Governing Body
To be held on Thursday 17 May 2018
From 1pm until 4pm in the Boardroom, Sovereign House, Heavens Walk, Doncaster DN4 5HZ
Governing Body To be held on Thursday 17 May 2018 Commencing at 1pm – 4pm In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ
PUBLIC AGENDA
Presenter Enc
1. Welcome and Introductions Chair Verbal
2. Apologies Chair Verbal
3. Declarations of Interest Chair Verbal
4. Questions from Members of the Public Chair Verbal (See our website for how to submit questions – required in advance)
5. Minutes of the previous meeting held on 19 April 2018 Chair Enc A
6. Matters Arising Chair Verbal
Strategy
7. Public Health Annual Report Dr Suckling Enc B
Assurance
8. Quality & Performance Report Mr Russell & Enc C Mr Fitzgerald • Spotlight Report on Planned Care • Spotlight Report on Primary Care
9. Finance Report Mrs Tingle Enc D
10. Corporate Assurance Quarter 4 Report Mrs Devanney Enc E
Standing Items
11. Chair & Chief Officer Report Dr Crichton Enc F
12. Locality Feedback Locality Leads Verbal
Items to Note/Receipt of Minutes
13. Receipt of Minutes Chair Enc G
• Quality & Patient Safety Committee – Minutes of the meeting held on 15 March 2018. • Executive Committee – Minutes of the meeting held on 4 April 2018. • Primary Care Commissioning Committee – Minutes of the meeting held on 8 March 2018.
14 Any Other Business Chair Verbal
15. Date and Time of Next Meeting Chair Verbal
Thursday 21 June 2018 at 1pm in the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ
To resolve that representatives of the press, and Chair other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest Section 1(2) Public Bodies (Admission to Meetings) Act 1960.
Verbal
Item 1
Welcome & Introductions
Verbal
Item 2
Apologies for Absence
Verbal
Item 3
Declarations of Interest
Verbal
Item 4
Questions from Members of the Public
Enc A
Item 5
Minutes of the previous meeting
Minutes of the Governing Body Held on Thursday 19 April 2018 commencing at 1pm In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ
Members Dr David Crichton – NHS Doncaster CCG Chairman (Chair) Present: Body Miss Anthea Morris – Lay Member and Vice Chair of the Governing Mrs Linda Tully – Lay Member Mrs Sarah Whittle – Lay Member Dr Emyr Wyn Jones – Secondary Care Doctor Member Dr Nick Tupper – Locality Lead, Central Locality Dr Jeremy Bradley – Locality Lead, North East Locality Dr Marco Pieri – Locality Lead, North West Locality Dr Niki Seddon – Locality Lead, North West Locality Dr Khaimraj Singh – Locality Lead, South East Locality Mrs Jackie Pederson – Chief Officer Mrs Hayley Tingle – Chief Finance Officer Mr Andrew Russell – Chief Nurse Formal Mrs Lisa Devanney – Associate Director of HR and Corporate Services Attendees Mr Anthony Fitzgerald – Director of Strategy & Delivery present Dr Victor Joseph – Public Health Representative (Attending on behalf of Dr Suckling) Mr Andrew Goodall – Healthwatch Doncaster Representative (Attending on behalf of Mrs Hilditch)
In Mrs Jayne Satterthwaite – PA (Taking Minutes) attendance: Mr Ian Carpenter - Head of Communications & Engagement Mrs Cath Doman – Director of Health & Social Care Transformation (Item 7) Mr Ian Boldy – Head Safeguarding Adults and Individual Placements (Item 8) Mrs Karen Tooley – Lead Nurse for Care Homes (Item 8) Mr Gareth Jones – Governance Manager (Item 11)
ACTION
1. Welcome and Introductions
Dr Crichton welcomed everyone to the Governing Body meeting.
There were 4 members of the public in attendance at the meeting.
2. Apologies
Apologies for absence were received from:
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• Dr Rupert Suckling – Director of Public Health • Mrs Deborah Hilditch – Healthwatch Representative (Attending on behalf of Mr Stephen Shore) • Mr Damian Allen – DMBC Representative
3. Declarations of Interest
The Chair reminded members of their obligations to declare any interest they may have on any issues arising at meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group.
Declarations declared by members are listed in the CCG’s register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link www.doncasterccg.nhs.uk
The meeting was noted as quorate.
Declarations of interest from sub-committee/working groups:
None declared.
Declarations of interest from today’s meeting:
Dr Crichton informed the Governing Body that a partner at his GP practice has been elected to the Board of the GP Federation and that he has completed a new Declaration of Interest Form accordingly.
All GP locality Governing Body members have a pecuniary conflict of interest in respect of Item 12 Clinical Leadership/Constitutional Changes. Having sort advice from the corporate governance lead it was agreed that they may remain in the room and take part in discussions, take into account the Nolan principles and accept any recommendations made.
4. Questions from Member s of the Public
There were no questions received from Members of the Public.
5. Minutes of the Previous Meeting held on 15 March 2018
The minutes of the meeting held on 15 March 2018 were agreed as an accurate record subject to the following amendment:
6. Matters Arising
Refreshing NHS Plans for 2018/2019 – Planning Guidance – Maternal
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Smoking
Dr Joseph reported that he did not have an update on the recruitment process into smoking in pregnant women and Dr Crichton asked that this be concluded outside of the meeting.
Delivery Plans
Mr Fitzgerald reported that patient experience has now been added to all Delivery Plans and that the Engagement & Experience Committee completes a ‘Deep Dive’ into 2 Delivery Plans per meeting.
Mr Russell informed the Governing Body that as the Care Home Delivery Plan becomes more formed additional data regarding A&E attendances will be included.
Healthwatch Doncaster published report and recommendations on
missed hospital appointments
Dr Crichton requested that Healthwatch Doncaster and Public Health Mr Goodall/ liaise outside of the meeting regarding the child friendly charter. Dr Joseph
7. Commissioners Agreement
Mr Fitzgerald presented the Commissioners Agreement to the Governing Body. Dr Crichton highlighted that there had been an anomaly on the page numbering when the document had been converted into an Adobe PDF document.
Mr Fitzgerald summarised the work undertaken by both NHS Doncaster CCG and Doncaster Council and the background to the development of the Agreement as follows:
• In 2017 the Doncaster Place Plan was developed and is a proposal toward integrated commissioning. • In November 2017 a Memorandum of Understanding was developed and is an intent toward integrated commissioning. • In April 2018 the Commissioning Agreement formalised our approach. It is a legally binding framework which commits the CCG and Doncaster Council to the development of place plan during 2018/19. It delegates commissioning responsibilities for 7 Areas of Opportunity (in first instance) to the Joint Commissioning Management Board (JCMB) and it describes the portfolios of work during the “Shadow Year” and ensures momentum. • The Commissioning Agreement is not a Section 75 agreement, it does not cover all CCG commissioning responsibilities, does not take away the required statutory responsibilities of the CCG (e.g Financial Balance, 4 hour A&E target etc). The financial arrangements will be complex and we are dependent on robust relationships to get us to a full Section 75 agreement. • The agreement will be aligned to the Provider Collaboration
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Agreement (PCA) and will not affect existing contracts with providers. • By 1 April 2019 we will work to fulfil the new Section 75 arrangements. • The Commissioners Agreement will be presented to the Doncaster Council Cabinet for approval on 24 April 2018.
Mr Fitzgerald asked that the Governing Body note the progress achieved by the Doncaster Place Plan partners and to approve the 2018/2019 Joint Commissioners Agreement on behalf of NHS Doncaster CCG, noting that this is a legally binding agreement, delegating authority to the Joint Commissioning Management Board for commissioning decisions associated with the delivery of the Doncaster Place Plan.
Mrs Whittle asked if the document would be presented to the Governing Body again if the Cabinet wished to make changes. Mr Fitzgerald advised that delegated authority has been given to Mrs Doman, Director Health & Social Care Transformation and Mr Allen, Director of People Learning and Opportunities: Children and Young People/Adult Health & Wellbeing Directorate, DMBC however it is not anticipated that any major challenges will be made.
Mr Goodall queried if the Agreement is not a Section 75, how money will be spent appropriately and what assurance may be given regarding engagement with the community. Mrs Tingle stated that the arrangements regarding finances are complicated and has not yet been finalised. Finance still currently sits with respective organisations; going forward we will move to pooled budgets. Notwithstanding the 7 areas of opportunity the public will be addressed on areas for concentration.
Dr Jones commented that it is an imaginative agreement and underpins our approach to collaborative working. He requested that, as we progress to a Section 75, that the Governing Body is kept aware of proceedings in order that we may remain assured and evaluate how it is functioning. Mrs Doman stated that the forthcoming year will focus on evaluation and business intelligence. Mr Russell added that we will work with Doncaster Council on a joint approach to quality assurance and look at our skill set to develop a good quality assurance framework.
The Governing Body noted the progress achieved by the Doncaster Place Plan partners and approved the 2018/2019 Joint Commissioners Agreement on behalf of NHS Doncaster CCG, noting that this is a legally binding agreement, delegating authority to the Joint Commissioning Management Board for commissioning decisions associated with the delivery of the Doncaster Place Plan.
8. Quality & Performance Report
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Mr Fitzgerald stated that the report is for noting by the Governing Body however wished to highlight the following points:
NHS Doncaster Clinical Commissioning Group (CCG)
• The percentage of patients waiting on a Referral to Treatment pathway less than 18 weeks at the end of February fell slightly to
90.2% against the 92% target and it is anticipated that it will fall again in March 2018. Work is being undertaken on waiting list management. • The percentage of people receiving a diagnostic test within 6 weeks increased to 99.0% and met the target for February 2018.
• Cancer measures – Performance underachieved for 2 week waits; (92.4% against a target of 93%), waits for breast symptoms (91.9% against a target of 93%), 31 day waits for radiotherapy (92.7% against a target of 94%) and screening (83.3% against a target of
90%) during February 2018. • A&E performance improved to 93.3% in March though remained below the 95% national target.
Rotherham, Doncaster & South Humber NHS Foundation Trust
(RDASH)
• IAPT access rate - nationally the service is required to meet 4.2% during Quarter 4. Performance during January and February 2018 for RDASH services show that 2.6% of the estimated population
accessed the service. It is anticipated that the service will have given access to 16.8% during 2017/2018 which was the stated overall national aim. It is anticipated that RDaSH will fail to meet the target and this has been addressed with the Trust however the overall target for the year is good. Mrs Pederson commented that
this is disappointing and reported that she has raised this with Mrs Singh, Chief Executive RDaSH who is unsure why the target has not been met. Dr Seddon suggested that the recent inclement weather may have contributed; a new triage pilot is to commence in May 2018 which may help going forward.
Mr Russell raised A&E performance and stated that the data from the Yorkshire Ambulance Service (YAS) is aggregated and gives an average time as a whole. It is important to understand the Doncaster position and to receive local data. Doncaster performs well and turnaround is good. A decrease in performance for ambulance handover times is noted and the Acute Trust and YAS have worked hard to handover patients into care and the ambulance crews available. Overall the numbers of Serious Incidents (SIs) are aggregated but are not Doncaster related.
Dr Tupper queried the 9 breaches relating to the Out Of Hours 1 hour Mr visit and requested clarity on how many were related to End of Life or Fitzgerald palliative care.
Spotlight on Medicines Management Delivery Plan.
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Mr Russell gave the following update on the Medicines Management Delivery Plan:
• The Medicines Management team is now undertaking actions for 2018/2019. • There has been much positivity regarding the successes of the team particularly regarding Quality Innovation Productivity and Prevention
(QIPP) and it is difficult to demonstrate the hard work which has been undertaken to reduce spending. There will be challenges ahead particularly gluten free prescribing. • The forthcoming year brings challenges regarding QIPP and plans
will be in place to work across the Integrated Care System (ICS) to optimise a suite of actions for savings. • Work has been undertaken on safety and quality and access to the minor ailment scheme has been increased for next year.
Dr Seddon commented that the work done on reducing the use of Pregabalin has also helped. The North West Locality has voiced its concerns regarding the lack of support from the Medicines Management Team and queried if NHS Doncaster CCG has been successful in recruiting into the team. Mr Russell advised that we have recruited into a vacancy and there remains one vacancy within the team. Discussions will be held to determine how the CCG can support General Practice in the future. Dr Crichton acknowledged that there has been a period of gaps in the structure and that the appointment into the Head of Medicines Management will be welcome.
Mrs Whittle advised the Governing Body that Mrs Bradley, Deputy Head of Medicines Management has attended an Engagement & Experience Committee (EEC) meeting to update on waste management and how this will be taken forward. Mr Russell added that this is also part of the ICS agenda.
Dr Crichton informed the Governing Body that NHS Doncaster CCG will hold its Annual Review meeting with NHS England on 25 April 2018 and with regards to antibiotics usage we have not benchmarked as well against other CCGs.
Dr Crichton thanked Mr Russell for the update.
Spotlight on Care Homes Delivery Plan
Mrs Tooley gave the following presentation on the Care Home Delivery Plan:
• The Care Home Strategy key priorities include: o High quality care. o Reduce premature admission to care homes. o Reduce hospital attendances and admissions. o Reduce out of area complex placements. o Skilled work force. o Commission for outcomes.
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o Engage with the market.
• The 2018/2019 key pieces of work include: o Continued Care Home Stakeholder engagement. o Processed and agreed priorities: Primary Care support and Care Planning. What does good look like? How do we measure core and
advanced care? Workforce development. Development of Community Provision. Red bag implementation.
• Primary Care support for Care Homes: o 2017/2018 mapped current support. o Identify Doncaster models and opportunities. o Horizon scan for best practice models. o Engage with trial sites to develop and roll out principles of
support. o Joint Advanced & Emergency Care Planning embedding actions within care homes. o Resident and staff experience measures. o Develop outcome measures.
• Core and Advanced Care: o Core and Advanced Tool – developed with Health & Social Care colleagues and Sheffield Hallam University. o Tested the tool, developed data capture and analysis methods. o Write methodology. o Identify cohort and trial sites. o Conduct a review and report findings.
• Workforce development: o Locality development – 4 localities across the Doncaster area. Members comprise of Care Homes Peers, Independent Strategic Lead Partnerships (Local Authority). o Live Booking System – launched January 2018. Book courses in
‘real time’. o Communication Hub – Jointly hosted ‘HUB’ to ensure Same Message – Same time. o Carer Career Pathway - Improving the ‘offer’ to carers with a career pathway working alongside locality peers/local & regional
education providers/Skills for Care. o Induction Programme - Programme development for ‘Work ready’ carers. Linked nationally through Expert Reference Group Member (ERGM) at Skills for Care, regionally through SYREC. o CCAST Integrated Competency Tool – ‘Care and Clinical
AssesSment Tool’. Currently developing with primary care and acute health providers (RDaSH/DBTHFT/LA/SYREC). o Core and Advanced Skills Tool – Exploration and development of a tool for use in planning future training development needs of the workforce. o ECHO Project.
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• Development of Community Provision: o Understand market need- care home and SLP’s. o Facilitate workshop to map Doncaster community assets & identify opportunities. o Horizon scan for development initiatives. o Engage My Life Principles. o Develop implementation plan: to act as a conduit to community and other organisations.
• Challenges: o Stakeholder Engagement. o Data Collection & Analysis. o Time. o Integrated commissioning & service provision. o Digital footprint. • Hopes: o Proactive Person centred care. o Integrated Work force development at local and regional levels. o Valued members of staff, move fluidly across partner organisations instead of leaving.
Mrs Pederson asked which organisation provided the education for staff. Mrs Tooley advised that the Local Authority provides the majority; it has been difficult for staff to access training and care homes have financed additional training elsewhere.
Dr Joseph queried if intermediate outcomes had been received. Mrs Tooley replied that we have been exploring how impact may be managed. There is no data on A&E admissions. Dr Tupper advised that a proforma has been developed which is being used in a number of care homes however to date there has been no formal analysis.
Mrs Tully said that it was very promising and asked how the differences with clients and families are measured. Mrs Tooley stated that an engagement event with clients, families and colleagues in primary care will be held in summer. It will provide an understanding of what it means to have a supported GP for this cohort of patients. Dr Tupper reported that a difference is already being noted. Miss Morris stated that we need to get baseline data to ensure we are going in the right direction and requested that the Governing Body have sight of Mr Russell the data before the next spotlight report.
Dr Crichton informed the Governing Body that Mr Tom Heywood, who is currently on secondment to the CCG from YAS, was due to present to the Clinical Reference Group (CRG), a pilot in care homes which endeavours to understand the assessment of falls and how care homes contact YAS as the first point of contact as a result, he asked for this to be delegated to the Care Homes group to prevent delay of progress.
Dr Crichton thanked Mrs Tooley for attending the Governing Body
8 meeting.
Patient Story
Dr Crichton informed the Governing Body that today’s patient story featured Sam who is a resident at Hesley Village.
Mr Boldy related Sam’s story to the Governing Body as follows:
• Sam is 32 years old and is a resident at Hesley Village. He has severe Learning Disabilities, Autism with associated sensory and communication difficulties and Epilepsy. He has significant challenging behaviour; biting, nipping, scratching, hair pulling and kicking requiring staff to wear protective equipment. Sam requires support with every aspect of his life. • In spring 2017, Sam required to undergo an examination of his teeth and mouth. He had had no dental examination for 20 years and limited clinical examination in the past 10 years. Identification that previous admissions Doncaster Royal Infirmary (DRI) had posed significant challenges as he would not disembark from the bus. • A multi-disciplinary team (MDT) was developed involving an Anaesthetist, Dental Surgeon, Learning Disability Liaison Nurse, Sister from Day Surgery, Matron from Theatres, CHC LD Case Manager and Several Hesley Staff. Using the Mental capacity Act that covers Best Interest and restraint plus the Equality Act around reasonable adjustments, multiple MDTs mapped the journey from Hesley Village to DRI and return identifying potential and actual risks to Sam and other patients. Several walkthroughs were undertaken. • An initial attempt failed due to transport issues. At the 11 th hour the transport organisation sought legal advice around using the Mental Capacity Act and identified they could only use the Mental Health Act. All arrangements were cancelled to enable use of theatre time. In October 2017 an alternative transport provider was identified and so the MDT’s were re-commenced. A full half day theatre session was organised. • Sam’s Procedure took place on 17 January 2018. He was admitted into Day Surgery at DRI following administration of sedation at Hesley using secure transport. A CT scan, chest x-ray, full medical review, including blood tests and ECG, ENT review, dental review and removal of his wisdom teeth were completed. • Mrs Beth Walker, CHC Manager stated that ‘The day could not have gone any smoother and where we did make last minute changes this was managed well. This was a clear demonstration of care and compassion to achieve the best outcome for Sam which will help inform his future care and treatment to promote his wellbeing and quality of life’. • Sam’s Mother stated ‘The care and support from all involved was marvellous to see, now Sam is more settled and we have peace of mind around his general health. I really appreciated the work that everybody did to make this happen’.
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Mr Boldy stated that this is a blueprint for how we provide care and how this may be undertaken for other patients in the future. Mrs Pederson asked if more could be done to eliminate similar problems occurring in the future. Mr Boldy stated that it has been our wish to provide both health and dental examinations to this cohort of patients however it has proven challenging in the past. We are now confident that more can be provided going forward.
Mrs Whittle questioned if everyone should have a primary health care plan and queried if there are other patients who do not have one. Dr Tupper explained that health checks require a level of individualised care within the process and are not regularly undertaken to the level given today due to risk involved when using sedation or anaesthetic; they have to be individually tailored to each patient.
Dr Jones queried who or what organisation gave consent. Mr Boldy stated that it deemed what was in Sam’s best interest and each clinician contributed towards the decision along the way. Mr Russell informed the Governing Body that Sam had been withdrawing and spending more time in his bed. Sam’s mother was involved advocating the process and received regular updates from the case manager.
Dr Joseph enquired about the plan for health checks. Mr Russell advised that the priority is to facilitate routine health care checks for Learning Disability patients. Dr Tupper re-iterated they would have to be done on an individual basis of needs.
Dr Crichton thanked Mr Boldy for attending the Governing Body meeting.
The Governing Body noted the Performance Report.
9. Finance Report
Mrs Tingle stated that the report was for noting by the Governing Body and provides the financial position for NHS Doncaster CCG for 2017/18 as at the end of February 2018 (Month 11) and also gives an overview of the final plans for 2018/19 for approval.
NHS Doncaster CCG is forecasting to achieve all of its financial targets for 2017/2018 but pressures are emerging. The Month 11 position reflects a surplus of £11,130k which is in line with the target set by NHS England and the forecast is to achieve the £12,142k surplus for the year.
Financial risks are as follows:
• Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust (DBTHFT) – The Acute contract over performance remains a key risk as providers are undertaking additional activity to meet Referral To Treatment (RTT) targets. The February monitoring
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information from DBTHFT indicates significant overtrading (£6.7m) relating to both a drive to deliver the 92% trust wide RTT target and the phasing of the demand management schemes in place across the system.
Individual Placements – Individual Placements remain a concern as cases continue to step down from Specialised Services (NHS England) without funding being transferred. NHS Doncaster CCG has already incurred a recurrent pressure of £1m during 2017/2018 resulting from this transformation agenda. The forecast overspend in this area is £2.1m. To help manage and offset the risks a small contingency fund of £2.5m was established as part of the NHS business rules. In addition, the 0.5% headroom reserve is currently being held as mitigation which equates to a further £2.5m, however both these values are non-recurrent in nature and poses a risk if relied upon to recurrently balance the financial position.
Financial Plans 2018/2019 - NHS England issued planning guidance titled “Refreshing NHS Plans for 2018/2019” in February 2018. Guidance has remained broadly similar to previous years but with a key focus on Commissioner and Provider Sustainability.
The requirement for CCG’s to ring-fence 0.5% of CCG allocation for wider system sustainability has been lifted and £600million of new funds have been allocated nationally in order to fund system pressures and ensure adherence to the Mental Health Investment Standard and transformation commitments. For NHS Doncaster CCG this means £3.5m of new funding has been allocated. However this will just help to ease some of the pressures seen in 2017/2018 and allow the CCG to contract for outturn activity.
The final plans are due to be submitted by 30 April 2018 but require submission to the Integrated Care System (ICS) in mid-April for consolidation of a South Yorkshire &Bassetlaw plan.
The plans have now been refreshed to reflect the final agreed contract values and the overall financial gap now stands at £10.6m. This has increased since the draft plan due to the agreement of the DBTHFT Contract. Plans are now in place for the majority of the QIPP but as per 2017/2018 the target is extremely challenging.
Mrs Tingle informed the Governing Body that a meeting is being held on 19 April 2018 with colleagues from NHS Doncaster CCG, DBTHFT, NHS England and NHS Improvement to discuss the misaligned financial plans.
Dr Seddon highlighted the overspend noted in respect of maternity and the concern regarding the complexity of cases. Mrs Tingle explained that this was as a result of HRG4 and the coding tool. The impact of HRG4 was different for organisations. An external audit has been commissioned to investigate if coding and complexity concerns.
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Mr Fitzgerald stated that QIPP is continuing to be addressed within teams however it is becoming increasingly more difficult to identify other schemes. There may be difficult discussions and decisions to be made in the future regarding what the CCG commissions if the gap continues.
Miss Morris congratulated everyone for attaining the QIPP current position however we must continue to maintain and improve in the future.
Mrs Pederson offered the Governing Body’s thanks to all teams for their relentless work on QIPP.
The Governing Body noted the report and approved the Financial Plan.
10. Assurance Framework Quarter 4 Report
Mrs Devanney presented the Assurance Framework Quarter 4 Report to the Governing Body for noting and explained that there are currently 6 risks which are Tolerated and 6 which are being Treated. The Corporate Governance Team meet with all risk owners and a Deep Dive will be undertaken into Corporate objectives when all risk owners will be invited to audit and challenge as necessary.
The Governing Body noted the Assurance Framework Quarter 4 Report.
Dr Pieri joined the meeting.
Mrs Devanney informed the Governing body that Mr Taylor, Head of Corporate Governance was leaving NHS Doncaster CCG and his successor will commence at the CCG in July 2018.
11. Equality & Diversity Annual Report
Mr Jones presented the Equality & Diversity Annual Report to the Governing Body and explained that, as set out in The Equality Act 2010, public bodies are required to declare their compliance with the public sector equality duties on an annual basis, and this report compliments and combines our mandatory reporting of the Equality Delivery System 2 and the Workforce Race Equality Standards. Our Equality and Diversity Strategy lists our objectives covering a four year period and further supports the on-going equality, diversity and engagement work across the CCG.
The Equality Delivery System supports local NHS organisations, in discussion with local partners and populations, to review and improve our performance for people with protected characteristics. We have committed as an organisation to the principles of the Equality Delivery
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System and have refreshed our self-assessment for 2017/2018. The Workforce Race Equality Standards helps us to identify the make-up of our workforce and this has also been refreshed for 2017/2018.
Some key areas of work in Equality and Engagement this year are as follows:
• We continue to be an active member of the Health Inequalities Working Group. • We are working on a partnership refresh of the Black and Minority Ethnic (BME) Health Needs Assessment to identify health needs of our BME communities. We have also been an active member of the BME Health Needs Workshop. • We are working in partnership across Doncaster, with members of our BME Community, in consultation for review of Hospital Services. Our Commissioning Teams have been involved in a BME Focus Group. • The Health Ambassadors Scheme has recruited members of our Trans Community. • We have promoted, in partnership with NHS England, a consultation on gender identity with results expected later in 2018. • We have engaged on the South Yorkshire and Bassetlaw Sustainability and Transformation Plan and Accountable Care System holding several different workshops and drop in sessions for members of the community.
Our proposed work for 2018/2019 will see a refresh in our objectives in line with the outcome of our self-assessment for the Equality Delivery System. A review of the strategy is currently taking place and will be presented to the Engagement and Experience Committee for comment.
In partnership with our HR Service, we aim to seek monitoring data from application stage to reach out to our BME community who may have applied for jobs but have not been successful in the shortlisting stage. At present, we are unable to see this data to ensure a fair service, however feedback from the Engagement and Experience Committee suggested we could obtain the feedback once the recruitment stage had passed.
We also propose the introduction of Equality Champions within the teams to further enhance and embed our equality and diversity work, the completion of equality impact assessments and to promote and raise awareness of the protected characteristics.
Mr Jones requested that the Governing Body note the contents of the Equality & Diversity Annual Report and endorse and facilitate the on- going delivery through 2018/2019.
Mrs Whittle reported that the report has been discussed at the Engagement & Experience Committee meeting and the Committee supports the objectives for the forthcoming year. Dr Crichton added
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that there has been press coverage recently on pay equality and although theoretical, NHS Doncaster CCG would rate well.
The Governing Body noted the contents of the report and endorsed the on-going delivery through 2018/2019.
12. Clinical Leadership/Constitutional Changes
Dr Crichton presented the paper regarding Clinical Leadership and Constitutional Changes and explained that a consultation exercise regarding the membership engagement model has now concluded. NHS Doncaster CCG is required to consider how the 4 Localities are represented on the Governing Body, across the Committee structure and how clinical input is secured to support the CCGs key areas of delivery. The conclusion is that there appears to be sufficient capacity to cover the corporate portfolio with 4 GP Governing Body members. This is dependent upon the 4 GP Governing Body members flexibility when required to ensure quoracy during periods of annual leave and sickness absence. The analysis indicates this should be achievable. A further piece of work will be undertaken to establish what additional support is required to cover clinical input to all of the key delivery areas.
The following 2 options were put forward for consideration:
• Option A - 4 Governing Body GPs to reflect 1 GP Locality Lead per locality. The remit of these roles would be to lead on the Corporate Portfolio. Clinical Leadership for the CCG’s key delivery areas would be considered as a separate function and additional clinical GP input would be sought to provide support to gaps identified. This option does not preclude GP Locality Leads fro also undertaking clinical leadership for key areas of delivery where capacity enables this. • Option B – 8 Governing Body GPs to reflect 2 GP Locality Leads per area. This would require an election process to secure suitable candidates.
Dr Crichton requested that the Governing Body accept the recommendation of Option A and for the relevant changes to the Constitution to be progressed through the Members and NHS England.
Miss Morris commented that the paper was both clear and concise and consequently she felt sufficiently reassured.
The Governing Body raised no objections and accepted the recommendation of Option A.
Dr Crichton thanked the Governing Body for its valuable input and reported that the next steps are to embed the changes within the Constitution and share the recommendation of Option A by the
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Governing Body to the wider membership and then submit this to NHS England.
13. Chair and Chief Officer Report
Mrs Pederson stated that the Chair and Chief officer Report was for noting by the Governing body however wished to highlight the following points:
• Doncaster CCG 360° Stakeholder Survey 2017/2018 Update –
The CCG’s 360° Stakeholder Survey for 2017/2018 has now concluded. Fieldwork was conducted between 15 January – 28
February 2018 with response rates overall being 64%, an increase from 57% for 2016/2017. Results are positive with 87% of stakeholders rating the effectiveness of their working relationship with the CCG as very/fairly good. An action plan is to be developed to further our working relationships with our stakeholders. It is anticipated that the report will be available at the end of June 2018. • The NHS70 Celebrations – The NHS turns 70 on 5 July 2018 and a Doncaster wide event is planned to take place on Sunday 8 July 2018, 11am – 4pm at Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH). A Planning Group has been established with colleagues from NHS Doncaster CCG, DBTHFT, RDaSH and Doncaster Council and all volunteers to take part are welcome. Updates will be provided to the Governing Body and any information will circulated as necessary.
The Governing Body noted the report.
14. Locality Feedback
Locality Leads gave the following feedback from their Locality meetings:
North East Locality – Dr Bradley reported that the following item was discussed:
• NHS Doncaster CCG Constitutional changes.
North West Locality – Dr Seddon reported that the following items were discussed:
• Mr Clayton, Head of Health Informatics (Doncaster and Rotherham CCGs) attended the meeting to discuss video consultation as Locality members were unsure of how to use it. Dr Crichton reported that he will raise this at the next Doncaster Health & Care Dr Crichton Interoperability Group meeting.
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South East Locality – Dr Singh reported that no meeting had taken place.
Central Locality – Dr Tupper reported that the following items were discussed:
• NHS Doncaster CCG Constitutional changes. The Locality felt unsure of the value of further locality meetings.
15. Receipt of Minutes
The following draft minutes were received and noted by the Governing Body:
• Audit Committee – Minutes from the meeting held on 11 January 2018. • Executive Committee – Minutes of the meeting held on 7 February and 7 March 2018. • South Yorkshire & Bassetlaw Sustainability & Transformation Collaborative Partnership Board – Minutes from the meeting held on 9 February 2018.
16. Any Other Business
Barnburgh Surgery
Mr Fitzgerald informed the Governing Body that following the procurement process in respect of the Barnburgh Surgery, the contract has been awarded to the New Surgery in Mexborough and will ‘go live’
on 8 May 2018.
Future Governing Body meetings
Mrs Pederson informed the Forum that discussions have been held
regarding aligning all CCG Governing Body meetings to take place in the first week of the month in order that any business discussions and important decisions may be made in unification.
Mrs Pederson proposed that the July Governing Body meeting is held
as normal on the third Thursday of the month, the August Governing Body meeting is cancelled and the September Governing Body meeting is held on the first Thursday of the month and that the meetings continue on this day going forward. The Strategy & Organisational Development Forum meetings will then move to the
third Thursday of the month.
The Governing Body agreed with this rationale.
Dr Crichton advised that the NHS Doncaster CCG website will be Mr amended accordingly. Carpenter
16
Tobacco Alliance
Dr Joseph informed the Governing Body that he is the Chair of the Tobacco Alliance Group and that the Local Authority has signed up to the Tobacco Alliance declaration some time ago and asked if the CCG would also be interested. Dr Crichton requested that Dr Joseph forward the document for our perusal.
Mrs Devanney advised that NHS Doncaster CCG has just recently updated its Smoking policy.
17. Date and Time of Next Meeting
1:00pm on Thursday 17 May 2018.
17
18 Verbal
Item 6
Matters Arising
Enc B
Item 7
Public Health Annual Report
Meeting name Governing Body Meeting date 17 May 2018
Director of Public Health Title of paper annual report for Doncaster
Executive / Dr Rupert Suckling, Director of Public Health, Clinical Lead(s) Doncaster Council Dr Rupert Suckling, Director of Public Health, Author(s) Doncaster Council
Purpose of Paper - Executive Summary
The Director of Public Health annual report for 2017 was approved for publication by Doncaster Council at its January 2018 meeting.
Previously the report was presented to the Health and Wellbeing Board where they were asked to take action to address the recommendations within its control and work with other boards where the Health and Wellbeing Board’s role is of a more supportive nature.
Recommendation(s)
The Governing Body is asked to note the report.
Impact analysis Quality impact Neutral Equality Neutral impact Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of Paper is for information. No relevant interests. Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report previously None presented at Risk Nil analysis Assurance 4.1, 4.2, 4.3 Framework
Health and Wellbeing: A Strength For Life Director of Public Health annual report for Doncaster 2017
1 Contents
1. Foreword and Introduction
2. The health of Doncaster people
3. Building blocks for health 3.1 Give every child the best start in life 3.2 Make ‘good growth’ our watchword for economic development 3.3 Improve healthy life expectancy through preventing disability 3.4 Tackle unfairness and health inequalities
4. Conclusions and recommendations
5. References
2 FOREWORD and Introduction
Welcome to my third Annual Report as Director of Public Health for Doncaster Council.
Winston Churchill famously said “Healthy citizens are the greatest asset any country can have” and that sentiment applies just as much to Doncaster as to any country. Whereas illness and ill-health can be seen as a cost to local people, a demand on local services and a burden on tax-payers, good health and wellbeing should be seen as a strength for life, a resource for living and something that’s worth investing in. Throughout 2017 there has been steady progress against the four challenges I outlined last year:
• Improving children’s health and wellbeing • Making the link between education, work and health • Increasing healthy life expectancy and reducing preventable health conditions • Reducing inequalities in health between and within Doncaster communities
This report shows some of that progress and through real life stories gives a flavour of the sort of approaches that are working based on improved working relationships between individuals, families and communities, along with statutory services. However, the impact of these initiatives needs to be more systematically captured to ensure that we are making enough progress to impact health outcomes, which can take years to change.
It is still the case that the best predictor of good health is having a good job, or if your parents have/had a good job. So, as our main goal we need to make sure our watchword for economic development is ‘good growth’ that everyone can benefit from. The downside of ‘bad growth’ is that individuals and families can enter a downward spiral and make short- term decisions that exacerbate the situation they find themselves in. Increasingly we can view poor diet, lack of exercise, smoking and excessive alcohol use as a response to the situation people find themselves in and not merely a lifestyle choice.
The focus on children’s health and wellbeing, particularly the first 1001 days of a child’s life should allow impact to be measured quickly. There is still more to do to tackle unfairness and health inequalities. The work on Black and Minority Ethnic (BME) health is identifying barriers to accessing health service for new arrivals to Doncaster as well as looking at any difference in access to or outcomes from mental health treatment. However, this is only a small part of the picture, gender based health inequalities should be reviewed. Finally despite the progress made some of the gains appear fragile and I would suggest a fifth building block for health and wellbeing be added and that Doncaster should become a sustainable and resilient borough.
In compiling this report I am grateful for the help of a number of colleagues. In particular I would like to thank Claire Hewitt, Dr Nick Leigh-Hunt, Steve Betts, Steph Cunningham, Dr Victor Joseph, Susan Hampshaw and Dan Debenham for designing and contributing to the overall report. I would also like to thank those that supplied updates including Allan Wiltshire, Jon Gleek, Riana Nelson, Carrie Wardle, Lee Golze, Leanne Hornsby, Clare Henry, Shaun Ferron, Jonny Bucknall, Louise Robson, Kirsty Thorley, Richard Smith, Matt Cridge, Nick Germain, Andy Maddox, Jenny Holmes, Tracey Harwood, Steve Helps, Paul Tanney and Cllr Charlie Hogarth.
If you have any questions or comments about any aspect of the report please send them to me at [email protected]
Dr Rupert Suckling @rupertsuckling Director of Public Health Doncaster Council
3 THE HEALTH of Doncaster people
How healthy are we?
Health can be a difficult word to define. As individuals we can all describe times when we feel healthy, and equally, can all describe times when we feel unhealthy. When we try and describe the heath of the whole of Doncaster we often use length of life (life expectancy) or the number of deaths (mortality). Obviously both these measures are related. We also try and capture the quality of life of the population and use healthy life expectancy (years lived in good health) as a measure of this.
There is mixed news about how Doncaster is doing on both measures of health (length of life and the number of deaths). Although life expectancy is unchanged at 77.6 years for men and 81.6 years for women. It is good that Doncaster has not seen the fall in life expectancy that other parts of the UK have seen, however this average life expectancy measure may mask different impacts in different groups of the population. The number of deaths in people under the age of 75 is falling as mortality from heart disease and cancer continue to decrease. However, there is still more that could be done. Although falling, the deaths from heart disease and cancer are still higher than regional and national averages. The gap in life expectancy between the most affluent and the least affluent parts of Doncaster remain stubborn and persistent (8.9 year difference for men and 7.2 years for women). The length of time people can expect to live in good health in Doncaster is below national averages at 59.7 years for men and 61.0 years for women.
What makes us healthy?
There are a lot of factors that contribute to health and many of these factors accumulate over the course of our lives. Recent research has shown that many of these factors impact us through stress and the body’s natural response to continuous stress. One of the best ways to describe the relative contribution of these factors to health is the Robert Wood Johnson Foundation work, estimating 20% of what makes us healthy is from medical services, 30% from behavioural fac- tors (e.g. smoking), 40% from socio-economic factors (e.g. education) and 10% from the quality of our built environment including housing. Population Health Physical Environment Environmental quality Built Environment
10% Health care Access to care Quality of care 20% 40%
Socio-economic factors Education Employment Income Family/social support Community safety 30% Health behaviours Tobacco use Diet and exercise Alcohol use Unsafe sex
Source: Authors analysis and adaptation from the University of Wisconsin. Population Health Institute’s County Health Rankings model (2010) 4 How is Doncaster doing on these causes?
It is good news that Doncaster’s economy is growing. However, the next challenge is to develop higher skilled, and therefore, higher paid jobs. In that way the benefits of economic growth will go to local people. Educational attainment is important too and the numbers of children ready for school at five-years-old has increased to 69%. Together, with the reduction in mothers smoking at the time of delivery to 12.9%, it is a step in the right direction to help every child to have the best start in life.
People could take more control of their own health and be supported more to do this. Almost a third of the population is inactive and only 50% of people are eating healthily. Smoking, although falling, is still a major risk factor and new risks including air pollution are being recognised and addressed.
Approaches to improving health
The council and its partners take two broad approaches to improving health. The first approach is to work with those people at highest risk of ill-health and the second is to support the whole population. In both cases a range of approaches from monitoring the situation, through to encouraging behaviour change (nudge) and finally considering legislation can be used. The choice of approach depends on local need, evidence of effective interventions, availability of resources, public perception and political priority.
The Nuffield Ladder
Eliminate Choice: regulate to eliminate
Restrict Choice: regulate to restrict the options available
Guide Choice through disincentives: use financial or other disincentives to influence people to not pursue certain activities
Guide Choice through incentives: use financial or other disincentives to guide people to pursue certain activities
Guide Choice through changing the default: make healthier choices the default option for people
Enable Choice: enable people to change their behaviours Greater levels of intervention
Provide information: inform and educate people
Do nothing or simply monitor the current situation
5 BUILDING blocks for health
If we want a healthier, more prosperous Doncaster, we should continue to focus on four building blocks for health.
1. Give every child the best start in life 2. Make ‘good growth’ our watchword for economic development 3. Improve healthy life expectancy through preventing disability 4. Tackle unfairness and health inequalities
This section provides an update on progress over the last year against these recommendations. Give every child the best start in life
Last year five recommendations were made to give every child the best start in life and progress against those is reported below.
Continue to monitor the effectiveness of the Early Help Strategy
The Early Help Strategy has been updated. It now reflects a clear definition of early help and includes an understanding of our areas of strength with our areas for improvement. The strategy sets out the principles and approach for early help which is informing our conversations and commissioning intentions with partners (e.g. adoption of principles and working practice in the Starting Well Strategy, Raising Aspirations and Achievement). The early help approach has been embedded and as a result we know that:
• Contacts into the Referral and Response service that require an early help response is steadily decreasing • 75% of all enquiries (6,628 of 8,835) into the early help hub are for children living in the 30% most deprived areas of Doncaster and 55% of enquiries are for children under 9-years-old • Early help episodes have increased by 24% and average 442 per month • There continues to be an increase in the number of open early help cases from 1100 in Q1 16/17 to 2052 in Q1 17/18, representing a 87% increase • Data suggests that once children have been identified as having multiple or complex needs these are being assessed earlier, resulting in children and young people being supported with a trusted person as their lead practitioner • There is evidence that the quality of assessments has also improved and audits show that 68% are judged as good or better • Over 74% of cases closed by the Early Help Team Around the Child (TAC) have been sustained within universal services following closure
69.7%
Over 69% of five-year-olds in Doncaster have a good level of development
6 Focus on vulnerable mothers from pregnancy until the child is 2 ½ years old (the first 1001 days)
In April 2017, the Health Visiting Service launched an enhanced element to their service offer. The aim of this service element is to intervene at the earliest opportunity with vulnerable families, to offer an enhanced service that ensures that those families are prepared for parenthood and are able to parent effectively, ensuring the optimal health and development of their child.
The recently approved Doncaster Starting Well strategy sets out a partnership vision to develop a Doncaster-wide Starting Well (0-5) offer. It highlights the collective ambition to achieve better outcomes and develop a shared ambition for integrated leadership, commissioning and delivery. A key priority of the strategy is to drive a focus on the first 1001 days of a child’s life.
Partners in Doncaster are exploring the potential to develop an ‘accountable care system’, focused on collaboration as opposed to competition. The first 1001 days has been chosen as an ‘area of opportunity’ in the first phase implementation of the Doncaster Place Plan.
England England England Best Average Worst
1.8% 12.9% 10.2% The percentage 26% of women who smoke at time of delivery
Trend
7 Build on the national Future in Mind developments to address bullying and improve the mental health of school children
The Local Transformation Plan is the agreed approach to addressing these issues and an updated report was published in November 2017.
The new community eating disorder service continues to evolve and grow. There have been strong links built between 20 academies, colleges and Child and Adolescent Mental Health Services (CAMHS) to promote a more joined up way of working with great effect and there has been the development of a new schools, academies and colleges mental health competency framework, which is being piloted in 2017/18. Working with Young Minds, we now have 15 mental health participation champions who will be at the heart of shaping how we do things in the future.
England Similar Yorkshire Authorities and Humber
13.1% 13.8% 14.2%
17.5%
Persistent absence in secondary schools is relatively high. The threshold has been altered from 15% down to 10% for 2015/16 resulting in a sharp upturn
8 Support schools to develop a Curriculum for Life
The Education and Skills programme recognises the importance of a broad and balanced curriculum that not only provides a rich educational experience for children and young people, but also seeks to build their levels of social and cultural capital, so that they can learn and increase their aspiration in a range of settings and contexts. The development of a project called ‘100 things to do before you’re 11’ which introduces a mutually agreed, guaranteed set of experiences for all children under the age of 11 in the borough, has helped bring this to life.
The expansion of the Doncaster Skills Academy over the next two years will ensure that young people in Doncaster meaningfully engage with employers and develop the skills necessary to meet their employment goals. Both of these strands are vital to the success of the Social Mobility Opportunity Area, which aims to improve social mobility for Doncaster children and young people by closing the gap in attainment between disadvantaged and non-disadvantaged children at primary school; improving the performance of the borough’s secondary schools, helping Doncaster’s young people to find the right academic and vocational routes to the careers they aspire to; and taking active steps to help the most vulnerable, to access opportunities that will support them in and out of education. Yorkshire Similar England and Authorities Humber
48.9% 48.8%
46.9% 50.1% Doncaster’s score is lower than the national average, and comparators, when measured against attainment 8, this measures the achievement of pupils across eight qualifications
9 Support schools to increase physical activity in the curriculum
The Daily Mile programme could lead to an additional 20 minutes of physical activity in every Doncaster school each day, contributing to improved learning, behaviour and health. It is being promoted to all schools with the offer of support if required to help with implementation.
Monitoring is taking place to measure uptake and materials have been produced. Healthy Learning, Healthy Lives (HLHL) is the Doncaster health and wellbeing award scheme designed for schools, colleges and early years providers. Launched in January 2018, it provides free support and guidance to education settings, including a comprehensive website and an accreditation scheme that recognises work to increase and support health in education settings.
England England England Best Average Worst
9.4% 19.8% 28.5% 19.5%
Percentage of children aged 10-11 years classified as obese
Trend
10 REAL life stories
St Leger Homes improving children’s health and wellbeing
St Leger Homes rehouse approximately 1500 households each year into council homes which are affordable, have security of tenure and benefit from an effective management, repairs and maintenance service.
In addition to ensuring that homes are safe and warm, St Leger also contributes to the health and wellbeing of their residents and provides a range of budgeting advice and signposting to support agencies if required. The team has also developed pathways to address cases where complex needs have been identified which impact on a child’s wellbeing including the Housing Assessment Panel, Vulnerable Person’s panel and day to day collaborative working.
Recently, St Leger rehoused an applicant who was living in a one-bedroom flat. His nine-month-old child had been removed from his former partner’s care and had been placed in a temporary foster placement. Working with the applicant and Doncaster Children’s Services Trust (DCST), St Leger awarded social and welfare priority and rehoused the tenant into a house near to his family for support. This minimised the amount of time that his child was in care. St Leger has also rehoused a number of other children where there has been intervention from DCST and have either prevented or reduced the length of time they have been in the care system.
Providing play areas to improve children’s health and wellbeing
Doncaster Council Street Scene and Highways operations have supported improving children’s health and wellbeing by providing fixed play area and sports facilities on parks and open spaces across Doncaster. The parks and open spaces are maintained to a high standard and a green flag award has recently been achieved as a result of the increased community involvement and work to improve the local environment. Free junior football facilities are also provided, these are popular and the sites are well used.
One particular example is the Sandall Park inclusive swing project. In 2017 Street Scene and the communities’ team worked with the Friends of Sandall Park group to secure external funding for the installation of a Disability Discrimination Act (DDA) compliant access friendly swing for all children to enjoy.
11 Make ‘good growth’ our watchword for economic development
Last year five recommendations were made to make the link between health and work stronger and ensure that economic growth benefits everyone and progress against those is reported below.
Use the Social Value Act to maximise equitable employment opportunities when commissioning
The council has started work on the development of a Social Value strategy and revised procurement guidance which will be linked to the ‘Doncaster Growing Together’ strategy. The aim of the strategy and guidance will be to ensure a consistent approach to the delivery of social value and initiate discussion amongst commissioners as to how social value can be delivered across the council’s key policy areas.
70.6%
The percentage of council spend with Doncaster companies: £31.2m from a revenue spend of £44.2m
Recommission the ‘work Yorkshire Similar England programme’ as part of the Sheffield and Authorities City Region to help those furthest Humber from the labour market find work and delivery of the Work and Health 8.1% Unit trial 9.5% 10.9% Led by the Sheffield City Region Executive, the Work and Health Programme is in the final stages of commissioning.
The tender scoring process was finalised and contracts were due to go live in autumn 2017. However, the funding for this programme from central government to the Sheffield City Region has been paused. 11.1% The The Work and Health Unit trial is progressing well. number of people South Yorkshire Housing Association has been claming out of work awarded the contract to test the effectiveness of benefits has reduced Individual Placement Support (IPS) to support people from 15.3% in 2011, with less severe mental health problems and those with musculoskeletal problems into work. This new a reduction of service will begin in early 2018. 8,450
12 Work to keep those with health issues in employment longer, improving health literacy and self management
The Workplace Wellbeing Programme continued to support local businesses to gain accreditation against the national Workplace Wellbeing Charter until it was withdrawn in late 2017. A new charter is being developed in partnership with other South Yorkshire local authorities to maintain momentum. In October the annual workplace health conference was held to support European Health and Safety Week.
The conference focussed on the ageing workforce with keynote speakers delivering presentations on topical issues such as musculoskeletal problems, carers and physical wellbeing. A self-management programme proposal and mapping process is underway and is being shared with key partners. A number of options are currently being explored and recommendations on the way forward are being considered, as part of the Doncaster Place Plan.
Continue to help residents keep their homes warm by improving the energy efficiency of properties, ensuring access to welfare advice and helping residents find a cheaper energy tariff via Great North Energy
Great North Energy launched on 7 November 2017. In addition the council continues to work with the National Energy Action (NEA) to address fuel poverty through the ‘Warm Homes’ fund and with Doncaster Clinical Commissioning Group to fund ‘Boilers on Prescription’ through the Better Care Fund.
The 11.1% percentage of households estimated to be fuel poor
13 Use community assets to join up health, social care, education, skills and employment around the family. Extend both the Stronger Families and Well North approaches to other groups and geographical areas in the borough
Loneliness and social isolation can be addressed through increasing the number of and strength of social networks. This can start in childhood, and can be sustained and built on in later life. The new Starting Well Service has begun operating with a focus on the first 1001 days and Children’s Centres have been transformed into Family Hubs in line with the All Party Parliamentary Group report from late 2016. Stronger Families principles and practices are being transferred to the Complex Lives programme to support adults with multiple issues. Well Doncaster continues to join up community groups and organisations, local schools, the Family Hubs, primary care, social care and employment programmes. Aspects of the work have been extended to include Conisbrough, while maintaining a focus on Denaby Main. A workshop in October 2017 helped develop plans for sustainable and inclusive growth in line with Doncaster Growing Together, drawing together Doncaster Council, Well North advisors and community organisations from Denaby, Edlington, Bentley and Stainforth.
Community organisations continue to be the basis for health and wellbeing in Doncaster communities. There has been an increase in both formal and informal activity to reduce the impact of loneliness locally involving established ‘health‘ groups (e.g. MIND, the Alzheimer’s Society, People Focussed Group and Age UK), established local organisations (including the Development Trusts, Parish Councils) or relative newcomers (e.g. Community Circles, b:Friend and Home Instead Senior Care). This is an increasingly complex area where more could be done to ensure local community organisations thrive and link with statutory sector approaches including social prescribing and Your Life Doncaster. New networks of organisations such as Expect Youth for children and young people could be adopted for adults.
45.7%
The percentage of adult social care users who have as much social contact as they Trend would like
14 REAL life stories
The World of Work academy programme
The World of Work (WOW) academy programme run by St Leger Homes offers a range of work related opportunities to tenants and their families. This includes training contracts such as work experience and a two-week work ready course in conjunction with Doncaster College.
Mark Redgrift is now a World of Work Handyman. He initially contacted WOW through his estate officer and requested more information. The WOW co-ordinator arranged to meet with Mark to discuss his barriers to employment, what his expectations were and what sort of employment he was seeking.
After discussing the possible options available to him, Mark completed a two-week customer service course with Doncaster College where he gained a full level 2 qualification in customer services and subsequently applied for the St Leger Homes temporary handy person vacancy that allows a candidate to earn while they learn. Mark hadn’t experienced this type of work before and was excited to learn a new skill. He was also looking forward to the extra training he would receive such as IOSH working safely, manual handling and gaining his Construction Skills Certification Scheme card.
Mark said: “The scheme run by St Leger Homes gives me a lot of pride, especially when you finish a job and realise someone is going to move into that house and make it a home.
“You know that you are doing something positive. World of Work has helped open up my finances and we’ve been able to live properly as a family.”
Manna counselling at Bentley Library
Manna counselling in Bentley Library offers clients a non-clinical, anonymous and accessible safe place to come to alongside other local services that serve the community. Bringing services together means easier access for clients and less travelling, which can sometimes be difficult when suffering from physical and mental illness. Supported by the Manna counsellor and local volunteers, a cancer support group meets at the library every Thursday mornings. The group is designed to bring people together to share their experiences, support one another and help combat loneliness and isolation.
As a result of the group, some people have found supporting others increases their self-confidence and self-esteem. Others find it helpful and easier to talk to the support group rather than with family or close friends as they don’t feel the need to hide their feelings or emotions that they perceive may distress those close to them.
The library also supports the mental health and social isolation needs of the wider community by providing a place to meet others and volunteering opportunities, enabling individuals to gain skills in getting back to work, which in turn provide purpose in life and improve self-esteem and a positive outlook. All of these positive outcomes link together and provide the people of Bentley with a place to provide a great many of the services to meet their needs by a committed and integrated team.
15 Include preventative approaches in all patient pathways and clinical services
The Doncaster (health and care) Place Plan recognises the importance of prevention. In the six areas of opportunity identified for greater collaborative working (complex lives, intermediate care, starting well, vulnerable adolescents, unplanned and emergency care and dermatology) prevention will be explicitly addressed. This should focus on the behavioural risk factors that determine health and includes smoking, diet, physical activity and alcohol, through both universal approaches such as Making Every Contact Count and more targeted approaches like the National Diabetes Prevention Programme. Locally, the council is working with partners, the Local Government Association and the Design Council to revamp the approach to self-management. England England England Best Average Worst 4.9% 15.5% 19.8% 25.7% The Prevalence of smoking among persons aged 18 years and over Trend
Focus on the Get Doncaster Moving campaign to increase physical activity
Get Doncaster Moving is one of the transformational programmes of Doncaster Growing Together. The 10 year strategy will be launched in 2018 with the vision of ‘healthy and vibrant communities through physical activity and sport’. It includes a focus on supporting the most inactive in Doncaster to get active using a number of approaches including cycling, walking, sport, dance and green spaces. Get Doncaster Moving will enable these improvements to be delivered more quickly and this will be further supported by the successful Sport England Local Delivery Pilot. Yorkshire Similar England and Authorities Humber 52.8% 52.6% 56.3%
The 57.0% percentage of Doncaster population who acheive 150 minutes of physical activity per week
16 Include preventative approaches in all patient pathways and clinical services
A ‘Food Hack’ event held in June 2017 brought together a wide network of participants from Doncaster’s food system and began the process of establishing a partnership of people interested in Doncaster’s food future. Following this an external food partnership has been established which includes a range of members from the council, Health Watch Doncaster, Flourish Enterprises, and other charity/community organisations. This partnership will work on a range of initiatives around an action plan, including four key points on promoting physical and mental health. This partnership has recently been awarded ‘Sustainable Food City’ status.
A new council food strategy will include a focus on reducing diet-related ill health, and promote workplace wellbeing. The strategy will include existing documents such as those in public health and environmental health, but will also cover the wider approach to food in the borough and will look at five key points:
• addressing food insecurity in Doncaster • promoting healthy food and lifestyles • supporting local communities to eat well • embedding healthy attitudes to food into the internal culture of the council • boosting the role of food in the local economy
A food poverty alliance is also being set up to address food poverty, a leading cause of diet-related ill health and we are exploring the adoption of Sugar Smart in the borough.
51.2%
The Percentage of the population eating five portions of fruit or vegetables a day Trend
17 Continue to reduce the negative impact of takeaways and fast food on health and air pollution by considering health in spatial planning and licensing approaches
A hot food takeaway review has been developed to provide evidence to support the consideration of health impacts for planning applications. There is the opportunity to include a policy in the developing Local Plan to restrict the proliferation of hot food takeaways and restrict the opening of them within the vicinity of secondary schools.
4.5 Fraction of annual all-cause adult mortality attributable to long-term exposure to current levels of anthropogenic particulate air Trend pollution
Evaluate local approaches with South Yorkshire Fire and Rescue (SYFR) to promote fire safety and address falls including enhanced home safety checks
A steering group supported by a variety of partners has resulted in SYFR delivering a Safe and Well service which includes advice and support relating to fire, crime safety, aging well and falls. The visits are focussed on the most vulnerable with referral pathways established for further support. In support of the introduction of the Safe and Well visits, SYFR has become an accredited centre for the delivery of the Royal Society of Public Health (RSPH) level 2 qualification in health improvement and over 100 staff across Doncaster have now received this training and qualification with other additional training scheduled for future dates.
The Safe and Well pilot was independently evaluated between Sept 2016 and March 2017, resulting in a number of recommendations. These recommendations are currently being reviewed and continued engagement with staff and partners within Doncaster is taking place in order to embed Safe and Well visits. Further partnership work has also taken place though initiatives including the ‘To Save A Life’ and the ‘Fakes Cause Fires’ campaigns. Adwick Fire Station at Quarry Lane, Woodlands, hosts a memory cafe as part of a new partnership between SYFR and the Alzheimer’s Society. The events, held once each month on a Thursday afternoon, provide an opportunity for people living with dementia and their carers to meet in a safe, managed environment and to take part in activities to promote mental and physical wellbeing, such as games and health walks.
Age-sex standardised rate of emergency hospital admissions for injuries due to falls 2,516 in persons aged 65 and over per 100,000 Trend population
18 REAL life stories
Reducing preventable health conditions by removing illegal products
The Doncaster Trading Standards Service enforces the sale of tobacco, nicotine inhaling products, alcohol and solvents in line with national legislation. Between April 2016 and April 2017 the team successfully removed over 169,640 cigarettes and 54kg of hand rolling tobacco from premises across Doncaster.
The seized products are unacceptable for a number of reasons:
• They may not display the important health warnings about the dangers of smoking that help to deter people. There is clear evidence that the health warnings carried on tobacco packaging increases consumer knowledge about the health consequences of smoking, and helps to change consumer behaviour • Some of the products are dangerous as they do not self-extinguish when not being smoked, this is a legal requirement that reduces the risk of deadly fires • The low prices that illicit tobacco is sold for may encourage underage smoking.
With the changes in the laws around nicotine inhaling products the service has also made proactive inspections to ensure traders are aware of their obligations. Prior to the investment by Public Health in the Trading Standards Service, illicit tobacco and alcohol were on open sale within the borough. This is no longer the case and some businesses have been dissuaded from continued sales.
19 REAL life story
Reducing preventable health conditions by improving air quality
The Doncaster Council Pollution Control team has a duty to deliver actions across the council that improve air quality within an Air Quality Action Plan. As part of this, the team delivers a number of projects:
• Daily public air quality broadcasts on social media inform the public about the levels of air quality and provide advice during particularly poor episodes. This serves to potentially reduce the harmful effects on vulnerable individuals and the need to seek healthcare • ECO stars- a heavy goods vehicle fleet emission reduction scheme that encourages cleaner fleet operations across Doncaster • The Fuelling Change campaign aims to promote alternative fuels and addresses the uncertainty that surrounds them for both the public and local businesses. As part of the campaign Doncaster Council has an electric car available to promote and familiarise the public and council employees with electric vehicles.
Making the link between education, work and health at North Bridge
At the council’s North Bridge depot, the Street Scene and Highways team has a number of Health Champions. Their role is to promote the benefits of healthy lifestyle choices, both in the workplace and at home.
The Health Champions initiative means that employees now have access to a wider range of information which has empowered them make to healthier choices and in the recent More Minutes initiative over 60 employees at North Bridge took part. On the day they received fruit and a free day’s membership at a local gym.
As a result of the work of the Health Champions and the high level of engagement at North Bridge participation levels in future health campaigns are likely to increase further.
20 TACKLE unfairness and health inequalities
Last year six recommendations were made to tackle unfairness and health inequalities make the link between health and work stronger and ensure that economic growth benefits everyone. Progress against those is reported below.
Adopt a ‘Health in all Policies’ approach
A Sector Led Improvement peer review of the Public Health function was undertaken in 2017 and the council was commended for how embedded the function is following its transfer from the NHS in 2013. Health implications will be included in all corporate reports and the Health Impact Assessment process for major developments has been agreed. The Local Government Association delivered ‘health training’ open to all Doncaster elected members in May 2017.
The percentage of people using 19.3% outdoor space for exercise or health reasons
Trend
Make a strategic shift to prevention through the Doncaster Place Plan
Prevention and demand management approaches are recognised across the six areas of opportunity in the health and care place plan (intermediate care, complex lives, first 1001 days, vulnerable adolescents, unplanned and emergency care and dermatology). Partners have commissioned ‘Doncaster Talks’ to understand what motivates local people in keeping themselves healthy and what the key barriers are. This approach will give more local insight into the drivers of behaviour and support future service planning. Yorkshire England and Humber
222 200 185 The rate of avoidable deaths has steadily reduced from 249 in 2006/08
21 Empower people and communities to take control of their own health and if services are required involve people in co-designing the services
The Community Engagement Framework sets out the importance of engaging people in decision making and acknowledging the different roles this can take, from information giving and consultation to co-production and citizen power. Further work on the strategy will set out how the council will approach the agreed policy statements:
• We will listen and understand • Doncaster people will inform our policy and we will keep people informed • We will be inclusive and act with purpose • We will make the most of what already exists in communities and where possible increase community capacity
There is a key role residents and communities can, and are, playing in contributing to the achievement of our strategic priorities as set out in the Doncaster Growing Together prospectus.
Percentage of people with 4.3% a low satisfaction score Trend
Improve data capture, sharing and reporting so that services can become more seamless and based on insight to address inequalities in access and outcomes
A new vision for Business Intelligence in the council has been agreed, which puts evidence based decision making at its centre and reflects an intent to use a range of tools and techniques to inform our understanding of communities, people and how services are responding. This is being driven at a leadership level of the council where managers are being asked to consider their contributions as data owners, and how data can be better shared, mixed and interpreted to reach deeper insights.
Work is progressing to consider how to create an integrated intelligence function between the council and Doncaster Clinical Commissioning Group, this integrated approach could include gathering evidence and insight to support health and care integration.
At a strategic level, Team Doncaster launched the first ever State of the Borough assessment on 21 September 2017 alongside the Doncaster Growing Together strategy at Full Council. For the first time, this pulled together one strategic assessment of people and place, with measures taken from the Outcomes Framework.
This sits above, and complements existing assessments such as the Joint Strategic Needs Assessment, and will enable specific assessments to ‘go deep’ into any subsequent questions the strategic State of the Borough assessment prompts.
22 Report back on the health needs assessment for Black and Minority Ethnic (BME) Groups
Under the guidance of the Health and Wellbeing Board a number of actions have been progressed to further understand the health needs of Doncaster’s BME populations. This BME needs assessment in 2017 identified two priority areas:
• The health of new migrants/arrivals • The mental health needs of the BME population
A series of focus groups with sections of the BME community have taken place and the recommendations arising from these focus groups are being checked with participants. A method to look at the prevalence of health conditions in BME groups, their access into services, the completeness rates for treatment and the impact of treatment has been developed. The first health conditions being tested are depression and anxiety.
Continue to move beyond integration to population health systems and budgets
The Doncaster Place Plan sets out six ‘areas of opportunities’ where integration of service delivery should improve the quality of care, improve individual health and wellbeing and also reduce the required financial investment. Doncaster Council and the Clinical Commissioning Group are exploring the establishment of more formal joint commissioning approaches.
Successful integration should also demonstrate improvements in population outcomes and in time allow budgets to be allocated to agreed population segments and increasingly moved to focus on preventative approaches that contribute to reducing demand.
REAL life story
Reducing inequalities in health within Doncaster communities
The Green Space Network is a group of volunteers and partners co-ordinated by Street Scene and Highways operations. The network participates in regular voluntary projects such as litter picking, horticultural activities and fund raising. Tools, bin bags and hi-visibility clothing are supplied on request for volunteers to get involved.
As well as improving the environment for others, taking part in the network actively encourages a healthier lifestyle and an increase in health and well-being as a result of using Doncaster’s outdoor spaces. This ‘health by stealth’ approach reduces the inequalities across communities and the number of volunteers supporting the network continues to grow across the borough.
23 CONCLUSIONS and recommendations
I hope you can see that despite on-going reductions and changes in public service finances there are still examples of innovative and impactful approaches that improve and protect the health of Doncaster people. As the real life stories indicate these approaches arise from within local communities, or jointly with the council and partners. The best of these approaches are where the state is ‘an extension of the community’ not ‘a replacement for the community’. These gains are hard won, yet given the current financial situation are fragile and could be lost. The impact of these initiatives needs to be more systematically captured to ensure that we are making enough progress to impact health outcomes which can take years to change. I have revised the wording of two of the building blocks and whilst the four building blocks are still relevant and need continued focus an additional focus should be brought on sustainability and resilience.
Recommendations for 2018
1. Give every child the best start in life
I am pleased with the progress on implementing the early help strategy, the focus on the first 1001 days of a child’s life and developments in schools focussing on mental health, physical activity and a curriculum for life.
I would like to see this focus continue but would also like partners to consider the potential impact of Adverse Childhood Experiences on Doncaster children and their families and what might be done to prevent these avoidable experiences.
I expect Doncaster’s Children, Young People and Families Board to take this recommendation forward.
2. Make good growth our watchword for economic development
Local social value approaches together with adoption of the minimum wage are starting to benefit Doncaster people. The establishment of Great North Energy and cheaper energy tariffs should be good for local people too. The delay in recommissioning the work programme across the Sheffield City Region is disappointing, but we must take advantage of the trial of Individual Placement Support to show how local involvement in work and health can have similar impacts to the local involvement with work and skills. Workplaces should be a key place for health improvement and health protection and we must not be out off by national decisions on the workplace charter.
Community organisations are contributing to wider community development and their part in the foundational economy needs to be emphasised as part of ‘good growth’. Collectively these approaches signal a strengths based approach which must support vibrant and thriving communities. I expect Doncaster Growing Together and the work theme in particular to take this forward.
3. Improve healthy life expectancy through preventing disability
A good start has been made by Get Doncaster Moving and Delicious Doncaster, however, now is the time to accelerate these approaches. The importance of the local plan together with good local intelligence to support healthy streets and environments is becoming more important following recent debates nationally and locally about hot-food takeaways and gambling premises. The development of the safe and well checks by SYFR is a good news story but does highlight the need to make sure tobacco control and substance misuse programmes are being implemented as effectively as possible.
There is still further work to do to place the work on improving air quality at the heart of planning and development as opposed to being on the periphery.
I expect Doncaster’s Health and Wellbeing Board to take this forward.
4. Tackle unfairness and health inequalities
Embedding the health in all policies approach should reduce unfairness and tackle inequalities. The council should consider a Local Government Association facilitated Sector Led Improvement self-assessment later in the year. Community engagement, development and capacity building should be a focus for all partners in order to deliver the aspirations of Doncaster Growing Together. Collection and sharing of data should be reviewed in light of the new General Data Protection Regulations and the new Borough Strategy. The learning from the BME health needs assessment and subsequent work should inform approaches to other dimensions of health inequality starting with gender.
24 Fairness by itself is not enough and Doncaster should look at becoming as inclusive as possible and translate it’s strengths in logistics and connectivity for business to connectivity and inclusion for local people and communities. I expect Doncaster’s Health and Wellbeing Board to take this forward.
Build a sustainable and resilient borough
Doncaster, its people and the place, has responded well to a wide variety of challenges and changes in its recent past. However, Doncaster should explore the possibility of ‘future-proofing’ itself from future environmental, social and economic changes. Protecting the borough from poverty should be as much of a public health priority as protecting it from polio. Doncaster Growing Together provides a good basis for drawing together interdependent change programmes for the medium term and should help prevent unintended consequences or perverse outcomes from these multiple change programmes. However longer term planning along the lines of the United Nations Sustainable Development Goals for 2030 is much weaker. Whilst some individual programmes exist (e.g. reducing the likelihood and impact of flooding, or resilient design), there are obvious gaps where there is either no obvious approach or the approach is too short term.
The work on the new local plan describing a vision and a framework for the future development of Doncaster, addressing needs and opportunities in relation to housing, the economy, community facilities and infrastructure – as well as a basis for safeguarding the environment, adapting to climate change and securing good design will be increasingly important, as well as how the local plan fits with developing neighbourhood plans. There may be benefits in a collective approach to addressing physical, social and economic challenges and this could be based on long term health and/or economic scenarios. In the first instance NHS partners should review and update their Sustainable Development Management Plans, local supply chains should be reviewed and the South Yorkshire Passenger Transport Executive should work with local councils to increase sustainable transport and active travel.
I expect to develop some proposals and solutions to this in 2018.
REFERENCES
Doncaster Growing Together - www.doncaster.gov.uk/services/the-council-democracy/doncaster-growing-together
Early Help Strategy - www.doncaster.gov.uk/services/schools/early-help-what-is-it-in-doncaster
Local Transformation Plan - www.doncasterccg.nhs.uk/wp-content/uploads/2017/11/Doncaster-LTP-2017-20-updated.pdf
Place Plan - www.doncasterccg.nhs.uk/wp-content/uploads/2016/10/Doncaster-Place-Plan.pdf
Starting Well Strategy - www.teamdoncaster.org.uk/ChildrenFamilies
25 We’re keen to hear your views and feedback on this report. Please get in touch at: Director of Public Health Doncaster Council Civic Office Waterdale Doncaster DN1 3BU Email: [email protected] Twitter: @Doncaster_PH 26 www.doncaster.gov.uk Enc C
Item 8
Quality & Performance Report
Meeting name Governing Body Meeting date 17th May 2018
Title of paper Quality & Performance Report
Executive / Mr Andrew Russell, Chief Nurse Clinical Lead(s) Mr Anthony Fitzgerald, Director of Strategy & Delivery Performance and Intelligence Team Author(s) Quality Team
Purpose of Paper - Executive Summary
This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (NHS Doncaster CCG) Governing Body on an exception basis. The performance rating, indicated by Red, Amber, Green or Blue status, denotes the current month performance and does not reflect the historic trends. The two Delivery Plan focus areas this month are Planned Care and Primary Care. A Summary of the actions status for the 2017/18 Delivery Plans has been included along with the end of year Highlight and Exception report for the Delivery Plans. Updates on the Quarter 4 Better Care Fund and Improvement and Assessment Framework are also included in sections 4 and 5.
The key areas of change, both positive and negative, to note since the last report are:
NHS Doncaster Clinical Commissioning Group (CCG) The percentage of patients waiting on a Referral to Treatment pathway less than 18 weeks at the end of March fell slightly to 89.2% against the 92% target. The percentage of people receiving a diagnostic test within 6 weeks decreased to 98.8% in March narrowly failing to achieve the 99% standard. Cancer measures – Performance underachieved in Quarter 4 for: - 2 week waits (89.3% against a target of 93%) - 2 week waits for breast symptoms (92.8% against a target of 93%) - 62 day screening (85.0% against a target of 90%) Overall Cancer 62 day waits from an urgent GP referral to treatment was achieved in Q4 and has now been achieved for 5 consecutive months. A&E performance decreased to 92.3% in April but above the same period in 2017 (90.4%) Continuing Healthcare – 100% of referrals were completed within 28 days of receipt with no Decision Support Tools (DST) completed in an acute hospital setting. This ranks Doncaster CCG as 1st in the country. Doncaster CCG are in the best performing quartile in 7 of the 51 indicators used to inform the Improvement and Assessment Framework rating, however are in the worst performing quartile for 12 of those indicators. The CCG has not met two of the four Better Care Fund national metrics as at current data for Q4 2017/18; however the CCG has improved on all four metrics compared to the previous year.
Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) There were two 52 week breaches during March 2018. There were no ambulance handovers at the Trust over 60 minutes during March 2018. Performance for receiving a diagnostic test within 6 weeks achieved the 99% target in March at 99.13%. Cancer – 2 week wait measure achieved the 93% target for February 2018 at 93.1% Care Quality Commission visit has taken place and a final report is now awaited.
Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH) IAPT access rate – Performance during Q4 reached 4.0% just below the national target of 4.2% during Quarter 4. The service achieved 16.9% during 2017/18. Care Quality Commission visit has taken place and a final report is now awaited.
Other Commissioned Services Yorkshire Ambulance Service - Of the 4 new categories (ranging from Life Threatening to Less Urgent) 2 were met during March 2018.
Recommendation(s) The Governing Body is asked to: Note the key quality performance areas for attention.
Impact analysis Positive quality impact from a consistent focus on quality outcomes. Quality impact Specific quality impact as identified in the report. Equality Neutral impact Sustainability Nil impact Financial As identified in the report. implications Legal Nil implications The report is for information – no conflicts of interest identified. Management It should be noted that some Governing Body members may be of Conflicts of employed in secondary employment by organisations referenced in this Interest report: please see Register of Interests for details. Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report previously N/A presented at Risk Risks are captured in the Executive Summary. analysis Assurance 2.1, 2.2, 2.3, 2.4, 3.1 Framework
Delivery Plan Overview of Actions 2017/18
A summary of the 2017-19 Delivery Plan action status' as at the end of the first year 2017/18, is shown below. Any actions which were due to be completed during 2017/18 which were not, will continue to be performance managed through the 2018/19 reporting schedule and reported to the CCG's Senior Managment Team and the Governing Body.
Off track due Actions due Slightly off On track - due 2017/18 and Delivery Plan 2017/18 and track - due 2018/19 rolled over to Area Completed 2018/19 2018/19
Planned Care 18 72.0% 5 20.0% 1 4.0% 1 4.0%
Cancer 8 57.1% 4 28.6% 0 0.0% 2 14.3%
Medicines 0 0.0% 7 77.8% 2 22.2% 0 0.0% Management
Children's 0 0.0% 4 57.1% 1 14.3% 2 28.6%
Learning 2 40.0% 1 20.0% 1 20.0% 1 20.0% Disabilities
Community 4 57.1% 2 28.6% 0 0.0% 1 14.3% and End of Life
Mental Health 8 72.7% 0 0.0% 0 0.0% 3 27.3%
Care Homes 1 8.3% 11 91.7% 0 0.0% 0 0.0%
Dementia 0 0.0% 6 100.0% 0 0.0% 0 0.0%
Primary Care 0 0.0% 12 85.7% 2 14.3% 0 0.0%
Urgent Care 4 26.7% 9 60.0% 1 6.7% 1 6.7%
Intermediate 3 37.5% 4 50.0% 1 12.5% 0 0.0% Care
Total 48 36.1% 65 48.9% 9 6.8% 11 8.3%
3 Delivery Plan Highlight & Exception Report: 2017/18 Year End Planned Care
Measures - Matrix Actions Summary
Completed 18 One of the two Quality measures; '92% of RTT maintained across % of Actions On Track & all specialities' is failing, with an overall performance of 89.06% Completed for March 2018. Nine specialities remain non-compliant in March On Track 5 2018 at DBTHFT. Weekly PTL meetings take place with Care Quality Groups where Delivery Plans are discussed to bring performance levels back in line with commissioned activity. Management of the Slightly Off 1 key areas takes place through fortnightly advanced performance 92.0% meetings with Ophthalmology, General Surgery, ENT and Off Track 1 Orthopaedics.
The measure '2017/18 Reduction in planned care referrals by 6%' is achieving target with a 8.2% fall in GP Referrals (less 2WW Activity adjusted for working days) year to date. Actions Off Track and Slightly Off Track
Development of Shared Decision Making Strategy, including the review and enhanced 'Reduction in planned care spend (DBH) 2017/18' remains off track use of patient decision aids - Ongoing plans to be captured within the Communications & with the QIPP savings not being attained due to a number of Engagement Strategy/Action Plan, currently in development. factors including QIPP schemes being behind, however additional QIPP schemes are seeing savings that weren't originally in the Actions outstanding as at the end of March 2018 have been reviewed and closed where Finance plan. Ongoing plans to be captured within Communications and appropriate, or carried forward into the 2018/19 Delivery Plan for continuation. Engagement Strategy/Action plan currently in development. The annual plan for QIPP savings was £4,184,000 actual QIPP saving at M12 is £2,038,000.
Cancer
Measures - Matrix Actions Summary
Completed 8 % of Actions On Track & Four of the measures failed to achieve target from the Completed National Cancer Measures for March 2018. Two Week Wait, On Track 4 Breast Symptomatic, 62 day Screening and 62 Day Upgrade. Slightly Off 0 Quality Prostate pathway remains a focus and key issues are mainly 85.7% related to the start of the pathway and the need for Off Track 2 diagnostic tests. DBTHFT have been successful in securing funding for Quarter 3 and Quarter 4 for diagnostic capacity (MRI) and for administrative MDT support. Actions Off Track and Slightly Off Track
Support Increase in provision of straight to test (direct access diagnostic) pathways in line with 2WW NICE Guidance 2015 and within High Value Pathways (HVP) work (Cancer The number of patients receiving first treatment is above last Alliance footprint) and review innovative diagnostic solutions to increase capacity to meet years position for the same period and year-to-date, there are demand - Cancer Vague Symptoms CT Chest/Abdominal and CT head pathways both now live Activity a total of 158 more patients being treated than 2016/17, for Doncaster GPs. A bid for funding for a One-Stop Prostate Clinic for all 2WW prostate therefore well on track. Diagnostic performance is however off referral patients has been submitted to SYBND Cancer Alliance. For appropriate patients this track at DBTHFT, failing target in March 2018 at 97.43%. would include Outpatient Appointment, MRI and Biopsy on the same day. A one-stop neck lump clinic into our Head and Neck pathway has also been implemented (excludes OMFS).
Measures for finance are in development. Actions Off Track (Cont) 'Commission and implement the Yorkshire and Humber High Value Pathway Specifications - Continuation of work across Place and SYBND Cancer Alliance to finalise proposed stratified follow-up pathways for breast, Colorectal and Prostate. Breast pathway is approved, awaiting final feedback on implementation by end April 18. Prostate, draft Pathway for comment 27 April. Colorectal, draft comments by 18 May. Local discussion within Cancer Programme Board. Requires modelling locally and engagement with Doncaster and Bassetlaw GPs.
Develop a regional Chemotherapy model - Sheffield Teaching Hospital to develop an interim Options Appraisal and present to SYBND Cancer Alliance in April with a full Appraisal by July ensuring any emerging models are available by May 18. Final model by January 2019, with a proposed implementation by April/May 2019. Discussions have included a move away from disease-based provision to a treatment-based model. This may mean Doncaster treat more patients, however still to be confirmed through modelling.
Ensure all breast cancer patients have access to stratified follow up pathways of care. Also work with DBHFT and Primary Care to develop ambitions and framework for access to services for patients with re-occurrence - Rapid cancer diagnostic and assessment pathways published by NHS England April 2018, with the documents setting out how diagnosis within 14 days and diagnosis within 28 days can be achieved for the colorectal, lung, and prostate cancer pathways. Pathways have been disseminated locally with discussion with clinical leads to take place via or outside of Cancer Programme Board.
Ensure all prostate and colorectal cancer patients have access to stratified follow up pathways of care. Also work with DBTHFT and Primary Care to develop ambitions and framework for access to services for patients with re-occurrence - Both stratified pathways now shared at place level for review. Commissioner and GP Lead currently reviewing with a view to identifying implications against current commissioned services. Further work to be taken forward locally within Cancer Programme Board and linked into Alliance LWABC Commissioner group.
Actions outstanding as at the end of March 2018 have been reviewed and closed where appropriate, or carried forward into the 2018/19 Delivery Plan for continuation.
4 Medicines Management
Measures - Matrix Actions Summary
Completed 0 % of Actions On Track & All quality measures are on track which are patients adopting Completed Quality self care for minor ailments and patients with long term On Track 7 conditions accessing pharmacy and lifestyle advisory services. Slightly Off 2 77.8% Activity Data indicates on average High Risk antibiotic prescribing is Off Track 0 reducing. Actions Off Track and Slightly Off Track
Nearly all actions are on track including developing the OptimiseRx profile and identifying The measure to reduce growth in medicines expenditure is on primary care rebates schemes suitable for implementation across Doncaster. track overall. Data is updated every quarter, GP Practices are reducing the growth in expenditure, the CCG growth in Medicines Managements of local clinical pathways - This action is slightly off track. Action Finance expenditure has increased. plans are being devised for Gluten Free Consultation and Drugs not recommended to be prescribed in Primary Care. QIPP cost savings work continues to be the focus of the The annual plan for QIPP savings was £2,534,000 actual QIPP Medicines Management Team (MMT) in line with CCG direction. saving at M12 is £6,206,000. Actions outstanding as at the end of March 2018 have been reviewed and closed where
Children's
Measures - Matrix Actions Summary
Completed 0 Activity for paediatric assessments is now off track as the % of Actions On Track & current activity has exceeded the 5% margin of the target. Asthma emergency admissions and Upper Respiratory Tract Completed On Track 4 Activity Infection emergency admissions are off target year to date. The year to date activity for Asthma and URTI has exceeded the target for 2017/2018 so this target can now no longer be achieved. There was 1 Tier 4 mental health admission in Slightly Off 2 January equalling to 8 Tier 4 admissions for the year. 57.1% Off Track 1
Finance The annual plan for QIPP savings was £470,000 actual QIPP saving at M12 is £228,000.
Measures for Quality are in development. Actions Off Track and Slightly Off Track Commission a Paediatric Respiratory Nurse - There has been little movement with the wider children's nursing arrangements as we are still waiting on agreement by the service provider (RDaSH) on the financial envelope. A series of meetings are arranged for late April to finalise this.
Commission a responsive community provision for the mild to moderately unwell children - The narrative provided for this action is the same as above.
Commission services to implement the Facing the Futures together for child health standards - The new strategy manager for Children and Young People is in the process of revising the Terms Of Reference and refreshing the group, that will oversee the implementation of this.
Learning Disabilities
Measures - Matrix Actions Summary
Completed 2 % of Actions On Track & 'There is one measure off track this month, the Transforming Completed Care Partnership (covering Sheffield, North Lincolnshire, On Track 1 Rotherham and Doncaster CCGs) trajectory of moving people to community. The number of inpatients for the end of Slightly Off 1 Activity Quarter 4 2017/18 was at 34 people against a trajectory of 20. The case managers from across the TCP are meeting with 60.0% DCCG's Chief Operating Officer weekly to ensure a reduction Off Track 1 in numbers is achieved. There are currently 12 Doncaster patients within this figure as at 23rd April 2018.
Finance The annual plan for QIPP savings was £11,000 actual QIPP saving at M12 is £6,000.
Actions Off Track and Slightly Off Track
Reduce Out of Area (OOA) placements, step down from locked rehabilitation - Numbers remain at 12 with a trajectory of 8. 3 potential to be moved. 1 has been identified as MH only and therefore removed from the TCP list. I has been identified as requiring more secure services and is waiting to step up. 1 is currently being worked up to transfer to a community placement.15 patients currently on the at risk register with 3 at heightened monitoring under regular review and being maintained in the community.
Implement intermediate care model - step down and step up crisis management - Still awaiting information from RDASH regarding position of CQC reapplication. Further updates around this action will be provided through the 2018/19 Delivery Plan reporting process.
Actions outstanding as at the end of March 2018 have been reviewed and closed where appropriate, or carried forward into the 2018/19 Delivery Plan for continuation.
5 Community & End of Life
Measures - Matrix Actions Summary
Completed 4 The response rate for the Friends and Family Test measure % of Actions On Track & remained below the 0.4% target at 0.2% during February 2018. Completed Quality The number of deaths in hospital within 72 hours of admission On Track 2 fell again in February to 35 though remained above the 32.75 target. Slightly Off 0 85.7% All measures are on track with the exception of the length of Off Track 1 stay for non-elective admissions of people with Parkinson's. Activity The is figure rose to 11.31 days against a target of 11.05 days.
The annual plan for QIPP savings was £222,000 actual QIPP Finance saving at M12 is £1,293,000.
Actions Off Track and Slightly Off Track Following the outcome from the NHS England Yorkshire & Humber review of neuro-rehabilitation services we will ensure that local patient pathways are aligned during phase 1 and that local commissioned services are reviewed to improve and standardise the quality for patients with acquired brain injury during phase 2 - No further update received from Integrated Care System. This action will be carried over to the 2018/19 delivery plan.
Mental Health
Measures - Matrix Actions Summary
Completed 8 % of Actions On Track & One measure was off track this month, the access rate to Completed Improving Access to Psychological Therapy (IAPT). On Track 0
RDASH's IAPT access rates remain below the cumulative target as at February at 15.5% against a 18.3% target. Adverse Slightly Off 0 weather affect achievement during the quarter with activity 72.7% affected. The IAPT service will continue to implement the Off Track 3 Activity following: • Cognitive Behavioural Therapy staff doing Pyschological Wellbeing Practitioner clinics (creates higher volume of Actions Off Track and Slightly Off Track patients into treatment) Development of collaborative pathways to deliver physical health for people with severe • Triage appointments in cancellations and enduring mental health problems - Joint work underway with primary care • Working through longer wait surgery appointments commissioning to analyse SMI physical initiative against both core primary care •Staff coming in from annual leave and carrying over next year responsibilities and the 5 year forward view for primary care. instead as an exception to boost capacity Modernise the adult mental health acute care and home treatment pathway - RDaSH proposal awaited, now expected April 2018. Met with RDASH on 23/04/18 to confirm Measure to meet the mental health Investment Standard is on urgency and need to go to Exec in May for sign off. track. Develop the IAPT pathway to include joint care management of people with long term conditions (LTC) -Proposal reviewed and business case under construction. The annual plan for QIPP savings was £278,000 actual QIPP Transferring stable patients back to primary care including training at practice level by saving at M12 is £278,000. RDASH consultant and locally developed algorithm to support. Annual health check - will Finance be further local tools developed to support - Impacted by SMI Physical Health Assessment / Follow-up - stocktake underway of responsibility / alignment with primary care 5 year forward view strategy.
Actions outstanding as at the end of March 2018 have been reviewed and closed where
Care Homes
Measures - Matrix Actions Summary
Completed 1 The implementation of the care home strategy across % of Actions On Track & Quality Doncaster is the in the early stages of planning and Completed development. Therefore the impact measures currently On Track 11 remain off track. Slightly Off 0 The implementation of the care home strategy across 100.0% Doncaster is the in the early stages of planning and Off Track 0 development. Activity measures are seeing a increase for Emergency Admissions, A&E and YAS with another slight Actions Off Track and Slightly Off Track Activity decrease in ECP visits for March but overall visits are up slightly on last year. (activity data flows have now restarted but are still All actions are on track including determining and establishing the Primary Care support undergoing validation checks so figures may be subject to model and developing and implementing integrated health and social care training and change) robust recruitment induction process across care home and home care sector.
The annual plan for QIPP savings was £2,500,000 actual QIPP Finance saving at M12 is £803,000.
6 Dementia
Measures - Matrix Actions Summary
Completed 0 The dementia quality measures remains overall 'On Track'. % of Actions On Track & There were 5 new delayed discharge in Winderemere for the Completed month of March and the Year to Date figure of Delayed On Track 6 Discharges is above that of last years position. Additional capacity is continuing to be put into home care and social Quality workers are being recruited which should alleviate the Slightly Off 0 pressure. Doncaster's Dementia Diagosis Rate has continued to decrease from August 2018 but remains above the National 100.0% average. The total number of deaths within 3 days of Off Track 0 admission saw a decrease in February compared to January. The year to date figure is greater than last years position. Actions Off Track and Slightly Off Track All actions are on track including developing and enhancing the post diagnostic offer There are no activity measures that are 'Off-Track'. Please through reconfiguration of existing contracts and resources. Activity note national data as of May 2017 does not identify where a patient is resident in a care home. This reporting is expected to resume but currently there are no timescales.
Primary Care
Measures - Matrix Actions Summary
Both actions (Primary Care Dashboard and National GP Completed 0 % of Actions On Track & Resilience Programme) which contribute to the Quality Completed Quality measure are on track. Further details on these actions can be On Track 12 found on the full delivery plan dashboard. Slightly Off 2 The investment measure is currently slightly off track due to 85.7% the Extended Primary Care and Keeping People Well action Off Track 0 reporting as amber. Progress has been achieved in regards to the Extended Primary Care action (The investment measure is Actions Off Track and Slightly Off Track currently on track however the Extended Primary Care and Keeping People Well action are reporting as amber. Progress Is the out of hospital care pillar to the Primary Care Strategy. Current suite of enhanced has been achieved in regards to the Extended Primary Care services are being delivered by general practice effectively - The Tier 2 LES's for non- action (which was reported as been slightly off track last Investment registered patients remains on hold due to the financial risk if the expected increased activity in month) however work is still underway to ensure various Local Primary Care cannot be offset by taking activity out of the contact with DBTH. Enhanced Services are relevant and fit for purpose. It has also been decided that the Keeping People Well strategy will not be The CCG's contract with member practices for the services within the extended primary care re-commissioned and the Clinical Commissioning Group is work stream has been sent to practices to review, sign and return. The aim is to have all signed continuing to look at how the investment can be better contracts back by the end of June 2018. utilised. This measure is indicated as on track as the majority of higher priority actions are have been reported as on track Is the prevention pillar to the Primary Care Strategy. Current commissioned service asks by the lead commissioner. practices to identify patients aged 18 - 40 on smoking and obesity registers not on any other disease register - The CCG is developing the new service with input from it's member practices. All actions (Workforce, Clinical Staff Education and Work Force draft options and service specifications will be presented to the Primary Care Commissioning Development) which contribute to the Workforce measure are Workforce on track. Further details on these actions can be found on the Actions outstanding as at the end of March 2018 have been reviewed and closed where full delivery plan dashboard. appropriate, or carried forward into the 2018/19 Delivery Plan for continuation.
The workload measure is currently on track as all three related actions (Patient Online, Up skilling of Clerical Staff and Workload Releasing Time For Care) are all rated as green. Further details on these actions can be found on the full delivery plan dashboard.
7 Urgent Care
Measures - Matrix Actions Summary
Completed 4 % of Actions On Track & A&E 4 hour performance remains challenging, with winter pressures Completed reducing performance. This is monitored through the local weekly On Track 9 operational group and performance monitored daily. The Ambulance Response Programme continues to be implemented and Slightly Off 1 the performance against set standards is now being published at Quality YAS level. Response times in March have remained similar to last 86.7% month and are still not meeting the standards . Delayed Transfers Off Track 1 of Care (DToC) have remained low in February. A number of DTOC workshops have taken place and agreed actions built into the Action Actions Off Track and Slightly Off Track Plan. Work across SRG to ensure that 4 hour A&E standard is delivered - 4 Hour performance was improved in March with monthly performance at 93.28%, however the final YTD position was 91.46% which reflected the challenges throughout the year Front Door Assessment and Signposting Service (FDASS) Streaming is and over Winter. currently not achieving 20% streamed away from ED and streaming
has increased in March to 14.6%. An action plan is in place from the Again re-iterating pervious updates It is worth noting however that DBH ED Trust to increase streaming in line with the audit results. performance is performing above that of it's peers for the winter period and is also Reduction in ambulance conveyance recording has changed to Activity above the national average. Phase 3 of NHS England’s Ambulance Response Programme (ARP)
pilot and cannot be compared with previous months, conveyances Working in support of the Doncaster digital road map - rates have seen a slight decrease during March. Work continues on • The revised iDCR system go-live date has been set for 23rd May 2018 Intermediate Care pathways to reduce conveyance rates. • The system has been reloaded with a new extract of data from all providers • User Acceptance Testing phase 2 (data quality) commenced to schedule on 18th April The investment to save on FDASS, to avoid double funding, has not 2018 yet been agreed, however please see the update above regarding streaming actions to increase streaming to 20%. Actions outstanding as at the end of March 2018 have been reviewed and closed where As the reduction in ambulance conveyance is improving but not appropriate, or carried forward into the 2018/19 Delivery Plan for continuation. currently on target, the associated costs are also not currently on Finance target.
The annual plan for QIPP savings was £975,000 actual QIPP saving at M12 is £229,000.
Finance Intermediate Care
Measures - Matrix Actions Summary
• Overall numbers of step-up referrals are higher than the previous Completed 3 year % of Actions On Track & Completed • Patient feedback from the Rapid Response service has been On Track 4 Quality continually positive throughout the last 12 months • By 28 February, 76% of patients accepted by the Rapid Response service were supported at home Slightly Off 1 • Of those followed up by the Rapid Response Service, 64% were 87.5% Off Track 0 • Overall conveyances to A&E for 65s and over, following a 999 call are lower than last year. The number conveyed due to a fall Actions Off Track and Slightly Off Track continues to be on a downward trend and is significantly lower than at this point last year . • A&E attendances for 65s are reducing but are slightly higher Develop Proof of concept for shared digital care record - Revised Go Live date now than this time last year. However, those receiving significant confirmed as 23rd May 2018. All CIROs have assured this and work continues at pace. treatment have reduced by 75% since the beginning of the year Initial benefits session also planned on 27th May. • Acute unplanned admissions have reduced slightly . Unplanned dmissions for falls remain on a downward trend. Actions outstanding as at the end of March 2018 have been reviewed and closed where Activity • Unplanned admissions for General Medicine continue to be appropriate, or carried forward into the 2018/19 Delivery Plan for continuation. lower than the previous year. • Bed based Intermediate care activity is still on a downward trend and lower than the previous year. • Community referrals continue to be higher than the previous year, mainly due to increased ECP referrals and Rapid Response. • The Proportion of patients discharged to a care home from an intermediate care bed has risen to 15% in February. This represents an upward trend since the beginning of the year
The annual plan for QIPP savings was £486,000 actual QIPP saving Finance at M12 is £826,000.
8 Planned Care Delivery Plan Impact Measures Progress Actions Progress
Engagement and Communication of Planned Care Workstreams and One of the two Quality measures; '92% of RTT maintained across all specialities' is failing. Ten specialities remain non- Process/system for ensuring implementation of the thresholds ambition to Primary & Secondary staff & Doncaster public compliant in March at DBTHFT. Weekly PTL meetings take place with Care Groups where Delivery Plans are discussed Quality Slightly Off Track to bring performance levels back in line with commissioned activity and meeting RTT. Management of the key areas Review and develop Referral Guidance and Criteria and Pathways for Patient Engagement and Communication takes place through fortnightly advanced performance meetings with Ophthalmology, General Surgery, ENT and the x7 specialities listed above Orthopaedics. Communicate and launch referral guidance/criteria and planned care Further exploration of Advice and Guidance and communication pathways between GPs and Consultants
The measure '2017/18 Reduction in planned care referrals by 6%' is achieving target with a 8.2% fall in GP Referrals Patient and Public awareness raising and communication regarding Activity On Track Ongoing Monitoring (less 2WW adjusted for working days) year to date. planned care
Engagement with SY Commissioners on standardisation of thresholds Development of Shared Decision Making Strategy, including the 'Reduction in planned care spend (DBH) 2017/18' remains off track with the QIPP savings not being attained due to a agreed through the STP review and enhanced use of patient decision aids number of factors including QIPP schemes being behind, and additional QIPP schemes seeing savings that weren't Finance Off Track Clinical Engagement - Primary and Secondary Care development and originally in the plan. Ongoing plans to be captured within Communications and Engagement Strategy/Action plan Review of current ERS booking and choice system currently in development. sign-up
Quality
Referral to Treatment - Incomplete - March 2018 Patient Choice is evidenced including information on patient waiting times Mar-18 RTT incomplete Pathways Specialty Group Under 18 Weeks 18 Weeks & Over Total Percentage General Surgery 2380 381 2761 86.2% Urology 1472 129 1601 91.9% T&O 4799 771 5570 86.2% ENT 2878 354 3232 89.0% Ophthalmology 2631 451 3082 85.4% Oral Surgery 1136 77 1213 93.7% General Medicine 2283 286 2569 88.9% Cardiology 1904 237 2141 88.9% Dermatology 1705 161 1866 91.4% Thoracic Medicine 838 49 887 94.5% Rheumatology 678 216 894 75.8% Geriatric Medicine 158 8 166 95.2% Gynaecology 1414 92 1506 93.9% Others 3710 225 3935 94.3% Awareness of online appointment booking: current performance and change Trust Total 27986 3437 31423 89.1% over time PTL Waits by Percentile (weeks) Specialty Group 92nd 95th 98th Q6. As far as you know, which of the following online services does your GP General Surgery 22 25 30 Urology 17 22 29 surgery offer? % ‘Booking appointments online’ T&O 21 25 31 ENT 20 23 29 Ophthalmology 22 24 31 General Medicine 20 23 28 Cardiology 21 23 27 Dermatology 17 20 23 Thoracic Medicine 17 19 24 20% 22% 2015 2016 Rheumatology 25 27 30 2% Geriatric Medicine 16 18 20 Gynaecology 17 19 25 Activity
Reduction of patients in Acute system 2017/18 M1-11 Reduction in planned care referrals by 6% (in line with peer group)
GP referrals less 2WW adjusted for working days: -8.2%
Total referrals adjusted for working days: -1.1%
Total referrals less 2WW adjusted for working days: -3.1%
Finance
Reduction in planned care spend (DBTHFT) 2017/18
GP Referrals, Outpatient Firsts and Follow Ups Day cases Activity vs Contract Elective Activity vs Contract OPFA Activity vs Contract £600,000.00 £600,000.00 3,000 700 7,000
6,000 2,500 600 £500,000.00 £500,000.00 500 5,000 2,000 400 4,000 1,500 £400,000.00 £400,000.00 300 3,000 1,000 200 2,000
500 £300,000.00 £300,000.00 Expected Position 100 1,000 Actual Saving 0 0 0 Total Projected Saving M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 £200,000.00 £200,000.00 Actual Actual Activity Plan Actual Actual Activity Plan Actual Actual Activity Plan
£100,000.00 £100,000.00 OPFU Activity vs Contract OP Proc FA Activity vs Contract OP Proc FU Activity vs Contract 14,000 2,000 3,500 1,800 12,000 3,000 £- £- 1,600 Reduced Referrals Outpatients First Reduced Referrals Outpatients Follow PLCV Outpatients - Dermatology PLCV Outpatients - Acupuncture 10,000 1,400 2,500 Up 1,200 8,000 2,000 1,000 6,000 1,500 QIPP - Elective Savings - PLCV - Part 1 800 4,000 600 1,000 £900,000.00 £900,000.00 400 2,000 500 200
£800,000.00 £800,000.00 0 0 0 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12
Actual Actual Activity Plan Actual Actual Activity Plan Actual Actual Activity Plan £700,000.00 £700,000.00
QIPP - Elective Savings - PLCV - Part 2 £600,000.00 £600,000.00 £25,000.00 £25,000.00
£500,000.00 £500,000.00 Expected Position £20,000.00 £20,000.00 Actual Saving £400,000.00 £400,000.00 Total Projected Saving
£15,000.00 £15,000.00 £300,000.00 £300,000.00 Expected Position Actual Saving
£10,000.00 £10,000.00 Total Projected Saving £200,000.00 £200,000.00
£100,000.00 £100,000.00 £5,000.00 £5,000.00
£- £- Hernias Hip & Knee Haemorrhoids £- £0.00 Asymptomatic Gallstones Carpal Tunnel Syndrome Cateract Surgery Duputrens Contracture Ganglion Feb-18 Mar-18 Apr-18 Period General Jan-Mar 18 Indicator Performance On Track On Track On Track
Communications & Engagement Strategy/Action Plan still in Engagement and Communication of Communications & Engagement Strategy/Action Plan still in The Planned Care Programme Board is currently developing a Communications development. Planned Care Workstreams and development. & Engagement Strategy/Action Plan. It is intended that the programme of work Communications regarding 100 Day Challenge work circulated to ambition to Primary & Secondary staff Update (Narrative) 100 Day Challenge update with supporting documentation will be jointly led by the CCG and Trust communications and engagement Primary and Secondary Care. RDASH to be approached. & Doncaster public currently in development for circulation via CCG, RDASH and teams. Healthwatch continue to update public regarding progress in the DBTH. Missed Appointments work
Workstream 1 - Right Care Programme and Pathway Redesign Jan - Mar 18 Indicator Performance On Track On Track Slightly Off
In addition to 100 Day Challenge Pathway work. The Review and develop Referral Guidance The Planned Care Programme Board is currently developing a Communications Urology, ENT and Cardiology Specialty Groups as part of 100 Day Ophthalmology Task and Finish Groups for Paediatric Screening and Criteria and Pathways for the x7 & Engagement Strategy/Action Plan. It is intended that the programme of work Update (Narrative) Challenge work are currently undertaking a range of work relating and Glaucoma have held their first meeting which includes review specialities listed above will be jointly led by the CCG and Trust communications and engagement to pathways, referral guidance and criteria. of the existing Pathways. teams. Liaising with ICS regarding SYB Lower GI Pathway+
Mar 17 onwards Indicator Performance On Track On Track On Track
Communicate and launch referral Communications have been circulated via DBTH/RDASH/DCCG re. guidance/criteria and planned care Action Plans to enable this will be incorporated into the Communications & Communications & Engagement Strategy/Action Plan still in Update (Narrative) 100 Day Challenge Pathway work. Further update currently in pathways Engagement Strategy/Action Plan currently in development. development. development.
Apr 17 onwards Indicator Performance On Track On Track On Track
Planned Care Programme Board to undertake review of workplan Planned Care Programme Board initial work plan review session Ongoing Monitoring Updates to Planned Care Programme Board as per highlight reports. Ongoing Update (Narrative) at April session which will include evaluation of workstream undertaken. Further detail relating to prioritisation, reporting, overall performance monitoring via Planned Care Dashboard. status and ongoing monitoring arrangements going forward. timescales and responsibility to be worked through
Workstream 2 - Threshold Management and Reduction in Procedures of Limited Clinical Value (POLCV) Dec 16 - Mar 18 Indicator Performance On Track On Track Complete
Engagement with South Yorkshire Commissioners on standardisation of Phase 2 checklists launched. thresholds agreed through the STP Policy amended and published taking into account local Update (Narrative) Doncaster revision to STP Policy to take into account local criteria where Working to STP policy Sustainability and Transformation Plan variation. necessary. (STP)
Dec 16 - Mar 18 Indicator Performance On Track On Track Complete
Attendance at SystmOne and EMIS user group meetings to provide an update. Clinical Engagement - Primary and Currently reviewing how information is made available on GP Find. Secondary Care development and sign- Some refinement of key word search on GP Find - Further review Contact completed with SystmOne Practices to ensure checklists Update (Narrative) up required. uploaded and shared within practice. Ongoing plans to be captured within Communications & Engagement Strategy/Action Plan currently in development.
Dec 16 - Mar 18 Indicator Performance On Track On Track Complete
Process/system for ensuring Audit findings to be used to identify system changes needed to support Financial analysis undertaken. Feedback to be discussed with Head of Planned Care and Head of Contracting to agree future implementation of the thresholds Update (Narrative) effective implementation DBTH re 17/18 and future audits planned for Q2 18/19. audit plans with Deputy COO, DBTH
Dec 16 - Mar 18 Indicator Performance On Track On Track Complete
Patient Engagement and CfV leaflet to be updated. DCCG Choose Wisely Information for Patients about Printed copies delivered to Primary Care and DBTH in April. Communication Update (Narrative) Ongoing plans to be captured within Communications & Engagement Commissioning for Outcomes shared with Planned Care Shared with Bassetlaw for circulation. Strategy/Action Plan currently in development. Programme Board for comment prior to wider circulation.
Workstream 3 - Improvement in Primary Care Information and Referral Management Nov - Mar 18 Indicator Performance On Track On Track Complete onwards Further exploration of Advice and 7 our of 8 Specialties have gone live. Urology is expected shortly. Consideration Guidance and communication between Agreement with DBTH regarding final phase 3 implementation for 9 Specialties have gone Live. 2018/19 CQUIN end of Q4 Target is is being given to inclusion of Ophthalmology which is being offered at no GPs and Consultants and implement outstanding Specialties. Variation in performance across that 75% of GP referrals are made to elective outpatient Update (Narrative) additional cost. recommendations Specialties highlighted as a concern at Planned Care Programme specialties which provide access to Advice and Guidance services. Ongoing plans to be captured within Communications & Engagement Board. Currently coverage is c.40%. Strategy/Action Plan currently in development.
Workstream 4 - Patient Engagement, Choice and Shared Decision Making Nov - Mar 18 Indicator Performance On Track On Track On Track
Missed Appointments "Keep, cancel or re-arrange" video 4,200 views between Patient and Public awareness raising 20th and 26th February. Missed Appointments Action Plan presented to and approved by and communication regarding planned Missed Appointment work linking in to eRS Group to ensure Update (Narrative) Missed Appointment Task and Finish Group reporting to the PCPB is being Planned Care Programme Board. Task and Finish Group care Patient and Public feedback is incorporate4d into eRS rollout established and the draft action plan to be submitted to PCPB 15th March established to take forward and coordinate actions. 2018.
Apr - Sep 17 Indicator Performance Off Track Off Track Off Track
Development of Shared Decision Making Strategy, including the review Ongoing plans to be captured within Communications & Engagement Ongoing plans to be captured within Communications & Ongoing plans to be captured within Communications & and enhanced use of patient decision Update (Narrative) Strategy/Action Plan currently in development. Engagement Strategy/Action Plan currently in development. Engagement Strategy/Action Plan currently in development. aids
Nov 16 onwards Indicator Performance On Track On Track On Track
Links established between ERS Task and Finish Group and Missed Appointments work.
Review of current ERS booking and Communications circulated in Doncaster & Bassetlaw November and February. Inclusion of eRS as one of the key principles of 2018/19 GMS Paper Switch-off reports being shared by DBTH. Awaiting latest choice system Update (Narrative) Attendance at Doncaster LMC 5 March. Contract Negotiations expected to inform and support Standard Operating Procedure regarding Polling Range. Visits to high-referring (paper) Practices planned throughout February/March. implementation. This includes a greater commitment from the Awaiting Exclusion specialities to share with Primary Care. . National eRS Team to work with Primary Care and CCGs to facilitate the effective implementation of eRS. Paper switch-off implementation plan agree across Doncaster & Bassetlaw. NHS Doncaster CCG Primary Care Delivery Plan April '18 Impact Measures Progress Actions Progress
Both actions (Primary Care Dashboard and National GP Resilience Primary Care Quality Dashboard. National GP Resilience Programme. (Q) Programme) which contribute to the Quality measure are on track. G The development and implementation G NHS England Programme to support On Track Quality: Further details on these actions can be found on the full delivery plan including engagement of a local dashboard vulnerable practices. dashboard. Q to understand the variation between Q 2 Doncaster GP Practices. 1
CCG Strategy - Extended Primary Care. CCG Strategy. - Responsive Primary Care. The investment measure is currently on track however the Extended A Is the out of hospital care pillar to the G Focuses on access in general practice. Primary Care and Keeping People Well action are reporting as amber. Primary Care Strategy. Current suite of Progress has been achieved in regards to the Extended Primary Care InV enhanced services are being delivered by InV action (which was reported as been slightly off track last month) however 6 general practice effectively. 5 (InV) work is still underway to ensure various Local Enhanced Services are On Track relevant and fit for purpose. It has also been decided that the Keeping Investment: People Well strategy will not be re-commissioned and the Clinical Commissioning Group is continuing to look at how the investment can be better utilised. This measure is indicated as on track as the majority of higher priority actions are have been reported as on track by the lead commissioner. GPFV - Extended Access. Estates. G Provision of 7 day services as detailed in G Development of Primary Care estates the GPFV. strategy including consideration for InV InV national estates funding routes. 4 3
CCG Strategy. - Proactive Coordinated CCG Strategy. - Keeping People Well. G Care. A Is the prevention pillar to the Primary Care Is the proactive care pillar to the Primary Strategy. Current commissioned service InV Care Strategy. Current commissioned InV asks practices to identify patients aged 18 - 2 service asks practices to identify their top 1 40 on smoking and obesity registers not on 2% most vulnerable patients and any other disease register. proactively manage their care in a holistic manner.
12 NHS Doncaster CCG Primary Care Delivery Plan April '18 Impact Measures Progress Actions Progress
All actions (Workforce, Clinical Staff Education and Work Force Workforce. Clinical Staff Education. (WF) Development) which contribute to the Workforce measure are on track. G Output and progress of the ACS workforce G Is the CCG supported education On Track Workforce: Further details on these actions can be found on the full delivery plan workstream. programme for GP's and Nurses i.e. dashboard. WF WF TARGET. 3 2
GPFV - Workforce Development. G Doncaster implementation of the GPFV workforce focused programmes including WF the GP Leadership Programme. 1
GPFV - Patient Online and Online GPFV - Up skilling of Clerical Staff. The workload measure is currently on track as all three related actions G Consultations G Implementation of Care Navigation and the (WL) (Patient Online, Up skilling of Clerical Staff and Releasing Time For Care) are On Track General practice offer of online roll out of GPFV funding for active sign Workload: all rated as green. Further details on these actions can be found on the full WL appointments, access to records, online WL posting and correspondence management. delivery plan dashboard. 3 repeat prescriptions and use of online 2 consultations.
Releasing Time for Care Programme. G NHS England programme to implement the 10 high impact actions including the at WL scale implementation of the Productive 1 General Practice Programme.
13 1.00 Proactive Coordinated Care April '18
Practice Breakdown - (h - More Than Previous Quarter i - Less Than Previous Quarter) 1.02 - No. Patients with new or reviewed care plan by quarter. Code Practice Name Sign Up 1.02 1.03 1..04 1.05 1.06 C86001 CARCROFT DOCTORS GROUP 212 h h g h h C86002 THE RANSOME PRACTICE 110 h i g i i C86003 HATFIELD HEALTH CENTRE 244 i h g h h C86005 MEXBOROUGH HEALTH CENTRE 109 i h h h i C86006 REGENT SQUARE GROUP PRACTICE 0 g g g g g C86007 DR P O'HORAN AND PARTNERS 160 h h g h h Quarter 1 Quarter 2 Quarter 3 Quarter 4 C86009 THE MAYFLOWER MEDICAL PRACTICE 146 i h h g i C86011 MOUNT GROUP PRACTICE 270 i i i g h 1.03 - No. Patients who agreed to share their enhanced summary care record by quarter. C86012 THE OAKWOOD SURGERY 140 h g i i h C86013 THE TICKHILL & COLLIERY MEDICAL PRACTICE 248 i h h i i C86014 PRINCESS MEDICAL CENTRE 128 h g g i i C86015 THE ROSSINGTON PRACTICE 164 h g g i h C86016 THE LAKESIDE PRACTICE 154 h i i h i C86017 KINGTHORNE GROUP PRACTICE 209 i g i h h C86018 NORTHFIELD SURGERY 317 h g g g g Quarter 1 Quarter 2 Quarter 3 Quarter 4 C86019 THE SCOTT PRACTICE 264 g h h h i C86020 ST.JOHNS GROUP PRACTICE 178 i h g i i 1.04 - Patients asked question 33 of the GP Patient Survey by quarter. C86021 WHITE HOUSE FARM MEDICAL CENTRE 128 i g g i i C86022 THE SANDRINGHAM PRACTICE 196 h h i h h C86023 BENTLEY SURGERY 121 h h g h h C86024 CONISBROUGH GROUP PRACTICE 215 h g g h h C86025 FRANCES STREET MEDICAL CENTRE 207 h h g h h C86026 EDLINGTON HEALTH CENTRE PRACTICE 98 i h h i h C86029 ST VINCENT MEDICAL CENTRE 233 i h i h h Quarter 1 Quarter 2 Quarter 3 Quarter 4 C86030 THE PHOENIX MEDICAL PRACT 79 h i g g i C86032 SCAWSBY HEALTH CENTRE PRACTICE 113 h h g h h 1.05 - No. Emergency admission from patients on the co-ordinated care register by quarter. C86033 THE NAYAR PRACTICE 107 h h i h i C86034 THE NEW SURGERY 144 h h h h h C86037 FIELD ROAD SURGERY 223 h h g i h C86038 PETERSGATE MEDICAL CENTRE 207 i h g h h C86039 THE VILLAGE PRACTICE 247 h h h i i C86605 ASKERN MEDICAL PRACTICE 178 i h g i i C86606 BARNBURGH SURGERY 80 h g g h g Quarter 1 Quarter 2 Quarter 3 Quarter 4 C86609 AUCKLEY SURGERY 69 i g h i h C86611 DUNSVILLE MEDICAL CENTRE 106 h h g h h 1.06 - No. A&E attendances not resulting in admission from the registers patients by quarter. C86613 THE NELSON PRACTICE 129 i h h i i C86614 THORNE MOOR MEDICAL PRACTICE 187 h h g h h C86616 CHURCH VIEW SURGERY 102 h g g h h C86621 WEST END CLINIC 100 h h g h h C86623 DR ME SHEIKH'S PRACTICE 83 g g g i h C86625 CONISBROUGH MEDICAL PRACTICE 39 i h i i i C86626 PARK VIEW SURGERY 46 i i g g h Quarter 1 Quarter 2 Quarter 3 Quarter 4 Y05167 FLYING SCOTSMAN HEALTH CENTRE 227 g g g h h
14 2.00 Extended Primary Care April '18
Practice Breakdown - (h - Over Achieving i - Under Achieving) 2.02 - Total Tier 1 variances between actual activity and expected activity by quarter. Code Practice Name Sign Up 2.02 2.03 2.04 0.00 C86001 CARCROFT DOCTORS GROUP 1,2,3 i h i C86002 THE RANSOME PRACTICE 1,2 i h g -200.00 -280.00 C86003 HATFIELD HEALTH CENTRE 1,2 g g g -400.00 -640.00 C86005 MEXBOROUGH HEALTH CENTRE 1,2 i g g -600.00 Quarter 1 C86006 REGENT SQUARE GROUP PRACTICE 1,2 i i g -800.00 C86007 DR P O'HORAN AND PARTNERS 1,2 i g g Quarter 2 C86009 THE MAYFLOWER MEDICAL PRACTICE 1,2 i h g -1000.00 -1003.00 C86011 MOUNT GROUP PRACTICE 1,2 h h g -1200.00 Quarter 3 THE OAKWOOD SURGERY i i g C86012 1,2 -1400.00 -1416.00 C86013 THE TICKHILL & COLLIERY MEDICAL PRACTICE 1,2 i i g -1600.00 Quarter 4 C86014 PRINCESS MEDICAL CENTRE 1,2 i i g C86015 THE ROSSINGTON PRACTICE 1,2 h h g C86016 THE LAKESIDE PRACTICE 1,2 i g g C86017 KINGTHORNE GROUP PRACTICE 1,2 i i g 2.03 - Total Tier 2 variances between actual activity and expected activity quarter. C86018 NORTHFIELD SURGERY 1,2 i i g 0.00 C86019 THE SCOTT PRACTICE 1,2,3 i h h C86020 ST.JOHNS GROUP PRACTICE 1,2 i h g -20.00 C86021 WHITE HOUSE FARM MEDICAL CENTRE 1,2 i g g Quarter 2 -40.00 -12.00 C86022 THE SANDRINGHAM PRACTICE 1,2 i i g -53.00 C86023 BENTLEY SURGERY 1,2 i i g -60.00 Quarter 1 C86024 CONISBROUGH GROUP PRACTICE 1,2 h i g -80.00 C86025 FRANCES STREET MEDICAL CENTRE 1,2 i i g Quarter 3 Quarter 4 -100.00 C86026 EDLINGTON HEALTH CENTRE PRACTICE 1,2 i i g -109.00 C86029 ST VINCENT MEDICAL CENTRE 1,2 i h g -120.00 -119.00 C86030 THE PHOENIX MEDICAL PRACT 1,2 i g g -140.00 C86032 SCAWSBY HEALTH CENTRE PRACTICE 1,2 i i g C86033 THE NAYAR PRACTICE 1,2 i i g C86034 THE NEW SURGERY 1,2 i g g C86037 FIELD ROAD SURGERY 1,2 i i g 2.04 - Total Tier 3 variances between actual activity and expected activity quarter. C86038 PETERSGATE MEDICAL CENTRE 1,2 i g g 50.00 C86039 THE VILLAGE PRACTICE 1,2 i i g 47.00 Quarter 3 C86605 ASKERN MEDICAL PRACTICE 1,2 i i g 40.00 C86606 BARNBURGH SURGERY 1,2 h h g C86609 AUCKLEY SURGERY 1,2 i h g 30.00 DUNSVILLE MEDICAL CENTRE C86611 1,2 g g g 20.00 C86613 THE NELSON PRACTICE 1,2,3 i h i 17.00 C86614 THORNE MOOR MEDICAL PRACTICE 1,2 i i g 10.00 -3.00 Quarter 4 C86616 CHURCH VIEW SURGERY 1,2 i g g 11.00 C86621 WEST END CLINIC 1,2 i g g 0.00 Quarter 2 C86623 DR ME SHEIKH'S PRACTICE 1,2 i h g -10.00 Quarter 1 C86625 CONISBROUGH MEDICAL PRACTICE 1,2 i h g C86626 PARK VIEW SURGERY 1,2 i h g Y05167 FLYING SCOTSMAN HEALTH CENTRE 1,2 h g g
* Information relates to practices providing enhanced services for registered populations only.
15 3.00 Keeping People Well April '18
Practice Breakdown 3.02 - No. Patients on the keeping well register by quarter. Code Practice Name Sign Up 3.02 3.03 3.04 C86001 CARCROFT DOCTORS GROUP Y C86002 THE RANSOME PRACTICE Y C86003 HATFIELD HEALTH CENTRE Y C86005 MEXBOROUGH HEALTH CENTRE Y C86006 REGENT SQUARE GROUP PRACTICE Y C86007 DR P O'HORAN AND PARTNERS Y Specification Currently Under Redesign. C86009 THE MAYFLOWER MEDICAL PRACTICE Y
C86011 MOUNT GROUP PRACTICE Y C86012 THE OAKWOOD SURGERY Y C86013 THE TICKHILL & COLLIERY MEDICAL PRACTICE Y C86014 PRINCESS MEDICAL CENTRE Y C86015 THE ROSSINGTON PRACTICE Y Quarter 1 Quarter 2 Quarter 3 Quarter 4 C86016 THE LAKESIDE PRACTICE Y C86017 KINGTHORNE GROUP PRACTICE Y 3.03 - No. Patients (new) add to the diagnosis register by quarter.
C86018 NORTHFIELD SURGERY Y Redesign.
C86019 THE SCOTT PRACTICE Y C86020 ST.JOHNS GROUP PRACTICE Y C86021 WHITE HOUSE FARM MEDICAL CENTRE Y C86022 THE SANDRINGHAM PRACTICE Y C86023 BENTLEY SURGERY Y C86024 CONISBROUGH GROUP PRACTICE Y Specification Currently Under Redesign. C86025 FRANCES STREET MEDICAL CENTRE Y C86026 EDLINGTON HEALTH CENTRE PRACTICE Y C86029 ST VINCENT MEDICAL CENTRE Y C86030 THE PHOENIX MEDICAL PRACT Y C86032 SCAWSBY HEALTH CENTRE PRACTICE Y C86033 THE NAYAR PRACTICE Y Quarter 1 Quarter 2 Quarter 3 Quarter 4 C86034 THE NEW SURGERY Y C86037 FIELD ROAD SURGERY Y 3.04 - No. Referrals to the national diabetes prevention programme. C86038 PETERSGATE MEDICAL CENTRE Y C86039 THE VILLAGE PRACTICE Y C86605 ASKERN MEDICAL PRACTICE Y C86606 BARNBURGH SURGERY Y C86609 AUCKLEY SURGERY Y C86611 DUNSVILLE MEDICAL CENTRE Y C86613 THE NELSON PRACTICE Y CurrentlyUnder Specification Specification Currently Under Redesign. C86614 THORNE MOOR MEDICAL PRACTICE Y C86616 CHURCH VIEW SURGERY Y C86621 WEST END CLINIC Y C86623 DR ME SHEIKH'S PRACTICE Y C86625 CONISBROUGH MEDICAL PRACTICE Y C86626 PARK VIEW SURGERY Y Quarter 1 Quarter 2 Quarter 3 Quarter 4 Y05167 FLYING SCOTSMAN HEALTH CENTRE Y
16 4.00 Responsive Primary Care April '18
Practice Breakdown - (h - Increasing From Previous Quarter i - Decreasing From Previous Quarter) 4.02 - Same Day Health Centre usage by quarter. Code Practice Name GPFW 4.02 4.03 4.04 C86001 CARCROFT DOCTORS GROUP Y h h h C86002 THE RANSOME PRACTICE Y h h i C86003 HATFIELD HEALTH CENTRE Y h h i C86005 MEXBOROUGH HEALTH CENTRE Y h h i C86006 REGENT SQUARE GROUP PRACTICE Y h h i C86007 DR P O'HORAN AND PARTNERS Y h h h C86009 THE MAYFLOWER MEDICAL PRACTICE Y h h h C86011 MOUNT GROUP PRACTICE Y h g i Quarter 1 Quarter 2 Quarter 3 Quarter 4 C86012 THE OAKWOOD SURGERY Y h h h C86013 THE TICKHILL & COLLIERY MEDICAL PRACTICE Y h i h 4.03 - Front Door Assessment & Signposting Service usage by quarter. C86014 PRINCESS MEDICAL CENTRE Y h h h C86015 THE ROSSINGTON PRACTICE Y i h h C86016 THE LAKESIDE PRACTICE Y i h h C86017 KINGTHORNE GROUP PRACTICE Y h h h C86018 NORTHFIELD SURGERY Y h h h C86019 THE SCOTT PRACTICE Y i h i C86020 ST.JOHNS GROUP PRACTICE Y h i i C86021 WHITE HOUSE FARM MEDICAL CENTRE Y h i h C86022 THE SANDRINGHAM PRACTICE Y h h h Quarter 1 Quarter 2 Quarter 3 Quarter 4 C86023 BENTLEY SURGERY Y h i i C86024 CONISBROUGH GROUP PRACTICE Y h i h 4..04 - GP Patient Survey - Ability to get an appointment by quarter ( % ). C86025 FRANCES STREET MEDICAL CENTRE Y h h i C86026 EDLINGTON HEALTH CENTRE PRACTICE Y h h h C86029 ST VINCENT MEDICAL CENTRE Y h h i C86030 THE PHOENIX MEDICAL PRACT Y h h i C86032 SCAWSBY HEALTH CENTRE PRACTICE Y h i i C86033 THE NAYAR PRACTICE Y i i i C86034 THE NEW SURGERY Y h h h C86037 FIELD ROAD SURGERY Y h i h C86038 PETERSGATE MEDICAL CENTRE Y h h i Quarter 1 Quarter 2 Quarter 3 Quarter 4 C86039 THE VILLAGE PRACTICE Y h h i C86605 ASKERN MEDICAL PRACTICE Y h h h C86606 BARNBURGH SURGERY Y h i h C86609 AUCKLEY SURGERY Y h i i C86611 DUNSVILLE MEDICAL CENTRE Y h i i C86613 THE NELSON PRACTICE Y h h i C86614 THORNE MOOR MEDICAL PRACTICE Y h h i C86616 CHURCH VIEW SURGERY Y h i i C86621 WEST END CLINIC Y i h h C86623 DR ME SHEIKH'S PRACTICE Y h h i C86625 CONISBROUGH MEDICAL PRACTICE Y h i h C86626 PARK VIEW SURGERY Y h g i Y05167 FLYING SCOTSMAN HEALTH CENTRE Y h h i
17 Contact Details April '18
Delivery Plan Lead: Carolyn Ogle Associate Director of Primary Care NHS Doncaster Clinical Commissioning Group Tel: 01302 566224 Email: [email protected]
Delivery Plan Lead: Kayleigh Wastnage Primary Care Manager NHS Doncaster Clinical Commissioning Group Tel: 01302 566343 Email: [email protected]
Clinical Lead: Dr Nabeel Alsindi GP & Clinical Lead for Primary Care and LTC. NHS Doncaster Clinical Commissioning Group Tel: 01302 566293 Email: [email protected]
Performance & Intelligence Lead: Chris Empson Informatics Programme Manager NHS Doncaster Clinical Commissioning Group Tel: 01302 566296 Email: [email protected]
18 Mar-18 Tracking Apr-18 Period by: ACTIONS - OPERATIONAL & STRATEGIC: Primary Care Quality Dashboard. Tracking The development and implementation including engagement of a PCMEG met at the beginning of April and reviewed the action plan. No new practices were identified for local dashboard to understand the variation between Doncaster GP inclusion at this meeting. Practices. The Primary Care Matrix Evaluation Report data sets have been updated and the full refreshed report will be Apr-17 The PCMEG continue to engage with identified practices as detailed on the Group's action plan. There is no discussed at the next PCMEG where any new variances in practice behaviour will be identified. onwards significant update from January. On Track An evaluation of the PCMEG / PC Matrix is being undertaken by Gemma Munce who will present the findings to the Primary Care Delivery Group at it's June meeting and the Primary Care Commissioning Committee at it's July meeting.
National GP Resilience Programme. Tracking The CCG was allocated £20k resilience funding to use to provide support for practices. The Primary Care Apr-17 NHS E Programme to support vulnerable practices. Doncaster Practices have fully utilised their allocated funding. The CCG's allocation will be utilised aiding a Commissioning Committee has agreed to utilise this funding to support a practice keep their list of patients onwards practice list to remain open by funding premises adaptations. On Track open by funding additional space within their premises. CCG Strategy - Extended Primary Care. Tracking Is the out of hospital care pillar to the Primary Care Strategy. Current suite of enhanced services are being delivered by general The Tier 2 LES's for non-registered patients remains on hold due to the financial risk if the expected increased practice effectively. activity in Primary Care cannot be offset by taking activity out of the contact with DBTH. The Tier 2 LES's for non-registered patients remains on hold due to the financial risk if the expected increased activity in Primary Care cannot be offset by taking activity out of the contact with DBTH. Apr-17 Changes have been made to the GTT and Hpylori service specification to bring them in line with current Slightly Off onwards practice. Work is still underway with secondary care around the prostate cancer monitoring LES. The CCG's contract with member practices for the services within the extended primary care work stream Track has been sent to practices to review, sign and return. The aim is to have all signed contracts back by the end The CCG's contract with member practices for the services within the extended primary care work stream is of June 2018. being drafted for the 2018/2019 period.
CCG Strategy. - Responsive Primary Care. Tracking Focuses on access in general practice.
Apr-17 The review of in hours access has begun and will inform a future options paper to be considered by the Primary The review of in hours access has begun and will inform a future options paper to be considered by the onwards On Track Care Commissioning Committee. Primary Care Commissioning Committee.
GPFV - Extended Access. Tracking Apr-17 Provision of 7 day services as detailed in the GPFV. The market engagement days have taken place and will inform the service specification which is now under The service specification has been drafted and was signed off by the Primary Care Commissioning onwards development. On Track Committee at it's April meeting. The service will be put out to tender by the end of April 2018.
Estates. Tracking Development of Primary Care estates strategy including The Primary Care Committee have agreed the estates strategy brief. An update will be presented at July's consideration for national estates funding routes. Primary Care Commissioning Committee. The Strategy is being drawn up by an external estates expert. Apr-17 The Primary Care Committee have agreed the estates strategy brief. An update will be presented at July's onwards Primary Care Commissioning Committee. The Strategy is being drawn up by an external estates expert. On Track The CCG is also putting in capital bids to the ICS Capital Investment Pipeline Oversite Group for consideration at their meting in April.
CCG Strategy. - Proactive Coordinated Care. Tracking Is the proactive care pillar to the Primary Care Strategy. Current commissioned service asks practices to identify their top 2% most vulnerable patients and proactively manage their care in a holistic manner.
Practices have been asked to confirm if they will be continuing to provide the service in 2018/2019 and to Apr-17 The agreed changes following the service refresh will be included in the 2018/2019 GP Contract. Practices will indicated any changes to the service they wish to make. Future updates will provide a summary of the onwards be allowed time to review these changes and sign up to the service. On Track outcome of this process.
19 Mar-18 Tracking Apr-18 Period by: ACTIONS - OPERATIONAL & STRATEGIC: CCG Strategy. - Keeping People Well. Tracking Is the prevention pillar to the Primary Care Strategy. Current Apr-17 commissioned service asks practices to identify patients aged 18 - 40 The CCG is developing the new service with input from it's member practices. draft options and service The CCG is developing the new service with input from it's member practices. draft options and service Slightly Off onwards on smoking and obesity registers not on any other disease register. specifications will be presented to the Primary Care Commissioning Committee in due course. specifications will be presented to the Primary Care Commissioning Committee in due course. Track
Workforce. Tracking Output and progress of the ACS workforce work stream and The CCG is considering using the 90p per head no longer in the Proactive Coordinated Care funding to development of the workforce strategy. incentivise practices to provide workforce data, however this is yet to be agreed. The CCG is leading on the The CCG is considering using the 90p per head no longer in the Proactive Coordinated Care funding to procurement of the new workload tool for SYB. Apr-17 incentivise practices to provide workforce data, however this is yet to be agreed. The CCG is leading on the onwards procurement of the new workload tool for SYB. The CCG will be taking part in an ICS workforce event on the On Track The CCG has directly awarded the contract for workforce development to Primary Care Doncaster. The aim 27th March. of this contract will be to collate primary care workforce data, engage with the NHS England funding tools and to produce a workforce strategy by September 2018.
Clinical Staff Education. Tracking Apr-17 Is the CCG supported education programme for GP's and Nurses i.e. The TARGET contract from 1st April 2018 has been awarded to Primary Care Doncaster. A stakeholder steering The TARGET contract from 1st April 2018 has been awarded to Primary Care Doncaster. A stakeholder onwards TARGET. group is being established to allow multi-agency input into the educational topics. On Track steering group is being established to allow multi-agency input into the educational topics.
GPFV - Workforce Development. Tracking Doncaster implementation of the GPFV workforce focused Apr-17 programmes including the GP Leadership Programme and local There has been no significant progress on this programme. There has been no significant progress on this programme. onwards development of workforce programmes On Track
GPFV - Patient Online and Online Consultations Tracking General practice offer of online appointments, access to records, online repeat prescriptions and use of online consultations. The CCG is looking to support practices engage with and utilise remote consultation software. The CCG is in the The CCG is looking to support practices engage with and utilise remote consultation software. The CCG is in Apr-17 process of developing the business case for this support which will be internal to the CCG via the Data Quality the process of developing the business case for this support which will be internal to the CCG via the Data onwards On Track Team. Quality Team.
GPFV - Up skilling of Clerical Staff. Tracking Implementation of Care Navigation and the roll out of GPFV funding for active sign posting and correspondence management.
Apr-17 There has been no significant progress on this programme. There has been no significant progress on this programme. onwards On Track
Releasing Time for Care Programme. Tracking NHS England programme to implement the 10 high impact actions Apr-17 including the at scale implementation of the Productive General There has been no significant progress on this programme. There has been no significant progress on this programme. onwards Practice Programme. On Track
20 Section 2: NHS Constitution Indicators (NHS Doncaster CCG) Referral to Treatment Times (RTT)
Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks
Commissioner Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Doncaster CCG 90.9% 91.3% 91.3% 91.4% 90.7% 90.6% 90.0% 91.3% 91.7% 90.5% 90.4% 90.2% 89.2%
Rightcare Peer Group 90.3% 90.2% 90.9% 90.9% 90.7% 90.6% 90.6% 91.1% 90.8% 90.0% 90.1% 89.9%
Doncaster and Bassetlaw Teaching Hospitals 90.5% 90.4% 90.6% 90.9% 90.3% 90.1% 89.5% 90.7% 90.8% 89.6% 90.0% 90.0% 89.1% Foundation Trust (DBTHFT)
England 90.7% 90.0% 90.5% 90.3% 90.0% 89.5% 89.2% 89.4% 89.8% 86.8% 86.9% 86.5%
Standard 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%
94% Patients on incomplete non-emergency pathways who have been waiting no more than 18 weeks 92% 90% 88% 86% 84% Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Doncaster CCG Rightcare Peer Group Doncaster and Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT) England Target
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Performance for DCCG patients at all Trusts remains below target at 89.2% in March 2018 with 9 specialties failing to meet the 92% standard: Cardiology (87.9%) Cardiothoracic Surgery (83.3%) Ear Nose and Throat (ENT) (88.8%) General Medicine (88.2%) General Surgery (86.7%) Ophthalmology (85.3%) Plastic Surgery (91.5% Rheumatology (74.2%) Trauma and Orthopaedics (T&O) (87.6%)
DBTHFT’s position deteriorated slightly during March to 89.1% (lowest position of 2017/18 with 9 specialties below 92%) which is below the target but above the national average. Key issues at DBTHFT relate to internal capacity to meet demand in the system. The Trust have purchased a modeling tool called Gooroo to more accurately calculate activity requirements over the year to maintain waiting lists as per the National Planning Guidance. The CCG is working with the Trust to progress the use of the tool to manage capacity and demand to ensure waiting list numbers do not deteriorate and as many patients will be treated within 18 weeks as possible within the agreed contract parameters.
March again saw improved theatre utilisation in Gastrointestinal , ENT and T&O. The Trust’s Elective Steering Board is reviewing theatre lists on all 3 sites to ensure that all lists are utilised effectively. The Elective Care Development Programme across the CCG, DBTHFT, RDaSH and DMBC is looking at 3 specialties, Cardiology, ENT and Urology to maximise the efficient use of out- patients which includes reviewing whether patients can be seen by other providers.
Weekly PTL meetings continue at the Trust and an invite has been extended for the CCG to also attend these meetings to provide enhanced assurance. The CCG has also proposed a revised Governance structure for 2018/19 for the discussion of RTT, waiting lists, referral demand and activity with the Trust which will provide a more robust assurance process with clear escalation routes within the CCG and Joint boards with the Trust.
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Patients waiting less than 6 weeks for a diagnostic test
Commissioner Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Doncaster CCG 96.9% 97.7% 98.8% 97.4% 98.3% 95.6% 97.6% 98.9% 99.1% 97.5% 98.5% 99.0% 98.8%
Rightcare Peer Group 98.7% 98.5% 98.6% 98.5% 98.9% 98.2% 98.4% 98.2% 98.1% 98.5% 97.9% 98.3%
DBTHFT 97.4% 97.5% 98.5% 97.7% 98.7% 96.2% 98.1% 99.3% 99.3% 98.5% 98.9% 99.4% 99.1%
England 98.9% 98.2% 98.1% 98.1% 98.2% 97.8% 98.7% 98.3% 98.6% 97.8% 97.7% 98.4%
Standard 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%
Patients waiting less than 6 weeks for a diagnostic test 100% 99% 98% 97% 96% 95% Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Doncaster CCG Rightcare Peer Group DBTHFT England Standard
DCCG performance deteriorated slightly during March 2018 to 98.8% below the 99% target. There were 56 breaches during the month with the highest number in Audiology Assessments (13) at DBTHFT due to demand and staffing issues though these have reduced in recent months as a result of action plans put in place by the service. There were 9 patients waiting for Echocardiography at STHFT due to staffing shortages which are being addressed with the Integrated Care System to increase capacity through
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support from other providers and to manage demand by reviewing referral thresholds, removing unnecessary repeats and considering the regularity of reviews.
DBTHFT achieved the diagnostic performance standard in at 99.13%. In March there were 41 breaches overall compared with 64 in February.
A&E attendance to admission, transfer or discharge
A&E attendances under 4 hours from arrival to admission, transfer or discharge
Provider Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18
DBTHFT 90.4% 91.4% 92.5% 93.2% 93.6% 93.7% 92.8% 91.2% 88.6% 87.2% 88.2% 93.3% 92.3%
England 90.5% 89.7% 90.7% 90.4% 90.3% 89.7% 90.1% 88.9% 85.1% 85.3% 85.0% 84.6%
Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
A&E attendances under 4 hours from arrival to admission, transfer or discharge 100% 90% 80% 70% Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18
Doncaster & Bassetlaw Teaching NHS FT England Standard Government Mandate
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The Government has set out in the NHS Planning Guidance for 2018-19, key steps towards fully recovering performance against the core A&E access standards. This will ensure that A&E performance meets 90% or greater than performance in the prior year in September 2018 and 95% in March 2019. All Trusts will be expected to achieve 95% thoughout the course of 2019/20.
Performance deteriorated slightly in April 2018 to 92.3% which is below the national standard but is higher than the same month last year. Internal A&E processes have been reviewed by the Trust to identify any potential areas of improvement, including the identification of the Emergency Physician in Charge and standardised operating protocols for escalation and shop floor management.
Cancer Measures
2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP Q1 Q2 Q3 Q4 Commissioner Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17/18 17/18 17/18 17/18 Doncaster CCG 90.6% 91.8% 87.5% 90.6% 90.0% 93.5% 94.5% 92.6% 93.5% 86.7% 92.9% 88.8% 89.3%
Rightcare Peer Group 94.9% 95.0% 94.9% 95.4% 95.1% 96.4% 95.4% 95.0% 95.9% 95.4% 96.3%
DBTHFT 90.6% 91.5% 88.1% 90.6% 89.9% 93.4% 94.0% 91.9% 93.1% 87.2% 93.1%
England 93.7% 94.1% 93.6% 94.0% 93.7% 94.7% 95.1% 94.9% 94.9% 93.9% 95.2% 93.2% 94.1%
Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%
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2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 98% 96% 94% 92% 90% 88% 86% 17-18 q1 17-18 q2 17-18 q3 17-18 q4
Doncaster CCG Rightcare Peer Group DBTHFT England Target
DCCG performance in March 2018 was below the 93% target at 88.8% and the 2017/18 Year to Date (YTD) performance of 90.9% is also below the target of 93%.There were a total of 108 breaches in March 2018 of which Administation Error, mainly attributed to difficulties with contacting patients, contributed to 39 of those breaches. There were 37 breaches due to Patient Choice, 27 breaches relating to Capacity issues and the remaining 5 were due to Hospital Cancellations. Compared to activity in 2016/17, there has been a 9.1% increase in Two Week Wait patients seen. Over the course of the year, 47% of breaches within 2017/18 were due to Patient Choice, 32% were due to Capacity Issues and 13% were due to Administration Error.
Administration Errors maily include circumstances where the Cancer Services Team have attempted to contact the patient and not succeeded. The prior process was to telephone the patient to book an appointment, and this was attempted three times over the course of the day; this has been changed to attempt three times over the course of two days to try increase chances of reaching the patient. Telephone booking in this way is preferable to sending a letter (where the referral wasn’t made via ERS) as it promotes choice for the patient and decreases DNAs.
A capacity and demand tool has been developed jointly with the Trust and CCG and is being implemented within the Care Groups to proactively manage the demand over a forward looking 6 week period. The tool has been set to aim to see patients within 7 days of referral to support 62 day performance and the 28 day Faster Diagnosis Standard. Additional clinics were put on in Urology in 26
April and May, a locum is supporting Skin from May, Lower GI patients should be seen in time from May, and meetings are taking place regarding the Oral Maxillo Facial Surgery pathway with STHFT. The contract query opened in Q1 2017/18 has again been reviewed with the Trust during March and will remain open due to the continuing under-performance.
2 week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) Q1 Q2 Q3 Q4 Commissioner Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17/18 17/18 17/18 17/18
Doncaster CCG 90.3% 86.5% 90.0% 87.0% 88.1% 96.3% 93.2% 89.8% 92.5% 95.2% 91.9% 90.9% 92.8%
Rightcare Peer Group 95.3% 95.4% 95.1% 95.0% 95.2% 96.7% 96.2% 95.8% 96.2% 95.3% 96.6%
DBTHFT 94.1% 88.0% 93.4% 90.1% 90.6% 92.7% 95.3% 93.5% 94.3% 93.9% 93.2%
England 90.7% 93.5% 93.1% 93.2% 90.7% 95.4% 95.6% 94.2% 95.15% 91.9% 94.1% 91.0% 92.3
Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%
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2 week wait for first outpatient appointment for patients referred urgently with breast symptoms 100%
95%
90%
85% 17-18 q1 17-18 q2 17-18 q3 17-18 q4 Doncaster CCG Rightcare Peer Group DBTHFT England Target
Two week waits for Breast Symptomatic patients narrowly missed the standard in March 2018 or Q4 2017/18. There were 6 breaches, 5 of which patients had cancelled an earlier appointment and one breach was due to Administration.
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31-day wait from diagnosis to first definitive treatment for all cancers
Q1 Q2 Q3 Q4 Commissioner Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17/18 17/18 17/18 17/18
Doncaster CCG 98.5% 96.4% 95.8% 90.6% 95.7% 96.4% 100% 97.0% 97.9% 94.8% 96.2% 98.7% 96.5%
Rightcare Peer Group 98.0% 98.2% 97.1% 96.8% 97.4% 97.7% 98.3% 97.8% 98.0% 96.4% 96.6%
DBTHFT 98.9% 99.4% 98.6% 98.5% 98.9% 100% 100% 100% 100% 98.5% 98.4%
England 97.4% 97.6% 97.7% 97.3% 97.4% 97.7% 97.5% 97.8% 97.7% 96.4% 97.6% 97.5% 97.2%
Target 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96%
31-day wait from diagnosis to first definitive treatment for all cancers 101% 100% 99% 98% 97% 96% 95% 94% 93% 17-18 q1 17-18 q2 17-18 q3 17-18 q4
Doncaster CCG Rightcare Peer Group DBTHFT England Target
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31 day wait for subsequent treatment where that treatment is surgery
Q1 Q2 Q3 Q4 Commissioner Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17/18 17/18 17/18 17/18
Doncaster CCG 100% 100% 100% 93.8% 98.1% 100% 100% 100% 100% 94.4% 100% 100% 98.1%
Rightcare Peer Group 96.8% 93.8% 95.3% 97.3% 95.4% 97.0% 98.3% 95.3% 95.5% 95% 97.9%
DBTHFT 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
England 96.1% 96.0% 95.9% 95.3% 96.1% 95.3% 95.5% 95.4% 95.6% 93.6% 95.4% 94.9% 94.6%
Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%
31 day wait for subsequent treatment where that treatment is surgery 100%
98%
96%
94%
92%
90% 17-18 q1 17-18 q2 17-18 q3 17-18 q4
Doncaster CCG Rightcare Peer Group DBTHFT England Target
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31 day wait for subsequent treatment where that treatment is drug regimen
Q1 Q2 Q3 Q4 Commissioner Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17/18 17/18 17/18 17/18
Doncaster CCG 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Rightcare Peer Group 99.8% 99.4% 99.5% 99.7% 99.6% 99.7% 99.7% 100% 99.5% 99.5% 100%
DBTHFT 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
England 96.1% 99.6% 99.4% 99.2% 99.4% 99.2% 99.5% 99.4% 99.5% 99% 99.6% 99.3% 99.3%
Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%
31 day wait for subsequent treatment where that treatment is drug regimen 100% 99% 98% 97% 96% 95% 94% 17-18 q1 17-18 q2 17-18 q3 17-18 q4
Doncaster CCG Rightcare Peer Group DBTHFT England Target
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31 day wait for subsequent treatment where that treatment is radiotherapy
Q1 Q2 Q3 Q4 Commissioner Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17/18 17/18 17/18 17/18
Doncaster CCG 96.9% 87.5% 100% 100% 96.1% 96.6% 100% 100% 98.6% 97.92% 92.7% 95.6% 95.0%
Rightcare Peer Group 99.8% 95.6% 98.0% 97.9% 97.2% 97.5% 98.7% 98.9% 97.42% 95% 98.5%
England 96.8% 96.9% 97.4% 96.6% 96.6% 97.0% 97.5% 97.9% 97.5% 96.1% 97.6% 97.1% 97.0%
Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%
31 day wait for subsequent treatment where that treatment is radiotherapy 100% 99% 98% 97% 96% 95% 94% 93% 92% 91% 17-18 q1 17-18 q2 17-18 q3 17-18 q4
Doncaster CCG Rightcare Peer Group England Target
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62-day wait from urgent GP referral to first definitive treatment for cancer
Q1 Q2 Q3 Q4 Commissioner Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17/18 17/18 17/18 17/18
Doncaster CCG 81.7% 76.3% 73.9% 73.6% 75.3% 79.0% 83.9% 86.0% 82.7% 86.0% 89.4% 88.0% 88.0%
Rightcare Peer Group 84.5% 82.8% 82.0% 81.9% 82.4% 81.1% 84.2% 86.6% 84.0% 82.7% 78.9%
DBTHFT 85.1% 84.9% 86.2% 82.1% 84.8% 86.2% 88.9% 87.8% 87.2% 85.6% 85.0%
Sheffield Teaching Hospitals 78.8% 75.8% 75.2% 82.0% 77.9% 80.4% 78.9% 81.5% 78.7% 75.2% 83.6% Foundation Trust (STHFT)
England 81.6% 81.2% 82.3% 81.8% 81.4% 82.0% 82.2% 84.0% 82.8% 80.9% 80.8% 84.5% 82.2%
Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%
62-day wait from urgent GP referral to first definitive treatment for cancer 90% 85% 80% 75% 70% 17-18 q1 17-18 q2 17-18 q3 17-18 q4
Doncaster CCG Rightcare Peer Group DBTHFT Sheffield Teaching Hospitals Foundation Trust (STHFT) England Target
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Across the Cancer Alliance the Cancer Services Managers continue to review all shared pathways. The Trust needs to achieve and maintain a 7 day access either to diagnostics or first consultation and achieve discussion at Central Multi-Disciplinary Team by Day 24 to allow for a smoother transition to Day 38. A Prostate One Stop Clinic will be implemented from September will Alliance Transformation funding to support faster time to diagnosis and transfer for treatment. Funding has also been bid for, for a specific Post-Menopausal Bleeding Clinic to support Gynaecological waiting times. The national timed pathways for Prostate, Lung and Lower GI tumours are also being implemented across the Alliance.
62-day wait from referral from an NHS screening service to first definitive treatment for all cancers
Q1 Q2 Q3 Q4 Commissioner Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17/18 17/18 17/18 17/18
Doncaster CCG 96.3% 100% 81.8% 94.4% 92.1% 86.7% 91.7% 100% 91.4% 85.7% 83.3% 85.7% 85.0%
Rightcare Peer Group 93.8% 91.6% 87.8% 92.1% 90.7% 93.8% 91.1% 90.3% 91.7% 93% 82.1%
DBTHFT 96.3% 100% 86.7% 95.5% 94.1% 88.2% 91.9% 96.0% 92.2% 96.2% 90.0%
Sheffield Teaching Hospitals Foundation Trust 98.9% 97.9% 95.5% 91.3% 95.7% 92.1% 95.8% 88.2% 91.3% 85.4% 83.3% (STHFT)
England 95.3% 90.5% 91.9% 92.1% 92.3% 89.3% 91.1% 91.7% 90.7% 87.8% 88.0% 90.6% 88.7%
Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
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100% 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers
95%
90%
85%
80% 17-18 q1 17-18 q2 17-18 q3 17-18 q4 Doncaster CCG Rightcare Peer Group DBTHFT STHFT England Target
There was 1 breach in the Breast tumour group that is still being investigated resulting in a performance of 85.7% in March 2018 which is below the 90% target.
62-day wait from referral from consultant upgrade to first definitive treatment for all cancers
Q1 Q2 Q3 Q4 Commissioner Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17/18 17/18 17/18 17/18
Doncaster CCG 72.0% 80.0% 92.9% 68.4% 79.3% 85.7% 93.8% 83.3% 90.0% 77.8% 50.0% 61.5% 61.3%
Rightcare Peer Group 84.9% 88.3% 88.8% 84.3% 87.3% 87.5% 92.4% 90.6% 89.6% 88.9% 89.6%
DBTHFT 80.2% 83.3% 92.7% 72.7% 83.6% 94.1% 88.9% 77.8% 87.7% 73.3% 63.6%
Sheffield Teaching Hospitals Foundation Trust 74.0% 66.7% 77.1% 93.0% 69.0% 76.9% 78.9% 83.0% 79.9% 73.8% 70.4% (STHFT)
England 86.8% 87.5% 87.7% 87.4% 85.8% 87.1% 93.8% 88.1% 88.4% 87% 86.2% 87.4% 87.1%
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62-day wait from referral from consultant upgrade to first definitive treatment for all cancers 100% 95% 90% 85% 80% 75% 70% 65% 60% 17-18 q1 17-18 q2 17-18 q3 17-18 q4
Doncaster CCG Rightcare Peer Group DBTHFT STHFT England
Performance against this standard improved in March compared to February but was below the 85% local target. This was due to five breaches, two of the breaches were due to the inter-Trust referral being received late in the pathway in the Lung and Upper GI tumour groups. One of the Urological breaches is still being investigated with the other breach being a mixed reason of the inter- Trust referral being received after thr breach date, but due to outpatient capacity issues early in the pathway. The final breach was in the Haematology tumour group. The actions for these pathways are part of the wider 62 day waiting times actions referred to above.
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Yorkshire Ambulance Service (YAS)
October 17 November 17 December 17 January 18 February 18 March 18 April 18 Category 1 (Life threatening injuries and illness) target of 00:07:11 00:07:30 00:08:18 00:08:01 00:07:53 00:08:17 00:08:01 average time less than 7min Category 2 (Emergency) target of 00:20:28 00:21:26 00:27:47 00:26:55 00:21:24 00:26:24 00:21:23 average time less than 18 min Category 3 (Urgent) target 90% of 01:33:56 01:42:52 02:33:03 02:29:17 01:53:56 02:23:18 1:59:06 times below 2 hours Category 4 (Less urgent) target 02:57:47 02:43:45 Not Available 03:43:23 03:06:33 03:22:30 02:50:45 90% of times below 3 hours
The previous Red 1 and Red 2 national standards have been replaced by a new call prioritisation system which sets standards for all 999 calls to ambulance services, including those requiring an ambulance intervention passed to ambulance services via 111. These two sets of standards are not comparable. These new standards are now recorded at a provider level so Doncaster data is no longer available. A meeting between YAS and appropriate CCGs has been held to discuss reporting and some Doncaster level data will be shared by YAS for analysis by the CCG.
In addition, the revised Clinical Quality Indicators (CQI) will include reporting of data across the patient pathway as Ambulance Trusts begin to utilise national outcome databases. Reporting of CQIs will move to a quarterly schedule to better monitor trends and will be ready for full publication in April 2018 due to the preparatory work required for the new stroke indicator. This requires ambulance services to measure the time it takes from the 999 call to the time it takes positive stroke patients to arrive at a specialist stroke centre so that they can be rapidly assessed for thrombolysis.
YAS CQC Visit
Currently there are no issues or concerns that CQC have with the Yorkshire Ambulance Service.
Following the last CQC inspection, where the service was rated as overall good, there were some issues highlighted relating to the Patient Transport Service. YAS devised an action plan with all actions now completed and closed.
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Section 3: Provider Exception Report
The following section of the report details performance by exception (those measures either rated Red or have deteriorated outside of normal range) for each main local provider, namely DBTHFT and RDASH and other commissioned services (FCMS and YAS). Performance is across a range of agreed quality and more traditional “performance” measures. As such the report includes performance as a whole for DBTHFT and Doncaster sites for RDASH, and does not simply relate to services provided to NHS Doncaster CCG. The following includes a summary of provider measures and exceptions, which are those causing concern either cumulatively for the year, quarter or in month.
Number of Indicators and percentage within each provider Green Red DBTHFT 20 (69%) 9 (31%) RDASH 30 (86%) 4 (12%) Other Commissioned Services 7 (44%) 9 (56%)
40 Total 35 30 25 20 15 Red Green 10 Green 5 Red 0 DBTHFT RDASH Other Commissioned Services
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3.1 Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust: Exception Report
This section only includes those measures in the DBTHFT contract currently not meeting target, which are not covered by the constitution measures in Section 2.
Cancelled operations
Cancelled operations (target less than 0.8%) Provider Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sept-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
DBTHFT 1.0% 1.1% 1.1% 1.0% 1.5% 1.1% 1.0% 1.0% 1.0% 1.5% 0.9% 1.4% 1.5% Target 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8%
Reduction in cancelled operations 2.0%
1.5%
1.0%
0.5%
0.0% Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Reduction in Cancelled Operations Target
In March, 1.5% of Trust operations were cancelled which related to 76 patients; 59 of which were cancelled for theatre reasons and 17 for non-theatre reasons (an increase of 12 from the previous month). Out of these overall cancellations, 30 patients were cancelled at Doncaster, 17 at Bassetlaw and 12 at Mexborough.
The reasons for the non-clinical cancellations are displayed in the graph below: 39
8 15 Insufficient time 6 Staff Urgent case Equipment 12 Beds 18
Cancelled Operations - 28 day standard Provider Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sept-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
DBTHFT 0 0 4 1 2 1 1 3 1 2 5 1 3 Target 0 0 0 0 0 0 0 0 0 0 0 0 0
Cancelled operations - 28 day standard 6
4
2
0 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Cancelled operations - 28 day standard
Three patients’ operations were cancelled on the day of admission and then waited over the 28 day standard for their surgery to be rearranged. 40
52 Week Waits – Incomplete Pathway
52 Week Waits – Incomplete Pathway Provider Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sept-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 DBTHFT 1 1 1 2 1 1 2 2 1 1 3 1 2 Target 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Week Waits – Incomplete Pathway 4 3 2 1 0 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
52 Week Waits – Incomplete Pathway
At the end of March 2018 there were 2 Incomplete Pathways over 52 Weeks both of which were Doncaster CCG patients. These pathways have been validated with agreed dates for treatment in May and June. The breach reports with full pathway timelines, reasons for the breach and a clinical assessment of harm will be received from the Trust once the patients have been treated.
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Stroke: Proportion of patients directly admitted to a stroke unit under 4 hours (target 90%) and the percentage of patients given thrombolysis (target 20%) and the Percentage of applicable patients who are discharged who were given a named person to contact after discharge (target 95%)
Stroke Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sept- Oct- Nov- Dec- Jan- 17 17 17 17 17 17 17 17 17 17 17 17 18 Proportion of patients directly admitted to a stroke 49.0% 51.2% 64.3% 56.5% 68.3% 74.5% 73.9% 66.0% 62.2% 66.7% 64.3% 64.3% 56.4% unit under 4 hours (stretch target 90%) Percentage of patients (according to the RCP guideline minimum threshold) given thrombolysis N/A N/A N/A 4.3% 8.3% 10.6% 13.0% 12.0% 2.2% 11.8% 5.4% 3.6% 7.3% (stretch target 20%) Percentage of applicable patients who are discharged who were given a named person to 65.9% 74.4% 80.7% 85.0% 80.8% 84.1% 82.2% 90.9% 83.3% 91.1% 98.0% 88.5% 84.1% contact after discharge (stretch target 95%)
Stroke measures 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18
Proportion of patients directly admitted to a stroke unit under 4 hours Percentage of applicable patients who are discharged who were given a named person to contact after discharge Percentage of patients (according to the RCP guideline minimum threshold) given thrombolysis
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The 4 Hour Direct Admissions standard is not being achieved by the Trust and January saw a deteriorating position compared with the previous months at 56.4%.
Validation of the breaches by the Stroke Nurse Practitioner team indicates that the majority of breaches were related to specific pathway issues. 80% of patients breaching the 4 hours were however admitted wihthin 5 hours. The reasons for the breaches are discussed at the main Contract meeting with the Trust and concerns escalated.
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3.2 Rotherham, Doncaster & South Humber NHS Foundation Trust
This section only includes measures in the RDASH contract currently not meeting target which are not included in the constitution measures in Section 2.
Improving Access to Psychological Therapies (IAPT)
IAPT Access - Compliance of those who have entered (i.e. received) treatment as a proportion of people with anxiety or depression (cumulative for financial year) Commissioner and Q1 Q2 Q3 Q4 year RDASH DCCG 4.5% 8.9% 12.8% 16.9% 2017/18 Local Stretch 5.0% 10% 15% 20% Target 2017/18 Doncaster CCG (all providers) 4.2% 8.4% 12.2% 2017/18
IAPT Access 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Q1 Q2 Q3 Q4 RDASH 2017/18 Target 2017/18 DCCG
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Performance for 2017/18 as a whole was slightly off track at 16.9%, against the local target of 20%; nationally the service was required to meet 4.2% during Quarter 4 and achieved 4.0% with a stated aim of 16.8% overall which was achieved.
During the quarter the impact of snow and ice had a detrimental impact on the amount of people able to access the service. To mitigate this the service deployed Cognitive Behavioural Therapy staff to psychological wellbeing practitioner clinics to increase the amount of capacity, continued to work through longer wait surgery appointments, allowed staff to carry over leave into the next financial year to increase the number of appointments available and implemented an additional stress control class.
DNA’s have also continued to fall within the service from 14.8% in April 2017 to 11.3% in March 2018.
Older People: Percentage of patients requiring non urgent treatment who receive treatment within 6 weeks of assessment (8 week pathway)
Non-urgent waits Provider Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sept-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 RDASH 82.9% 88.4% 87.5% 87.0% 95.00% 90.8% 89.1% 90.7% 93.3% 95.7% 88.0% 83.3% 89.1% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
Older people non urgent waits
100.00% 90.00% 80.00% 70.00% Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
8 week waits Target
Performance improved in March to 89.1% however remained below the 95% target. There were a total of 10 waits that were seen over eight weeks. A number of breaches were affected by scans at DBTHFT with the remainder due to staff capacity within the North Team which the Locality Service Managers are investigating. DBTHFT have previously informed RDaSH that there are a high 45
number of DNAs which are thought to be caused by patients being given appointments for CT scans & ECGs at Bassetlaw District General Hospital. The Trust has raised this with DBTHFT at the Provider to Provider meeting.
Older People: The percentage of patients receiving a 12 month Section 117 (S117) Review
Non-urgent waits Provider Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sept-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 RDASH 94.0% 93.3% 94.8% 96.7% 93.3% 91.8% 98.3% 96.8% 96.7% 94.8% 92.5% 85.9% 88.7% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%
S117 Reviews - OP 100.0%
95.0%
90.0%
85.0% Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
S117 reviews Target
March’s performance improved to 88.7% though remains below the target of 95% as a result of 7 breaches. The S117 Lead Practitioner is currently working with the Care Co-ordinators across the Care Group to ensure compliance is achieved as soon as possible. S117 reviews for adults and people with Learning Disabilities remain on track.
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Speech and Language Service Patients on incomplete pathways (yet to start treatment) should have been waiting no more than 18 weeks
Speech and Language Provider Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sept-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 RDASH 100% 100% 100% 100% 99.3% 92.9% 90.2% 80.2% 88.6% 71.1% 77.2% 76.4% 86.8% Target 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%
SALT incomplete waits 100.00% 90.00% 80.00% 70.00% Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
18 week incomplete waits Target
Performance improved during March by 10.4% to 86.8% though this is still below the target (92%). The Service are triaging the patients most at risk – there have been no reported incidents into the service although they recognise the increased risk; particularly with the dysphagia patients. If there is updated information added to the referral staff reasess the severity.
The service are now up to full capacity and a locum member of staff will remain in place until April 2018 which will improve performance and reduce the total number of patients on the waiting list.
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3.3 Other Commissioned Services
3.3.1 FCMS:
Definitive Clinical Assessments undertaken under 60 minutes (non-urgent)
Out of Hours - Definitive Clinical Assessment 100.00% 90.00% 80.00% 70.00% 60.00% Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Definitive Clinical Assessment <60 mins (non urgent) Target
Performance improved again in March 2018 to 90.5% though remained below the 95% target. This is the best performance since September 2017.
A new role of Pathway Lead has been put into place within the service from February and is supporting Call Handlers on a one-to- one basis to ensure correct actions and recording take place. Though the majority of breaches presented involved the case type being changed before triage and causing delays, there have been visable improvements through the month.
Month Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sept-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Advised within 60 1537 1221 214 148 85 66 52 65 70 46 45 46 72 minutes Not advised within 60 62 51 24 20 6 6 16 19 17 26 20 12 12 minutes 48
Out of Hours (OOH) Surgery face to face assessments triaged as emergency in less than 1 hour and as urgent under 2 hours; Visits face to face assessments triaged as urgent under 2 hours
Out of Hours - Surgery and Visits 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Surgery < 1 hour Surgery < 2 hours Target Visits < 1 hour Visits < 2 hours
OOH Surgery breaches for Red Priority (1 hour): Performance increased to 59.1% in March. There were 9 breaches as broken down below:
Case Category 1.00-1.30 1.30-2.00 2.00-2.30 2.30-300 3+ Patient Choice/first 2 2 1 1 3 appointment
The longest wait time from initial assessment was 3 hours 51 minutes 16 seconds.
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OOH Surgery breaches Amber Priority (2 hours): Performance improved to 81.7% in March with the breaches broken down below.
Case Category 2.00-2.30 2.30-3.00 3.0-4.0 4+ Patient arrived late 11 2 1 1 Patient Choice/first 24 14 23 8 appointment Clinician delay 24 10 2 1 Incorrect reporting 0 0 0 1
The longest wait time from initial assessment was 11 hours 50 minutes 39 seconds. This case involved patient choice/ first appointment. The appointment was not booked within the recommended timeframe by the call handler causing an initial breach. The delay was significantly increased due to patient delay.
The longest clinical delay was 5 hours and 5 minutes. This delay was on a busy day over the weekend. To mitigate this in the future the clinician involved has reviewed the case to identify where improvements can be made.
Patient choice/ First Appointment: The service is working to separate this category so that the extent of which this problem is a capacity issue in comparison to patient choice can clearly be seen. A mandatory field has been implemented within the recording system and call handlers are being reminded to record whether there was patient choice to delay the appointment. This will make future clarifications easier.
OOH Visit breaches Red Priority (1 Hour): There were 3 breaches in March, 2 of which were clinical delays with 1 case of incorrect reporting. The longest clinical delay was 2 hours and 12 minutes This delay was caused by staff change-over during a busy weekend. The patient was seen immediately after the clinician arrived. Clinicians involved are reminded to be attentive to delays that could be caused by changeover. The case was ended on a red priority. A clinical review of this case has been undertaken and will be shared with the CCG.
OOH Visit breaches Amber Priority (2 Hours): Performance improved in March to 82.8% with 5 breaches. All of these related to clinical delays. The longest delay was 9 hours 22 minutes and 54 seconds. The clinician left the case open therefore did not visit the patient in the recommended timeframe. An incident report has been submitted and the GP involved has been required to review and reflect on current and future practices and share this with the CCG. This case ended on an amber priority. 50
Same Day Health Centre: face to face assessments triaged as emergency and seen in less than 1 hour and as urgent fewer than 2 hours
Same Day Health Centre 100% 80% 60% 40% 20% 0% Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Target SDHC < 1 hour SDHC < 2 hours
Red Priority (1 hour) breaches: Performance deteriorated to 50.0% in March 2018 with 1 breach.
It was identified that the call handler did not allow enough time for the clinician to avoid clinical delay. This case finished on Green Priority.
Amber Priority (2 hour) breaches: Performance deteriorated slightly to 78.6% in March 2018 with 66 breaches.
Case Category 2.00-2.30 2.30-3.00 3.00-4.00 4+ Patient arrived late 5 0 1 0 Patient Choice/first 16 14 10 12 appointment Clinician delay 8 0 0 0
The longest clinical delay was 2 hours 13 minutes and 23 seconds. The appointment was not booked within enough time to allow the clinician to avoid delay. This case completed on an amber priority. A review of this case has been made to prevent this occurring in the future.
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3.3 Other Commissioned Services
3.3.2 Nursing / Care Homes / Domiciliary Care Providers
The information provided within this section is taken up to 30th April 2018. Since the last Governing body meeting there remains 1 formal embargo and 1 voluntary embargo against admissions / new care packages placed.
3.3.3 Serious Case Reviews / Lesson Learnt Reviews
No new Serious Case Reviews or Lessons Learnt Reviews have been commissioned since the last Governing Body Report.
3.3.4 Domestic Homicide Reviews
There are currently 2 Domestic Homicide Reviews taking place within Doncaster. An independent chair has been commissioned for both reviews. The check and challenge meetings have taken place for both cases and the Chair is currently developing the Overview Report.
A further Domestic Homicide Review was considered and agreed on 18th January 2018. Doncaster CCG has received two of the three Primary Care records for parties involved. Chronologies have been developed for these two individuals and the CCG is currently awaiting information regarding an introductory meeting with the Independent Chair.
3.3.5 Mixed Sex Accommodation
Breaches of Mixed Sex Accommodation May- Commissioner Mar-17 Apr-17 Jun-17 Jul-17 Aug-17 Sept-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 17 Doncaster CCG 1 0 0 0 0 0 0 0 0 1 0 0 0
No mixed sex accommodation breaches were reported for Doncaster CCG in Mrach 2017.
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3.3.6 Complaints and Concerns (DBTHFT)
Complaints and concerns 200 150 100 50 0 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Complaints and concerns
There has been a reduction in the complaints response timeframe during March. This has in part been due to resource issues. Weekly complaints tracking meetings with Heads of Nursing and with the Director of Nursing, Midwifery and Allied Health Professionals continue.
3.3.7 Serious Incidents (SI)
100 Doncaster CCG Serious Incidents
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0 Q1 2017/18 Q2 2017/18 Q3 2017/18 Q4 2017/18 Serious Incidents reports Number delogged
Please note that the above figures include incidents which may be subsequently de-logged as a SI. A total of 11 SIs from Q4 have now been delogged. All of the SIs have been reviewed by the CCG and no concerns have been raised. 53
3.3.8 Continuing Healthcare (CHC)
Quarter 1 2017/18 Quarter 2 2017/18 Quarter 3 2017/18 Quarter 4 2017/18 Percentage of referrals compelted within 48.1% 31.1% 97.5% 100% 28 days of receipt (target > 80%) The percentage of Decision Support Tools (DST) completed in an acute 0.4% 0.9% 0.0% 0.0% hospital setting (target <15%)
SECTION 4: Improvement and Assessment Framework
NHS England has a statutory duty to conduct an annual performance assessment of every CCG. The annual assessment will be a judgement reached by taking into account the CCG’s performance in each of the indicator areas over the full year balanced against the financial management and a qualitative assessment of the leadership of the CCG. To ensure that the framework is being applied consistently, regional and national moderation takes place.
As in 2016-17 the Improvement and Assessment Framework covers the following four domains: 1. Better Health: this section looks at how the CCG is contributing towards improving the health and wellbeing of its population and bending the demand curve. 2. Better Care: this focuses on care redesign, performance of constitutional standards, and outcomes, including in important clinical areas. 3. Sustainability: this section looks at how the CCG is remaining in financial balance and securing good value for patients and the public from the money it spends. 4. Leadership: this domain assesses the quality of the CCG’s leadership, the quality of its plans, how the CCG works with its partners, and the governance arrangements that the CCG has in place to ensure it acts with probity, for example in managing conflicts of interest.
Underpinning the four domains are 51 indicators which are used to inform the ratings. According to data published by NHS England on 26th April 2018 Doncaster CCG is in the best performing quartile in England in 7 of the indicators, however Doncaster CCG is in the worst performing quartile in England for the indicators highlighted in dark blue below:
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The following work is being undertaken to address performance against these indicators:
Injuries from falls in people aged 65 and over As part of the system transformation of Intermediate Care a new Rapid Response Service was launched in January 2017. Ambulance staff assess patients who have fallen and those who require short term health or social care support to stay at home will be referred to this service rather than conveyed to A&E. Targeted work is also being undertaken with Care Homes to develop a falls pathway.
Inequality in unplanned hospitalisation for chronic ambulatory care sensitive and urgent care sensitive conditions The Doncaster Health and Wellbeing Board have established a Health Inequalities Steering Group which has developed an Action Plan to address health inequalities in Doncaster. The Steering Group includes representation from DMBC, DCCG, Primary Care Doncaster and Doncaster Healthwatch. DCCG and DMBC have agreed a methodology for dividing Doncaster into 5 deprivation quintiles.
Antimicrobial resistance: appropriate prescribing of antibiotics in primary care DCCG’s prescribing rate of antibacterial items per STAR-PU for the 12 months ending 28th Feb was 1.159 which is marginally within the 2017-18 national target (1.161). The Medicines Management Delivery Plan aims continue this improvement by monitoring the use of antimicrobials in order to assure appropriate use. The OptimiseRX medicines optimization solution is being utilised by all bar one of Doncaster GP Practices.
Staff Engagement Index This indicator is derived from the results of the 2016 NHS Staff Survey for DBTHFT and RDaSH. DBTHFT’s overall Staff Engagement Score in 2016 is significantly worse than in 2015 and is in the lowest 20% of its benchmark group. To address this issue DBTHFT have developed a Staff Survey Action Plan which contains five key elements: Communicating with staff Listening to staff Involving staff Supporting and engaging with managers A program of staff experience
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Cancers diagnosed at early stage The proportion of patients diagnosed at stages 1 and 2 increased from 37.8% in 2014 to 48.6% in 2015 but reduced to 47.7% in 2016. The Cancer Delivery Plan aims to increase in provision of straight to test (direct access diagnostic) pathways in line with 2 week wait NICE Guidance and within High Value Pathways work and review innovative diagnostic solutions to increase capacity to meet demand. Work is being undertaken with Cancer Research UK to support the Cancer Alliance Early diagnosis work stream focusing on enhanced follow-up with patients who don’t respond to screening invites via; text reminder or phone call. A 'Vague Symptoms' pathway is being piloted which may incorporate shorter waiting times for diagnostics for patients referred via this route.
One year survival from all cancers The survival rate improved from 68.9% in 2014 to 70.3% in 2015. The Cancer Delivery Plan aims to increase one year survival rates to 75% by 2020.This will be achieved via the awareness, prevention and early diagnosis actions in the plan.
Reliance on specialist inpatient care for people with a learning disability and/or autism There are currently 12 patients against a target 8. Of these 3 can potentially be moved. 15 patients are currently on the at risk register with 3 at heightened monitoring under regular review and being maintained in the community. A Provider Event was held in January 2018 to begin to stimulate the market further and prepare for acceptance of more complex and challenging cases.
Maternal smoking at delivery Doncaster Council commissions a smoking in pregnancy service from RDaSH which engages with women from booking throughout pregnancy. The service uses a host of tools to encourage and maintain smoking cessation including motivational interviewing, education, nicotine replacement therapy and cognitive behavioural therapy. The service is exploring the use of incentives for service users to maintain quits up to and beyond 4 weeks. DMBC Public Health are working with the wider children, young people, and families workforce to offer brief interventions around smoking cessation and also exploring improving midwifery interventions with families where there is smoking.
Experience of maternity services This is based on the CQC Maternity Survey undertaken in 2017 which involved a questionnaire being sent to all women who gave birth in Feb 2017. The Children’s Delivery Plan includes mapping current maternity provision against the National Maternity Review “Better Births” recommendations. The South Yorkshire & Bassetlaw Local Maternity System Plan has been signed off and implementation has commenced.
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Dementia care planning and post-diagnostic support This is the General Medical Services Quality and Outcomes Framework (QOF) indicator DEM004 which is the percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face meeting in the preceding 12 months. 95% of referrals for dementia are diagnosed within 10 weeks. Commissioners are working with providers to achieve diagnosis within 6 weeks of referral by 2020. The post diagnostic Admiral Service has been commissioned to be a point of contact on discharge from assessment and treatment services.
Emergency admissions for urgent care sensitive conditions The Urgent Care Delivery Plan aims to increase the proportion of patients streamed away from the Emergency Department at DRI to an average of 20% per month and also to reduce ambulance conveyances to DRI. Streaming increased from 12.5% in 2016-17 to 14.5% in 2017-18. The Rapid Response service now includes respiratory patients from YAS and this is to be extended to patients referred by GPs. 24 hour access whereby referrals taken overnight are seen the following morning was trialed in April. The Doncaster Place Plan aims to reduce emergency admissions for older people with these conditions by developing out of hospital services and fostering community resilience to improve support and provide services closer to home.
Patient experience of GP services The Primary Care Delivery Plan aims to reduce inequalities in care and quality between Practices. Joint education programs for GPs and Nurses and education sessions for Practice Managers are being developed. DCCG is launching a patient campaign to raise awareness of Patient Online Services and the Primary Care Team is working with the Data Quality Team to support practices offering the services. DCCG is reviewing of GP access both in and out of hours starting with a patient survey on extended access and use of remote consultation types.
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SECTION 5: Better Care Fund
Performance for all the national metrics in 2017-18 was better than in 2016-17. Reablement and Admissons to Care Homes have not met the 17/18 target, Non-Elective admissions has met target, and the number of delayed days as at Feb-18 is higher than the target for the year to date, the monthly trajectory for November to February was met as required nationally.
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The percentage of people still at home after 91 days following discharge in 2017-18 was 81.49% which is only marginally lower than the BCF Target (82%) and higher than in 2016-17 (78.72%). To sustain this improvement there is a requirement to build community capacity to provide additional support to enable people to remain at home post discharge. The transformation of intermediate care will help improve performance by simplifying pathways that ensure rapid access to multi-disciplinary step up support and a shift to more community based interventions. The Doncaster Place Plan will establish a Central assessment and navigation service which will coordinate reablement and rehabilitation plans in each of the 4 neighbourhoods in Doncaster.
There were 403 admissions to Care Homes for patients aged 65+ in 2017-18 which is higher than the BCF target (371) but fewer than in 2016-17. There is now a stronger grip on residential care admissions. All admissions are agreed via a resources panel in conjunction with social care professionals. This ensures that people have their independence considered and access residential care only when all other options for their wellbeing have been exhausted. There has been a significant reduction in admissions over the last 2 years and this has resulted in the lowest number of people in residential care for many years. To sustain this improvement families and communities require additional support to enable people to retain their independence for longer. The system transformation of Intermediate Care will support independence in people’s own homes and reduce admissions to care homes. 60
There were 37554 non-elective admissions to acute specialties for Doncaster residents in 2017-18 which is fewer than the BCF target (38722) and marginally fewer than in 2016-17 (37630). Avoidable emergency admissions (as defined by the NHS Digital) were 5.1% lower in 2017-18 than in 2016-17: - Acute ambulatory care sensitive conditions – 7.1% fewer than in 2016-17 - Chronic ambulatory care sensitive conditions -3.1% fewer than in 2016-17
The Rapid Response service has been extended to include respiratory patients. Customer Insight work has been commissioned from UsCreates to improve understanding of behaviours and motivations associated with unhealthy lifestyles. Prevention work including the “Move More” programme offers accessible exercise classes each week to people over 50 encouraging them to become more active.
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There were 6078 delayed days due to delayed transfers of care Apr 2017 – Feb 2018 which is 5.5% higher than the BCF target but 5.3% fewer than in the corresponding period in 2016-17 and the trajectory was met as required from November 2017.
Significant progress has been made on implementation of the High Impact Change Model. BCF monies have been used to fund a pilot of the Homefinder role which will provide a link between the patient, hospital and other non-acute settings e.g. RDaSH, Positive Steps and Care Homes. The aim is to reduce length of stay and prevent delays in transfers of care for patients requiring discharge into a care home or extra care housing. Key challenges exist around recruitment to the care sector, seven day services, trusted assessors and the discharge (home) to assess pathway. Stakeholders have agreed a single reporting and monitoring process and a business case has been agreed for developing a single reporting tool.
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Almost 53% of delayed days in 2017-18 to date are due to persons awaiting assessments to be completed or a care package in their homes.
There were 196 NHS attributable delayed days in February which equates to a daily average of 7 which is higher than the national expectation (5.14) 63
There were 94 Adult Social Care attributable delayed days in February which equates to a daily average of 3.4 which is below the national expectation (6.31)
There were 78 delayed days jointly attributable to the NHS and Social Care in February which equates to a daily average of 2.8 which is below the national expectation (5.57) 64
Enc D
Item 9
Finance Report
Meeting name Governing Body Meeting date 17th May 201 8
Title of paper Finance Report March 2018 (Month 12)
Executive / Hayley Tingle, Chief Finance Officer Clinical Lead(s) Author(s) Tracy Wyatt, Deputy Chief Finance Officer
Purpose of Paper - Executive Summary
This report sets out the financial position as at the end of March 2018 and also gives an update of the final plans including the High Level Budget Book and QIPP plans for 2018/19 for approval.
The CCG has achieved all of its financial targets for 2017/18.
The report also outlines:
• The key risk areas identified for 2017/18 and how they were managed • A summary of the CCG Efficiency Savings for 2017/18 (Appendix 2) • A summary of the CCG’s Resource Allocation (Appendix 3) • A summary of the CCG’s Reserve position (Appendix 4) • A high level summary of final 2018/19 Financial Plans (Appendix 5) • A high level summary of 2018/19 QIPP Plans (Appendix 6)
Recommendation(s)
Members are asked to:
• Receive the report and note the financial position for March 2018 (Month 12). • Receive the further detail in relation to the Financial Plans and approve the Budget Book and detailed QIPP plans for 2018/19.
1
Impact analysis Quality None identified impact Equality None identified impact Sustainability Nil impact Financial As highlighted within the report implications Legal None identified implications Management of Conflicts None Identified of Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report previously None presented at The CCG identified a number of risks as part of the Financial planning for 2017/18. These included:
• Non delivery of parts of the Efficiency Savings programme • Over performance against the main acute contracts Risk • Prescribing and High Cost Drugs Expenditure analysis • Individual Placements
A small contingency fund of £2.5m, which equated to 0.5% of the CCG’s allocation, was set aside to mitigate against these risks, as required by the business rules. Assurance 3.1, 3.2, 3.3, 3.4 Framework
2
NHS DONCASTER CCG
2017/18 FINANCE REPORT MONTH 12 – MARCH 2018
1. Introduction
This report provides the financial position for NHS Doncaster CCG for 2017/18 as at the end of March 2018 (Month 12). The CCG achieved all of its financial targets for 2017/18.
2. Year End Position
The following table shows the CCG’s year end position for the key financial targets and statutory duties -
Key Duty Target Month 12 Achieve annual target of £12,142k £15,009k surplus Financial £2,867k Position NHSE In year reporting - breakeven surplus QIPP Achievement (Plan £11,660k) £12,817k 95% + invoices paid within 30 days 95.82% (NHS) 95% + invoices paid within 30 days 98.22% (non NHS) BPPC 95% + invoice values paid within 30 99.86% days (NHS) 95% + invoice values paid within 30 98.47% days (Non NHS) Cash 1.25% of monthly drawdown remaining 0.14% Drawdown at period end Running Maintain spend within annual target of £6,209 Costs £6,978k Capital Expenditure not to exceed allocation N/A Resources (N/A)
Key
Red Not achieving and unlikely to be met Amber Not currently achieving but could be recovered or under- performing (QIPP) Green Achieving and on target to be met
The Month 12 position reflects a surplus of £15,009k which is £2,867k above the target set by NHS England. The reason for the increase is due to the release of the 0.5% Non Recurrent Mitigation reserve to the bottom line £2,226k, as requested by NHS England and the return of the Cat M savings by NHS England £630k which also
3 had to be released to the bottom line. Both of these values will be added to our historic surplus for drawdown in future years.
The QIPP plans have over achieved by £1,157k mainly due to an increase in prescribing QIPP savings, see section 4 below for more detailed information.
The year- end position is summarised in the Operating Cost Statement included at Appendix 1.
3. Key Messages and Risks
The largest financial risks identified as part of the Financial Planning process were around achievement of the ambitious efficiency plans, acute contract over performance, prescribing, and increased funding associated with individual placements (including Continuing Healthcare, Specialist Placement and Section 117 packages).
The delivery of the efficiency programme progressed in year particularly in terms of prescribing which over achieved helping to offset some of the areas where slippage took place. The acute contract and individual placements are caused the biggest in year pressure and were managed by using the CCG’s contingency budget.
DBTH Contract
The Acute contract with DBTH over performed by £7.6m although this position will be reconciled once the final coded activity is available from the Trust. The main areas of over performance related to -
Variance Activity Contract Area £'000 variance % Elective & Day Case Activity 683 4.86% Emergency Activity 3,238 5.28% Outpatient Activity 648 7.77% Maternity Pathway 1152 N/A A & E (Emergency Department) 1020 11.08% Paediatric Assessment Activity 702 68.30% Diagnostic Imaging & Direct Access 375 7.73% Non PbR Audiology Activity 188 1.07% Excluded Drugs and Devices 212 N/A Excluded HRG’s -212 -14.09% Other minor -409 N/A Total 7,597
Prescribing The prescribing budget underspent by £3.9m which is a reduction in spend of £4m since last year which is a real positive improvement and demonstrates the significant work that has been undertaken by the Medicines Management Team in year. It
4 should also be noted that the volume of prescriptions is remaining quite static compared to previous years which is also positive.
Individual Placements Individual Placements remain a concern as cases continue to step down from Specialised Services (NHS England) with no funding being transferred. The CCG have already incurred a recurrent pressure of £1m during 2017/18 resulting from this transformation agenda. The overall overspend in this area was £1.9m.
To help manage and offset the risks the small contingency fund of £2.5m was released to the bottom line at year end.
4. Efficiency Savings Programme
The CCG set an ambitious efficiency plan equating to £11.6m. The main contracts with Doncaster and Bassetlaw Teaching Hospitals NHS FT and Rotherham, Doncaster and South Humber NHS FT were negotiated net of the agreed efficiency targets of £4.5m and £0.5m respectively.
The year-end position showed an overall achievement of £12.8m which includes £0.8m of productivity savings achieved by increasing activity without increasing the costs. The largest achievement was made in prescribing where £6.5m of savings were achieved compared to the original target of £2.5m. This over achievement has helped to offset some of the slippage in other areas.
A summary of the achievement against each scheme can be found at Appendix 2.
5. Further Allocations
The CCG has received the following non recurrent allocations in March; Primary Care at Scale £179k, Elective Care Wave 3 £10k, LD Transformation Funding Q3 & 4 £55k and TPP Reconciliation £10k.
6. Capital Resource
The CCG has not received any capital funding in 2017/18.
5
7. Better Care Fund
The allocation for the Better Care Fund has been spent in full as per the summarised breakdown below.
Scheme £ Aids & Adaptations 2,238 Aids and Adaptations 1,562 Community capacity / Assets 550 Dementia 265 Discharges 804 Enablers 909 Intermediate care 3,689 Intermediate Care Services 8,666 Mental Health 2,914 Mental Health 261 Neighbourhood delivery 1,974 Preventing admissions 546 Prevention 75 Totals 24,453
8. Financial Planning 2018/19
The final financial plans were submitted to NHS England on 30th April 2018 and it is expected that NHS Doncaster CCG’s plan will be approved in the next few weeks. As outlined previously the plans for 2018/19 are very challenging with the CCG facing unprecedented pressures and a £10.6m QIPP target which is all recurrent.
The culmination of the above has resulted in the preparation of a detailed budget book which sets the budgets at an individual provider level for the main contracts split between the key areas of Acute, Mental Health, Community, Primary Care, Continuing Healthcare and Corporate budgets. A High Level Summary of the Budget Book is attached at Appendix 5 together with the detailed QIPP Plans at Appendix 6.
For the Financial Plans the CCG has had to identify the potential risk to QIPP Delivery and this is outlined in the Appendix together with the RAG rating of potential achievement. The overall risk of slippage has been estimated at £2.5m and is based on previous experience and potential slippage in implementation of the schemes. This will be monitored closely in year through the QIPP Programme Board.
Once approved, the detailed Budget Book will be formally issued to Budget Managers for in year management. The budgets will be monitored at a detailed level and reported to the Governing Body on a monthly basis.
9. Conclusion and Recommendations
The committee is asked to receive and note the Finance Report for March (Month 12) and agree the Budget Book and QIPP Plans for 2018/19.
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NHS DONCASTER CLINICAL COMMISSIONING GROUP Appendix 1 2017/18 FINANCE REPORT MARCH 2018
Opening Budget YEAR TO DATE Variance OPERATING COST STATEMENT Recurrent Non Rec Total Recurrent Non Rec (Under)/ Budget Budget Budget Budget Budget Total Budget YTD Actual Over £000s £000s £000s £000s £000s £000s £000s £000s
Baseline Allocation -445,139 -445,139 -445,139 0 -445,139 -445,139 Co-Commissioning -42,534 -42,534 -42,534 0 -42,534 -42,534 HRG4+ 4,024 4,024 0 4,024 4,024 4,024 IR Rule Chnages -362 -362 0 -362 -362 -362 In year drawdown of prior year surplus -438 -438 0 -438 -438 -438 Historic Drawdown -12,021 -12,021 0 -12021 -12,021 -12021 Running Cost Allowance -6,773 0 -6,773 -6773 0 -6,773 -6773 Initial Allocation -494,446 -8,797 -503,243 -494,446 -8,797 -503,243 -503,243
In year changes Surplus/Deficit Carry Forward - 1617 Final Outturn 0 -121 -121 -121 Reception and clerical training - (Training Care Navigators and Medical Assistants) 0 -54 -54 -54 Diabetes Treatment and Care Transformation Fund - Intervention funded: Multi-disciplinary Footcare Team (MDFT) - Bid ID DTCN08 MDFT 0 -44 -44 -44 Diabetes Treatment and Care Transformation Fund - Intervention funded: Diabetes Inpatient Specialist Nurses (DISN) - Bid ID DTCN08 DISN 0 -26 -26 -26 NHS WiFi 0 -137 -137 -137 Market Rents - Admin adjustment 0 -157 -157 -157 Market rents adjustment 0 303 303 303 Paramedic Rebanding Additional Funding 2017-18 0 -98 -98 -98 £86,014 - HSCN - GP funding , £48,401 - HSCN - CCG funding , 0 -134 -134 -134 CYPT IAPT Trainee staff support costs 0 -21 -21 -21 Transfer NHCN - CCG funding from programme to running costs 0 48 48 48 Transfer NHCN - CCG funding from programme to running costs 0 -48 -48 -48 Transfer of Cancer MDT funding £289,659 to NHSE Specialised services 290 0 290 290 LD transformation funding for TCP 0 -28 -28 -28 Additional month5 IR Changes 0 -22 -22 -22 LD transformation funding for TCP Q2 0 -28 -28 -28 Diabetes Treatment and Care Transformation Fund - Intervention funded: Multi-disciplinary Footcare Team (MDFT) - Bid ID DTCN08 MDFT Q2 0 -44 -44 -44 Diabetes Treatment and Care Transformation Fund - Intervention funded: Diabetes Inpatient Specialist Nurses (DISN) - Bid ID DTCN08 DISN Q2 0 -26 -26 -26 Working Together Vanguard Funding for STH 0 -618 -618 -618 CYP IAPT Trainee staff support costs 0 -21 -21 -21 CYP Crisis Acceleration Funding - North 0 -25 -25 -25 NCm vanguard evaluation funding - WTP Q1&2 0 -25 -25 -25 Elective Care Rapid Test Sites - Waves 2 and 3 0 -50 -50 -50 NCM Q3-4 Local Evaluation funding - WTP ACC 0 -24 -24 -24 Charge Exempt Overseas Visitor (CEOV) Adjustment - 469 469 469 [email protected] 0 Additional Mth08 IR Changes - agreed by J Stalker Booth 0 22 22 22 SCH Amber services 0 -193 -193 -193 Quality Premium 16/17 stage one payment - All QP measures except for 0 -154 -154 -154 performance on cancers diagnosed at an early stage. DISN: Diabetes Transformation Fund - ID: DTCN08 0 -17 -17 -17 MDFT: Diabetes Transformation Fund - ID: DTCN08 0 -8 -8 -8 GP WIFI - rounding correctn to M3 Allocation 0 1 1 1 Additional Winter Funding - (GP Winter Access Bid etc. ) 0 -5 -5 -5 Share of £2.8M Transformation Resource 0 -573 -573 -573 Primary Care Network funding @ £1 per head 0 -315 -315 -315 NCM Q4 funding - WTP ACC vanguard 0 -206 -206 -206 GPFV Online consultations - North cohort 1 0 -79 -79 -79 Primary Care at Scale 0 -139 -139 -139 elective care wave 3 0 -10 -10 -10 LD transformation funding Q3 & Q4 0 -55 -55 -55 CYP IAPT trainee staff support costs 0 -30 -30 -30 TPP reconciliation - month 12 0 -10 -10 -10 0 0 0 0 TOTAL ALLOCATIONS -494,446 -8,797 -503,243 -494,156 -11,499 -505,655 -505,655 0
Acute Contracts - DBHFT 186,163 1,186 187,349 187,215 0 187,215 194,813 7,597 Acute Contracts - Other NHS 37,241 4,848 42,089 39,890 0 39,890 33,943 -5,947 Acute Contracts - Other Providers Non NHS 4,443 125 4,568 4,333 0 4,333 4,698 365
Acute Contracts - Urgent Care 5,843 0 5,843 5,843 0 5,843 6,036 193 Acute - Non Contract Activity 2,574 0 2,574 2,579 0 2,579 4,128 1,549 Total Acute Services 236,264 6,159 242,423 239,861 0 239,861 243,618 3,757
Mental Health Contracts - RDaSH FT 34,864 0 34,864 35,003 0 35,003 34,557 -446 Mental Health Contracts - Other NHS 1,094 0 1,094 1,579 0 1,579 935 -644 Mental Health Contracts - Other Providers 17,435 0 17,435 17,080 0 17,080 19,952 2,872 Mental Health - Non Contract Activity 6 06 6 0 6 4-2 Total Mental Health Services 53,399 0 53,399 53,668 0 53,668 55,448 1,780
Community Contracts - RDaSH FT 30,857 0 30,857 31,587 0 31,587 31,521 -65 Community Contracts - Other NHS 395 438 833 344 0 344 344 0 Community Contracts - Other Providers 10,977 0 10,977 11,971 0 11,971 12,160 189 Total Community Services 42,229 438 42,667 43,902 0 43,902 44,025 123
Prescribing 63,565 0 63,565 63,565 0 63,565 59,616 -3,949 Oxygen Services 614 0 614 614 0 614 669 55 Other Primary Care Services 4,176 0 4,176 4,763 0 4,763 4,550 -213 GPIT 802 0 802 945 0 945 1,327 382 Delegated Co-Commissioning 41,992 0 41,992 42,047 0 42,047 41,112 -935 Primary Care Services 111,149 0 111,149 111,933 0 111,933 107,274 -4,660
Continuing Healthcare 27,164 0 27,164 28,174 0 28,174 29,956 1,782 Continuing Healthcare Services 27,164 0 27,164 28,174 0 28,174 29,956 1,782
Non Recurrent Programmes 0 0 0 1,519 0 1,519 1,468 -51 Non Recurrent Programmes 0 0 0 1,519 0 1,519 1,468 -51
Medicines Management 518 0 518 518 0 518 497 -22 Safeguarding 39 0 39 39 0 39 39 0 Mental Health Assessments 0 0 0 0 0 0 0 0 NHS Property Services Recharge 2,404 0 2,404 2,234 0 2,234 2,113 -121 Corporate non running costs 2,961 0 2,961 2,791 0 2,791 2,649 -143
Chief Pharmacist 88 0 88 88 0 88 51 -37 Admin & Business Support 879 0 879 1,063 0 1,063 291 -771 Contract Management 535 0 535 539 0 539 551 11 Finance 717 0 717 679 0 679 642 -38 Corporate Costs & Services 397 0 397 442 0 442 704 262 Human Resources 82 0 82 84 0 84 112 28 Health & Safety 11 0 11 11 0 11 11 0 Patient & Public Involvement 112 0 112 112 0 112 102 -9 Communications & PR 5 05 5 0 5 3-2 Performance 833 0 833 881 0 881 813 -68 Quality Assurance 628 0 628 631 0 631 588 -42 Primary Care Support 193 0 193 147 0 147 211 64 Strategy & Development 803 0 803 806 0 806 791 -16 Governing Body 1,491 0 1,491 1,491 0 1,491 1,340 -151 Corporate Running Costs 6,773 0 6,773 6,978 0 6,978 6,209 -769
Total Corporate Costs 9,734 0 9,734 9,769 0 9,769 8,858 -911
1% Non Recurrent Headroom Reserve 2,226 2,226 2,226 0 2,226 0 -2,226 Contingency Reserve 0.5% 2,460 2,460 2,460 0 2,460 0 -2,460 Total Reserves 2,460 2,226 4,686 4,686 0 4,686 0 -4,686
TOTAL APPLICATION OF FUNDS 482,399 8,823 491,222 493,513 0 493,513 490,646 -2,867
SURPLUS 1% REQUIREMENT* 12,021 12,142 0 -12,142
TOTAL 503,243 505,655 490,646 -15,009
* As directed by NHS England - All CCGs are required to make a surplus of at least 1% NHS DONCASTER CLINICAL COMMISSIONING GROUP
Savings / Efficiency Programme 2017/18 - Position as at Month 12 March 2018
Annual Month 12 RAG Recurrent Non Recurrent Delivery Plan Scheme Contract Plan £'000 £'000 Rating £'000 £'000 Childrens & Maternity Paediatric Assessment Tariff Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 154 80 80 0 Childrens & Maternity Paediatric Assessment Activity Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 172 0 0 0 Childrens & Maternity Asthma, LRTI and URTI Activity Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 91 47 47 0 Childrens & Maternity Paeds A&E Activity Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 53 47 47 0 Childrens & Maternity NEL Activity reductions Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 0 54 54 0
Community & End of Life Community QIPP various schemes Rotherham, Doncaster and South Humber NHS FT 222 222 222 0 Community & End of Life Dietetics Review Prescribing 277 277 0
Continuing Healthcare/Care Homes Improved Governance, Assessment and Reviews, S117 and Market Engagement N/A 2,500 803 803 0
Intermediate Care Impact of Intermediate Care redesign on NEL Admissions Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 461 770 770 0 Intermediate Care Impact of Intermediate Care redesign on A&E Attendances Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 25 56 56 0
Mental Health & LD LD frequent flyers Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 11 6 6 0 Mental Health & LD Mental Health QIPP various schemes Rotherham, Doncaster and South Humber NHS FT 278 278 278 0
Planned Care Reduction in Gp referrals 6% Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 963 1,023 1535 -512 Planned Care Reduction in acupuncture activity (NICE guidance) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 96 16 16 0 Planned Care Procedures of Limited Clinical Value/Thresholds (Asymptomatic Hernias) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 420 72 108 -36 Planned Care Procedures of Limited Clinical Value/Thresholds (Hip & Knee replacements) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 809 37 37 0 Planned Care Procedures of Limited Clinical Value/Thresholds (Haemorrhoiderectomy) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 99 13 13 0 Planned Care Procedures of Limited Clinical Value/Thresholds (Dermatology) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 201 24 48 -24 Planned Care Procedures of Limited Clinical Value/Thresholds (Asymptomatic Gallstones) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 0 44 106 -62 Planned Care Procedures of Limited Clinical Value/Thresholds (Carpal Tunnel Syndrome) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 0 44 66 -22 Planned Care Procedures of Limited Clinical Value/Thresholds (Cataract Surgery) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 0 6 6 0 Planned Care Procedures of Limited Clinical Value/Thresholds (Dupytrens Syndrome) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 0 37 74 -37 Planned Care Procedures of Limited Clinical Value/Thresholds (Ganglion) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 0 32 32 0 Planned Care Procedures of Limited Clinical Value/Thresholds (other providers) Other Acute providers 1,300 0 0 0 Planned Care Use of biosimilars (FY impact) Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 296 690 690 0
Prescribing Review of formulary links to Right Care Prescribing TBD 0 Prescribing Medicines optimisation Prescribing 150 799 799 0 Prescribing Medicines Wastage Prescribing 0 0 0 0 Prescribing Optomise Rx Prescribing 400 268 268 0 Prescribing Primary Care Rebates Prescribing 50 46 46 0 Prescribing Specials/non part 8 Prescribing 75 181 181 0 Prescribing Other Savings to be verified by scheme (currently underspending) Prescribing 1,859 4,912 4,912 0
Urgent Care Reduction in NEL Admissions Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 461 0 0 0 Urgent Care Urgent care signposting and streaming to UCC Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 456 155 155 0 Urgent Care A&E YAS Conveyances Doncaster & Bassetlaw Hospitals Teaching Hospitals NHS FT 58 74 127 -53
Running Costs Non recurrent holding of vacancies N/A 0 770 0 770 Patient Transport Retendering of PTS Services N/A 0 140 140 0
Total Cash Releasing Savings 11,660 12,023 11,999 24
Productivity Community & End of Life Catheter/Incontinence Reviews 0 163 163 0 Community & End of Life District Nursing Productivity 0 214 214 0 Community & End of Life Palliative Care redesign 270 270 0 Community & End of Life Virtual Clinics - Spinal and Fracture 147 147 0 Total Productivity Savings 0 794 794 0
Total All Savings 11,660 12,817 12,793 24
Notes Each scheme has now been RAG rated based on a financial assessment of current and forecast delivery, this does not necessarily reflect the actions and progress made in the delivery plans. Where information is difficult to obtain the RAG rating will be Amber until such time as the savings can be quantified.
RAG Rating key Scheme has clear deliverables and is on target to be met in full or exceed target Slippage on scheme, savings likely to be greater than 50% of target but will not be met in full No clear plans, scheme not delivering or scheme will deliver less than 50% of target NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 3
SUMMARY OF RESOURCE ALLOCATIONS AS AT MONTH 12 MARCH 2018
Recurrent Non Recurrent Total £000's £000's £000's Baseline Allocation -445,139 -445,139 Co-Commissioning -42,534 -42,534 HRG4+ 4,024 4,024 IR Rule Chnages -362 -362 In year drawdown of prior year surplus -438 -438 Historic Drawdown -12,021 -12,021 Running Cost Allowance -6,773 0 -6,773 Total Resources Available at Plan Stage -494,446 -8,797 -503,243
Adjustments to the Resource Limit:
Month 01 April No adjustments 0 0 0 0 0 0
Month 02 May No adjustments 0 0 0 0 0 0
Month 03 June Surplus/Deficit Carry Forward - 1617 Final Outturn -121 -121 Reception and clerical training - (Training Care Navigators and Medical -54 -54 Assistants) Diabetes Treatment and Care Transformation Fund - Intervention -44 -44 funded: Multi-disciplinary Footcare Team (MDFT) - Bid ID DTCN08 MDFT Diabetes Treatment and Care Transformation Fund - Intervention -26 -26 funded: Diabetes Inpatient Specialist Nurses (DISN) - Bid ID DTCN08 DISN NHS WiFi -137 -137 Market Rents - Admin adjustment -157 -157 Market Rents Programme adjustment 303 303 Paramedic Rebanding Additional Funding 2017-18 -98 -98 £86,014 - HSCN - GP funding , £48,401 - HSCN - CCG funding , -134 -134 CYPT IAPT Trainee staff support costs -21 -21
0 -489 -489 Month 04 July Transfer of Cancer MDT funding £289,659 to NHSE Specialised 290 290 services LD transformation funding for TCP -28 -28 290 -28 262 Month 05 August Changes to IR Rules -22 -22 0 -22 -22 Month 06 September Diabetes Treatment and Care Transformation Fund - Intervention -44 -44 funded: Multi-disciplinary Footcare Team (MDFT) - Bid ID DTCN08 MDFT Diabetes Treatment and Care Transformation Fund - Intervention -26 -26 funded: Diabetes Inpatient Specialist Nurses (DISN) - Bid ID DTCN08 DISN Vanguard Funding - Sheffield Teaching Hospitals -618 -618 LD transformation funding for TCP Q2 -28 -28 0 -716 -716 Month 07 October CYP IAPT Trainee staff support costs -21 -21 CYP Crisis Acceleration Funding - North -25 -25 NCm vanguard evaluation funding - WTP Q1&2 -25 -25 0 -71 -71 Month 08 November Elective Care Rapid Test Sites - Waves 2 and 3 -50 -50 NCM Q3-4 Local Evaluation funding - WTP ACC -24 -24 Charge Exempt Overseas Visitor (CEOV) Adjustment 469 469 Additional Mth08 IR Changes 22 22 0 417 417 Month 09 December SCH Amber services -193 -193 Quality Premium 16/17 stage one payment -154 -154 DISN: Diabetes Transformation Fund -17 -17 MDFT: Diabetes Transformation Fund -8 -8 GP WIFI - rounding correction to M3 Allocation 1 1 Additional Winter Funding - (GP Winter Access Bid etc. ) -5 -5 0 -376 -376 Month 10 January Share of £2.8M Transformation Resource -573 -573 Primary Care Network funding @ £1 per head -315 -315 Working Together Vanguard Funding for STH Q4 -206 -206 0 -1,094 -1,094 Month 11 February GPFV Online consultations - North cohort 1 -79 -79 0 -79 -79 Month 12 March Primary Care at Scale -139 -139 elective care wave 3 -10 -10 LD transformation funding Q3 & Q4 -55 -55 CYP IAPT trainee staff support costs -30 -30 TPP reconciliation - month 12 -10 -10 0 -244 -244
Revised Resources available as at Month 12 March 2018 -494,156 -11,499 -505,655 NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 4 SUMMARY OF RESERVES AS AT MONTH 12 MARCH 2018
RESERVES Recurrent Non Total Recurrent £000's £000's £000's
RISK RESERVES AND CONTINGENCIES National Risk Reserve Initial Plan 0 2,226 2,226 Budget Transfers No transfers as at Month 12 - funding uncommitted and 0 ringfenced as per NHSE Guidance
0 2,226 2,226
0.5% Contingency Initial Plan 2,460 0 2,460 Budget Transfers No transfers as at Month 12 0 2,460 0 2,460
Total Reserves 2,460 2,226 4,686 Cross Check to Operating Cost Statement 2,460 2,226 4,686 NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 5 2018/19 Budget Book Summary
Recurrent Non Recurrent Total £000's £000's £000's Baseline Allocation -Recurrent (Incl PC Co-Commissioning) -494,730 -494,730 Running Cost allocation -6,741 -175 -6,916 Baseline Allocation-Non recurrent -154 -154 Use of Drawdown -700 -700 Total Initial Allocation -501,471 -1,029 -502,500
Acute Contracts - Doncaster & Bassetlaw NHS FT 194,950 194,950 Acute Contracts - Other NHS 33,434 80 33,514 Aucte Contracts - Other Providers Non NHS 4,787 4,787 Acute - Non Contract Activity 4,170 4,170 Urgent Care 5,945 5,945 Other acute 4,518 4,518 Total Acute Services 247,804 80 247,884
NHS Community Services 31,450 356 31,806 Non NHS Community Services 2,542 700 3,242 Better Care Fund 7,302 0 7,302 Intermediate Care CAP Beds 959 0 959 Total Community Services 42,253 1,056 43,309
Mental Health Contracts - Rotherham , Doncaster & South Humber NHS FT 35,068 0 35,068 Mental Health Contracts - Other NHS 884 0 884 Mental Health Contracts - Non NHS 21,454 0 21,454 NCA's 4 0 4 Total Mental Health& Learning Disabilities 57,410 0 57,410
Prescribing 60,774 0 60,774 Oxygen Services 671 0 671 Primary Care Co-Commissioning 42,700 0 42,700 GPIT 1,105 74 1,179 Other Primary Care Services 3,031 0 3,031 Primary Care Services 108,281 74 108,355 Continuing Healthcare 29,779 0 29,779 Continuing Healthcare Services 29,779 0 29,779
Total Healthcare Services 485,527 1,210 486,737
Admin Costs 6,741 175 6,916 Other Corporate Costs including Property Costs 4,075 0 4,075 Total Corporate Costs 10,816 175 10,991 Surplus Target * 0 0 0 Risk Reserve & Contingencies 2,513 0 2,513 Other CCG Reserves 0 2,259 2,259 Total Reserves 2,513 2,259 4,772
Total Application of Funds 498,856 3,644 502,500
Note * NHS England have now moved to "in year reporting" in 2017/18 therefore there is no surplus target. The CCG will instead be monitored against its movement from the prior years surplus achievement. NHS DONCASTER CLINICAL COMMISSIONING GROUP
Savings / Efficiency Programme 2018/19 Recurrent Annual RAG Risk of Delivery Plan Scheme Contract Plan £'000 Rating Slippage Urgent care DBH Contract A&E Streaming DBH 186
Intermediate Care NEL reductions DBH 855 400
Children, Young People and Maternity Paediatrics NEL adminssions DBH 105 Children, Young People and Maternity Paediatric Assessment DBH 102 Children, Young People and Maternity Referral reductions DBH 146
Planned care Referral reductions DBH 153 Planned care Dermatology Activity DBH 56 Planned care Acupuncture decommissioning DBH 185 Planned care Commissioning for Value Other specialties DBH 1,979 500 Planned care Commissioning for Value Dermatology DBH 87 Planned care Impact of acute schemes on other providers DBH 830 400 Planned care PTS retender savings PTS 209
Mental Health MH RDASH contract savings RDASH Mental Health 228 Community CH RDASH contract savings RDASH Community 359
Medicine's Management Prescribing Prescribing 3,520 1,000
CHC Continuing Healthcare Continuing Healthcare 800 100 CHC Specialist Placements Specialist Placements 800 100
Total Plan 10,600 2,500
RAG Rating Likely to achieve in full May be some slippage but likely to achieve > 50% High Risk, may achieve less than 50% of target
Enc E
Item 10
Corporate Assurance Quarter 4 Report
Meeting name Governing Body Meeting date 17 May 201 8
Title of paper Corporate Assurance Report – Quarter 4 2017/18
Executive / Mrs Lisa Devanney, Associate Director of Human Resources Clinical Lead(s) and Corporate Services Author(s) Mr Gareth Jones, Corporate Governance Manager
Purpose of Paper - Executive Summary The key points from this report to which the organisation attention is particularly drawn are:
• Risk Register: At the end of Quarter 4, we had 27 risks on the risk register with 10 of these risks being rated as high. 9 are being treated and have action plans in place with 1 being tolerated.
• External assessments: Work from the audit plan continues to progress with the Conflicts of Interest Audit receiving significant assurance in the last quarter. The final Head of Internal Audit Opinion is being finalised with the outcomes provided at the next Audit Committee. The external audit deliverables for the year were outlined in the technical report/progress report.
• Constitution, governance structure, standards of business conduct and conflicts of interest: The Member Engagement model, at the request of locality members, has been option appraised and consultation with member practices has taken place. Further details were explored regarding how the CCG may configure the Governing Body to respond to the desired move to 4 localities. A paper was provided to Governing Body with a recommendation to amend the CCG Constitution to reflect 4 GP Locality Leads and this was approved. Further communication has been shared with member practices for comment or objection with the outcome expected in the next Quarter. The CCG continues to collect declarations of interest forms and has published a refreshed register of interest in line with the June 2017 NHS England Conflicts of Interest Guidance.
• Health & Safety, Fire and Security: The competent person for Health & Safety at the CCG has confirmed that the CCG is in compliance with legislation. Fire drills for Sovereign House and White Rose House respectively have been successfully concluded with the CCG having a full complement of fire marshals. COSHH (Control of Substances Hazardous to Health) risk assessments for Sovereign and White Rose House have been reviewed and updated taking into account new products on site. Draft policy revisions have been received for Health and Safety and Security. The Health and Safety Policy includes appendices covering procedures for display screen equipment, moving and handling, driving at work, first aid and control of substances hazardous to health. The Security Policy has been amended to include guidance on handling violence and aggression. NHS Doncaster CCG is part of a partnership with the South Yorkshire and Bassetlaw CCG’s for Health, Safety and Security hosted by NHS Rotherham Clinical Commissioning Group. As part of this service we have access to advice and support from an experienced and accredited NHS security management professional.
• Emergency Preparedness, Resilience & Response (EPRR): The CCG has been involved in the planning aspects of Tour de Yorkshire on 03 rd and 4 th May 2018 and have provided assurance to Doncaster Council that services will operate as usual, particularly the Same Day Health Centre and the Burns Practice in which the route directly affects. The CCG team business continuity team have met to discuss the business continuity plan enactment that took place during inclement weather on the 28 th February and 01 st March 2018 and business continuity plans have been reviewed and updated to reflect any changes within teams and in recognition of our partnership with the South Yorkshire and Bassetlaw CCG’s for Health, Safety and Security hosted by NHS Rotherham Clinical Commissioning Group.
• Information Governance: An Information Governance Workplan for 2017/18 has been developed and is being implemented. Work undertaken in the last Quarter includes the Information Governance Policy including Strategy, Framework and associated procedures being updated for minor amends required through the year, review of the Information Asset Register for 2017/18 and Information Governance bulletins issued. The Information Governance Toolkit was successfully submitted in the last quarter with a 72% compliance which is a satisfactory rating. Work continues to take place on the implementation of the General Data Protection Regulations with an action plan and communications plan in place in readiness for 25 th May 2018.
• Organisational Development: During quarter 3 the annual NHS staff survey closed. The response rate for Doncaster CCG was 70%. The overall results have been published and shared with staff. Staff engagement has taken place via the Colleague Engagement Group on the results of the staff survey to review areas for improvement and reflection on the positive outcomes. An action plan will be presented to the Executive Committee in the next quarter. Work with individual teams is also planned. On a wider level the CCG and Local Authority are planning and beginning to implement a number of actions to support and encourage joint working and some OD support is planned.
• Mandatory & Statutory Training: There is an improved position in respect of compliance with mandatory & statutory training. NHS England has introduced additional mandatory training for Managing Conflicts of Interest. All staff must complete this training by 18 th May 2018.
Recommendation(s) Governing Body is asked to consider and note the information provided.
Impact analysis Quality impact Nil Equality Neutral impact Sustainability Sustainability impacts are listed in the report impact Financial Nil implications Legal Nil implications Management of Conflicts of None identified Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report Information which fed into the report has previously been received in previously sections at the Quality and Patient Safety Committee and the presented at Engagement and Experience Committee. Risk Risks are highlighted throughout the report analysis Assurance 1.1, 2.1 Framework
CORPORATE ASSURANCE REPORT
Quarter 4 2017/18 (1 January – 31 March 2018)
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Contents ______
Section Sub-Section Page
Executive Summary 3
Section 1 Risk Management 5 1.1. Assurance Framework 5 1.2. Risk Register 5 1.3. Internal Incident Reporting 6 1.4. Claims & Legal Issues 7
Section 2 External Assessments 8
Section 3 Committee Activity 9
Section 4 Corporate Governance 13 4.1. Constitution & Establishment 13 4.2. Standards of Business Conduct / Conflicts of Interest 13 4.3. Governance Structure 13 4.4. Statutory roles 15 4.5. Procedural Document Management 15 4.6. Health & Safety, Fire Safety & Security 15 4.7. Emergency Resilience & Business Continuity 16 4.8. Sustainability 16 4.9. Complaints Management 16 4.10. Counter Fraud 17 4.11. Whistleblowing 18
Section 5 Information Governance 19 5.1. The protection and use of personal confidential data 19 5.2. Information Governance Toolkit 19 5.3. Information Governance Workplan 19 5.4. Freedom of Information Act Requests 20 5.5. Subject Access Requests 20
Section 6 Organisational Development & Staffing Governance 21 6.1. Organisational Development 21 6.2. Workforce Structure 21 6.3. Workforce Breakdown 22 6.4. Mandatory & Statutory Training 23
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Executive Summary ______
The key points from this report to which the organisation’s attention is particularly drawn are:
Risk Register: At the end of Quarter 4, we had 27 risks on the risk register with 10 of these risks being rated as high. 9 are being treated and have action plans in place with 1 being tolerated.
External assessments: Work from the audit plan continues to progress with the Conflicts of Interest Audit receiving significant assurance in the last quarter. The final Head of Internal Audit Opinion is being finalised with the outcomes provided at the next Audit Committee. The external audit deliverables for the year were outlined in the technical report/progress report.
Constitution, governance structure, standards of business conduct and conflicts of interest: The Member Engagement model, at the request of locality members, has been option appraised and consultation with member practices has taken place. Further details were explored regarding how the CCG may configure the Governing Body to respond to the desired move to 4 localities. A paper was provided to Governing Body with a recommendation to amend the CCG Constitution to reflect 4 GP Locality Leads and this was approved. Further communication has been shared with member practices for comment or objection with the outcome expected in the next Quarter. The CCG continues to collect declarations of interest forms and has published a refreshed register of interest in line with the June 2017 NHS England Conflicts of Interest Guidance.
Health & Safety, Fire and Security: The competent person for Health & Safety at the CCG has confirmed that the CCG is in compliance with legislation. Fire drills for Sovereign House and White Rose House respectively have been successfully concluded with the CCG having a full complement of fire marshals. COSHH (Control of Substances Hazardous to Health) risk assessments for Sovereign and White Rose House have been reviewed and updated taking into account new products on site. Draft policy revisions have been received for Health and Safety and Security. The Health and Safety Policy includes appendices covering procedures for display screen equipment, moving and handling, driving at work, first aid and control of substances hazardous to health. The Security Policy has been amended to include guidance on handling violence and aggression. NHS Doncaster CCG is part of a partnership with the South Yorkshire and Bassetlaw CCG’s for Health, Safety and Security hosted by NHS Rotherham Clinical Commissioning Group. As part of this service we have access to advice and support from an experienced and accredited NHS security management professional.
Emergency Preparedness, Resilience & Response (EPRR): The CCG has been involved in the planning aspects of Tour de Yorkshire on 03rd and 4th May 2018 and have provided assurance to Doncaster Council that services will operate as usual, particularly the Same Day Health Centre and the Burns Practice in which the route directly affects. The CCG team business continuity team have met to discuss the business continuity plan enactment that took place during inclement weather on the 28th February and 01st March 2018 and business continuity plans have been reviewed and updated to reflect any changes within teams and in recognition of our partnership with the South Yorkshire and Bassetlaw CCG’s for Health, Safety and Security hosted by NHS Rotherham Clinical Commissioning Group.
Information Governance: An Information Governance Workplan for 2017/18 has been developed and is being implemented. Work undertaken in the last Quarter includes the Information Governance Policy including Strategy, Framework and associated procedures being updated for minor amends required through the year, review of the
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Information Asset Register for 2017/18 and Information Governance bulletins issued. The Information Governance Toolkit was successfully submitted in the last quarter with a 72% compliance which is a satisfactory rating. Work continues to take place on the implementation of the General Data Protection Regulations with an action plan and communications plan in place in readiness for 25th May 2018.
Organisational Development: During quarter 3 the annual NHS staff survey closed. The response rate for Doncaster CCG was 70%. The overall results have been published and shared with staff. Staff engagement has taken place via the Colleague Engagement Group on the results of the staff survey to review areas for improvement and reflection on the positive outcomes. An action plan will be presented to the Executive Committee in the next quarter. Work with individual teams is also planned. On a wider level the CCG and Local Authority are planning and beginning to implement a number of actions to support and encourage joint working and some OD support is planned.
Mandatory & Statutory Training: There is an improved position in respect of compliance with mandatory & statutory training. NHS England has introduced additional mandatory training for Managing Conflicts of Interest. All staff must complete this training by 18th May 2018.
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Section 1 – Risk Management ______
1.1. The Governing Body Assurance Framework captures risks to the achievement of our strategic corporate objectives. It is reported quarterly to the Governing Body for Assurance oversight of risks and approval of changes and has been refreshed during the last Framework Quarter. Audit Committee also receive the Framework quarterly and undertake a “deep dive” on the risks associated with one corporate objective per meeting; Corporate Objective 3 and 4 was reviewed by the Audit Committee during Quarter 4.
Start of End of End of End of End of
year Q1 Q2 Q3 Q4 Number of risks 12 12 12 12 12
Start of End of End of End of End of
year Q1 Q2 Q3 Q4 Risk TOLERATE 6 6 6 6 6 treatment TREAT 6 6 6 6 6
Start of End of End of End of End of Score Risk rating year Q1 Q2 Q3 Q4 1 to 5 Low 0 0 0 0 0 6 to 11 Medium 6 8 8 8 8 12 to 15 High 5 4 4 4 4 16 to 20 Very High 1 0 0 0 0 25 Extreme 0 0 0 0 0 TOTAL 12 12 12 12 12
1.2. At the end of Quarter 4, we had 27 risks on the risk register with 10 of these risks being rated as high. Risk Register These are: 1) A&E 4 hour waits, 2) impact on reporting figures for Delayed Transfers of Care that may have a negative CCG position, 3) impact on re-procurement of NHS 111 4) primary care prescribing, 5) the ability to robustly forecast prescribing expenditure, 6) sharps bin contract and the financial and quality impact 7) potential cost increase with the prescribing of Freestyle Libre 8) viability and sustainability of General Practice due to a closure at short notice, 9) preparation and readiness for future national primary care policy requirements, and 8) lack of Primary Care Estates Strategy in Doncaster.
9 are being treated and have action plans in place with 1 being tolerated.
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End of End End End End Q4 of Q1 of Q2 of Q3 of Q4 16/17 Number of risks 27 21 23 22 27
End of End End End End Q4 of Q1 of Q2 of Q3 of Q4 16/17 Risk TOLERATE 20 11 11 12 14 treatment TREAT 7 10 12 10 13
End of End End End End Score Risk rating Q4 of Q1 of Q2 of Q3 of Q4 16/17 1 to 5 Low 1 1 1 3 6 6 to 11 Medium 22 14 12 11 11 12 to 15 High 4 6 10 8 10 16 to 20 Very High 0 0 0 0 0 25 Extreme 0 0 0 0 0 TOTAL 27 21 23 22 27
There have been 5 incidents reported in the last Quarter. 1.3. • All incidents related to information governance issues, 4 were breaches outside Internal of the organisation with one internal breach relating to personal identifiable data Incident incorrectly stored. Reporting None of the incidents were externally reported to the Information Commissioners Office or via the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR).
End of End of End of End of End of
Q4 16/17 Q1 Q2 Q3 Q4 Number of incidents 9 9 8 10 5
End of End of End of End of End of
Q4 16/17 Q1 Q2 Q3 Q4 Accident / Injury 0 1 1 0 0 Communication 0 0 0 0 0 Information Governance 7 7 5 9 5 Disruptive or Violent 0 0 0 0 0 behaviour / Assault Category Estates / Facilities / Security / Health & 2 1 2 1 0 Safety Financial loss 0 0 0 0 0 Patient Safety 0 0 0 0 0 Other 0 0 0 0 0 TOTAL 9 9 8 10 5
End of End of End of End of End of Score Risk rating Q4 16/17 Q1 Q2 Q3 Q4 1 to 5 Low 9 9 8 9 5 6 to 11 Medium 0 0 0 1 0 12 to 15 High 0 0 0 0 0 16 to 20 Very High 0 0 0 0 0 25 Extreme 0 0 0 0 0 TOTAL 9 9 8 10 5
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1.4. Insurance to the CCG is commissioned from the NHS Litigation Authority (NHSLA), which has renamed to NHS Resolution in April 2017. Claims & Legal No new claims were received in the last quarter and there are no claims outstanding issues for the CCG.
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Section 2 – External Assessments ______
The following external assessment/inspection reports have been received in the last Quarter.
Completed Audit Reports: Work from the audit plan continues to progress with audits on the Information Governance Toolkit and Conflicts of Interest undertaken in the last quarter. The Conflicts of Interest Audit received significant assurance in the last quarter. Internal Audit Follow-up of previous years audit recommendations: A number of (Service actions from 2015/16 and 2016/17 internal audits are awaiting reporting. commissioned from 360 Head of Internal Audit Opinion: The external audit deliverables for the Assurance) year were outlined in the technical report/progress report. The Head of Internal Audit opinion is to be concluded in 4 stages with progress reported by the Internal Auditors at the Audit Committee. Stages 3 and 4 have been concluded in the last quarter. The final Head of Internal Audit Opinion is being finalised with the outcomes provided to Audit Committee.
External Audit Deliverables: The external audit deliverables for the year were outlined in the technical report/progress report containing the external External audit plan presented to Audit Committee in the last quarter, the report to Audit those charged with CCG governance and the year-end auditor’s report detailing the auditor’s opinion on the CCG’s accounts. (Service commissioned 2017/18 External Audit Plan: The external audit plan was presented with from KPMG) the nature, scope and type of the External Audit activities once completed producing two end of year opinions; financial statements and value for money.
Shared Business Services (Financial Accounting Services): No significant issues affecting the CCG. Service Auditor Business Services Authority (Prescribing): No significant issues Reports affecting the CCG.
Electronic Staff Record: No significant issues affecting the CCG.
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Section 3 – Committee Activity ______
At the two meetings held in the last Quarter the Committee: Noted the External Audit progress report with a focus on financial statements and financial sustainability. Received the Primary Care Strategy and assurance on the governance arrangements in place to support. Noted the Quality of Care in Care Homes follow up report. Discussed the Head of Internal Audit Opinion Report and noted the recommendations. Approved legal action against First Care. Undertook a deep dive into Corporate Objective 3 and Corporate Objective 4 of the Assurance Framework. Noted the implementation of Audit Recommendations. Audit Approved the 2018/19 Draft Internal Audit Plan. Committee Noted the Shared Services Review Report for Individual Funding Requests. Noted the significant assurance received for the Conflicts of Interest Audit. Noted the Counter Fraud Plan, Counter Fraud Progress Report and the Counter Fraud Risk Assessment. Noted the Risk Register Annual Report and acknowledged the updated Risk Management Policy. Noted the Probity Register Report including Register of Gifts, Hospitality and Sponsorship and Register of Interests. Approved the IG Policy, Framework and Associated Procedures. Approved the Information Asset Register. Discussed further the compliance with the upcoming implementation date of the General Data Protection Regulations (GDPR).
The Remuneration Committee meets as required. No meeting was held Remuneration in the last Quarter to discuss issues in line with its terms of reference as Committee approved by the Governing Body.
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At the two meetings held in the last Quarter, the Committee discussed the following: Overview of the Individual Placement Report including discussion on 28 day compliance, outstanding reviews and joint working with DMBC. Care Homes Operational Report as an update, live bed state, review of recently published CQC report, and evacuation of a care home in 2017. Care Home Strategy Implementation as an update on progress with the complexity tool, the training pathway and locality meetings. Overview of DBTHFT Quality Report including maternity services, system perfect, MRSA and deep clean policies, elective care programme and feedback on winter planning. Overview of RDaSH Quality Report including discussion on safer staffing, Trust transformation, and the quality dashboard. Update on FCMS Quality including discussions on the dashboard, Quality & winter planning, and end of life pathways. Patient Safety Medicines Management Report including clear dosing instructions, Committee fraudulent Pregabalin requests, and the review of the Medicines Management Group Terms of Reference. Overview of Primary Care Quality Report including discussion on care navigation, case conference reports and feedback on practice ratings from CQC. Noted the Q2 CQUIN attainment reports for DBTH and RDaSH. Overview of the Infection and Prevention Control Report including MRSA blood stream infection, Clostridium Difficile infection, pressure ulcer reduction, influenza, and offensive waste and sharp bin contract. Overview of the Safeguarding Children and Adults Report including the child sex abuse action plan and neglect task and finish group developments. Updates to the Caldicott log and work plan. Reviewed the Quality and Safety work plan for 2017 – 19. Reviewed the Quality and Patient Safety risk register. Noted the refreshed CHC Appeals Procedure and agreed the policy.
One meeting was held in the last Quarter where the following areas were discussed: Accountable Care System update with further information regarding the Hospital Services review and the continuing public engagement. Updates on priority areas for engagement for Urgent Care including results from work undertaken with Co:Create, the Health Bus, public materials redesign, and work undertaken on the Choose Well app. Engagement & Review of the Engagement Dashboard. Experience Meeting our Public Sector Equality Duties by publishing the Equality Delivery System 2 Self-Assessment and Workforce Race Equality Committee st Standards Report by 31 January 2018. Acknowledged the Equality and Diversity progress including the work currently underway on the refresh of the strategy, equality objectives, and the Equality and Diversity approach for the Accountable Care System. Healthwatch Update Report including new Health Ambassadors, TransMission, Mental Health survey, hospital services review, and PPG Network discussions.
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You Said We Did Report as an overview of the Q2 and Q3 period and complaints report for Q3. Agreed a multi-agency approach to the Doncaster BME Health Needs Assessment. Received updates on the NHS England Engagement Assessment review. Engagement and Experience Committee review of effectiveness and the updated Terms of Reference.
Three meetings were held in the last Quarter at which the Committee: Reviewed and made recommendations for the areas of improvement identified in the NHS England Patient and Community Engagement Indicator. Noted an update on the financial position of DBTHFT. Discussed and acknowledged the QIPP highlight and exception reports and current performance over the three meetings. Acknowledged updates in team recruitment and meeting structures. Agreed the contract and extension of the pilot for Consultant Connect. Discussed the CCG Extended Access Service to Primary Care. Agreed a preferred option and acknowledged audit process requirements relating to the Thyroid Register Decision. Discussed the RDaSH / SYHA Residential Care Home Fees and acknowledged the paper making recommendations on the funding proposal.
Noted the NHS 111 update report, approved the planned next steps Executive and confirmed the DCCG signatories on the agreement. Committee Agreed the proposal and recommendation in principle for the Community Tier 2 Wound Care Service. Approved the recommendation to extend the current contract with FCMS for a two year period until 30 September 2020. Noted risks and ratified recommendations relating to the Yorkshire and Humber Integrated Urgent Care Service Development and Procurement. Agreed the non-recurrent funding and review processes for services within the Trust relating to the Sexual Dysfunction Service (Leger Clinic). Discussed the Tier 3 Weight Management Service Review and made considerations to the recommendations. Approved the awarding of the TARGET contract to Primary Care Doncaster. Agreed the proposal for investment of £1 per head of population for development of Primary Care Networks. Approved the Risk Management Policy.
Three meetings were held during the last Quarter at which the Committee: Discussed finance including the draft 2018 / 19 financial plans and Primary Care the Primary Care Leasers and Debtors issues. Commissioning Discussed and noted several reports including Primary Care Strategy Committee Internal Audit Report, Delivery Plan Exception Report, and the Proactive Care Specification Quarterly Report. Received an update on the TARGET, Church View Mobilisation, and the GPFV monitoring survey.
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Received a Primary Care Heatmap update. Received and noted the Primary Care Commissioning Committee Annual Report. Discussed the Primary Care Strategy for 2018/19. Received Practice updates and further noted the practice estates strategy. Received minutes from sub groups.
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Section 4 – Corporate Governance ______
4.1. As a Membership organisation comprising 42 Member Practices, NHS Doncaster CCG remains fully authorised by NHS England. Constitution and The Member Engagement model has been option appraised and Establishment consultation with member practices has taken place in the last quarter. It is anticipated that recommended changes to the Constitution will be agreed.
This will require the CCG to amend its constitution and this will be concluded in line with the NHS England amendments to constitution process, with authorisation by the CCG’s members and consultation with key stakeholders.
Terms of reference of all committees are currently under review as part of an internal review of the governance structure of the CCG by the Head of Corporate Governance.
4.2. Declarations of Interest: In line with the guidance released by NHS England in June 2017 on managing conflicts of interest for CCG’s, the Standards of CCG has undertaken a refresh of the register of interests and Business subsequent reporting of declared interests for employees, GP Practices Conduct & and partners and colleagues involved in CCG business. The CCG has Conflicts of completed the process of collecting these forms and a published version Interest of the register of interests which includes all decision makers can be found on the CCG website or at the following link: http://www.doncasterccg.nhs.uk/wp-content/uploads/2018/01/Register-of- Declarations-of-Interests-28-December-2017-Website-Edition.pdf There have been no recorded breaches in the last quarter.
Conflicts of Interest Training is now mandatory for all staff. There are 3 modules, all staff will undertake module 1 and modules 2 and 3 will be undertaken as appropriate to job role.
Disclosure of Gifts and Hospitality: There has been no disclosure of gifts and hospitality within the last quarter.
4.3. Our meeting governance structure is detailed overleaf. Activity flowing through each formal Committee of the Governing Body is captured in Governance Section 3 of this report. Structure There have been no changes to the governance structure during the last quarter. Work on any potential delegation of duties to the Accountable Care Partnership and System is ongoing.
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4.4. The Officers fulfilling the key statutory roles required of a CCG are:
Statutory roles Strategic: Accountable Officer – Chief Officer Accounting Officer – Chief Finance Officer
Governance: Accountable Emergency Officer – Chief Officer Conflict of Interest Guardian – Lay Member for Audit & Governance Conflict of Interest Lead – Associate Director of HR and Corporate Services Whistleblowing Lead – Associate Director of HR and Corporate Services Senior Information Risk Owner – Associate Director of HR and Corporate Services Health & Safety Competent Person – Head of Health, Safety & Security Fire Safety Responsible Person – Associate Director of HR and Corporate Services Fire Safety Competent Person – Head of Health, Safety & Security Security Management Director – Associate Director of HR and Corporate Services Local Security Management Specialist – Head of Health, Safety & Security Claims Officer – Associate Director of HR and Corporate Services Local Counter Fraud Specialist – 360 Assurance Registration Authority – HR Team
Quality / Safeguarding: Caldicott Guardian – Chief Nurse Safeguarding – Chief Nurse Research Governance – Chief Nurse Equality & Diversity Executive Lead – Associate Director of HR and Corporate Services Accountable Officer Controlled Drugs – Director of Nursing in the local NHS England Area Team (delegated operationally to the CCG Head of Medicines Management)
4.5. Procedural documents due for review are on track. The Health, Safety and Security policy is currently under review and will be taken for Procedural approval to the Executive Committee. The Information Governance Document Policy including Strategy, Framework and associated procedure and the Management Risk Management Policy have been approved by Audit Committee in the last quarter.
4.6. Health & Safety: The Competent Person for Health & Safety has confirmed that the Health & CCG remains compliant with health & safety legislation. Safety, Fire Safety &
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Security Fire: Fire Marshalls are running weekly fire alarm tests at Sovereign House and have reported no problems. The Landlords Agent (Integral) run weekly fire alarm tests at White Rose House. The facilities team continue to conduct daily fire safety checks at Sovereign House and members of admin support conduct fire safety checks at White Rose House. Members of staff of the PuPOC team based at 722 Prince of Wales Road have volunteered to become fire marshals and trained in the safe use of the evacuation chair.
Security: NHS Doncaster CCG is part of a partnership with the South Yorkshire and Bassetlaw CCG’s for Health, Safety and Security hosted by NHS Rotherham Clinical Commissioning Group. As part of this service we have access to advice and support from an experienced and accredited NHS security management professional. There have been no security concerns in the last quarter. Access codes as per policy have and will continue to be routinely changed on CCG premises, to enable access for CCG staff and authorised visitors only.
4.7. Emergency Preparedness, Resilience & Response (EPRR): Emergency Planning continues to take place for Tour de Yorkshire for Emergency emergency services and health care in Doncaster. Resilience and Business Business Continuity: Continuity CCG team business continuity plans continue to be reviewed and updated to reflect any changes within teams and in recognition of our partnership with the South Yorkshire and Bassetlaw CCG’s for Health, Safety and Security hosted by NHS Rotherham Clinical Commissioning Group.
4.8. The end of year reporting process in the annual report and accounts in coordination with NHS Property Services is now planned as part of the Sustainability year end reporting process. Sustainability reporting has been captured in the Annual Report.
The CCG continues at Sovereign House and White Rose House respectively, to have recycling facilities in place for paper, cans, batteries and plastics which will be built-in to wider sustainability plans reportable locally through the corporate assurance report and nationally according to forthcoming annual guidance.
4.9. Summary: Below is a summary of complaints data for NHS Doncaster CCG for the last quarter which has been reported to NHS Digital. Complaints management Partially Total Upheld Not upheld upheld 2016/17 70 10 31 65 Annual Total 2017-18 12 0 4 7 Quarter 1
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Quarter 2 29 3 5 15 Quarter 3 24 2 13 8 Quarter 4 20 4 7 7 1 complaint opened in Qtr 3 to be carried forward to Qtr 1 – (awaiting information external to the CCG) 2 complaints opened in Qtr 4 to be carried forward to Qtr 1
Themes and trends from complaints are reported through the Committee structure of the organisation.
Of the 20 complaints received and investigated during the quarter (5 included an MP letter):
CHC Complaints • 3 related to the CHC assessment process, and delays. • 1 related to correspondence not being received. • 1 related to the delay in approving a Personal Health Budget. • 1 related to errors in paperwork • 1 related to reductions in funding • 1 related to a complex Child Care Package
CCG Complaints • 4 related to the recently procured renal transport • 2 related to delays in the Appeals department • 3 related to the IFR referral and process • 1 relate to the Agreed Rates of Pay for Care Homes • 1 related to the limitations of a Care Package • 1 relate to a limitations of a Pathway as it has not been nationally recognised.
The complaints which were upheld related to: • CHC -1x Complex Child Care • CCG – 1x Delays in the Appeals department • CCG - 1x Renal Transport • CCG – 1x IFR referral and process
The complaints which were partially upheld related to: • CHC – 3 x CHC assessment process, and delays • CCG – 1 x Delays in the Appeals department • CCG – 2 x Renal Transport • CCG - 1 x Limitations of a Pathway
4.10. The CCG’s Counter Fraud Specialist (CFS) is commissioned via 360 Assurance. The Audit Committee receives assurance via Counter Fraud Counter Fraud reports which cover the areas of contract performance, strategic governance, inform and involve, and prevent and deter.
The Counter Fraud Specialist prepared a comprehensive report of all counter fraud activities undertaken during 2016/17, which was aligned to the CCG’s self-assessment of compliance with commissioner standards and provides evidence to support the declared overall ‘green’ rating.
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4.11. Whistleblowing may relate to financial, employment or clinical care concerns. There were no whistleblowing disclosures in the last Quarter. Whistleblowing 2016/17 2017/18 Category Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Whistleblowing disclosures 1 0 0 0 0 0 0 0
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Section 5 – Information Governance ______
5.1. We continue to operate within the Section 251 exemptions agreed by the national Confidentiality Advisory Group. The protection CAG 7-04(a)/2013 Disclosure of commissioning data sets and GP and use of data for risk stratification purposes to data processors working on Personal behalf of GPs. Confidential CAG 7-07(a)(b)(c)/2013 Application for transfer of data from the Data HSCIC to commissioning organisation accredited safe havens: inclusion of invoice validation as a purpose within CAG 2-03 (a)/2013.
We have a Data Sharing Contract with NHS Digital the renewal of which is currently being processed by NHS Digital and a consolidated Data Sharing Agreement which also under renewal from the same date.
Our Fair Processing Notice was last updated in April 2017 and is published on our website. The Fair Processing Notice is currently under review in line with the General Data Protection Regulation enforceable from 25th May 2018.
5.2. The Information Governance Toolkit is a national toolkit administered by NHS Digital which enables us to measure our information governance Information compliance. Our 2016/17 Information Governance (IG) Toolkit score was Governance 77% with a minimum score of 2 achieved across all the standards, Toolkit meaning that our Toolkit meets the required standard. Our last published (IGT) CCG assessment is available online via the Information Governance Toolkit website: https://www.igt.hscic.gov.uk/reportsnew.aspx.
The Information Governance Toolkit was successfully submitted in the last quarter with a 72% compliance which is a satisfactory rating. Work continues to take place on the implementation of the General Data Protection Regulations with an action plan and communications plan in place in readiness for 25th May 2018.
NHS Digital has also released a Data Security e-learning package which replaces the annual IG training provided through the IG Training Tool. Staff have been reminded of the importance of concluding this as part of the toolkit compliance.
5.3 An Information Governance Workplan for 2017/18 has been developed and is being implemented. Work undertaken in the last Quarter includes: Information The Information Governance Policy including Strategy, Governance Framework and associated procedures being updated; Workplan Review of the Information Asset Register; Information Governance Bulletin to staff to raise awareness across the organisation; Processing of increased Subject Access Requests during the period; and
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The continued development and preparation of the General Data Protection Regulations (GDPR) implementation in May 2018.
5.4. The following table shows the number of Freedom of Information Act requests received and the number responded to within the 20 working Freedom of day timeframe. Information Act Requests 2016/17 2017/18 Enquirer type Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Commercial 32 25 18 26 20 26 24 16 Education Establishment 2 2 3 0 3 3 3 3 Legal 0 1 0 0 0 0 0 0 Media 7 16 11 18 8 14 13 8 Member of Public 18 20 14 28 29 13 32 26 MP 2 3 9 3 1 6 3 0 Other NHS 3 7 2 2 3 13 2 7 Public Authority 0 0 0 0 0 1 0 1 Staff 0 0 0 0 0 0 0 0 Voluntary Sector 12 9 9 11 6 1 1 8
Total 76 83 66 88 70 77 81 69
% responded to within 20
working days
100% 100% 100% 100% 100% 100% 100% 100%
Five Section 21 exemptions were quoted for information accessible by other means, which is linked to our ongoing approach to place more information into the public domain on our website to support transparency. We also used a Section 30 (Information held for the purposes of criminal investigations) and a Section 40 exemption (information which constitutes personal data of any person other than applicant).
There was a marked increase in the numbers of requests for the attention of Medicines Management; the bulk of these were queries about the Freestyle Libre Glucose monitoring Equipment available to those with Diabetes. Requests around Clinical Policies and Commissioning for Value remained steady, as did the number of queries for information on staff details. The number of queries for Continuing Healthcare and Personal Health Budgets remains at an average of 4 per quarter (over Q3 and Q4).
5.5. The CCG is required to meet statutory timeframes for responding to Subject Access Requests under the Data Protection Act. The statutory Subject Access timeframe is 40 days. Requests Ten subject access requests were received within the last quarter and was responded to within the required timescales.
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Section 6 – Organisational Development & Staffing Governance ______
6.1. Organisational Development is our systematic approach to improving organisational effectiveness – one that aligns our strategy, our people Organisational and our processes to drive forward our vision and effectively enact our Development Strategic Plan.
During quarter 3 the annual NHS staff survey closed. The response rate for Doncaster CCG was 70%. The overall results have been published and shared with staff. The Colleague Engagement Group are working on an action plan on the broad organisational themes and development sessions at team level are planned.
The CCG is part of an OD network across Doncaster and we are exploring opportunities for joint development programmes. Work is progressing well with the Local Authority and a scheme for job shadowing has been agreed, appraisal processes are being reviewing to ensure joint working is reflected in objective setting and a specific OD session is planned for Commissioning Teams.
6.2. Governing Body: Our Governing Body membership comprises 18 roles – the Chair, 10 elected Locality Leads (two in each of the five Workforce commissioning Localities), 3 Lay Members, a Registered Nurse (also the Structure Chief Nurse), a Secondary Care Specialist Doctor, the Accountable Officer (the Chief Officer) and the Chief Finance Officer.
Chair: Dr David Crichton.
Chief Officer: Mrs Jackie Pederson.
Locality Leads: Post holders and portfolios are detailed below:
Locality Lead Lead clinical areas Lead corporate areas Remuneration Committee Dr Jeremy Bradley Prescribing North East Locality Quality & Patient Safety Committee Planned Care Dr Marco Pieri Cancer North West Locality Musculoskeletal (MSK) Dr Niki Seddon Primary Care Commissioning Mental Health North West Locality Committee Planning Dr Nick Tupper Remuneration Committee Learning Disability Central Locality Audit Committee Care Homes Engagement & Experience Neurology Dr Khaimraj Singh Committee Information Technology & South East Locality Primary Care Commissioning Premises Committee
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Lay Members: Post holders and portfolios are detailed below:
Lay Member Lead areas Lay Member - Audit Chair of Audit Committee & Governance Chair of Remuneration Committee Miss Anthea Morris Lay lead for Audit and Governance Lay Member - Patient & Public Chair of Engagement & Experience Committee Involvement Public and Patient Involvement Champion Mrs Sarah Whittle Lay Member - Primary Care Chair of Primary Care Commissioning Committee Commissioning Lay lead for primary care commissioning Mrs Linda Tully Secondary Care Chair of Quality & Safety Committee Doctor Member Lead for Secondary Care, bringing an understanding of patient care Dr Emyr Wynn Jones in the secondary care setting
Senior Management Team: Post holders and portfolios are detailed below:
Team Member Lead areas Chief Finance Officer’s Team: Financial Strategy, management, control, reporting & governance Chief Finance Contracting Officer Procurement Mrs Hayley Tingle External Audit Internal Audit Counter Fraud Chief Nurse’s Team: Quality & Safety Safeguarding Medicines Management Chief Nurse Serious Incident management Mr Andrew Russell Contractual quality Clinical governance and assurance Continuing Healthcare (including Previously Unassessed Periods of Care) Personal Health Budgets Director of Strategy & Delivery’s Team: Strategic Plan Delivery Plans Director of Strategy System transformation & Delivery Commissioning in partnership Mr Anthony Fitzgerald Performance management, Business Intelligence & Information Technology Primary Care Commissioning Communications, Engagement and Experience Associate Director of HR & Corporate Services’ Team: Corporate Governance – including Risk Management, Information Associate Director Governance, Health, Safety & Security, Emergency Planning, and of HR & Corporate Headquarters management Services Human Resources & Organisational Development Mrs Lisa Devanney Equality & Diversity Secretariat and corporate support function
6.3. Workforce: A breakdown of the workforce is detailed below:
Workforce Headcount 173 Whole Time Equivalent 152.19 Breakdown Cumulative Sickness 3.88% Absence Rate Turnover Rate 1.94% Gender Male 25% Female 75% Age 16-20 2% 21 - 30 9%
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31 – 40 25% 41 – 50 34% 51 – 60 26% 61 – 70+ 4% Ethnicity White 89% Mixed – Multiple Ethnic 1% Groups Asian/Asian British 2% Black/African/Caribbean/Black 2% British Other 1% Not disclosed 5% Disability Declared disability 5% No declared disability 84% Not disclosed 11% Religion/Belief Christianity 66% Buddhism 0% Islam 1% Atheism 15% Other 6% Not disclosed 12% Sexual Orientation Gay 1% Lesbian 1% Heterosexual 91% Not disclosed 7%
6.4. Mandatory & Statutory Training: Compliance is monitored on a quarterly basis to ensure that employees who are non-compliant, or who Mandatory & will become non-compliant in the next three months, are encouraged to Statutory complete their training. The Quarter end position is detailed below Training alongside a comparison with the previous Quarter. Those areas that are requiring attention are being addressed through Executive leads and line managers to address the compliance rate.
Compliance rate Name of Training Q3 2017/18 Q4 2017/18 Equality & Diversity 75% 85% Fire Safety 62% 84% Fraud 85% 92% Health & Safety incorporating Risk 56% 87% Management Information Governance 53% 87% Moving & Handling 58% 82% Safeguarding Adults 58% 85% Safeguarding Children & Young People 56% 88% Infection Prevention 54% 86%
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Item 11
Chair & Chief Officer Report
Meeting name Governing Body Meeting date 17 May 2018
Title of paper Chair and Chief Officer Report
Executive / Dr David Crichton, Clinical Chair Clinical Lead(s) Mrs Jackie Pederson, Chief Officer Mrs Lisa Devanney, Associate Director of HR & Corporate Author(s) Services
Purpose of Paper - Executive Summary
The purpose of this report is to update the Governing Body on issues relating to the activity of the CCG of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper. This month the paper includes updates on the following areas:
• NHS England Annual Assurance Meeting • Primary Care • NHS70 • Constitution • 2018 Pay Reform • Mental Health Awareness Week • Cancer Research UK
Recommendation(s)
The Governing Body is asked to:
• Note the report.
Impact analysis Quality impact Neutral Equality Neutral impact Sustainability Nil impact Financial Nil implications Legal Nil implications Management of Conflicts of Paper is for information. No relevant interests. Interest Consultation / Engagement (internal N/A departments, clinical, stakeholder & public/patient) Report previously None presented at Risk Nil analysis Assurance 1.1, 4.2, 4.3 Framework
Chair and Chief Officer Report May 2018
1. NHS England Annual Assurance Meeting
The CCG’s Annual Assurance Meeting took place on 25 April 2018. The feedback was very positive overall considering the pressures in the system and challenges the CCG has overcome this year. It was recognised that the CCG had done well to achieve the Quality Innovation Productivity and Prevention (QIPP) target and the hard work involved in doing so was acknowledged. The CCG was commended on the progress with the Place Plan and integrated working and positive feedback was received on our model for clinical leadership. We were advised to focus on ways to input to and develop the Integrated Care System (ICS).
2. Primary Care
The CCG has overseen the merger of two GP practices in Doncaster and a further two mergers are progressing well. This means that we will now have 42 GP practices in Doncaster.
The New Surgery at Mexborough commenced the new contract to provide primary care services at Barnburgh Surgery on 8 May 2018.
Mrs Laura Sherburn has been formally appointed as Chief Executive of Primary Care Doncaster.
3. NHS70
The CCG is leading a joint event to celebrate NHS70 and showcase the health care services available in Doncaster. The event will be held on Sunday 8 July 2018 on the Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) site.
On 5 July 2018 events will be held at Westminster Abbey and York Minster. Mrs Hayley Tingle will represent the CCG at Westminster Abbey and Dr David Crichton will attend York Minster. Further places were allocated to the CCG and staff were asked to express their interest to attend and a random draw has been made to select who will receive the tickets.
4. Constitution
Following the last Governing Body Meeting further consultation was undertaken with Member practices regarding the recommendation to reduce the number of GP Governing Body Members and to progress with strengthening clinical input into our key delivery areas. This was unopposed therefore an application has been submitted to NHS England to amend the Constitution. It is anticipated that we will be advised of the outcome in approximately 6 – 8 weeks.
5. 2018 Pay Reform
Proposals regarding the 2018/2019 pay deal have been received and are currently out for consultation. The proposal is a 3 year pay deal which will include:
• A new pay progression systems • Reduced length of pay bands • Removal of overlap between pay bands • Shorter time to progress to the top of the pay band • Higher starting salaries
The consultation ends 30 June 2018 and it is highly likely the proposal will be accepted by Trade Unions. If accepted it will be implemented on 1 July 2018 and will be back dated to 1 April 2018.
6. Mental Health Awareness Week 14 – 18 May 2018
The CCG is supporting Mental Health Awareness Week and the focus will be on stress and how to deal with stress effectively. A number of activities are planned for staff including:
• ‘How to deal with Stress’ – Doncaster Improving Access to Psychological Therapies (IAPT) • Health Tests • Indian Head Massage • UNISON drop in session • Mindfulness and Relaxation Sessions • Back, neck and shoulder massage
7. Cancer Research UK
The CCG continues to support a number of charities including Cancer Research UK. We took part in the Stand Up to Cancer Bake Off event, Michelle Rhodes won Star Baker and the runner up was Andrea Stothard. A total of £204.20 was raised. Verbal
Item 12
Locality Feedback
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Item 13
Receipt of Minutes
Minutes of the Quality & Patient Safety Committee Held on Thursday 15th March 2018, 09:30 – 11:30 Boardroom, Sovereign House
Formal Committee Members Present : Committee Dr Emyr Jones (Chair) Secondary Care Doctor Member, DCCG Members Mr Ian Boldy Designated Nurse for Safeguarding & Quality, DCCG Present: Mr Mick Booth Specialised Rehabilitation Case Manager, DCCG Mrs Andrea Ibbeson Deputy Designated Nurse for Children’s Safeguarding & LAC Mrs Hannah Joerning Patient Experience Manager, DCCG Mr Andrew Russell Chief Nurse, DCCG Formal Committee None Members in Attendance:
In attendance: Mrs Lesley Twigg Senior Corporate Support Officer Dr Khaimraj Singh GP Representative, DCCG Mrs Alison Williams Nurse Assessor, DCCG Mrs Tracey Thomas CHC Team Leader, DCCG Mrs Michaela Hunter CHC Team Leader, DCCG Mrs Jenny Rayner Senior Officer for Quality, DCCG Mrs Amanda Johnson PHB & DOLS Lead, DCCG
Action
1. Welcome and Apologies
Dr Jones welcomed everyone to the meeting, apologies for absence were received from:
Mrs Gill Bradley, Deputy Head of Medicines Management, DCCG Dr Jeremy Bradley, GP Representative, DCCG Mrs Suzannah Cookson, Deputy Chief Nurse, Designated Nurse for Safeguarding Children and LAC, DCCG Mrs Leah Denman, Lead Nurse for All Age Individual Placements & Safeguarding Adults Mrs Wendy Feirn, Senior Nurse for Quality & Patient Safety, DCCG Mrs Zara Head, Primary Care Quality Nurse, DCCG Dr Eric Kelly, GP Safeguarding Children Lead DCCG Mrs Andrea Stothard, Quality & Patient Safety Manager, DCCG Mrs Karen Tooley, Lead Nurse for Care Homes DCCG
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2. Declarations of Interest
The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG).
Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk
The meeting was noted as quorate. Dr Jones thanked Dr Singh for attending today to enable the meeting to be quorate and to go ahead.
Declarations of interest from today’s meeting:
There were no declarations made.
3. Minutes of the Previous Meeting
th The minutes of the meeting held on 18 January 2018 were approved as a true record.
4. Matters Arising not on the Agenda
The Committee went through the action log for the meeting. All updates are recorded on the action log.
There were no other matters arising raised by Committee Members.
5. QUALITY
5.1 Individual Placement Report
Mr Boldy asked that committee members take the report as read but highlighted the following and invited questions:
Performance
28 Day Compliance: 98% achieved for Q3 and 96% achieved to date for Q4. There has been 1 breach; this was an Out of Area (OoA) case belonging to another Local Authority.
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Reviews
40% of assessments are out of date, each member of staff has a schedule for undertaking reviews, and the schedules will be monitored / reviewed on an on-going basis.
CHC Standard Eligibility
Mr Boldy advised that where once Doncaster was an outlier we are now 109 out of 207 CCGs.
Mr Boldy updated that the CHC journey will be mapped; Dr Jones asked if this would be brought to Governing Body. Mr Russell responded that a quarterly report will be produced and it will be included in that report and possibly it was more appropriate to go to Strategy & Delivery Group rather than Governing Body. Dr Jones agreed; Mr Russell advised that there is a richness of data from clinical staff which helps us to understand the clinical needs of the Doncaster population. Dr Jones said that he will discuss with
Dr Crichton when this should go to Strategy & Delivery Group.
Action 008 / 15.03.18: Dr Jones to agree with Dr Crichton when CHC eligibility is scheduled for a future Strategy & Development Group meeting. EJ
Joint Working with DMBC
A new CHC Framework has been published for implementation in October. The CHC process will be reviewed end to end; once the national documentation is received it will be brought to this committee and will be mapped against the framework. Dr Jones asked if there was a focus on quality and safety; Mr Boldy replied that there is and this would remain a focus.
Children’s Team
Mr Boldy advised on the ongoing work plan within the Children’s team. He advised that this work has stalled due to sickness within the children’s team, the member of staff who was sick is due back soon and this work will be resumed.
Dr Jones thanked Mr Boldy for a very comprehensive report and acknowledged the amount of work being done within CHC and asked that the committee’s thanks are passed on to the full team.
Adult Specialised Individual Placements
Mr Booth advised the committee that Mr Evans is now in post and is working with colleagues to get patients to a safe point where they can be
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discharged from hospital into an appropriate community setting.
Patient numbers are similar to the same time last year; Mr Russell advised that across the TCP, South Yorkshire and North Lincs footprint we need to better understand what provision is available and why patients are placed Out of Area. Mrs Pederson is SRO and Mrs Glover is the Project Manager for this piece of work.
Children’s Update
Mrs Ibbeson updated that she is heavily involved in Care Treatment Reviews (CTRs) for children and is working closely with Mr Golze, Commissioner for Children which is a joint post between the CCG and the Local Authority.
Dr Jones advised that there is a responsibility for this committee to
represent both children and adults within the Doncaster population and
said that future reports must provide that level of assurance. Mr Russell
agreed and updated that NHS England have asked for a quarterly report
with this data; Mr Boldy’s report will include Children, Adults and
Specialised Placement patients updates for future committee meetings with
Mrs Ibbeson and Mr Booth both providing input to these reports and
presenting at meetings when appropriate.
Action 009 / 15.03.18: Mr Boldy’s future Individual Placements report to include Children, Adults and Specialised Placement patient updates. IB
The committee noted the report, no further questions or comments received.
5.2 Care Home Operational Report
Mr Boldy asked that committee members take the report as read but highlighted the following and invited questions:
Quality Monitoring of OoA Placements
Mr Boldy advised that the Local Authority team monitor this on our behalf.
Care Home Concerns
Very little to update on Doncaster care homes; some homes have changed from Residential to Nursing and vice versa. Mr Boldy will keep an eye on this but stated that he is confident in the systems that are in place.
Dr Jones asked if there had been an improvement in workforce retention within care homes’ Mr Boldy responded that anecdotally he believes that
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this has improved.
The committee noted the report, no further questions or comments received. Dr Jones thanked Mr Boldy and noted that the report provided was excellent.
5.3 Care Home Strategy Implementation – Verbal
Care Home Strategy
The market has changed and the strategy has been refreshed to take this into account. A review of what is currently in place within the care home sector will take place in Q1 of 2018/19; Dr Jones asked if vanguard sites would be looked at. Mr Boldy replied that the model will be worked through to identify what is in place and what should be in place.
Complexity Tool
Mr Boldy advised that a meeting had been held 14.03.18. The information from a complex patient from the Old Rectory care home was put through the tool and results will be evaluated.
Mr Boldy updated that care homes are being considered within the context of the place plan and may become an ‘area of opportunity’ of the Place Plan and advised that this conversation is due to take place within the next Joint Commissioning Operational Group (JCOG) meeting next week.
No further questions or comments received regarding this update.
5.4 DBTH Quality Report
Mr Russell advised that he would provide the update on behalf of Mrs Cookson who was unable to attend today’s committee meeting. Mr Russell asked that committee members take the report as read but highlighted the following and invited questions:
60 Minute Plus Ambulance Handover
This has been challenging over winter on a national level; DBTH have performed well compared to other South Yorkshire acute trusts. The Trust is managing risk and impact to services and patients.
NHS England initially advised that every +60 minute ambulance handover should be recorded as a Serious Incident (SI). This has been the subject of discussion at a regional and national level to ensure that processes were proportionate and adding value. DBTH, in agreement with the CCGs, have been more pragmatic and have risk assessed each incident and where
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potential harm has been found these have been raised as an SI. Data is sent to the CCG on a weekly basis and we are lower than the national average. A full assessment of every patient is undertaken and an SI is triggered if we think there has been harm, this assessment is also done as part of the trusts mortality reviews. There has not been any SIs to date where a patient had to wait more than 60 minutes.
CQC Inspection
The final report is expected imminently; Dr Jones asked if the CCG had input to factual evidence within the report. Mr Russell responded that only the Trust is able to comment. Dr Jones asked if we would be copied into the Action Plan that the Trust develop; Mr Russell confirmed that we would and this would be monitored via the CQRG meeting and any concerns highlighted to this committee.
Maternity Services
Mr Russell advised that Mrs Hardy, Director of Nursing wants to make the Head of Maternity a sustainable and meaningful post. Dr Jones commented that rotating heads of midwifery may not provide continuity for staff or patients. Mr Russell said that any concerns would feed into the CQRG meeting with the Trust.
LeDeR Reviews
Mr Russell updated that both RDaSH and DBTH are now involved in these reviews and have extended the number of trained reviewers that they have. No gaps have been identified in LD provision by the national team.
The committee noted the report, no further questions or comments received.
5.5 RDaSH Quality Report
Mr Russell advised that he would provide the update on behalf of Mrs Cookson who was unable to attend today’s committee meeting. Mr Russell asked that committee members take the report as read but highlighted the following and invited questions:
CQC Inspection
Mr Russell advised that the Trust have made improvements with leadership. The neuro rehabilitation environment is an issue and we need to reconsider our commissioning intentions with regard to this. We have commissioned a number of beds and this does not necessarily relate to the levels of care required, this is being looked at.
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LeDeR
Training was held last month, a wider pool of staff has now been trained, and an annual report on this will be produced and come to the May 2018 meeting.
Action 010 / 15.03.18: Mrs Cookson to provide a LeDeR annual report for SC / LT the next meeting in May 2018. Mrs Twigg to add to the agenda.
The committee noted the report, no further questions or comments received.
5.6 FCMS Quality Report
Mr Russell advised that he would provide the update on behalf of Mrs Cookson who was unable to attend today’s committee meeting. Mr Russell asked that committee members take the report as read but highlighted the following and invited questions:
Dr Jones asked how successful the Urgent Care Centre (UCC) has been; Mr Russell responded that over the winter period it had worked very well. The UCC original aspiration is 20% of patients attending to DBTH are ‘streamed’ to the UCC but they have not yet reached that on a consistent basis however this is continually reviewed. The service is seeing 40-50 patients each day and there is on-going work on streaming and the overall service.
Dr Jones asked about GP recruitment for FCMS as this has been raised in the past as an issue; Mr Russell responded that this is reviewed on a weekly basis and to date there have not been any issues as the posts are always covered. Mr Russell advised that Mrs Leighton is looking at areas such as diagnostics within the UCC service and how this moved forward in relation to the Urgent Care Services; Dr Singh commented that this would make the service consistent to that provided in Sheffield.
The committee noted the report, no further questions or comments received.
5.7 Section 117 Exception Reporting - Verbal
Mr Russell advised that a report will come to the May 2018 meeting.
Action 011 / 15.03.18: Mr Russell to provide a S117 report for the May AR 2018 meeting.
5.8 Medicines Management Report
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Mr Russell advised that he would provide the update on behalf of Mrs Bradley who was unable to attend today’s committee meeting. Mr Russell asked that committee members take the report as read but highlighted the following and invited questions:
Team Vacancies
Mr Russell advised that a new Head of Medicines Management Alexander Molyneux has been appointed and will start work in June 2018; he has experience leading across a number of CCGs. A new pharmacist has also been appointed.
QIPP
A QIPP plan for Medicines Management is in development.
OptimiseRx
Dr Jones asked about the success of OptimiseRx; Mr Russell responded that the benefits are financial as well as quality. Dr Jones asked if it worked well in general practice. Dr Singh replied that it encourages you to use the system which is a really good prompt.
The committee noted the report, no further questions or comments received.
Terms of Reference (ToR): Medicines Management Group
Mr Russell advised that the Terms of Reference had come to today’s committee meeting for approval. Dr Jones asked the committee if they agreed with the ToR; the committee noted and agreed the ToR.
5.9 Primary Care Quality Report
Dr Jones advised that Mrs Head was unable to attend today’s meeting as she was travelling to Buckingham Palace for the Nursing Ceremony, Dr Jones asked that the committee note the Primary Care report and asked if there were any questions.
The committee noted the report, no further questions or comments received.
5.10 Q3 SI Report
Mr Russell advised that he would provide the update on behalf of Mrs Stothard who was unable to attend today’s committee meeting. Mr Russell asked that committee members take the report as read but highlighted the
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following and invited questions: There has been a potential rise in the numbers of pressure ulcers being reported as a SI, there are robust processes in place as both Trusts undertake a Root Cause Analysis (RCA) for every pressure ulcer. Where the Trust is not at fault these cases are de-logged as an SI.
Mr Russell informed the committee that it may well be that both Trusts are getting better at recording; we will keep an eye on this. Dr Jones noted that it was reassuring that staff are reporting PU’s as an SI. Mr Russell agreed and said that it would be useful for this report to have some narrative to explain the data; Dr Jones agreed and asked if the data could be triangulated with Never Events, Complaints etc; Mr Russell responded that it is triangulated via the Business Intelligence Report that is presented monthly at CQRG meetings.
Action 012 / 15.03.18: Mrs Stothard to provide some contextual narrative AS for future SI reports.
The committee noted the report, no further questions or comments received.
6. PATIENT SAFETY
6.1 IPC Report
Mr Russell advised that he would provide the update on behalf of Mrs Feirn who was unable to attend today’s committee meeting. Mr Russell asked that committee members take the report as read but highlighted the following and invited questions:
Clostridium Difficile Infection (CDI)
Mr Russell advised that this is a challenging target but it should be noted that we are GREEN against trajectory.
Gram Negative Blood Stream Infections (BSI)
Mr Russell advised that Mrs Feirn will soon have access to the necessary systems to undertake these checks.
Influenza
This year has seen the worst reported flu numbers for the last 7 years. The CCG will work with Public Health on the vaccination to be used for winter 2018/19.
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Sharps Waste
Mr Russell advised that the CCG has undertaken a lot of work collecting patient information and creating a database, we are hopeful that the contractor will take over management of the database in the near future. Mr Russell responded that this is our statutory responsibility and that the numbers of calls into the CCG seem to be reducing. Mrs Joerning responded that the number of complaints is not reducing regarding this issue and that she will continue to work with Mrs Feirn on this.
The committee noted the report, no further questions or comments received.
6.2 Q3 Safeguarding Children and Adult’s Report
Mrs Ibbeson advised that she would provide the update on behalf of Mrs Cookson who was unable to attend today’s committee meeting. Mr Boldy asked that committee members take the report as read and both he and Mrs Ibbeson highlighted the following and invited questions:
Mrs Ibbeson advised that there have been discussions regarding integration and streamlining of Safeguarding Teams and how to work closer together within the safeguarding community. A paper from both RDaSH and DBTH on how they will work jointly is awaited. Dr Jones asked if the Trusts would use the Place Plan approach; Mr Russell responded that Mr Damian Allen (DMBC) is advocating a Safeguarding Single Point of Contact (SPOC) for health, police, etc; this will provide efficiencies across all ages.
Mrs Ibbeson advised that the Children’s Working Together document is out for review / consultation, in Doncaster they have gone ahead and documented what the Boards will look like. Dr Jones asked if this document would come to this committee once finalised; Mrs Ibbeson said that it would.
Mr Russell updated that a Performance and Accountability Board meeting is planned for 16.03.18, this meeting will consider Board models. Mrs Ibbeson advised that this work is moving at pace as the deadline is April 2019.
Mr Russell informed the committee that there are two separate systems at present for Adult Safeguarding adding that Safeguarding Assessments will be the statutory responsibility of the Local Authority, NHS, police etc under the Health & Social Care Act 2012. Dr Jones asked if work done to date is helping to make organisations work more effectively on a day to day basis; Mr Russell and Mr Boldy both responded that there is a shift in Board thinking as there is now
Page 10 of 14 much more assurance, this allows providers to do pieces of work and the more strategic challenges are tackled at Board level.
Mr Boldy advised that Adult Safeguarding have recently undertaken an Emergency Bombshell Desktop Exercise; this proved a valuable exercise. An adult safeguarding time out session is also planned in the near future.
The committee noted the report, no further questions or comments received.
Children & Maternity Quality Assurance Strategy
Mrs Ibbeson introduced the strategy which has been developed following the success of the Primary Care strategy; Mrs Cookson has read the strategy and believes it provides governance assurance for the Boards and Panels that we work with. Mr Russell noted that the strategy reflects where we are in Doncaster and also aligns with the view of NHS England.
Mr Russell informed the committee that a Joint Commissioning Workshop had recently been held, there were approximately 120 commissioners from the Local Authority and CCG who had attended. Part of the day had been to discuss the Place Plan and to understand the relationship, functions, skills etc for both organisations, there were also conversations regarding joint commissioning posts, and for example, Lee Golze is now the Children’s Commissioner for both organisations.
Dr Jones thanked Mrs Ibbeson and Mr Russell and asked if there would be any metrics collected to monitor performance? Mrs Ibbeson updated that a dashboard has been developed and has been tested with Children’s Community Nursing as part of a pilot.
Dr Jones asked if it was this committee’s role to approve the strategy or should it be approved by the Strategy & Delivery Operational Group? Mr Russell responded that in future this will form part of the overall Individual Placements report adding that if we remove children from the strategy it formalises this as an ‘all age’ strategy. Dr Jones said that due to the issues within Maternity that it made sense to keep that strategy separate but agreed that an Adult Strategy is required and that this committee would approve and review the strategy on an annual basis. Mr Boldy agreed that he would produce the same type of strategy for Adult services which will come to this committee for approval.
Dr Jones asked the committee to formally approve the strategy, the
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committee agreed.
Action 013 / 15.03.18: Mr Boldy to develop an Adult Services Quality Assurance g strategy and bring to Q & PSC for approval. IB / LT Mrs Twigg to add the Children and Maternity Quality Assurance strategy to the meeting matrix as a yearly annual report.
6.3 Caldicott Log – Verbal
Mr Russell advised that that no Caldicott enquiries have been received.
6.4 Caldicott Work Plan (Exceptions) – Verbal
Mr Russell advised that there was nothing to report; he will bring the Caldicott Work Plan to the next meeting.
Action 014 / 15.03.18: Mrs Twigg to change from verbal to a report in LT respect of the Caldicott Work Plan for the next meeting.
No further questions were asked regarding this update.
6.5 Quality & Safety Work Plan 2018/19
Mr Russell advised that the plan is for information only and that there are no major issues which require escalating through this committee or the Governing Body adding that it is a challenge to identify what is day to day work for the Quality Team and what is extra and should be included on the Work Plan.
No further questions were asked regarding this update.
7. Quality Team Risk Register
Mr Russell advised the committee that the CHC risk is an on-going risk that we tolerate adding that he will refresh the wording of this risk.
Action 015 / 15.03.18: Mr Russell to speak to Mr Jones regarding the AR wording of the CHC risk.
8. Any Other Business (AOB)
Patient Experience and Engagement
Mrs Joerning advised the committee that the Engagement & Experience Committee had asked about how patient complaints and experience are reported, on the back of this Mrs Joerning said that she thought it was time
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to refresh how the data is presented and tabled an example asking for the committee’s thoughts on the charts tabled. Dr Jones and Mr Russell said that they liked the format but said that narrative to explain the charts was also needed. Mrs Joerning said that she will provide a quarterly report which will include narrative. Dr Jones asked that the monthly chart also has some narrative but agreed that a quarterly report providing a more detailed view would be beneficial. Mrs Joerning will also look to provide some historical data on themes and trends in the Annual Report.
Action 016 / 15.03.18: Mrs Joerning to email the charts tabled at today’s committee meeting to Mrs Twigg who will email them to committee HJ / LT members. It was agreed that Mrs Joerning will provide a monthly update in the form presented today which will include some narrative explaining the data. Mrs Joerning to also produce a more detailed quarterly and annual report which will include further narrative regarding themes and trends. Mrs Twigg to update the meeting reporting matrix to reflect these changes.
Meeting Scheduled for 03.05.18 rd Mrs Twigg highlighted to the committee that the next meeting 3 May 2018 is when year-end annual reports are brought to the committee and asked if the meeting time needs to be extended by 30 minutes as we have struggled in previous years to keep to time. The committee agreed and asked that Mrs Twigg extend the meeting time by 30 minutes. Action 017 / 15.03.18: Mrs Twigg to extend the time of the meeting from LT 0930 – 1130 to 0900 – 1130 for 03.05.18.
9. Minutes and Information
Medicines Management Group: Minutes of meeting held 14.12.17 and 11.01.18
Incident Management Group: Minutes of meeting held 09.01.18 and 14.02.18
Area Prescribing Committee: Minutes of meeting held 30.11.17
Safeguarding Assurance Group: No ratified minutes from meeting held 30.01.18
The committee noted the minutes provided and no questions were asked.
10. Date and Time of Next Meeting
The next meeting will take place on Thursday, 3rd May 2018, 0900 – 1130
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in the Boardroom in Sovereign House.
Meeting dates for the remainder of 2018 can be found below.
FUTURE 2018 MEETING DATES
Thursday 5th July 2018 0930 - 1130 Boardroom, Sovereign House
Thursday 6th September 2018 0930 - 1130 Boardroom, Sovereign House
Thursday 1st November 2018 0930 - 1130 Boardroom, Sovereign House
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Executive Committee Held on Wednesday 4 April 2018 commencing at 9am In Dr David Crichton’s Office, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ
Formal Members Mrs Jackie Pederson – Chief Officer (Chair) Present: Dr David Crichton – Chairman Mr Andrew Russell - Chief Nurse Mr Anthony Fitzgerald – Director of Strategy & Delivery Mrs Hayley Tingle – Chief Finance Officer Formal Attendees Present: Mr Ian Carpenter – Communications and Engagement Manager Mr Mike Taylor – Head of Governance
In attendance: Mrs Jayne Satterthwaite – PA to Chair and Chief Officer (taking minutes)
ACTION 1. Apologies
Apologies were received from:
• Mrs Lisa Devanney – Associate Director of HR and Corporate Services
2. Declarations of Interest
The Chair reminded committee members of their obligations to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group.
Declarations declared by members of the committee are listed in the CCG’s register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link www.doncasterccg.nhs.uk
The meeting was noted as quorate.
Declarations of interest from sub-committee/working groups:
None declared.
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Declarations of interest from today’s meeting:
Dr Crichton declared a pecuniary interest in Item 8, Extended Access to General Practice Services Update. The Executive Committee agreed that, as this item provided an update to the Committee and no decision was required, Dr Crichton may remain in the meeting.
3. Minutes from the Meeting held on
The minutes from the Executive Committee meeting held on
2017 was agreed as a correct record subject to the following amendment:
Page 9, Item 11, Proposal for Investment of £1 per head of population for development of Primary Care Networks, Paragraph 5, amend to read ‘Mrs Ogle requested that, and the Executive Committee agreed to support a direct award for the contract for the Development of Primary Care Networks (£1 per head of population) to Primary Care Doncaster’.
• Executive Committee Action Log
The Executive Committee discussed and updated the action Log.
4. Matters Arising
RDaSH/SYHA Residential Care Home
Mrs Tingle confirmed that Mr Allen was in agreement to funding.
The next step is to agree a joint solution of how services are funded with a view to pooled funding arrangements. Mrs Wyatt,
Deputy Chief Finance Officer is leading on this from an NHS Doncaster CCG perspective.
Community Tier 2 Wound Care Service : Business Case
Mrs Tingle confirmed that the business case has not yet been
discussed at the DBTHFT Finance, Performance and Intelligence Mrs Tingle Group (FPIG).Mrs Tingle to action and feedback at the next meeting.
Tier 3 Weight Management Service Review
Mr Fitzgerald confirmed that this was discussed at the Clinical Reference Group for clinical input where there was strong support for the services to continue however a decision will need to be made regarding the funding of the service going forward.
As a result it has not been discussed at Cabinet. M Fitzgerald and Mrs Tingle are meeting with Dr Suckling, Director of Public
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Health to discuss funding in more depth. An update will be Mrs Tingle/ provided at the next meeting. Mr Fitzgerald
Leger Clinic – Sexual Dysfunction Service (Business Case)
A letter has been written to the provider regarding the agreement of the Executive Committee to additional non-recurrent funding for the service.
5. Commissioner Agreement
Mr Fitzgerald presented the draft Joint Commissioner Agreement to the Executive Committee and gave a summary of our approach to it.
The integration of local health and social care is a key policy priority for the CCG and the Team Doncaster Partnership. The Joint Commissioner Agreement will comprise of a 1 year legally binding agreement setting out the ambition and intentions of the partnership, followed by a full Section 75 Agreement from 1 April 2019. The agreement will delegate commissioning decisions associated with the Areas of Opportunity from the Governing Body, Doncaster Metropolitan Borough Council (DMBC) Cabinet and the Joint Commissioning Management Board (JCMB).
Central to the work which has been progressing to put in place arrangements and drive the delivery of the Doncaster Place Plan ambition for integrated health and social care, there has been four key stands of work:
• Identifying initial areas where Doncaster resident can benefit most from integration and making joint improvement and reform plans. • Development of formal agreements to create conditions for joint commissioning and collaboration between providers. • Revision of governance arrangements to support integration. • Development of delivery arrangements to support implementation.
Work between the partners has identified 7 areas of opportunity to focus initial integration efforts as follows:
• Starting well o First 1001 days. o Vulnerable Adolescents.
• Living Well o Complex Lives.
• Ageing Well o Intermediate Care.
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• Strategic, all age development areas o Learning Disability. o Urgent and Emergency Care. o Dermatology.
Partnership work has now progressed to where there are ambitious integration goals for each area of opportunity with clarity about the role of providers working in collaboration and joint commissioners. The exception to this is dermatology where specific goals and plans have not yet emerged.
The draft Joint Commissioner Agreement builds on the previously agreed Memorandum of Understanding (MOU) between NHS Doncaster CCG and DMBC. It will facilitate joint investment in health and social care in Doncaster longer term. Initially a one year agreement is being sought and sets out the legal frame necessary to support effective joint commissioning which provide necessary legal assurance for both the Local Authority and the CCG. The agreement will enable work between the CCG and the Local Authority during 2018/2019 to prepare for formal joint commissioning of services under a full Section 75 agreement on contracting, payment mechanisms and incentives to secure more integrated working between providers. Work has also been undertaken on a Provider Collaboration Agreement (PCA) and a draft agreement is expected week commencing 26 March 2018.
A revised governance framework has been established to support integration which includes the Accountable Care Leadership Team, the Joint Commissioning Management Board and the Provider Collaborative Executive Group. The Provider Collaborative Executive Group will not be legally binding however Hill Dickinson solicitors will provide support as necessary.
The key strategic options available to DMBC and health and social care partners in securing improved health and wellbeing outcomes and tackling financial challenges in the system are:
• Do nothing. This option would maintain existing pattern of commissioning from DMBC and NHS Doncaster CCG and rely on co-ordination efforts only to support collaboration between providers. This would not secure the efficiency and impact gains of joint investment in services required or incentives for providers to integrate activity. • Joint Commissioning focus. This option would strengthen the capacity for joint strategic planning and investment between DMBC and NHS Doncaster CCG enabling a shared approach to developing provision to meet the needs of Doncaster residents. • Whole System Approach. This option would strengthen the capacity for joint strategic planning and investment between
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DMBC and NHS Doncaster CCG enabling shared approach to developing provision to meet the needs of Doncaster residents. It would aim to secure a collaborative relationship between providers in the system, with commissioners working together with providers to remove barriers to integration and person centred delivery.
The whole system approach is considered to be the approach most likely to secure the level of integration needed to ensure services are joined up at key points in the liver of Doncaster residents when they need it most.
Mr Fitzgerald advised that the Commissioner Agreement will also be presented to the Strategy & Organisational Development Forum on 5 April 2018 for comment and to the Governing Body for approval on 19 April 2018. This process will be mirrored in DMBC and the Cabinet.
Mr Fitzgerald requested that the Executive Committee:
• Note progress achieved by the Place Plan partners to develop a Joint Commissioning Agreement and Provider Collaborative Agreement. • Recommend the 2018/2019 Joint Commissioner Agreement to the NHS Doncaster CCG Governing Body, noting that this is a legally binding agreement, delegating authority to the Joint Commissioning Management Board for commissioning decisions associated with the delivery of the Place Plan. • Delegate authority to the Director of Transformation to make final amendments to the Agreement resulting from discussions at the Executive Committee and the Strategy & Organisational Development Meeting.
The Executive Committee:
• Noted progress achieved by the Place Plan partners to develop a Joint Commissioner Agreement and Provider Collaborative Agreement. • Recommended the 2018/2019 Joint Commissioner Agreement to the NHS Doncaster CCG Governing Body, noting that this is a legally binding agreement, delegating authority to the Joint Commissioning Management Board for commissioning decisions associated with the delivery of the Place Plan. • Delegated authority to the Director of Transformation to make final amendments to the Agreement resulting from discussions at the Executive Committee and the Strategy & Organisational Development Meeting.
6. 2018/2019 Contract Agreement Update
Mrs Tingle informed the Executive Committee that the contracts 5
with our two main providers Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) and Rotherham
Doncaster and South Humber NHS Foundation Trust (RDaSH) have now been agreed.
Although the contract has been agreed and signed up to with DBTHFT, it reflects the CCG’s activity and financial plan. The
activity and financial plan submitted to NHS Improvement by DBTHFT does not align. A meeting with colleagues from NHS Doncaster CCG, NHS England and DBTHFT is planned for 19 April 2018 to demonstrate the difference in submitted plans and mitigation. Mrs Pederson asked that an update on the activity
planning work being undertaken jointly with DBTHFT colleagues suing the Gooroo software tool. Mr Fitzgerald agreed to liaise with Amy Coggan regarding a more in-depth discussion at a Mr Fitzgerald future Informal Senior Management Team meeting.
7. Procurement Forward Plan
Ms Tingle presented the Procurement Forward Plan to the Committee for noting which provides details of the Procurement Plan for 2018/2019 including procurement processes currently running, contracts expiring and processes about to commence. The Plan also provides details of potential procurement projects
subject to internal decision making processes to support a proactive approach to procurement decision making and the identifications of sufficient resource for future procurement.
Mr Fitzgerald suggested that it may be timely to hold a refresh
session on what procurement means with NHS Doncaster CCG Managers.
The Executive Committee noted the Procurement Forward Plan and agreed that Mr Taylor liaise with Mrs Burns, Head of
Procurement to discuss how more detail could be added and how it could be used as an effective planning tool. Mrs Pederson requested that a contract end date be added to the plan and a Mr Taylor RAG rating applied.
8. Risk Stratification
Mr Williams informed the Committee that the Sussex Combined Predictive Model (SCPM) is a tool which looks at previous healthcare activity to predict how likely each patient is to go into hospital in the coming year with an emergency acute condition. The information can be used to identify and proactively manage patients at high risk of admission and understand risk patterns across the population. NHS Doncaster CCG commissioned this tool for approximately 5 years however in October 2017 the system was de-commissioned due to the provider ceasing further development and support of the application.
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The CCG conducted a review to understand how the SCPM was used in primary care, determining what methods of identifying patients for proactive case management are currently being used and if there is an interest in the use of risk stratification tools in the future.
The findings of the review suggests that risk stratification tools to be of value however evidence suggests that proactive uptake of SCPM was low. The following options are therefore available to the CCG:
• Option 1 - NHS Doncaster CCG investigate the market with a view to procuring a new risk stratification tool to replace the SCPM. • Option 2 – NHS Doncaster CCG do not replace the SCPM with a new tool but revisit the possibility of an in-house tool provided by the Performance and Intelligence team once progress has been made in securing the team access to linked data sets. • Option 3 – NHS Doncaster does not replace SCPM and takes no further action.
Mr Williams stated that, based on the findings of the review, it is recommended that the Executive Committee consider and agree Option 2.
The Executive Committee agreed Option 2.
9. Extended Access to General Practice Services Update
Mr Fitzgerald provided an update on the Extended Access to General Practice Services to the Executive Committee and advised that refreshing NHS Plans for 2018/19 confirmed that NHS Doncaster CCG is now required to have commissioned an additional service, available to the whole of Doncaster, meeting
the core requirements of Extended Access to General Practice Services by an accelerated deadline of 1 October 2018.
As per the update and discussion at the Executive Committee on 7 February, a procurement plan timeline was set out to have a
service procured with a go live date on 1 October. In the 2 months since:
• There were multiple expressions of interest in response to the Prior Information Notice (PIN) which closed at the end of
February. • 4 of these expressions of interest were scheduled for 1:1 interviews on Friday 16 March as part of market engagement. Mrs Leighton, Dr Alsindi., Mr Fitzgerald and Mrs Ogle were involved in the interviews.
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• Wider clinical input has been sought through the March Clinical Reference Group.
The procurement timeline remains on track with the service specification currently being finalised to reflect recent input and developments. It is planned for the Invitation to Tender (ITT), along with the final specification, to be published on 25 April, with
an award date at the end of June giving 3 months mobilisation for the successful provider ahead of the 1 October contract start date.
Mr Fitzgerald requested that the Executive Committee note the
update.
The Executive Committee noted the update and agreed that regular updates be provided in the Informal Senior Managers Meetings.
10. Highlight and Exception Report
• Medicines Management • Care Homes
Mr Fitzgerald presented the Highlight and Exception Report and stated that the report is in the usual format however it will change
in line with our refreshed Delivery Plans going forward. It was noted that the 2017/2018 reporting year usually ends in May of the following year therefore the new Delivery Plans will be presented from June.
The Governing Body spotlight reports for April will focus on Medicines Management and Care Homes. Mr Russell informed the Committee that Month 10 data will be used for Medicines Management and will reflect details from the Deep Dive on what future challenges and our aspirations are.
The Care Homes report will focus more on delivery and what our expectations are for the forthcoming year. It is difficult to ascertain from the data received where patients are going into services or coming from.
The Executive Committee noted the reports.
11. QIPP/Performance
Mrs Tingle reported that NHS Doncaster CCCG remains on track to deliver 92% of the 2017/2018 Quality Innovation Productivity Prevention (QIPP) plan. It was noted that NHS England had commissioned Deloittes to look at QIPP for all CCGs within the Yorkshire & Humber region.
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This is now complete for NHS Doncaster CCG and a positive report from Deloittes was received. They were particularly
complementary regarding the level of detail contained in a number of schemes. It was recommended to include an assessment and to give a clear indication of the process undertaken to how schemes are identified. The Committee agreed that the report should be presented at the next QIPP
Board to agree the recommendations made by Deloittes and an action plan developed as necessary. The report should also be seen by the Audit Committee, Executive Committee and noted Mrs Tingle within the Governing Body Finance report.
12. Bring Forward Agenda
The Committee agreed the following:
Strategy & Organisational Development Forum
April • Commissioning Agreement • GP Federation Business Plan • Future Clinical Leadership • Hospital Services Review Update
May • Adults and Children’s safeguarding update • Customer Insight update • Doncaster Growing Together update and Industrial Strategy • General Data Protection Regulations (GDPR) awareness • Joint Committee Clinical Commissioning Groups/Cancer Alliance Commissioning/Macmillan Living with and beyond
cancer programme
June • Assurance Framework • CHC presentation
Governing Body
April • Commissioning Agreement • 360°Stakeholder review • Equality & Diversity Annual report • Clinical Leadership/Constitutional changes
May • Corporate Assurance report/ GDPR • Hospital Services Review final report • Extra-Ordinary Governing Body meeting
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June • Financial Plan • Safeguarding report
13. Items to Note/Receipt of Minutes
The Executive Committee noted the receipt of the following minutes:
• System Resilience Group – Minutes from the meeting held on 22 February 2018.
14. Any Other Business
Mr Fitzgerald stated that a significant impact has been made this
year in respect of elective and non-elective activity. More work has been undertaken on Did Not Attend (DNAs) and follow up appointments in elective care. This will be discussed further in the Planned Care Board meetings.
Mrs Pederson informed the Executive Committee that Mr Idris Griffiths, Chief Officer NHS Bassetlaw CCG gave a presentation on Medicines Management at the South Yorkshire Accountable Officer meeting on 26 March 2018. It indicated that NHS Doncaster CCG still remains an outlier.
15. Date and Time of Next Meeting
Wednesday 2 May 2018 at 9am, Dr Crichton’s Office, Sovereign House
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Minutes of the Primary Care Commissioning Committee Held on Thursday 8 March 2018 commencing at 12.30pm In the Boardroom, Sovereign House
Voting Mrs Linda Tully – Lay Member (Chair) Members Mrs Hayley Tingle – Chief Finance Officer Present: Mr Anthony Fitzgerald – Director of Strategy & Delivery Mrs Sarah Whittle – Lay Member
Non-Voting Dr Niki Seddon – Locality Lead, North West Locality Members Mrs Carolyn Ogle – NHS England Representative Present:
Formal Mrs Suzannah Cookson – Deputy Chief Nurse attendees Mrs Kayleigh Wastnage – Primary Care Manager present Mrs Deborah Hilditch - Healthwatch Doncaster Representative (non- voting): In Mrs Kelly Smith – Primary Care Support Officer – Commissioning attendance: Mrs Jo Forrestall – Head of Strategy & Delivery – Community Services (In attendance for item 8.3)
There was 1 member of the public in attendance.
ACTION
1. Apologies for Absence
Mrs Jackie Pederson – Chief Officer Dr Khaimraj Singh – Locality Lead, South East Locality Dr Nabeel Alsindi – Clinical Lead for Primary Care and Long Term Conditions Dr Dean Eggitt – Medical Secretary, Doncaster Local Medical Committee (LMC) Mr Ian Carpenter – Head of Communications Mr Daniel Simmons – Development Manager, CHP/CityCare
2. Declarations of Interest
The Chair reminded Committee members of their obligations to declare any interest they may have on any issues arising at Committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group.
Declarations declared by members of the Committee are listed in the CCG’s register of Interests. The Register is available either via the 1
secretary to the Governing Body or the CCG website at the following link www.doncasterccg.nhs.uk
The meeting was noted as quorate.
Declarations of interest from sub-Committee/working groups:
None declared.
Declarations of interest from today’s meeting:
None declared.
3. Minutes of the Previous Meeting held on 8 February 2018
The minutes of the meeting held on 11 January 2018 were agreed as an accurate record.
4. Matters Arising not on the Agenda, including progressing the action tracker
Risk Register Item has been added to all future agendas.
ACS Update
Mrs Ogle advised the committee that Mrs Burns plans to issue the Framework during the week commencing 19 March 2018.
Finance – Full Quarterly Report Mrs Ogle advised the committee that the Online Consultation monies
now sit within the CCG and is to be carried forward for implementation by March 2019.
The revised Primary Care funding streams will be included in the next Finance Full Quarterly Report.
Mrs Tingle confirmed that oxygen services have been removed from all future reports.
Mrs Tingle confirmed the reasons for PMS practices being
underspend and APMS being overspent in the last Full Quarterly Report is due to changes to Practice contracts, these will realign in 2018/2019.
Primary Care Leases & Debtor Issues with CHP and Action Plan
Mrs Tingle to contact with Mr Day at CHP following discussions at Mrs Tingle the last committee.
Primary Care Heatmap Update Mr Empson to give the Primary Care Heatmap Update at the May 2018 committee.
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Primary Care Strategy 2018/2019 Following discussions at the last committee, Mr Fitzgerald suggested the Primary Care Delivery Group could work up the proposal for the £0.90 per patient and present the final proposal to the Primary Care Commissioning Committee, for sign off. The committee agreed.
Thorne Moore List Closure The options paper was added to the March agenda.
Primary Care Commissioning Committee Action Tracker The Primary Care Commissioning Committee Action Tracker was updated appropriately.
5. Finance
5.1 Interim Exception Report Mrs Tingle updated the committee on the forecast position and explained that the previous reported forecast of £300,000 underspend in General Practice; has now increased to £400,000, supporting the overall financial position.
Mrs Ogle advised the committee that there is £300,000 available for the development of Local Care Networks. A specification for delivery of Local Care Networks is in development and the CCG has agreed to direct award this to Primary Care Doncaster.
£860,000 has been top sliced across the Integrated Care System for Workforce, incentivising the use of the Apex Tool to link into the Workforce Strategy.
Mrs Whittle questioned how Primary Care Doncaster will report back to the CCG, and how the CCG will evaluate how the money has been spent. Mr Fitzgerald assured the committee that governance arrangements will be in place in terms of assurance through service specification with providers for 2018/2019.
The Committee noted all of the above.
6. Quality :
6.1 Interim Exception Report Mrs Cookson advised the committee that the Named GP for Safeguarding is working with Primary Care Doncaster to support the provision of services.
The first Safeguarding TARGET session was held on 7 March 2018, with approximately 170 attendees.
The committee noted the report.
7. Committee Business:
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7.1 Delivery Plan Exception Report The Delivery Plan Exception Report was shared as a paper ahead of the meeting. Mrs Wastnage highlighted those areas that were off track and advised of the areas that are on track and moving forward .
The committee noted the report.
7.2 ACS Primary Care Steering Board • Minutes of 29 January 2018 The Minutes were shared ahead of the Meeting for information, Mrs Ogle highlighted: • Social Prescribing update – Looking to recruit a Project Manager. • Local Care Network CCG Plans – Plan received and agreed. • GP International Recruitment Scheme – 2 Expressions of interest were put forward for Doncaster, applications will go to panel later in the month. • SY&B Advance Training Practice Hub – Proposal approved. • 27 March 2018 Workshop Event – The Agenda had not yet been released; the venue was confirmed to be Tankersley Manor, Barnsley.
Dr Seddon highlighted the discussions around the GP International Recruitment Scheme and questioned whether any consideration to retaining GPs in Primary Care. Mrs Ogle advised the committee that discussions are being held around the GP Retention and GP Returners Schemes.
As noted last month, Mrs Whittle highlighted the lack of GP attendance at the Meeting and questioned whether there is any scope to reschedule the Meeting to ensure it doesn’t fall on a Monday morning. Mrs Ogle advised the committee that the group are looking to change the days.
7.3 DRAFT Primary Care Delivery Group Minutes The draft Primary Care Delivery Group Minutes were shared ahead of the meeting for information. The group noted the Extended Access approach as detailed in the minutes. Mrs Ogle, Dr Alsindi and Mrs Burns are scheduled to meet the following week to further develop the Service Specification.
7.4 DRAFT Primary Care Provider Engagement Group Notes The draft Primary Care Provider Engagement Group notes were shared ahead of the meeting for information. The meeting focussed on the Primary Care Strategy for 2018/2019.
8. Commissioning:
8.1 Primary Care Estates Strategy Brief Due to apologies received from Mr Simmons, Mrs Wastnage updated the group on the Estates Strategy Brief. A paper (shared ahead of the meeting) sets out the methodology used when pulling together the strategy.
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In order to progress with the strategy, the committee were asked to consider; • What is the strategy going to be used for, what are the aims? • Who needs to be involved?
The group confirmed that the strategy should:
• Ensure the committee is better informed of Doncaster’s current baseline position, • Optimise the efficient use of estates, • Inform decision making • Inform the Primary Care Heatmap.
Mrs Whittle questioned whether links will be made with planning departments regarding new development and population changes.
Mrs Wastnage advised that the links are already in place and the CCG does feed into local plans.
Mr Fitzgerald and Mrs Wastnage advised the committee that Mr Simmons will meet with all major stakeholders to ensure the work is not done in isolation.
Mrs Hilditch explained the importance of service user engagement and suggested hotspots be recommended for areas of engagement.
Mrs Wastnage, Mr Fitzgerald and a member of the Quality Team will be involved in the Strategy moving forward.
The Estates Strategy is expected to be in place by July 2018.
Mrs Forrestall joined the meeting.
8.2 Thorne Moor List Closure AT the February Committee meeting further information regarding the issues the practices face was requested.
Mrs Wastnage presented a paper responding to the issues, including the changing workforce and lack of space within the buildings, and outlined 6 options and 3 recommendations.
Mrs Wastnage explained that a GP recently resigned and the practice is looking to recruit 2 Advanced Nurse Practitioners.
At the request of the committee, Mrs Wastnage and Mrs Feirn visited both Practice sites to understand how the space is utilised. The practice is struggling to house clinicians, and has an increasing list size. The Practice have resorted to adopting “non-clinical “space at The Vermuyden Centre to try and cope with the increasing demand, however upon inspection these rooms are not considered clinically safe. It was suggested that GP Resilience Funding could be used to convert these rooms to a clinically safe standard.
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The paper detailed the results of the NHS England Space Tool which suggests requires an additional 3-4 clinical rooms.
Mrs Wastnage shared copies of floor plans for both buildings and talked through the current bookable room use in both buildings. It is thought that a room within The Orchard Centre is not fully utilised, despite being booked out could potentially be divided into 2 clinical rooms, funded through the GP resilience fund. Mrs Wastnage agreed to explore this further.
The Primary Care Commissioning Committee: • Noted the paper • Agreed that the Practice does require more space. • Agreed the use of the GP Resilience Funding to fund the use of room 009 at The Orchard Centre and to fund adaptations to the non-clinical rooms that the practice is using at The
Vermuyden Centre. Mrs Wastnage
8.3 Complex Wound Care Update Mrs Forrestall updated the committee on complex wound care. The business case was recently approved by the Executive Committee who supported the proposal of commissioning a Tier 2 Complex Wound Service and the proposed approach for procurement.
The Service is expected to be ready for delivery from July 2018.
The committee noted the update. Mrs Forrestall left the meeting.
8.4 The Oakwood Surgery & Mayflower Medical Practice Merger Update Mrs Ogle updated the committee on the practice merger and, as detailed in the paper, explained that the system merger had been cancelled.
This decision was due to issues with the lease at The Oakwood Surgery and increasing non reimbursable bills at The Mayflower Medical Practice’s Bawtry site, both of which were not clear before the merge process began.
Dr Eggitt has met with all partners who feel the merge has gone as far as it can. Both Practices are working closer together, sharing staff, have an integrated telephone system and can access each other’s patient records. Both Practices have displayed notices in all sites updating patients on the merge.
The Primary Care Commissioning Committee noted the update and felt that no further action was needed.
It was recommended that in future, where practices apply to merge, early notice should be given informing practices that the CCG may claim back funding where a merge doesn’t complete.
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9. A Risk Register and New Potential Risks
Mrs Tully advised the committee that the Risk Register is updated quarterly and therefore the updated version will be shared each quarter, not each month. Mrs Smith
Mrs Tingle discussed previous Primary Care risks at the Audit Committee and will continue to feed into this along with the Risk Register.
Mrs Tingle and Mrs Ogle are noted as the joint Risk Owners.
10. Any Other Urgent Business
Mrs Tully advised the committee that the 12 April meeting will be a Development Session dedicated to Informed Decision Making; any urgent business can be discussed following this.
It is expected that the 14 June session will be dedicated to Confidentiality Training.
Mr Fitzgerald announced that following procurement of TARGET, Primary Care Doncaster was awarded the contract from April 2018. Primary Care Doncaster has been caretaking the contract from January 2018. A stakeholder group is being convened; Mr Fitzgerald and Mrs Cookson agreed to be involved in the group.
11. Date and Time of Next Meeting
Thursday 12 April 2018, Boardroom, Sovereign House at 12.30pm
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8 Verbal
Item 14
Any Other Business
Verbal
Item 15
Date & Time of Next Meeting
Thursday 21 June 2018 at 1pm in the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ