,033 F81067 - AMBROSE AVENUE GROUP PRACTICE 146,810 142,695 (4,115) 1,224,969 1,223,660 (1,309) 1,866,500 1,866,500 0 13,503 13,523 F81094 - NORTH HILL MEDICAL GROUP 137,860 139,989 2,129 1,114,595 1,046,019 (68,576) 1,733,800 1,733,800 0 YTD Underspend due to a NR clawback of overpaid rent to the practice 11,543 11,712 F81115 - CREFFIELD MEDICAL CENTRE 112,544 119,475 6,931 944,988 943,780 (1,208) 1,438,300 1,438,300 0 11,689 11,957 F81133 - TIPTREE MEDICAL CENTRE 113,014 123,750 10,736 833,416 836,204 2,788 1,285,700 1,285,700 0 7,710 8,137 F81012 - WEST MERSEA SURGERY 70,459 69,587 (872) 539,840 536,929 (2,911) 839,200 839,200 0 8,472 7,613 F81028 - WIVENHOE SURGERY 65,799 66,231 432 513,740 515,694 1,954 797,100 797,100 0 7,144 7,729 F81044 - THE ARDLEIGH SURGERY 78,019 86,724 8,705 620,270 627,906 7,636 959,300 959,300 0 6,570 6,353 F81069 - STANWAY SURGERY 72,599 68,916 (3,683) 596,187 551,435 (44,752) 919,600 919,600 0 YTD underspend the result of Prof fees and Premises costs have reduced from the previous year 10,589 10,377 F81079 - PARSONS HEATH MEDICAL CENTRE 95,736 97,005 1,269 766,401 755,540 (10,861) 1,184,500 1,184,500 0 YTD Underspend due to baseline budget release and no matching spend 14,358 14,370 F81095 - MERSEA ROAD PRACTICE 133,325 132,704 (621) 1,119,069 1,113,828 (5,241) 1,710,200 1,710,200 0 6,095 5,344 F81109 - LAYER ROAD SURGERY 50,315 49,737 (578) 391,823 396,042 4,219 598,500 598,500 0 12,502 9,222 F81141 - ROWHEDGE SURGERY 110,069 107,930 (2,139) 876,067 861,817 (14,250) 1,338,100 1,338,100 0 YTD Underspend due to practice not claiming Q1 & Q2 extended hours 12,065 10,263 F81636 - MILL ROAD SURGERY CO1 5LE 104,754 96,714 (8,040) 873,214 878,728 5,514 1,334,400 1,334,400 0 3,660 2,862 F81746 - BLUEBELL SURGERY 31,837 32,130 293 266,530 264,824 (1,706) 402,000 402,000 0 4,967 4,287 Y00484 - HAWTHORN SURGERY CO4 3GW 47,154 45,068 (2,086) 387,565 373,324 (14,241) 578,000 578,000 0 YTD Underspend due to no YTD claim for rates and baseline budget release and no matching spend 10,160 10,833 F81116 - COLNE MEDICAL CENTRE 104,011 107,993 3,982 821,373 818,307 (3,066) 1,276,900 1,276,900 0 6,499 8,263 F81213 - THORPE SURGERY 69,720 87,540 17,820 550,094 573,284 23,190 852,000 852,000 0 3,039 3,318 F81606 - HAREWOOD SURGERY 38,626 39,009 383 305,077 307,218 2,141 477,400 477,400 0 3,392 3,564 F81633 - LAWFORD SURGERY 40,183 40,552 369 324,263 313,161 (11,102) 500,700 500,700 0 YTD Underspend ue to prof fees and YE Accrual with no spend to match 5,591 5,709 F81757 - THE RIVERSIDE HEALTH CTR CO11 1AA 55,353 55,976 623 446,260 443,084 (3,176) 689,100 689,100 0 8,795 11,341 F81017 - WALTON SURGERY CO14 8PA 97,027 120,741 23,714 765,653 789,455 23,802 1,186,700 1,186,700 0 8,570 10,059 F81021 - THE HOLLIES CO7 8PJ 85,804 75,612 (10,192) 683,167 680,747 (2,420) 1,057,400 1,057,400 0 9,536 10,598 F81037 - EAST LYNNE MEDICAL CENTRE 91,328 93,920 2,592 734,987 727,741 (7,246) 1,152,200 1,152,200 0 13,225 16,044 F81052 - ST.JAMES SURGERY CO15 1DA 137,458 141,416 3,958 1,102,682 1,107,516 4,834 1,730,800 1,730,800 0 7,314 8,156 F81156 - RANWORTH SURGERY 75,188 78,878 3,690 601,735 601,353 (382) 931,700 931,700 0 - - F81672 - PORTLAND ROAD SURGERY CO2 7EH (191) 2,500 2,691 (1,534) 6,733 8,267 (11,500) (11,500) 0 Correction required for closed practice 6,559 5,905 F81679 - HIGHWOODS SURGERY 62,940 63,009 69 512,521 516,573 4,052 780,200 780,200 0 7,079 6,410 F81716 - TOLLGATE HEALTH CENTRE 67,125 65,561 (1,564) 582,569 578,586 (3,983) 870,000 870,000 0 17,673 17,968 F81019 - MAYFLOWER MEDICAL CENTRE ALLDRICK 194,017 190,612 (3,405) 1,565,381 1,547,626 (17,755) 2,395,400 2,395,400 0 Underspend due to enhanced services not being claimed and prof fees variance GMS Total 2,771,788 2,825,342 53,554 22,321,014 22,181,318 (139,696) 34,376,000 34,376,000 0 APMS 5,495 6,932 F81157 - THE FRINTON ROAD MED CTR 94,183 93,831 (352) 733,412 731,609 (1,803) 1,114,600 1,114,600 7,507 9,216 F81026 - CARADOC SURGERY 93,449 84,204 (9,245) 729,043 728,161 (882) 1,117,800 1,117,800 0 3,293 4,040 F81670 - EPPING CLOSE 52,883 52,855 (28) 420,066 415,585 (4,481) 664,800 664,800 0 7,363 9,491 F81681 - GREEN ELMS HEALTH CENTRE 132,841 132,409 (432) 1,041,179 1,037,648 (3,531) 1,612,600 1,612,600 0 6,780 5,596 Y02646 - NORTH COLCHESTER HEALTHCARE CENTRE 42,115 139,477 97,362 336,924 417,826 80,902 505,400 505,400 0 Practice list increased, reconciliation to be carried out for period 9 APMS Total 415,471 502,776 87,305 3,260,624 3,330,829 70,205 5,015,200 5,015,200 0 0

Grand Total 3,439,277 3,556,081 116,804 27,578,912 27,543,530 (35,382) 42,476,200 42,476,200 0 20 Practice Expenditure Summary for North East Essex For period 8 - 2016 - 17

APMS Total 2,498,811 2,498,650 (161) 70,145 66,081 (4,064) 340,590 417,876 77,286 175,958 173,117 (2,841) 175,122 175,108 (14) 0 0 0 3,260,626 3,330,831 70,205 GMS F81091 - EAST HILL SURGERY 442,425 442,238 (187) 29,298 23,751 (5,547) 5,129 127 (5,002) 62,693 62,428 (265) 53,999 53,993 (6) 0 361 361 593,544 582,897 (10,647) F81042 - CASTLE GARDENS MEDICAL CENTRE 1,279,478 1,273,211 (6,267) 83,097 93,001 9,904 12,800 5,844 (6,956) 152,993 153,051 58 136,200 136,200 0 0 0 0 1,664,568 1,661,307 (3,261) F81067 - AMBROSE AVENUE GROUP PRACTICE 792,740 794,612 1,872 51,548 52,294 746 9,329 2,987 (6,342) 287,087 289,498 2,411 84,265 84,269 4 0 0 0 1,224,969 1,223,660 (1,309) F81094 - NORTH HILL MEDICAL GROUP 764,933 762,218 (2,715) 47,898 43,352 (4,546) 77,200 70,283 (6,917) 136,429 82,066 (54,363) 88,135 88,101 (34) 0 0 0 1,114,595 1,046,019 (68,576) F81115 - CREFFIELD MEDICAL CENTRE 633,202 633,900 698 40,098 41,997 1,899 7,929 6,464 (1,465) 197,700 195,325 (2,375) 66,059 66,095 36 0 0 0 944,988 943,780 (1,208) F81133 - TIPTREE MEDICAL CENTRE 634,224 634,755 531 42,999 49,018 6,019 19,000 14,901 (4,099) 69,864 70,172 308 67,329 67,359 30 0 (0) (0) 833,416 836,204 2,788 F81012 - WEST MERSEA SURGERY 434,034 433,116 (918) 17,149 16,980 (169) 4,264 1,011 (3,253) 32,929 34,325 1,396 51,464 51,497 33 0 0 0 539,840 536,929 (2,911) F81028 - WIVENHOE SURGERY 408,929 409,206 277 19,848 19,250 (598) 4,329 1,700 (2,629) 33,900 38,819 4,919 46,734 46,717 (17) 0 (0) (0) 513,740 515,694 1,954 F81044 - THE ARDLEIGH SURGERY 416,707 418,817 2,110 18,799 18,414 (385) 95,736 101,023 5,287 49,228 49,858 630 39,800 39,794 (6) 0 0 0 620,270 627,906 7,636 F81069 - STANWAY SURGERY 383,219 379,091 (4,128) 25,148 18,011 (7,137) 71,064 52,412 (18,652) 79,222 64,413 (14,809) 37,534 37,509 (25) 0 0 0 596,187 551,435 (44,752) F81079 - PARSONS HEATH MEDICAL CENTRE 589,938 581,346 (8,592) 37,099 37,532 433 6,000 4,048 (1,952) 73,100 72,356 (744) 60,264 60,257 (7) 0 (0) (0) 766,401 755,540 (10,861) F81095 - MERSEA ROAD PRACTICE 840,518 836,261 (4,257) 53,229 55,637 2,408 49,729 37,038 (12,691) 93,264 92,763 (501) 82,329 92,130 9,801 0 0 0 1,119,069 1,113,828 (5,241) F81109 - LAYER ROAD SURGERY 314,330 319,758 5,428 13,900 14,123 223 2,464 1,292 (1,172) 33,000 32,766 (234) 28,129 28,102 (27) 0 (0) (0) 391,823 396,042 4,219 F81141 - ROWHEDGE SURGERY 687,969 680,475 (7,494) 43,199 31,198 (12,001) 53,671 59,194 5,523 57,028 56,775 (253) 34,200 34,176 (24) 0 0 0 876,067 861,817 (14,250) F81636 - MILL ROAD SURGERY CO1 5LE 546,374 546,609 235 48,347 51,711 3,364 48,000 52,644 4,644 174,828 172,077 (2,751) 55,665 55,687 22 0 0 0 873,214 878,728 5,514 F81672 - PORTLAND ROAD SURGERY CO2 7EH (2) 0 2 (1,531) (3,082) (1,551) 0 9,816 9,816 0 0 0 (1) 0 1 (1,534) 6,733 8,267 F81746 - BLUEBELL SURGERY 170,354 170,349 (5) 12,348 11,746 (602) 929 754 (175) 70,100 69,148 (952) 12,799 12,827 28 0 0 0 266,530 264,824 (1,706) Y00484 - HAWTHORN SURGERY CO4 3GW 297,609 288,477 (9,132) 11,699 10,618 (1,081) 2,329 821 (1,508) 55,264 52,768 (2,496) 20,664 20,640 (24) 0 0 0 387,565 373,324 (14,241) F81116 - COLNE MEDICAL CENTRE 622,768 623,030 262 25,748 23,477 (2,271) 32,265 31,648 (618) 67,793 67,321 (472) 72,799 72,832 33 0 (0) (0) 821,373 818,307 (3,066) F81213 - THORPE SURGERY 421,274 422,479 1,205 24,798 29,219 4,421 29,464 27,837 (1,627) 33,764 52,964 19,200 40,794 40,785 (9) 0 0 0 550,094 573,284 23,190 F81606 - HAREWOOD SURGERY 210,521 209,751 (770) 10,999 11,693 694 45,329 47,856 2,527 18,093 17,782 (311) 20,135 20,136 1 0 0 0 305,077 307,218 2,141 F81633 - LAWFORD SURGERY 220,036 219,673 (363) 13,999 8,860 (5,139) 52,600 43,867 (8,733) 16,564 19,664 3,100 21,064 21,096 32 324,263 313,161 (11,102) F81757 - THE RIVERSIDE HEALTH CTR CO11 1AA 330,404 330,198 (206) 16,998 13,944 (3,054) 50,700 50,907 207 19,829 19,708 (121) 28,329 28,327 (2) 0 0 0 446,260 443,084 (3,176) F81017 - WALTON SURGERY CO14 8PA 612,133 633,930 21,797 22,699 26,584 3,885 5,929 3,880 (2,049) 50,228 50,362 134 74,664 74,699 35 0 0 0 765,653 789,455 23,802 F81021 - THE HOLLIES CO7 8PJ 542,175 546,349 4,174 25,699 21,640 (4,059) 4,529 2,234 (2,295) 50,364 50,111 (253) 60,400 60,413 13 0 0 0 683,167 680,747 (2,420) F81037 - EAST LYNNE MEDICAL CENTRE 580,254 577,103 (3,151) 38,599 24,794 (13,805) 5,800 1,352 (4,448) 39,000 53,172 14,172 71,334 71,322 (12) 0 0 0 734,987 727,741 (7,246) F81052 - ST.JAMES SURGERY CO15 1DA 852,883 851,209 (1,674) 49,648 60,137 10,489 10,264 7,270 (2,994) 65,828 64,840 (988) 124,059 124,059 0 0 0 0 1,102,682 1,107,516 4,834 F81156 - RANWORTH SURGERY 478,294 475,022 (3,272) 25,948 27,400 1,452 4,664 6,364 1,700 35,700 35,426 (274) 57,129 57,140 11 0 0 0 601,735 601,353 (382) F81679 - HIGHWOODS SURGERY 401,130 399,826 (1,304) 20,898 18,136 (2,762) 1,464 1,646 182 54,164 62,106 7,942 34,865 34,859 (6) 0 0 0 512,521 516,573 4,052 F81716 - TOLLGATE HEALTH CENTRE 366,770 367,337 567 27,448 20,510 (6,938) 2,464 697 (1,767) 150,687 154,840 4,153 35,200 35,202 2 0 (0) (0) 582,569 578,586 (3,983) F81019 - MAYFLOWER MEDICAL CENTRE ALLDRICK 1,040,170 1,035,047 (5,123) 63,548 55,071 (8,477) 80,400 76,656 (3,744) 284,329 283,929 (400) 96,934 96,923 (11) 0 (0) (0) 1,565,381 1,547,626 (17,755) GMS Total 16,315,793 16,295,392 (20,401) 961,201 927,017 (34,184) 795,774 724,572 (71,202) 2,544,972 2,520,833 (24,139) 1,703,274 1,713,144 9,870 0 361 361 22,321,014 22,181,318 (139,696) PMS F81018 - GREAT CLACTON MEDICAL PARTNERSHIP 495,700 473,193 (22,507) 24,649 24,151 (498) 9,729 1,859 (7,870) 27,629 27,405 (224) 58,070 58,048 (22) 0 0 0 615,777 584,655 (31,122) F81212 - OLD ROAD SURGERY 481,564 569,685 88,121 31,348 31,255 (93) 6,064 2,470 (3,594) 46,758 47,543 785 52,664 52,675 11 618,398 703,628 85,230 F81221 - FRONKS RD FAMILY SURGERY 282,550 258,615 (23,935) 9,800 8,054 (1,746) 15,800 9,378 (6,422) 23,429 23,081 (348) 13,130 13,118 (12) 0 0 0 344,709 312,247 (32,462) F81741 - CRUSADER SURGERY 309,805 323,294 13,489 19,098 21,097 1,999 3,600 1,207 (2,393) 50,158 49,550 (608) 35,729 35,707 (22) 0 0 0 418,390 430,854 12,464 PMS Total 1,569,619 1,624,787 55,168 84,895 84,557 (338) 35,193 14,913 (20,280) 147,974 147,578 (396) 159,593 159,547 (46) 0 0 0 1,997,274 2,031,383 34,109 () / (() ) Grand Total 20,384,223 20,418,829 34,606 1,116,241 1,077,655 (38,586) 1,171,55721 1,157,361 (14,196) 2,868,904 2,841,528 (27,376) 2,037,989 2,047,799 9,810 0 361 361 27,578,914 27,543,532 (35,382)

Agenda Item 7

NHS England, MECCG and NEECCG Primary Care Commissioning Committee Meeting of 11 January 2017

IT and Premises Update

1. Estates and Technology Transformation Fund (“ETTF”)

A final list of schemes covering a 3 year period and split into 2 cohorts have been supported in principle by the NHS England national team. Cohort 1 schemes must be completed by 31st March 2017. Cohort 2 Schemes must be completed to an agreed timescale between 31st March 2018 and 31st March 2019. In order to achieve full approval to enable commencement all projects are now subject to due diligence. Bids that are supported in principle are not approved until due diligence requirements have been met and final approval is given for a scheme/project to proceed

Supported Cohort 1 schemes and their current status are shown below:

CCG Project Name Brief Description Status NE Essex Tollgate MC Extension to provide additional clinical Awaiting due diligence space – project likely to change Mid Kelvedon & Feering Reconfiguration to provide additional Awaiting due diligence Essex Health Centre clinical space - funding gap identified Mid Wyncroft Surgery Conversion of office space to clinical Awaiting due diligence Essex room NE Essex Clacton Hospital New build - Fees to work up OBC/FBC Approved NE Essex Tiptree Medical Centre New build - Fees to work up OBC/FBC Approved Mid Maldon Healthcare New build - Fees to work up OBC/FBC Approved Essex Reprovision Mid Witham Hub Surgery New build - Fees to work up OBC/FBC Approved Essex NE Essex GPIT Mobile/Remote Working Awaiting work programme Mid GPIT Mobile working Awaiting work Essex programme Mid GPIT Wifi Provision Awaiting work Essex programme Mid GPIT Video Conferencing Awaiting work Essex programme NE Essex GPIT Wifi Provision Awaiting work programme NE Essex GPIT NEE CARE IS Pilot and Rollout Awaiting work programme

In addition the following scheme originally submitted as an ETTT bid will now instead be funded as Premises Improvement Grant:

CCG Project Name Brief Description Status NE Creffield Road Reconfiguration to provide Awaiting due Essex Medical Centre additional clinical space diligence

22 Note that a number of Mid Essex CCG sponsored IT schemes now cover the whole of the Mid and South Essex STP area.

2. Other Premises Developments

The following updates on schemes within the pipeline should be noted:

Riverside, Manningtree: The lease has now expired a new lease is being negotiated.

A new portacabin is required as an interim measure whilst a longer term plan is identified. Costs have now been received and a PID is to be prepared and funding sought.

Wivenhoe Health Centre: A full business case has been approved. Currently awaiting a revised construction programme and finalised IT costs.

West Mersea: Currently on hold

Harewood Surgery - currently on hold, awaiting revised proposal

Beaulieu Park - awaiting commissioning decision before estates proposal can progress.

South Woodham Ferrers- PID approved, Business case to be prepared

Kennedy Way, Clacton: - Architect has been commissioned by NHSPS to draw up initial plans for review

St Lawrence, Braintree- Work on the new premises are underway. Completion expected March 2017

Abbeyfield, Colchester - Expression of Interest for premises improvements has been approved – awaiting Project Initiation Document – Currently on hold

Guidance Note: GP Practices serving

Atypical Populations

OFFICIAL

NHS England INFORMATION READER BOX

Directorate Medical Commissioning Operations Patients and Information Nursing Trans. & Corp. Ops. Commissioning Strategy Finance

Publications Gateway Reference: 06265 Document Purpose Guidance

Document Name Guidance Note: GP Practices serving Atypical Populations

Author NHS England / Primary Care Commissioning Publication Date December 2016 Target Audience CCG Clinical Leaders, NHS England Directors of Commissioning Operations, GPs Additional Circulation Heads of Primary Care List Description Small numbers of GP practices provide services to a patient population which is sufficiently different (“atypical”) to result in workload challenges that are not always recognised in existing contracts or funding allocations. This document outlines challenges faced by providers and offers examples that may help articulate and/or address these pressures.

Cross Reference N/A

Superseded Docs N/A (if applicable) Action Required N/A

Timing / Deadlines N/A (if applicable) Contact Details for Primary Care Commissioning Team further information NHS England 4W56, Quarry House Quarry House Quarry Hill, Leeds, LS2 7UE [email protected] 0 Document Status This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet.

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Guidance Note: GP Practices serving Atypical Populations

Version number: 1

First published: December 2016

Prepared by: Sarah Stephenson, Primary Care Commissioning Team

Classification: OFFICIAL

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Contents

Contents ...... 4 1 Introduction ...... 5 1.1 Purpose of this document ...... 5 1.2 Background to this work ...... 5 1.3 Call for evidence ...... 6 2 Context: General Medical Services (GMS) Funding Formula Review ...... 7 2.1 Commitments to reviewing primary care funding ...... 7 2.2 Existing GMS funding formula (introduced in 2004) ...... 7 2.3 What does the GMS funding formula not achieve? ...... 7 3 Background to developing this document ...... 8 4 Identifying ‘Atypical’ populations locally ...... 9 5 Unavoidably small and isolated ...... 9 5.1 Description of the Issues ...... 9 5.2 Information / data considerations ...... 10 5.3 Case studies ...... 10 5.4 Patient Group Observations ...... 12 6 University populations ...... 12 6.1 Description of the Issues ...... 12 6.2 Information/Data considerations ...... 13 6.3 Support Initiatives ...... 13 6.4 Patient Group Observations ...... 13 7 Practices with a high number of patients who do not speak English ...... 14 7.1 Description of the Issues ...... 14 7.2 Information/Data considerations ...... 15 7.3 Examples of support ...... 15 7.4 Patient Group Observations ...... 16 8 Conclusion ...... 16 9 Notes for NHS England commissioners ...... 16 10 Scheduled update ...... 16

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1 Introduction

1.1 Purpose of this document The General Medical Services (GMS) funding formula (Carr-Hill formula) is an attempt to fund practice workload, regardless of the population they serve. It is applicable to the vast majority of the UK, but there are some practice populations that are so significantly atypical that using the GMS funding formula would not ensure the delivery of an adequate general practice service. This working group has looked at three such atypical populations: unavoidably small and isolated; university practices and; those with a high ratio of patients who do not speak English.

Support for practices should directly impact on patient care as well as the long term viability of practices, and therefore commissioners are encouraged to undertake a review of identified practices in their area. By reviewing the practices in your area, commissioners and providers can identify practices that require such support. Without this support many practices will be unable to maintain the service and as a result health outcomes may suffer. Where available, The Learning Environment provides examples of support that commissioners are providing to some practices serving atypical populations.

1.2 Background to this work

Whilst the vast majority of GP practices serve communities that have common characteristics and work to contracts that have similar terms, conditions and funding arrangements, a small cohort of practices provide services to a patient population which is sufficiently demographically different to result in particular workload challenges that are not always recognised in the practice’s existing contract/s or its funding allocation. A population that triggers ‘uncommon’ workload challenges that are not experienced by the majority of GP practices is referred to here as ‘atypical’.

This document was produced to assist NHS England and delegated Clinical Commissioning Group (CCG) commissioners of 3 such atypical ‘populations’ by detailing the particular challenges faced by providers and offering examples of either provider or commissioner reports that may help either articulate or address these pressures. How members of the public relate to and use GP services is influenced by the accessibility of other services including, for example, pharmacy, A & E, Walk-In Centres and voluntary agency support infrastructure.

The populations are:

 Unavoidably small and isolated  University populations and  Practices with a significantly high ratio of patients who do not speak English including those services designed to address the needs of migrants.1

1 For the central Primary Care Commissioning Team, the project files include further background to developing this guidance’.

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This document guides commissioners to the types of issues and data sources they could consider in coming to a judgement about support that is relevant to their particular circumstance, where commissioners and individual practices have a shared concern about meeting the health needs of their patients.

This document outlines the additional needs of these patient groups, the pressures that providers face and the duty on commissioners to secure quality services which may legitimately require consideration of additional funding support.

In reading this document, commissioners and providers should be aware that services should be equitable for all population groups in line with the Public Sector Equality Duty (PSED) under the Equality Act 2010 and have regard to reduce health inequalities under the Health and Social Care Act 2012.

Promoting equality and addressing health inequalities are at the heart of NHS England’s values. Throughout the development of the policies and processes cited in this document, we have:

 Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it.  Given regard to the need to reduce inequalities between patients in access to, and outcomes from, healthcare services and in securing that services are provided in an integrated way where this might reduce health inequalities.

In addition, this guidance is designed to complement but not duplicate or replace other related support initiatives. As such it does not advocate any one service model over another, specify or advocate specific funding arrangements, specify financial arrangements for managing the workload associated with Temporary Residents or describe how to distribute the national programme funds2 supporting struggling practices to improve their sustainability and resilience over the short/medium term.

1.3 Call for evidence

Where available, this document also describes some examples of innovative practice to overcome challenges associated with serving the atypical populations. Hyperlinks to further information are included in this document where available. Over the coming months, where available, other examples will be posted on the free access Case Studies pin board of The Learning Environment.

If commissioners have further examples of local initiatives to address issues associated with ‘atypical practices’ please submit them to [email protected] with the heading ‘Atypical Populations: Call for

2 £10m Vulnerable Practice Programme (2016-17), £40m General Practice Resilience Programme (£16m 2016-17 and £8m p.a. for the following 3 years)

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To complement these case studies NHS England will consider the viability of commissioning a more detailed investigation into these cohorts of patients to properly understand the difference in workload and related pressures not recognised in the funding formula.

2 Context: General Medical Services (GMS) Funding Formula Review

2.1 Commitments to reviewing primary care funding

NHS England has committed to reviewing the GMS funding formula which underpins the capitation payments made to GP practices under the General Medical Services (GMS) contract. This commitment was confirmed in the General Practice Forward View. We are working with the BMA’s General Practitioners Committee, NHS Employers, the Department of Health and academic partners on the review to develop a formula that better reflects the factors that drive workload, such as age or deprivation.

2.2 Existing GMS funding formula (introduced in 2004)

The intention of the formula was to weight remuneration to reflect the comparative practice workload, complexity and the relative costs of service delivery based on the demographics of the patient list. As such the formula has two parts:

a. A workload part that provides an estimate of the workload for each GP practice based on its list size and various patient and practice characteristics; and b. A cost part that adjusts the payment for workload for variation in costs experienced by practices in different places.

The workload part is also used to inform the primary medical services component of the primary care allocation formula. It is recognised that due to the wide diversity of populations serviced by GP practices, a national formula will never be able to accommodate the workload needs of all practices, hence the need for guidance on atypical practices.

2.3 What does the GMS funding formula not achieve?

It has been suggested that the GMS funding formula could be improved upon in a number of ways:  The data that make up the formula requires updating (some of the data are more than ten years out-of-date)

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 Factors currently included do not adequately reflect the workload associated with older people who may not be living in nursing or residential care and have a range of complex co-morbidities  The impact of deprivation has been questioned and all the weightings will need to be reviewed.

It is acknowledged that no formula will address the particular characteristics of ‘atypical’ populations hence this guidance.

3 Background to developing this document

A joint workshop between NHS England, the British Medical Association’s (BMA) GPs’ committee, Local Medical Committee (LMC) representatives and NHS Employers was convened in September 2015 to:

 Provide a list of propositions on atypical practices and views on whether these could or could not be reflected in a formula  Identify those characteristics that will never be fully met by a formula, and  Aid a description about the characteristics of a practice where it is likely that some additional support is required due to the practice characteristics not being fully recognised by any formula approach.

The information used at that workshop has been used as the basis for this paper focusing on 3 specific cohorts, agreed with the BMA’s GPs’ committee:  Unavoidably small and isolated (from other practices and other NHS services) with static populations  University practices  Practices with a significantly high ratio of patients who do not speak English including those designed to address the needs of migrants (Asylum seekers are excluded from the scope of this work as it is recognised this group requires a more specialised service).

These populations were chosen as priority areas because:  Small and isolated practices have particular challenges when meeting demand from dispersed rural communities. Opportunities to develop primary care working ‘at scale’ are more limited and population growth is slower, impacting on the available primary care budget  Anecdotal evidence tells us that university practices (in particular campus- based services) have a population that consults general practice more than expected for their age and health (e.g. in terms of mental health and sexual health issues)  Practices supporting a significant number of patients that do not speak English have operational complications associated with communication problems (this also links to a separate NHS England work stream on translation and interpreting).

A working group was convened in Spring 2016, comprising NHS England and Clinical Commissioning Group (CCG) commissioners, LMC representatives, a BMA

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4 Identifying ‘Atypical’ populations locally

Because of the degree of variation nationally in terms of health and social care economies and patient expectation, demand and behaviour, there is no one method of identifying which populations could be considered as atypical. There are however a number of examples of how commissioners have scoped the issues and what data sources they have used (an example from Devon can be found on The Learning Environment’s case studies pin board).

5 Unavoidably small and isolated

5.1 Description of the Issues

 Practices serving small but dispersed populations have limited ways in which to influence their income or costs yet provide a vital primary care service  Their funding is governed by their registered list (global sum / QOF payments) which, by the nature of their geography, cannot be expanded and may compromise the ability to deliver quality care and exacerbate workload pressures  Because of their location they are often serviced by small B class roads, potentially making travel difficult and time consuming for patients and service providers  Many such communities do not have easy access to a pharmacy or an A&E Department, ambulance access and response times can be longer than in an urban environment and community services are diluted  Public transport makes it difficult for patients to attend outpatient departments and other health facilities. As a result, some patients tend to rely on practices to provide a wider range of services than is normally regarded as ‘core’ general practice and staff require regular training to maintain their skills for providing first response in the absence of A&E. It may be hard to measure this effect but it can be summarised as a greater independence by patients from hospital care and a higher level of intervention and support from the practice  Engagement of GP locums or recruitment of successors to a contract can be problematic because of geographic isolation, income and potential workload pressures. It is recognised that country or island life is not everyone’s preference  Housing costs associated with ‘desirable’ or expensive country or island locations can also negatively impact on recruitment of practice administrative staff  Some rural locations attract itinerant workers who may not speak English, have no accessible medical record and consultations take longer.

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5.2 Information / data considerations

Here are some data sources or information that you may wish to consider when trying to define if a population is atypical:

 The average population density and average distance from patient residences are both available for individual practices and, when considered in conjunction, may produce some useful insights. It should be noted that population density is measured in persons per hectare (calculated from the population density of the relevant electoral ward) and distance to main surgery is measured in 100 metre units (as the average distance from patient’s home to main surgery location). It may be useful to consider practices that rank in the top percentiles for both indicators, to help in reaching a judgement about relative rurality and isolation. These data are available as an extract from the Exeter system  Ambulance response times (available from the local Ambulance Trust on request by the lead commissioning CCG in your area)  Current Service profile: does the practice provide additional or extra services that are not commonly available in other practices and not additionally funded. Could these be captured in a bespoke enhanced service, set of KPIs or added formally into a PMS agreement? Examples may relate to the absence of locally accessible health and social care services  Does the total practice income adequately cover the cost of providing services? Data sources that you could use to compare practices in your area include:  General Practice Expenses, GMS and PMS Contracts in England 2013/14 (NHS Digital, published July 2016)3  Adjusting the General Medical Services Allocation Formula for the unavoidable effects of geographically-dispersed populations on practice sizes and locations (Deloitte, published 2006) 4  NHS Payments to General Practice, England, 2015/16 (NHS Digital, published July 2016).

5.3 Case studies

The case studies listed below are not an exhaustive list. Commissioners and providers can review these case studies, tailor them to their local area as required, and / or decide on other support arrangements that might be appropriate:

 Contract for primary care support to secondary care (e.g. pre-operative assessments, post-operative wound checks and suture removal)

3 The report finds that there is no reduction in expenses per patient as practices grow. The data are basic and commissioners may want to consider the point below which a list size is too small for a WTE GP. 4 This document’s value might be limited as it is 10 years’ old and the data cannot be refreshed as the datasets are not available.

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 The ‘My Life A Full Life‘ programme is a collaboration between NHS Isle of Wight Clinical Commissioning Group, Isle of Wight NHS Trust, Isle of Wight Council, Community Action Isle of Wight and other local voluntary sector organisations. Its aim is to change the face of social and health care on the Island, helping people live life to the full. Objectives are to achieve a more co- ordinated approach to the delivery of health and social care services for older people, and people with long term conditions  First Responders such as Rural Responders in Suffolk supporting East of England Ambulance NHS Trust and Community First Responders supporting South Western Ambulance Service  Dorset Community Action’s Navigator Pilot was a collaboration with Dorset CCG as part of the Better Together programme. The pilot aimed to improve integration of care to provide more efficient use of resources and improve patient experience by supporting practitioners to refer patients to support services . Its key aims were to:  Manage long term conditions, especially those amongst the increasingly large cohort of older people living in, and migrating to, Dorset  Reducing the demand (need) for high cost care (acute hospital interventions, and long term residential and nursing care)  Enabling much more care to be delivered locally and enabling people to live independently for as long as possible  Village Agent schemes or Link schemes:  Somerset: Work with all ages. A number of clients are elderly and involve social care issues. Village Agents also have the role of helping to shape services by feeding back to the appropriate body information about gaps in service e.g. transport provision. They can also motivate and support a community to respond to a local need by working together to address issues e.g. by helping them to set up a coffee morning for a group of lonely people or start a volunteer car scheme. A Village Agents pilot project is using the social prescribing model, taking referrals from GPs and assisting with care planning for patients. A second pilot is taking referrals from social workers at the area’s Adult Social Care Hubs  Bedfordshire: Supported 950 clients over the financial year (with an average three visits per client) delivering a range of outcomes that included accessing health and housing services, getting home adaptations, obtaining mobility aids, take-up of benefits and tackling isolation through transport  Gloucestershire: The Village Agents support older people living in the area. Reports on their projects are here and case studies can be found here. Polish speaking agents are employed to support the local Polish community  Wiltshire: The Link Schemes are community-based initiatives that aim to improve the quality of life for disadvantaged, elderly or infirm people by providing a structured good neighbour service delivered by volunteers from within the local community. The range of Link Scheme services varies from providing volunteer drivers to take someone to a medical appointment, taking them shopping or to visit an old friend, or

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simply providing good neighbour care. They aim to complement the provision of other services, whether statutory or voluntary.

5.4 Patient Group Observations

Support services provided by volunteers and community groups act as a link between statutory services and the local community (some examples are listed in the Case Studies section above). They are well-placed to work across various isolated groups and share good practice as needed. Services such as those in Dorset (Dorset Community Action’s Navigator pilot as part of the Better Together programme) and the Isle of Wight (My Life A Full Life)) operate at a strategic level to bring providers and commissioners together to address issues and find solutions. The key challenge is that all these services need support by commissioners and funding in some way, so that there is a whole system approach. This support is not free, but can be tailored to meet the needs of statutory providers and help to fill gaps and is cost effective, flexible and resourceful in its approach.

Provided by Paul Dixon, Action with Communities in Rural England

6 University populations

6.1 Description of the Issues  Some practices serving university populations are not able to earn as much QOF funding due to the low prevalence of disease. There is an assumption by some that service provision is less onerous due to low disease prevalence.  Anecdotally, it is believed that: o Since many students are living independently for the first time, this can be a time when they experiment by engaging in behaviours that affect their health and need for service interventions e.g. around alcohol and drug use and sexual activity, leading to a higher than average demand for services related to these. In addition, for students who do not have access to immediate family support, there can consequently be a greater need for primary care services especially in respect of mental health support o Students can present with minor ailments or with seemingly unfounded worries about their wellbeing. For those who have moved away from home and are living independently for the first time it is important that they are provided with information about the range of primary care services available including pharmacy as well as online sources of support (i.e. supported to develop “health literacy”) o A significant number of students with long term and complex health needs attend university (e.g. CF, transplants, MS, asthma, diabetes) and transition to new primary care and secondary care arrangements, if they are leaving home, is important as is support for transition to adult services which can take place during the university years. o For foreign students, a lack of familiarity with the country and how health services work can create additional demand for GP practices to

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signpost patients to more appropriate services or lead foreign students to go directly to A&E which leads to additional demand on CCG resources o In addition some foreign students may have greater health risks/needs (e.g. TB, hepatitis)  Additional administrative effort required to register large numbers of new patients in September / October and de-register in the summer.

6.2 Information/Data considerations

Here are some data sources or information that you may wish to consider when trying to define if a population is atypical:

 Comparative consultation rates (if local data available)  Prevalence of disease not covered by QOF, particularly mental health  Per-patient weighted funding level provided by global sum  Registration data in September – October to identify student registrations and de-registrations over the summer.

6.3 Support Initiatives

The case studies listed below are not an exhaustive list. Commissioners and providers can review these case studies, tailor them to their local area as required, and / or decided on other support arrangements that might be appropriate.

 GP Champions for youth health project - funded by the Department of Health  Promotion of online support tools for young people e.g. NHS Go app  Using technology to reduce administration e.g. text message results service, online administration e.g. updating address (University Health Centre, Sheffield)  Local QOF or Local Enhanced Service for specific needs of the population  Skype consultations e.g. Newham’s young people with diabetes project  Shared care between ‘home’ and university-based health care services can help support adherence of and management of long term conditions for young people.

6.4 Patient Group Observations

 There is a risk that primary care practitioners expect young people to behave in a particular way. It is important that assumptions aren’t made about young people based on their age or that all university students behave the same way  The issue that a young person may present with may not be the real reason they have attended. Young people need to feel confident to trust a clinician. Clinicians need to be skilled in recognising where there may be an underlying issue and give the young person the confidence to reveal it during a consultation

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 Young people are undergoing a significant transition when they start university and having a trusted primary care practitioner to talk to can be extremely significant. They need to have information about the range of health services which exist so that they can be confident to seek help from primary care, pharmacy, A&E etc.  Young people may wish to attend services with their peers. Practice staff should not be surprised if students attend in a group to support each other using health services, in the same way that younger children attend with a parent or carer. If a peer wishes to sit in on a consultation clinicians should ensure that part of the consultation is with the patient alone – this would also be recommended for young people attending consultations with parents or carers  There is a unique opportunity to increase university students’ awareness of how to use health services appropriately which has long term benefits for the health service  Young people with long term conditions need to access repeat prescriptions quickly when they move to university to avoid gaps in medication. Foreign students don’t always recognise drug brand names and often do not understand how to access medication.

Provided by Emma Rigby, Association for Young People’s Health

7 Practices with a high number of patients who do not speak English

Some practices have a high ratio of patients who do not speak English, including practices designed to address the needs of migrants.

Asylum Seekers: The working group had initially intended to include asylum seekers as part of the non-English speaking atypical group. However it became clear that the needs of asylum seekers may go beyond “ordinary” primary care. There are often significant levels of Post-Traumatic Stress Disorder (a result of trafficking, torture, violence, rape (for women, children and men) and illness (e.g. HIV, Hepatitis B / C, TB)).

Note: A separate work stream to this Atypical Population work stream is ongoing in NHS England’s Primary Care Commissioning Team on translation and interpreting services. Further information can be found here. Another separate work stream to the Primary Care Team’s translation and interpreting project is ongoing between the Race Equality Foundation and NHS England’s Equalities Team to scope the viability of a community languages information standard.

7.1 Description of the Issues

 The need for an interpreter means that all conversations take longer and increases the cost of each patient contact (in relation to time taken and the cost of interpreting)

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 If interpreting is not available, miscommunication increases the risk of patients not attending follow up appointments and delayed access to care  Surrounding support services (e.g. IAPT, obesity management) and literature are usually in English, thus necessitating the development of additional in- house support  Lack of literacy, both in English and for some groups their native language, removes the value of written material normally used to reinforce appropriate access (e.g. appointments) and health advice  In addition the lack of cultural understanding of the NHS requires extra support, signposting and often the recalibration of patient expectations  Some patients have a basic lack of health education - for instance no knowledge of terms that describes cholesterol or calories, or the importance of taking medication correctly.

7.2 Information/Data considerations

Here are some data sources or information that you may wish to consider when trying to define if a population is atypical:

 Evidence of languages spoken and percentage of list  Percentage of patients requiring an interpreter (recognising that the level of support may decrease over time for some patients as they learn English)  Consultation rates compared to the average and whether different language groups consult more, and what the reasons may be for this  Reported average length of consultation  Demand for interpreting (spoken word) and translation (written word) support services and growth in demand over time.

7.3 Examples of support

The examples cited below are not an exhaustive list. Commissioners and providers can consider these, tailor them to their local area as required and / or decide on other support arrangements that might be appropriate. Where available, documents have been added to The Learning Environment Case Studies pin board.

 Funding that recognises increased consultation times / access  Education materials available in community languages  Acknowledgement of costs associated with interpreting, either in contractual payments or a provided service (Local Enhanced Service)  Public Health support for staff to help manage different needs of patients (e.g. hepatitis B vaccinations)  Additional training for staff in public heath messaging / realistic health interventions e.g. patient issues surrounding diet, behaviours and expectations of services  Screening for patients new to the UK for communicable diseases

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 Staff training on the use of interpreters particularly recognising where a patient is uncomfortable with the interpreter and knowing what action to take if staff question the quality of the interpreting service  Bilingual receptionist or in-house interpreting.

7.4 Patient Group Observations

Professional interpreters are the preferred means of communication and may also have knowledge of medical language. In addition, family interpreting may not be appropriate where the procedures or consultations are of a sensitive or intimate subject. Family interpreters may have no, or limited, medical knowledge.

Provided by Samir Jeraj, Race Equality Foundation

8 Conclusion

We hope that this document will enable local commissioners to identify and support the practices that serve these populations in order that patients will continue to receive effective primary care. Further examples of case studies can be submitted to the Primary Care Commissioning Team by e-mail to be shared with colleagues across the country via The Learning Environment.

9 Notes for NHS England commissioners

When discussing this topic locally, please be aware that you may need to review equalities and health inequalities and the 13Q duty to consult. Copies of supporting documents completed for this project are available in the project files. Please contact the Primary Care Commissioning Team for more details by e-mailing [email protected] or calling 0113 825 1244 (PCC Team use: the files are kept here on the shared drive).

10 Scheduled update

This document is not scheduled to be updated. Further examples of local initiatives or case studies will be added to The Learning Environment website as they become available.

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Agenda Item 11

NHS England, MECCG and NEECCG Primary Care Commissioning Committee Meeting of 11 January 2017

Merger of Abbey Field Medical Centre and Hawthorn Surgery

Submitted by: Adrian Thrower, Primary Care Commissioning Officer (NEE)

Presented by: Alison Cowie, Head of Commissioning

Status Decision

GP Practices GMS F81095 Abbey Field Medical Centre

GMS Y00484 Hawthorn Surgery

New Partnership Name – Abbey Field Medical Centre

1 Information and Decision At the meeting on 16th November PCJCC approved an application from 2 GMS Practices in North East Essex CCG area to merge their GMS contracts and form one practice, operating from 3 sites with effect from 1st April 2017. Since that time the practice have asked to reduce the hours at the Hawthorn Surgery to 8.00am to 2.00pm with no evening surgeries.

2 Summary Hawthorn surgery has been running with one principal GP supported by locums. Abbey Fields Medical Centre has had an advert placed with a view to recruiting another full-time doctor but to date have been unsuccessful in recruiting. Before patient engagement is started more actively the practice are seeking NHS England’s endorsement of the reduction in hours at Hawthorn as the way forward. If the practice are successful in recruiting then this would revert back to morning and evening surgeries. Patient can access services at any of the three sites.

3 Finance There are no financial implications to NHS England or NE Essex CCG from this proposal other than those previously identified around the merger of the clinical systems.

40 Introduction

Hawthorn’s surgery is located between Abbey Field MC and their branch surgery in Elmstead Market 5 miles away.

Practice Address List Size Boundary Map Hours GMS F81095 Ypres Road, 12,917 8.am - 7.pm Abbey Field Colchester, See Appendix 1 MC CO2 7UW

Chapel Lane 1,400 8.am - 6.30pm Elmstead Includes See Appendix 2 Market, 1,228 Colchester, dispensing CO7 7AG GMS Y00484 St Edmunds 5,030 8.am - 6.30pm Hawthorn Centre, See Appendix 3 (Proposed 8.am Surgery Tamarisk Way - 2.00pm) CO4 3GW

Background

The practice have considered a number of options, namely:

1) Reviewing the opening hours across all three sites. The practice felt they cannot reduce the hours at Abbey Fields and Elmstead having only just increased them as part of the previous merger between Portland and Abbey Fields. 2) Increase the nurse practitioner input instead of the another GP The practice felt that nurse practitioners were just as hard to recruit as GPs and they also should operate in a supported environment and are not best suited to isolated/remote working. 3) Redefine practice boundaries to reduce practice workload The practice did not want to consider reducing their patient list as a way of managing this situation. The practice plan is to build their list not to reduce it with a view to fulfilling the criteria to become a hub.

Recommendation

NHS England is generally supportive of merger proposals so long as they are in the best interests of patients and they meet the expectations the CCG hub and spoke model.

Decision

The PCCC are asked to approve the reduction in hours at Hawthorn Surgery as part of the merger with Abbey Fields .

41 GP Practice Boundaries Appendix 1 The boundary area for patients registering with the GP Practice

Abbey Fields Medical Centre $

Boundary

42 0 0.15 0.3 0.6 Contains Ordnance Survey data Crown copyright and database right 2011 Essex Public Health Intelligence March 2013 Miles ´ GP Practice Boundaries Appendix 2 The boundary area for patients registering with the GP Practice

F81672 Portland Road Surgery Branch $

Inner Outer 43 0 0.175 0.35 0.7 Contains Ordnance Survey data Crown copyright and database right 2011 Essex Public Health Intelligence January 2013 Miles ´ GP Practice Boundaries Appendix 3 The boundary area for patients registering with the GP Practice

Y00484 HAWTHORN SURGERY $

Inner Outer 44 0 0.2 0.4 0.8 Contains Ordnance Survey data Crown copyright and database right 2011 Essex Public Health Intelligence December 2012 Miles ´

Agenda Item 12

NHS England, MECCG and NEECCG Primary Care Commissioning Committee Meeting of 11 January 2017

Exercise of Emergency Powers – SAS Procurement

Submitted by: Viv Barnes, Director of Corporate Services MECCG

Status To note

1 Purpose The Committee is asked to note the decision made under the exercise of Emergency Powers on 13 December 2016 to commission Beacon House to deliver SAS services in North East Essex on a short-term contract from 1st January 2017 until 30th September 2017.

2 Summary Nestor Primecare Services Ltd served notice on their contract to deliver the Special Allocation Scheme (SAS, also known as the Violent Patient Scheme) in North East Essex, with effect from 31st December 2016. Interim arrangements were therefore required to maintain this essential service provision until an Essex-wide procurement is completed in September 2017.

3 Finance No financial implications to NHS England or NE Essex CCG were highlighted in relation to this proposal.

Introduction

Under their respective Standing Orders, the Boards and committees of Mid Essex and North East Essex CCG are permitted to exercise their powers in an emergency or where urgent decisions need to be made that cannot wait until their next formal meeting. In the case of the Primary Care Commissioning Committee, such decisions may be made by the Chairman after having consulted at least one NHS England member and one member from each CCG affected by the decision.

The exercise of such powers by the Chairman shall be reported to the next formal meeting of the Primary Care Commissioning Committee in public session for formal ratification.

Recommendation

The request for the exercise of emergency powers was supported by NHS England and North East Essex CCG, subject to a caveat from the latter that it should be made clear that this is a temporary arrangement and that a Tendring base is specified in the future procurement.

Decision

The Committee is asked to endorse the emergency powers decision, a copy of which is attached for information.

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Agenda Item 13 ii)

REPORT TO THE MID ESSEX, NORTH EAST ESSEX & NHS ENGLAND PRIMARY CARE COMMISSIONING COMMITTEE

Meeting Date:

Agenda No:

FOR DECISION / INFORMATION

Report Title: Executive Sponsor:

Presented by: ______

1. Summary

2. Key Points to Note

3. Risks Identified

4. Accountability

5. Resource Implications

6. Strategic Objectives

7. Impact on Commissioners & Providers

8. Finance Impact

Q1 Is investment required?

Non- In-year £ Full year £ Yes No Recurrent recurrent requirement requirement

Q2 What is the net impact of the proposal? (after any investments)

Negative - Neutral - Positive - Cost pressure No budget impact QIPP available £

48 Q3 What is the impact of the proposal?

Non- In-year £ Full year £ Recurrent recurrent requirement requirement

Negative - Neutral - Positive - Cost pressure No budget impact QIPP available £

Q4 What is the current budget position?

Existing annual budget available: Current year-end forecast expenditure on this budget Budget code: Management account lead name:

9. Implications for Engagement and Communication

10. Equality and Diversity

11. Recommendation