Public Primary Care Commissioning Committee to Be Held On

MEETING OF THE NHS LINCOLNSHIRE CLINICAL COMMISSIONING GROUP’S (CCG)

PUBLIC PRIMARY CARE COMMISSIONING COMMITTEE

TO BE HELD ON WEDNESDAY 10th FEBRUARY 2021 AT 11.00 AM – 12.30 PM THE MEETING WILL BE HELD VIRTUALLY VIA MS TEAMS LIVE EVENT

LINCOLNSHIRE CCG – PUBLIC PRIMARY CARE COMMISSIONING COMMITTEE Wednesday 10th February 2021 at 11.00 am – 12.30 pm The meeting will be held virtually via MS Teams Live Event

A G E N D A

Item Standing items Enc Action* Lead 1 Welcome, Introductions and Apologies: Mr Moore, G McSorley

Standing Items 2 To note any **Declarations of Interest Pecuniary or Non-Pecuniary Interests

3 To approve the Minutes of the Public Primary Care Commissioning Enc G McSorley Committee Meeting Held on 11th November 2020

4 To consider Matters Arising not on the agenda G McSorley

Quality (Safety, Effectiveness, Patient Experience and Performance 5 To receive an update in relation to Quality, Patient Experience and Enc Discuss M Fahy/ Effectiveness W Martin

Developing Primary Care 6 To receive an update in relation to the Lakeside Practice, Stamford Verbal Discuss N Blake/ J Bunce

7 To receive the Stackyard Public Consultation and Engagement Report Enc Approve S Brewster Stackyard Transfer and Closure of the Woolsthorpe Branch

8 To receive an update in relation to the Learning Disabilities Health Checks Enc Note N Blake/ A Rix 9 To receive the Primary Care Access Programme Brief Enc Discuss A Foy

10 To receive an update from HealthWatch Verbal Note L Moulder

11 To receive an update in relation to Covid-19 – Primary Care including the Verbal Note SJ Mills/A Foy Primary Care Network Vaccinations

Governance 12 To receive a Finance Update Enc Note E Frost

13 To receive and review the Public Primary Care Commissioning Committee Enc Discuss SJ Mills Risk Register

14 To escalate any issues/risks to the Board G McSorley

Governance 15 To receive Any Other Business

16 Date and Time of Next Meeting – 10th March 2020 at 11.05 am via MS Teams Please send apologies to: Sarah Bates, Deputy Board Secretary via email at: [email protected] Papers are available on the CCG website at www.lincolnshireccg.nhs.uk

*Decision/Discussion/Note Membership Name Position Dr Gerry McSorley Non-Executive Director (Chair) Sue Liburd Non-Executive Director Murray Macdonald Non-Executive Director Pete Moore Non-Executive Director John Turner Chief Executive Matt Gaunt/Nominated Deputy Director of Finance and Contracting Martin Fahy/Nominated Deputy Director of Nursing and Quality Sandra Williamson Chief Operating Officer – LE Locality Dr David Boldy Secondary Care Doctor GP Member TBC Adrian Audis NHSE/I Dr John Parkin Clinical Leader – Lincolnshire West Locality Councillor Sue Woolley Health and Wellbeing Board Representative Lyndy Moulder Senior HealthWatch Lincs Representative Wendy Martin Associate Director of Nursing – West Locality LMC – Dr Kieron Sharrock/Kate Pilton Observer

**Definition of a Conflict of Interest Conflicts of interest can arise in many situations, environments and forms of commissioning, with an increased risk in primary care commissioning, out of hours commissioning and involvement with integrated care organisations, as clinical ccommissioners may here find themselves in a position of being at once commissioner and provider of primary medical services. Conflicts of interest can arise throughout the whole commissioning cycle from needs assessment, to procurement exercises, to contract monitoring.

Interests can be captured in four different categories:

Financial interests: This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could include being:

 A director, including a non-executive director, or senior employee in a private company or public limited company, partnership or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations;  A shareholder (of more than [5%] of the issued shares), partner or owner of a private or not for profit company, business or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.  A consultant for a provider;  In secondary employment (see paragraph 52-53)  In receipt of a grant from a provider;  In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and  Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider).

Non-financial professional interests: This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may include situations where the individual is:

 An advocate for a particular group of patients;  A GP with special interests e.g., in dermatology, acupuncture etc.  A member of a particular specialist professional body (although routine GP membership of the RCGP, British Medical Association (BMA) or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);  An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE);  A medical researcher.  GPs and practice managers sitting on the governing body or committees of the CCG should declare details of their roles and responsibilities held within member practices of the CCG.

Non-financial personal interests: This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

 A voluntary sector champion for a provider;  A volunteer for a provider;  A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;  A member of a political party;  Suffering from a particular condition requiring individually funded treatment;  A financial advisor.

Indirect interests: This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). This should include:

 Spouse/partner  Close relative e.g., parent, [grandparent], child, [grandchild] or sibling;  Close friend;  Business partner.  Whether an interest held by another person gives rise to a conflict of interests will depend upon the nature of the relationship between that person and the individual, and the role of the individual within the CCG.

Attachment A

Minutes of the Primary Care Commissioning Committee held in Public on Wednesday 11th November 2020 at 11.05 am – 12.30 pm MS Teams

Present: Dr Gerry McSorley Chair – Non-Executive Director Dr David Boldy Secondary Care Doctor Mr Martin Fahy Director of Nursing and Quality Mr Matt Gaunt Director of Finance and Contracting Ms Sue Liburd Non-Executive Director Mr Murray Macdonald Non-Executive Director Mr Pete Moore Non-Executive Director Dr John Parkin Clinical Leader - Lincolnshire West Locality Mr John Turner Chief Executive – Agenda Item 7 Mrs Sandra Williamson Chief Operating Officer – Lincolnshire East Locality

In Attendance: Ms Sarah Bates Deputy Board Secretary Mr Adrian Audis Commissioning Manager – NHSE/I Mr Nick Blake Head of Transformation and Delivery - Agenda Item 7 Mrs Jacqui Bunce Programme Director Strategic Estates – Agenda Item 7 Mrs Emma Frost Assistant Director of Finance (Management Accounting) Ms Wendy Martin Associate Director of Nursing and Quality – West Locality Mrs Kate Pilton LMC Chief Operating Officer (Observer) Mr Andy Rix Chief Operating Officer – South Locality Mrs Sarah Starbuck Head of Transformation and Delivery – Agenda Item 8

20/071 Mrs Alaina Foy Delivery Director Apologies: Ms Sarah-Jane Mills Chief Operating Officer – Lincolnshire West Locality Ms Lyndy Moulder HW Lincs Sarah Southall Deputy Chief Nurse Councillor Sue Woolley Chair - Health and Wellbeing Board

Dr McSorley welcomed members to the meeting and advised that he is a Non-Executive Director and Chair of the Committee.

Dr McSorley added that the CCG is very appreciative of the amount of public interest that has been generated in relation to the St Mary’s Lakeside Practice agenda item. It was noted that there is both public interest and public concern in relation to this item.

Dr McSorley stated that all formal Public Primary Care Commissioning Committee meetings of the NHS Lincolnshire Clinical Commissioning Group are held in public and that the Committee usually meets on a bi- monthly basis to enable the members to make collective decisions on the review, planning and procurement of primary care services in the CCG and this is done under delegated authority from NHS England.

Dr McSorley advised that these are not public meetings in the normal sense but they are meetings held in public. Usually these meetings would be held on a face to face basis/in person but in light of the Covid-19 pandemic they are for the time being taking place via Microsoft Teams as a live event. It was noted that members of the public have the ability to post any questions they wish to submit either through the Question and Answer facility, or alternatively a proforma is included within the meeting papers pack and on the website.

Page 1 of 9

Dr McSorley added that any questions that are submitted to the Committee Secretary, Ms Bates these would be acknowledged and responded to after the meeting.

Dr McSorley advised that given the considerable public interest in relation to agenda item 7 the St Mary’s Lakeside Practice Stamford this item would be brought forward and taken after the routine meeting business has been transacted. Dr McSorley added that he would provide a further update at the original specified agenda time for those members of the public joining the meeting at that time. Dr McSorley added that Mr Turner, Chief Executive will provide members with an update in relation to the background as to the current state of this particular issue.

20/072 DECLARATIONS OF INTEREST PECUNIARY OR NON-PECUNIARY

Dr McSorley reminded members of the importance in the management of Conflicts of Interest and asked members to consider each item carefully as the meeting progressed in order to identify any risk or conflicts that may arise during the course of the meeting. Members were also asked to consider if an interest required declaring before, during or after the meeting that relevant steps are taken to ensure that plans are in place to mitigate the risk.

There were no declarations of interest noted at the meeting.

20/073 MINUTES OF THE LAST MEETING DATED 16th SEPTEMBER 2020 AND ACTION LOG

The minutes of the previous meeting held on 16th September 2020 were received and approved. The Public Primary Care Commissioning Committee agreed to:-

 Approve the minutes dated 16th September 2020.

20/074 MATTERS ARISING

There were no matters arising.

20/075 REVISED TERMS OF REFERENCE AND PROPOSED MEETING DATES FOR 2020/21

Mrs Williamson advised members that the revised Terms of Reference had been reviewed and updated and that these require approval by the Committee. It was noted that the approved Terms of Reference will be presented to the Board meeting for approval with the need for them to be signed off by NHSE/I which will require a change to the Constitution. Post meeting note: action completed on 12.11.20 Action: Ms Bates Mr Fahy requested that an amendment is made to section 3.14 which reads: “The Primary Care Commissioning Committee will have oversight for quality and patient experience in primary care and QPEC (Quality and Patient Experience Committee) will have oversight for quality and patient experience across all CCG commissioned services”. It was agreed that subject to this change the Terms of Reference would be approved. The Public Primary Care Commissioning Committee agreed to:-

 Receive and approve the Terms of Reference.  The revised Terms of Reference to be shared with the Board Secretary for inclusion with the agenda and papers for the next meeting. Post meeting note: action completed on 12.11.20.

QUALITY (SAFETY, EFFECTIVENESS, PATIENT EXPERIENCE AND EFFECTIVENESS)

20/076 QUALITY, PATIENT EXPERIENCE AND EFFECTIVENESS INCLUDING HEALTH PROFESSIONAL FEEDBACK

Ms Martin referred members to the Quality update report and stated that with the second wave of Covid 19 the priority for General Practices is to maintain safe environments and safe routes for consultations of patients. It was noted that face to face consultations are being undertaken where indicated and that patients need to be encouraged to present to services where it is needed either through the Pharmacy for advice or via telephone or E Mail contact in the first instance with their GP Practices.

Page 2 of 9

Ms Martin added that activity levels for General Practice and Primary Care services in general have increased due to normal workload, plus the backlog of patients now making contact with services after full ‘lockdown’. In addition there is focused work to ensure that all identified groups of patients and staff, including the most vulnerable receive the influenza vaccination. It was also discussed that General Practices will be key in delivering and administering the Covid-19 vaccine when it becomes available.

Mrs Martin added that Covid-19 has had an impact on the staffing levels within some Practices and therefore business continuity plans have had to be enacted. It was noted that this has been due to staff testing positive which has been low and isolation requirements with children and carer responsibilities.

Ms Martin stated that the previously raised concerns in relation to the Ask My GP digital platform appear to be resolved following corrective actions to improve the stability of the platform and that the situation remains under close surveillance.

It was noted that the issues in relation to the national supply of bio-chemistry tests and the re-agent supply for these tests has now been resolved. It was noted that Practices are now resubmitting requests for routine tests for patients.

Ms Martin advised that the details in relation to the Beacon Medical Practice have been discussed in detail at the Private forum. It was noted that the Practice currently as a CQC rating of inadequate and that the Practice has been working closely with the CCG and LMC to continue to make improvements against the action plan. The Public Primary Care Commissioning Committee agreed to:-

 Note the update.

DEVELOPING PRIMARY CARE

20/077 ST MARY’S LAKESIDE PRACTICE STAMFORD UPDATE

Dr McSorley welcomed Mr Turner, Chief Executive to the meeting. Mr Turner advised members that he would provide members with the context in relation to the current position with St Mary’s Lakeside Practice and advised that the Committee is familiar with the issues that have arisen in the recent months with the primary care premises at St Mary’s Lakeside Practice and the application to close the premises.

Mr Turner advised members that a significant amount of papers had been received in relation to this item and that all these papers had been made available in the public and that this is vital in paying respects to all of the work and input that the CCG has received. It was noted that this included detail in relation the patient consultation and engagement exercise, details received from the public and information from the Patient Participation Group and that a comprehensive report had been received and shared. Mr Turner also referenced the letter that he had received from the MP’s serving the area and the Leader of the County and District Councils.

It was noted that the scale and depth of the feedback received is very comprehensive and highlights the significant level of interest that has been generated in relation to this matter. Mr Turner wished to thank all that have contributed to the process and that all comments will be reviewed, examined and respected.

Mr Turner advised that the situation with the St Mary’s Lakeside Practice premises is that the Lakeside Practice put forward an application to close the St Mary’s Lakeside Practice which was based on the failure to reach an agreement with the freeholders to enable services to continue to be provided from the site in Stamford. It was noted that the CCG formed a clear view regarding the availability of the premises for the next few years and that the CCG committed to work with both St Mary’s Lakeside Practice and the freeholders to find and broker an agreement to enable the premises to continue to be available. Mr Turner advised that negotiations and discussions are on-going and as yet no agreement has been secured.

Page 3 of 9

Mr Turner referenced the first recommendation to the Committee and advised that the team is continued to be supported for those that are taking these negotiations forward and that the CCG continues to do all that it can to secure that agreement of the premises. Mr Turner reinforced that this is where the time and energy needs to be focussed. Mr Turner made the recommendation to the Committee that at the current time the CCG is concentrating its efforts and energy to secure an agreement. Mr Turner added that the Committee is therefore not in a position to consider the application to close the premises at St Mary’s Lakeside Practice and make a decision. The CCG wishes to continue to pursue the discussions in relation to the premises matter.

Mr Turner referred to the feedback received and that a number of operational concerns had been raised by members of the public and the Patient Participation Group and that key themes relate to access, the telephone system and availability of appointments. Mr Turner stated that the St Mary’s Lakeside Practice will be asked to review all the operational comments and provide their perspective on the comments and advise on how they will address these operational concerns that have been raised.

Mr Turner added that there are a number of strategic longer term issues that the Committee will want to pay attention to. It was noted that it has been expressed very clearly in the correspondence received from the MP’s and Council Leaders regarding the longer term strategy for primary care provision in Stamford. It was noted that Stamford along with other areas in Lincolnshire is a growing town and that there is housing growth and quite a significant anticipated increase in the population in the town and clearly there is a question regarding how primary care services will evolve to meet the demands for the growing population.

Mr Turner referred to the important points raised in relation to the structure of primary care arrangements serving Stamford and a clear suggestion that comprehensive public engagement in terms of longer term planning for healthcare in the town needs to be undertaken. Mr Turner advised of the recommendation to the Committee in that the immediate short term issue is to secure the St Mary’s Lakeside Practice with the Committee committing to exploring the longer term strategic matters that have been raised.

Mr Turner provided a summary and advised that:-

 The CCG continues to support the on-going discussions to continue to secure an agreement for St Mary’s Lakeside Practice.  At this moment in time the CCG will not consider the Lakeside application to close.  St Mary’s Lakeside Practice will be asked to review all of the operational concerns that have been raised and provide their perspective and how they will respond and to commit to exploring the longer term strategic points that have been consistently raised through the exercise and that which were well articulated in the MP’s and Council Leaders letters.  A report to be presented at a future meeting on the responses to the operational concerns.

Dr McSorley added that it is obvious that there will be some concerns expressed regarding levels of confidence and the time lines associated with these negotiations given that the lease expires on the St Mary’s Lakeside Practice in the middle of December 2020. Dr McSorley queried if a time line could be provided as to when these discussions may be resolved.

Mr Turner added that this is a pressing and urgent matter for the CCG and stated that it would be advisable to allow for the negotiations to continue without applying further pressures and that clearly the CCG wishes to reach a positive conclusion and arrive at this as soon as possible.

Dr McSorley referred to the richness of the comments that have been received through the consultation engagement exercise and advised that the Committee will request that the St Mary’s Lakeside Practice respond to these concerns raised.

Page 4 of 9

Mr Macdonald wished to comment and reinforce the importance of the feedback received and that clearly this is an issue that is of great importance to the local community and that is reflected very clearly by the comments made by the MP’s and the Council. Mr Macdonald referred to the time that this issue has consumed by officers and the Committee and to endorse the recommendation given the amount of the comments that we ask St Mary’s Lakeside Practice to further reflect on these and we come back to these discussions at a later date. Mr Turner referred to the number of comments that had been provided through the Question and Answer facility from members of the public and that these will be captured and responded to as appropriately going forward. Mr Turner wished to acknowledge that a high number of comments had been received and that the CCG will pay due regard to these.

Dr McSorley summarised that in the light of the on-going discussions between all parties and St Mary’s Lakeside Practice that the CCG sets aside a decision in respect of the St Mary’s Lakeside Practice site. It was noted that the CCG acknowledges the considerable work that has been undertaken by the Patient Participation Group and also the responses that have been received through the St Mary’s Lakeside Practice patient engagement consultation exercise. It was noted that all these operational concerns will be acknowledged and responded to and that the Committee will receive a report on these aspects irrespective of the St Mary’s Lakeside Practice issue. Action: Mr Blake/Mrs Bunce The Committee supported the efforts of officers to resolve any outstanding issues with a renewal of the lease. Further, it agreed, in the light of these negotiations, to defer any decision on the application to close the St Mary’s branch surgery.

Dr McSorley added that the CCG continues its commitment to a longer term planning arrangement for the growing population in Stamford and its surrounding area in the course of time. Members wished to endorse and agree the recommendations. Dr McSorley added that the CCG will not lose sight of the experiences that have been shared with the CCG through the patient engagement exercise and grateful for the contributions.

Dr McSorley wished to thank officers for their continued support and commitment to this matter. The Public Primary Care Commissioning Committee agreed to:-

20/078 2020/21 QUALITY AND OUTCOMES FRAMEWORK (QOF)

Mrs Starbuck presented the report in relation to the changes to the 2020/21 Quality and Outcomes Framework (QOF) report and advised that NHSE/I have published a revised approach to QOF for 2020/21 to reflect the impact of Covid-19 on general practices.

Mrs Starbuck added that it has been recognised that Practices will need to reprioritise aspects of care not related to Covid-19. It was noted that the modified QOF requirements for 2020/21 aim to support this and help release capacity in general practice to focus on Covid-19 recovery.

Mrs Starbuck added that in terms of the key elements this allows payment protection to Practices for some indicators and also focusses on other key areas which include flu, early cancer diagnosis and learning disabilities.

Page 5 of 9

It was noted that this is national guidance however the local element is for Practices to agree an approach for population stratification. Mrs Starbuck added that the CCG has been working with the LMC to review a county- wide consistent approach to support Practices. Furthermore data support has been provided to Practices to enable them to identify the 20% most deprived neighbourhoods. Mrs Starbuck added that the plan that has been submitted is the draft approach that will be shared with Practices over the coming days. It was noted that this will allow Practices to focus on priority areas whilst protecting income in order to manage their workload.

Mr Fahy commented on the Transforming Care programme and stated that it is pleasing to see learning disabilities as a key area and the commitment to meet the challenge to ensure that people with a learning disability have access to an annual health check.

Mr Gaunt stated that this process removes any uncertainty in relation to the income that primary care will receive over the course of the winter period. It was noted that this certainty allows Practices to focus on an extremely busy winter period and that the resources are in place to meet the needs as far as possible including the likelihood of a mass vaccination programme for Covid-19. The Public Primary Care Commissioning Committee agreed to:-

 Note and accept the report.

20/079 PRIMARY CARE COVID-19 UPDATE

Mrs Williamson provided members with an update and advised that work continues with Practices in refreshing their Business Continuity Plans as work progresses through the on-going pandemic.

Mrs Williamson advised that primary care is developing OPEL (Operational Pressures Opel Reporting) and that this is already in place for the acute providers. Mrs Williamson advised that this will allow primary care to work as a system and be in a position to be able to respond to the increase in demand in primary care and any of the workforce pressures as winter is managed.

It was noted that this reporting will provide assurance and provide the triggers for escalation that relate to primary care and that this will be part of the system care urgent reporting going forward. The Public Primary Care Commissioning Committee agreed to:-

 Note the update.

GOVERNANCE

20/080 FINANCE UPDATE

Mrs Frost gave an update on the budget setting process as part of the system financial plan that was submitted to NHSE/I for the second half of the financial year for months 7-12. It was noted that the primary care budget for primary care medical totals £60.235m of which £60.23m allocation that has been received to date.

Mrs Frost advised that the report provides a breakdown across the primary care medical budget and includes the spend for the additional roles and responsibilities, the PCN funding, increase in dispensing and prescribing costs in light of recent Covid-19 activity that has been particularly during and the introduction of the Investment and Impact Fund as part of the PCN DES from 1 October.

Mrs Frost stated that the Appendix provides a brief update on the position as at the close of Month 6 which shows an overspend against budget of £730k however it is expected that when the CCG receives the matched allocation from NHSE/I this will be resolved.

Page 6 of 9

Mr Gaunt stated that the oversight budget management for primary care is a key element for this Committee. Mr Gaunt added that going forward a regular report against the budget will be provided and that total CCG expenditure and financial position is the remit of the Finance and Performance Committee that provides updates and assurances to the Board.

Mr Gaunt added that the CCG is aiming to secure as much resource as possible into primary care and that additional investment was made than originally planned in the first half of the year and work continues to build on that investment and support at that level.

Dr McSorley queried the financial planning arrangements and timelines for 2021/22 and when the Committee may be presented with an opening budget.

Mrs Frost advised that the national planning detail guidance has yet to be released for the financial planning round 2021/22 and that the normal cycle commences in the next few weeks where a review of what resources are required is undertaken. Mrs Frost added that the expectation is that this will be undertaken on a system wide basis and that work has already commenced within the CCG.

Mrs Frost advised that a report detailing the assumptions and intentions for primary care that is linked to the overall CCG plan will be presented for discussion at the Committee. Action: Mrs Frost/Mr Gaunt The Primary Care Commissioning Committee agreed to:-

 Note the update.  Receive the financial planning detail for 2021/22 at the next meeting.

20/081 PUBLIC PRIMARY CARE COMMISSIONING COMMITTEE RISK REGISTER

Mrs Williamson presented the Primary Care Risk Register and advised members that future iterations will be supported with a report cover highlighting the specific key risks for escalation. Action: Ms Mills It was noted that the Risk Register includes 14 risks associated to primary care that details the actions and mitigations and the forums where the oversight of the risk is managed.

Mrs Williamson advised that the Register is due further refinement and that this will feed into the overarching Corporate Risk Register and Board Assurance Framework. Mrs Williamson added that the Register covers some of the strategic risks and specific operational risks and that the Register is a framework to capture these for on-going monitoring and also includes any system wide priorities/risks.

Mrs Williamson requested feedback and observations from members regarding the format and content of the Register and advised that this is an iterative process as it is further developed.

A query was raised in relation to the national Roche supply chain position and the impact on primary care and the situation with these being pause. Ms Martin confirmed that the issue has now been resolved and that for those patients requiring an urgent test these were still managed and processed. A further query was raised in relation to the timeline for ensuring that those patients that were unable to be tested have now been completed. Mr Fahy stated General Practices are now requesting the tests. Mr Fahy added that the supply chain issue is now resolved and assured the Committee that this area has returned to business as normal within the last fortnight.

A question was raised in relation to the St Mary’s Lakeside Practice and where this risk sits within the Risk Register. Dr McSorley stated that until the St Mary’s Lakeside Practice premises issue is resolved this remains a significant risk to the CCG and therefore the risk profile needs to be constructed and included within the Risk Register. Action: Ms Mills/Mrs Williamson

Page 7 of 9

The Primary Care Commissioning Committee agreed to:-

 Note the Risk Register.  Future iterations to be accompanied with a report cover paper highlighting key areas and areas for escalation.  St Mary’s Lakeside Practice to be included in the next iteration of the Risk Register.

20/082 ESCALATION OF RISKS AND ISSUES TO THE BOARD

Dr McSorley referred to the escalation of the following risks:-

 St Mary’s Lakeside Practice and to appraise the Board on the current situation.  The revised Terms of Reference for approval by the Board.

20/083 ANY OTHER BUSINESS

Dr McSorley thanked colleagues and members of the public for attending and listening to the meeting. Dr McSorley added that it is hoped that a successful conclusion will be brought to the St Mary’s Lakeside Practice to remain open and that the CCG will not lose sight of the significant concerns that have been raised through the public engagement exercise.

Dr McSorley wished to thank members of the public for contributing to the question and answer forum in the meeting and advised that all the comments would be acknowledged and reviewed.

20/084 DATE AND TIME OF NEXT MEETING

Wednesday 10th February 2021 at 11.00 am via MS Teams Live Event.

Page 8 of 9

Not Delivered/Off Track In Progress

On Track to Deliver Delivered Public Primary Care Commissioning Committee

Action Log as at 11th November 2020

Minute Meeting Item Action Required Responsible Date to be Progress as at Status Number Officer Completed Month/Year By

20/075 11.11.20 Terms of Reference  The revised Terms of Reference to be shared with S Bates Nov 2020 Action the Board Secretary for inclusion with the agenda completed on and papers for the next meeting. Post meeting 12.11.20. note: action completed on 12.11.20.

20/077 11.11.20 St Mary’s Lakeside  St Mary’s Lakeside Practice to be asked to review N Blake/J Bunce Jan 2021 Practice all of the operational concerns that have been raised and provide their perspective.  A report to be presented at a future meeting on the responses to the operational concerns.

20/080 11.11.20 Finance Update  Receive the financial planning detail for 2021 at E Frost Jan 2021 the next meeting.

20/081 11.11.20 Risk Register  Future iterations to be accompanied with a report SJ Mills Jan 2021 cover paper highlighting key areas and areas for escalation.  St Mary’s Lakeside Practice to be included in the next iteration.

Page 9 of 9

Primary Care Commissioning Committee – PUBLIC

Date of Meeting: 10 February 2021 Agenda item: 5

Title of Report: Quality Update Report ( Primary Care) Report Author and Wendy Martin, Associate Director of Nursing and Quality Title: Appendices: None attached

1. Purpose of the Report (including link to objectives)

To highlight any general quality concerns for General Practice with information on any mitigating actions.

2. Recommendations

To ensure the PCCC are aware of any significant Quality concerns for General Practice, where Quality covers the domains of patient experience, patient safety and clinical effectiveness. The Board to receive assurance on the mitigations in place to address the highlighted concerns.

3. Executive Summary

Quality surveillance and oversight within General Practices is undertaken by the locality Nursing and Quality Team in conjunction with CCG Locality staff. Quality information pertaining to each Practice is considered through a locality Primary Care Quality Assurance Group (or equivalent) that usually meets monthly. At this meeting General Practice Quality Dashboard information is considered alongside other quality marker information i.e patient experience information, information on complaints and incidents, and CCG hard and soft intelligence. This enables a Quality Risk Register to be constructed for each Practice, which highlights the issues, but also the summary actions being taken by the CCG in conjunction with the relevant Practice to mitigate the concerns.

During the Covid 19 pandemic response, there has also been a regular (weekly) county wide GP Clinical Lead meetings and a CCG Clinical Leads meeting twice weekly to ensure any immediate Primary Care clinical and quality concerns are addressed during the pandemic.

With the second wave of Covid 19 the challenges for General Practice have been maintenance of safe Infection Prevention and Control practices and to ensure appropriate and safe patient access to services, be this via telephone or video consultation routes or via face to face appointments where indicated. The significant increase in recent weeks of positive Covid cases has necessitated enacting business continuity plans for ensuring staffing levels in several practices eg. use of locums; sharing facilities across practices, etc.

Activity levels for General Practice and Primary Care services in general have increased due to normal workload, the backlog of patients making contact with services after ‘lockdown 1’, the notable increase in positive covid cases with wave 2/3 of the pandemic and because of the additional workload associated with Covid 19 and influenza vaccination programmes. Work to ensure good uptake of the influenza vaccination has continued, including roll out to the new cohort of patients this year that are between 50 and 64 years of age.

All 13 Primary Care Network vaccination hubs for Covid 19 are now operational and staffed from PCN constituent Practices. General Practice are also undertaking ‘roving’ vaccination provision to care homes and to housebound patients currently in the priority cohorts to receive vaccination (care home residents; > 75 year olds, extremely clinically vulnerable and to clinical staff delivering direct patient care).

General Practices have implemented pulse oximetry at home monitoring for suitable Covid positive patients > 65 years and/or clinically vulnerable, with all Practices taking delivery of additional pulse oximeters to enable this provision at the end of December 2020.

General Practices within Primary Care Networks and new contractual arrangements (PCN Directed Enhanced Services) have also delivered enhanced services to Care Homes during these challenging times; working even more closely with local community teams to ensure there is wrap around support for all care home residents and staff. Two PCNs particularly are supporting the two Designated Care Homes who admit Covid positive patients needing residential care in the first 14 days of illness post hospital admission or from home.

AskmyGp online consultation platform

AskmyGP issues previously reported now resolved following corrective actions to improve the stability of the platform, with no further reports of problems in the last three months.

Roche biochemistry reagent shortage

Also now resolved and restrictions on routine tests are now lifted. There are no continued concerns raised from Practices about backlog effect as were able to sustain testing for urgent need and safely postpone routine tests to a later date after risk assessment for the appropriateness of this given consideration of each patient’s condition/ health profile.

Incident Reporting

Reports about General Practice from other providers remain low ( 24 HPF reports in Q3). All incidents highlighted are followed up for action with the specific General Practice involved. The highest reported category in Q3 relates to Diagnostic Processes/Procedures (n=9) as below:  Monitoring/On-Going Assessment of Patient Status (n=5) o Failure/insufficient/incomplete monitoring x 4 o Incorrect/insufficient handover/transition x 1  Laboratory Investigations/Interpretations (n=4) o Specimen labelling error x 2 o Preparation of patient for investigation insufficient/incorrect/incomplete x 1 o Specimen insufficient/incorrect/incomplete x 1

General Practice continue to report for follow up via the Healthcare Professional Reporting Route and via Clinical Forums any concerns about care interfaces or care provided by other providers. By far the greatest incidents reported from General Practices about other providers relate to lack of complete discharge information from our Acute Trusts. CCG Quality Leads working within the Covid Discharge and Flow Cell are continuing to follow up each individual discharge concern, to ensure corrective actions are taken.

GP Quality Risk Register

There are known and ongoing significant quality issues with a few of our General Practices which rate higher on the CCG Quality GP Risk Register and these are considered fully through the Private PCCC. The CCG locality and quality teams work to support any General Practices with required improvements.

Particularly of note is the work with Beacon Practice following an inadequate rating post CQC inspection in April 2020. The Practice is being supported by the CCG Locality & Quality Team with the Local Medical Committee to ensure the required improvement actions are progressed. A regular progress report on actions is being provided by the Practice to the CQC. For the CCG assurance on progress with the required actions is secured through the locality Primary Care Quality Assurance Meeting and ultimately via the Primary Care Commissioning Committee. An independent mock CQC inspection visit and a recent quality assurance visit undertaken by the CCG at the end of September provided assurance on sustained progress with required actions. There was a further inspection visit by the CQC on the 22nd October and publication of the outcome of that visit is imminent at the time of writing this report.

New patient registrations with the Practice are currently suspended. It is a large practice with a list size of 21500. If General Practice services were unable to be safely sustained at this Practice there would be significant implications regarding list dispersal and sequelae effects for other Practices and Primary Care provision in that area. Currently a neighbouring Practice, supported by the CCG re: locum workforce is supporting with registration and primary care of any new patients who would normally fall within Beacon’s registration boundary.

4. Management of Conflicts of Interest

Nil to note.

5. Finance, QIPP and Resource Implications

Additional expenditure as a result of the Covid 19 pandemic response by both commissioners and providers. Where incurred it is necessary to ensure accurate financial records are maintained, in order for financial compensation to occur through Covid 19 resilience funding, if this is appropriate.

6. Legal/NHS Constitution Considerations

Nil specific to note. Through the Covid 19 pandemic response the aim has been to maintain constitutional standards where appropriate to do so, however in several areas eg. referral to treatment times these were relaxed to ensure organisations could create the additional bed and critical care capacity to cope with the expected surge in patient numbers due to the adverse health effects of the virus. It is important to maintain safe services for Covid 19 effected patients but also ensure the staged return to services meeting the constitutional standards for all patients.

7. Analysis of Risk including Assessments

 Risk of NHS capacity being exceeded in various areas due to increased demand as a result of Covid 19 - additional capacity was successfully created to accommodate predicted surge in activity as a result of Covid 19.  Creation/re-purposing of capacity causing a negative effect on achievement of some of the constitutional standards – post predicted surge staged recovery to normal service provision underway, cognizant of second/third wave response requirements.  Focus on Covid 19 response diverting attention from other areas of quality concern – quality surveillance mechanisms have been revised but have continued.  Patients not presenting to services for health needs because fearful of consequences of Covid 19 infection or because do not want to put undue pressure on challenged health services. – national and local communication campaigns to encourage patient access/attendance.

Please state if the risk is on the CCG Risk Register. Yes ✓ No

8. Outline engagement – clinical, stakeholder and public/patient

By necessity of social isolation, during the Covid 19 response normal CCG public/patient face to face engagement activities have been suspended eg. patient council meetings, listening clinics etc. These will be resumed as soon as appropriate, but in the meantime triangulation of any concerns raised by the public/ patients is maintained through surveillance of complaints, patient feedback virtual sites/avenues and through Healthwatch reports and feedback.

9. Outcome of Impact Assessments

N/A

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process:

Finance ✓ Commissioning ✓ Contracting ✓ Medicines Optimisation ✓ Clinical Leads ✓ Quality ✓ Safeguarding ✓ Other ✓

11. Report previously presented at: N/A

12. For further information or for any enquiries relating to this report, please contact

Wendy Martin [email protected]

PUBLIC PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Date of Meeting: 10th February 2021 Agenda item: 7

Title of Report: Stackyard Surgery, South West Locality Consideration of Proposals – 1) Transfer to East Leicestershire and Rutland CCG 2) Application to close Woolsthorpe Branch Report Author and Shona Brewster, Head of Transformation and Delivery, South West Locality Title: Appendices: Appendix 1 – CCG Report Appendix 2 - Patient Letter Appendix 3 – FAQs Appendix 4– Survey Report Appendix 5 – Q&As from Live Events Appendix 6 – EIA

1. Purpose of the Report (including link to objectives)

To update the committee on the outcome of the consultation and findings in relation to the proposal to close the Stackyard branch surgery at Woolsthorpe.

To update the committee on the progress of the transfer to East Leicestershire and Rutland CCG (ELRCCG).

2. Recommendations

The Lincolnshire Primary Care Commissioning Committee is asked to approve the recommendation to permanently close the Woolsthorpe Branch of Stackyard Surgery if the following are carried out:

 Patient choice will be promoted for those that choose to change surgery  Medication delivery to Woolsthorpe to be piloted and evaluation provided to the CCG (due to commence 17 February 2021)

The Lincolnshire Primary Care Commissioning Committee is being asked to note the outcome of the engagement process in response to the transfer to ELRCCG. The final decision on this transfer will be made and communicated by ELR CCG.

The Lincolnshire Primary Care Commissioning Committee is being asked to permit the Board secretary to submit an application by 30th September 2021 to remove the surgery from its constitution that will take place on 31st March 2022.

3. Executive Summary

1. Transfer

The transfer process commenced in July 2019 with a report and a formal request from the Practice for approval to start the process and this was ratified. A further update report was presented to the predecessor CCG South West Lincolnshire CCG (SWLCCG) in January 2020 and then again an update report to this committee in July 2020. An extension had to be made to the timeline due to the covid pandemic. Work is ongoing with ELRCCG to enable the application to change the respective CCG memberships. Contracting and Finance leads are currently working through the implications of transferring the community provider contracts. No issues have been identified to date.

2. Closure of Woolsthorpe Branch

A formal letter of application to permanently close the branch was submitted to SWL CCG on the 29th April 2020 following agreement to temporarily close the branch late March 2020 due to the Covid-19 pandemic. This was due to staff shortages which made it extremely difficult to maintain the safe operation of both the main and the branch site.

4. Management of Conflicts of Interest

None identified

5. Finance, QIPP and Resource Implications

1. The approval previously given to formally transfer is on the basis that any identified issues relating to finance and contracts that emerge would be managed through both CCGs due process and overcome. To date nothing has been identified that would impact on the transfer completing.

2. There are no identified financial and resource implications to the CCG on the recommended closure of the Woolsthorpe Branch of Stackyard Surgery.

6. Legal/NHS Constitution Considerations

1. The transfer of Stackyard is subject to a successful application by ELRCCG to vary its list of members to NHSE by 30 September 2021 so that the change can be reflected in the allocations for the following financial year. The change will take effect from 1 April 2022 of the following year.

Both CCGs will need to demonstrate the amendment to the respective Constitutions has been discussed with their members prior to the deadline date. This had been agreed by the predecessor SWLCCG Members Council and remains supported by the locality.

2. There is a legal requirement to involve the public  In the planning of the commissioning arrangements by the group,  In the development and consideration of proposals by the group for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and  In decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact Patient and public participation guidance (2017)

Please refer to section 8 on the process that was completed.

7. Analysis of Risk including Assessments

There is a risk that Stackyard surgery would lose registered patients but equally they could also gain due to the positive impact of the transfer.

No other risks have been identified that can’t be mitigated Yes No X Please state if the risk is on the CCG Risk Register.

8. Outline engagement – clinical, stakeholder and public/patient

This was carried out through the following:

1. An 8 week consultation and engagement process which from the 1st Sept to the 27th October 2020 o Consultation letters were sent to all households of registered patient and all stakeholders o Details were published on the Website, Facebook and within the surgery o Registered patients were invited to complete a survey made available on line and by hard copy posted out. Patients could also email telephone or speak to staff in person – 138 responses in total were received o The Practice also held 2 online live events (Covid restrictions) one in the afternoon and one in the evening. Please refer to the report at appendix 4 for more detail.

9. Outcome of Impact Assessments

Please refer to the updated EIA at appendix 6 which covers both the transfer and the closure. This replaced the EIA completed in January 2020 which only covered the transfer.

An Equality Impact Assessment has been completed by ELRCCG and SWLCCG and no negative impacts were identified.

10. Assurance Departments/Organisations who will be affected have been consulted

The following departments have been consulted with:

Finance X Clinical Leads X Commissioning X Quality X Contracting X Safeguarding Medicines Optimisation Other X

11. Report previously presented at:

Reports have previously been presented as follow South West Lincolnshire CCG  Primary Care Commissioning Committee 17th July 2019 – transfer  Primary Care Commissioning Committee 22nd January 2020 – transfer

Lincolnshire CCG  Primary Care Commissioning Committee 8th July 2020 – transfer and proposed closure  Primary Care Commissioning Committee 13th January 2021 – verbal update

East Leicestershire and Rutland CCG  Primary Care Commissioning Committee n 9th July 2019 - transfer  Primary Care Commissioning Committee 7th January 2020 - transfer

12. For further information or for any enquiries relating to this report, please contact

Shona Brewster, Head of Transformation and Delivery, South West Locality [email protected] 07717 423342

Clair Raybould, Director of Operations, [email protected] 07917 070943

Appendix 1

STACKYARD SURGERY– WOOLSTHORPE BRANCH

1. INTRODUCTION

1.1. The purpose of this paper is to present a branch closure application submitted by Stackyard Surgery to the Lincolnshire Primary Care Commissioning Committee and to update on the progress of the transfer to East Leicestershire and Rutland CCG (ELRCCG)

1.2. The Lincolnshire Primary Care Commissioning Committee is asked to review, comment on the application and agree the recommendations.

2. CONTEXT

2.1. Stackyard Surgery is situated in Croxton Kerrial; Leicestershire just over the Lincolnshire border, Grantham is 8 miles to the North East and Melton Mowbray 9 miles to the South West. The branch surgery, Woolsthorpe, is 3.6 miles from the main site to the North being 7 miles from Grantham. The branch site is not owned by the contract holder.

2.2. The practice in 2019 commenced formal proceedings to apply to join ELRCCG which would by default remove it from Lincolnshire CCG. Practices are able to change CCG with only the incoming CCG having any decision making authority, the outgoing CCG remit is to agree the funding transfer and manage any contractual requirements as a result of a transfer. The predecessor: South West Lincolnshire CCG (SWLCCG) Primary Care Commissioning Committee was fully briefed on the intention to transfer and on the discussions between the two CCGs and gave approval for the CCG Finance and Commissioning teams to carry out all due diligence required. Update reports have been presented in January 2020 and July 2020.

2.3. A formal letter of application to permanently close the branch was submitted to SWL CCG on the 29th April 2020. The branch surgery had been temporarily closed with agreement from the CCG in March due to the Covid-19 pandemic. This was due to both staff shortages and infection prevention control measures which made it extremely difficult to maintain the safe operation of both the main and the branch site.

2.4 There are currently a total of 3800 patients registered with Stackyard Surgery, of these 1650 patients consider the branch surgery to be their practice. From this number of registered patients 1263 live outside of the village and 387 patients reside in the village. All patients have the option to register at another Practice that is within the boundary of their home address.

2.5. The reasons given for the application were:

 Long term changes in patient demographics and clinical practice resulting in ongoing provision of GMS from Woolsthorpe increasingly problematic.  Changes to the delivery of GMS services that were nationally implemented in the wake of the Covid-19 pandemic which would render Woolsthorpe non-viable for a variety of reasons. Some are listed below:

 Pandemic and staffing – social distancing risk of infection  Reception and waiting area very small - risk of infection  New ways of working  Car park unsafe not owned by the practice  Estate not owned by the practice, historically lease issue and problematic maintenance upkeep

2.6. Following the formal application, the CCG advised the practice that they would need to formally complete the required patient and public consultation and report back to the CCG. The CCG would consider the proposal and feedback together and then make a recommendation to the committee.

2.7. ELRCCG would require patient engagement for the application to join their CCG so it was agreed between the two commissioning organisations that for reasons of transparency and openness the consultation should cover both the transfer and the branch closure at the same time. Although these are two individual matters with differing decision makers they are inextricably linked.

3. BRANCH SURGERY CLOSURE APPLICATION

3.1. The application, the Lincolnshire Primary Care Commissioning Committee is being asked to consider is addressed in the report from the report from the consultation and engagement process see attached appendices 2-6.

Patient Engagement and Stakeholder Feedback

3.2. The proposed branch closure will change the way patients access services so it is essential the practice and CCG discharge the duty to consult and engage with the public on the proposed changes.

3.3. Due to the Covid-19 pandemic the way that normal engagement would take place has not been possible on this occasion. With limited numbers of patients attending the practice there has not been opportunity to engage with patients face to face as normally would be the case. Patients are not using the waiting areas where normal engagement opportunities would present e.g. physical questionnaires, posters, electronic message screens due to Infection Prevention & Control measures practices are taking.

3.4. The practice wrote to all households detailing the engagement and consultation process and how they could become involved and feedback on the survey either, online, email, phone or to request a paper copy. The Practice provided full details including an introductory video on their surgery website and the consultation period ran from 1st September 2020 to 27th October 2020.

3.5. The Practice held two online live events where the proposals were fully explained, by the Practice Partners, the CCG Chief Operating Officer and Head of Transformation for South West Locality. This process was then followed by an open Q&A session which the public participated in. Please refer to appendix 5.

3.6. The practice have concluded a final survey report which can be found at Appendix 4.

It addresses the key areas of concern the public have and how these could be mitigated where possible:

 Travel o new ways of accessing primary care services for example telephone triage, virtual online appointments as part of general access o approached Lincolnshire County Council to explore feasibility of using voluntary community care schemes, o active involvement from the Patient Participation Group on issues raised o Home visiting service remains unchanged and remains accessible for those with a clinical need o Survey showed that of the respondents 89% have access to a car, there is ample parking with disabled bays

 Medications o online ordering service already in place, 57% use this service the remainder can order by email, repeat slip by post or in person and by telephone. The surgery is looking to enhance the delivery service with designated collection points manned by a member of staff also allowing repeats to be handed in. The parish council have been invited to discuss this proposed enhancement with a senior dispenser. Advice in the interim has been sought from the Dispensing Doctors Association and to identify any issues with such a scheme. A trial is due to start on the 17th February 2021 and will be fully evaluated. o A secure post box outside the surgery has already been implemented so patients do not have to enter the building

 Appointments – a main concern was the loss of the open access surgery. Many surgeries have already taken the decision that this model is not the way forward as it is outdated and in the current situation is an infection risk. Online access is a more efficient way of managing on the day care needs without patients having to sit and potentially wait for hours to be seen. For those that do need to be seen urgently this is still available.

 Online - as a result of levels of concern raised on online access, there is support available from staff who are super users, to help with – initial set up and ongoing support and guidance. Access can still be made by telephone or email if this is preferred.

 Hospital Services – this was a misunderstanding as registered patients had thought they would not be able to access pathways at local hospitals. This was in the main a concern for the transfer to ELR and not the closure.

3.7. Key group objections were received from:

 Parish Council – The points below were made via formal letter o premises can be made Covid secure, o car park surface can be remedied, o will impact on the most vulnerable.

 Health Overview and Scrutiny Committee (HOSC) – points made at the meeting on and followed with a formal letter

o access and public transport, o facilities at Woolsthorpe and making them safe, o management of future patient consultations

3.8. The Patient Participation Group has been fully involved and supports both the transfer to ELR CCG and the application to close Woolsthorpe Branch. Two key members of that group live in the village

3.9. An EIA was completed for the transfer this only required level 1 assessment and it did not highlight any inequality impact. This was redone recently to include the closure and was completed to the full level 2 assessment. Please see appendix 6.

RECOMMENDATION

4.1. The Lincolnshire Primary Care Commissioning Committee has a duty as part of its delegated responsibilities to demonstrate the necessary consultation has taken place, clearly demonstrate the grounds for the decision and fully consider the impact on the practice’s registered population and that of surrounding practices.

4.2. The Lincolnshire Primary Care Commissioning Committee is asked to approve the recommendation to permanently close the Woolsthorpe Branch of Stackyard Surgery if the following are carried out:

 Patient choice will be promoted for those that choose to change surgery  Medication delivery to Woolsthorpe to be piloted and evaluation provided to the CCG (due to commence 17 February 2021)

4.3. The Lincolnshire Primary Care Commissioning Committee is being asked to note the engagement in reaction to the transfer to ELRCCG and will receive final decision from that CCG of their intention.

4.4. The Lincolnshire Primary Care Commissioning Committee is being asked to permit the Board secretary to submit an application by 30th September 2021 to remove the surgery from its constitution that will take place on 31st March 2021

Vale Medical Group Stackyard & Woolsthorpe Surgery Dr S Wooding - Partner Stackyard Surgery Dr P Rathbone - Partner 1 The Stackyard Dr B Dorling Croxton Kerrial Dr K Rice Grantham Dr C Griffiths Lincs Dr A Wyatt NG32 1QS Ms J Perez - ANP Tel: 01476 870900 Mrs R Ashworth - Group Practice Manager www.valemedicalgroup.co.uk

Dear Householder

You will probably be aware that Woolsthorpe Surgery building has been closed since March 2020. This is as a direct consequence of the Covid-19 pandemic, because it was no longer possible to provide safe care from the building, due to the lack of space to accommodate social distancing and, therefore, the potential risk of coronavirus infection.

As a result of Woolsthorpe Surgery’s closure in March, we have been providing all GP services from the Stackyard Surgery at Croxton Kerrial, and we would like your thoughts about our proposal to make this a permanent arrangement.

In addition, we are also proposing to make an administrative change, moving Stackyard and Woolsthorpe Surgery from NHS Lincolnshire Clinical Commissioning Group (LCCG), formerly South West Lincolnshire CCG, into NHS East Leicestershire and Rutland Clinical Commissioning Group (ELRCCG).

Details of our proposal/have been sent to NHS England, NHS Lincolnshire CCG, and NHS East Leicestershire and Rutland Clinical Commissioning Group, for their consideration and we would like to hear your thoughts on them too.

Below we have included a series of questions and answers to explain why we are hoping to make these changes and what they will mean for you:

Proposal to close Woolsthorpe Surgery

Why is it not possible to use Woolsthorpe Surgery?

The reception and waiting area at Woolsthorpe Surgery is very small, which means that it is not possible to ensure safe social distancing, and patients and staff attending the building would be subject to an unacceptable increased risk of infection. As the risk from Covid-19 is likely to be with us for many months - possibly years - this risk is not going to disappear soon. Covid-19 has heightened everyone’s awareness about the risk of infection and many of us are working to adopt new ways of keeping people safe.

The car park at Woolsthorpe Surgery has recently been declared unsafe by the local council. Whilst patients and staff have previously been able to use it, from a health and safety perspective we do not feel now we can ask you to use the car park.

Will Stackyard Surgery be too small to accommodate all your patients when you resume normal services?

During the Covid-19 pandemic we have successfully introduced safer and more efficient ways of delivering primary care including internet, telephone and video consultations, all of which have been operating since March 2020. As a result of these changes we have been able to deal with about 80-90% of all patient contacts remotely without patients having to attend for a face-to-face assessment. This means that patient requests can be managed quickly and with less inconvenience as most practice visits can be avoided. If the GP decides that a face-to-face assessment is required this will still be provided as appropriate. As only a small number of patients will need to attend the practice, we will be able to ensure the lowest possible risk of infection from diseases such as Covid-19, Influenza etc.

Stackyard Surgery is a purpose-built surgery which is much larger than Woolsthorpe Surgery. It has multiple consulting rooms and has the capacity to grow and adapt to our patient population needs. It has designated disabled parking, as well as same level access, and has a segregated waiting area.

When Stackyard Surgery and Woolsthorpe Surgery merged in 2017 you said you would not close Woolsthorpe. Why the change now?

The proposal to close Woolsthorpe Surgery permanently has been considered at length by the partnership. There had been no intention of closing the building, however, the Covid- 19 pandemic has resulted in unprecedented and unanticipated changes to the health service, particularly in how primary care services are provided. It is mainly as a result of this that we are considering the permanent closure of Woolsthorpe Surgery, also bearing in mind the issues we have highlighted concerning patient and staff safety.

Will many patients feel disadvantaged by the closure of Woolsthorpe Surgery?

As we are now providing the majority of our care remotely by phone or internet, most patients will not have to visit the surgery and so will not be disadvantaged. For those patients who have a genuine medical need, our home visiting service will remain unchanged.

What if I am unhappy with the proposal?

We understand that change can impact some patients differently than others. Please fill in the survey - available online www.valemedicalgroup.co.uk or by email at [email protected] or on request/via post from any of our GP practices - to tell us why you are unhappy with the proposal

We must also advise you that you have the right to re-register at another practice, which covers the area in which you live, should you wish to do so.

Proposal to move the administration to NHS East Leicestershire and Rutland Clinical Commissioning Group

How is it run now?

Stackyard Surgery is situated on the edge of the CCG boundary between Lincolnshire and Leicestershire, and historically was a single-handed practice. Several years ago, the practice became part of a wider group of practices called the Vale Medical Group, located in NHS East Leicestershire and Rutland Clinical Commissioning Group.

Stackyard Surgery has continued to work well across both Lincolnshire and East Leicestershire and Rutland Clinical Commissioning Groups. More recently when Primary Care Networks (PCNs) were being formed, it was agreed by all parties that Stackyard and Woolsthorpe Surgeries should form part of the PCN that sits outside Lincolnshire, which is called Melton Syston Vale.

How does the move of Stackyard and Woolsthorpe Surgery into East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) affect me?

The purpose of this is to make it much easier to administer the practices and to provide more effective patient care. The move will mean that administrative responsibility for the practices will transfer from Lincolnshire Clinical Commissioning Group to East Leicestershire and Rutland Clinical Commissioning Group. There will also be a change to the community services provider. This should have a beneficial effect for you, as it will mean that we will be able to access primary care services in Leicestershire that are currently not available to you - e.g. X-ray services.

We have continually considered the impacts of this proposal for our patients and have undertaken an equality impact assessment. Lincolnshire CCG and East Leicestershire and Rutland CCG have jointly agreed that there would be no known negative impacts for the patients of Stackyard and Woolsthorpe Surgeries, if the change was to go ahead.

How do I know you will not close Stackyard Surgery if we move into NHS East Leicestershire and Rutland Clinical Commissioning Group?

The two practice buildings at Long Clawson and Stackyard will both be necessary to provide sufficient space to continue to deliver primary care to all our patients. How do I get involved and share my views

If I want to comment on these proposals what can I do?

You can provide feedback by completing the online survey on our website www.valemedicalgroup.co.uk or email us to request a copy of the survey at [email protected] or you can contact our receptionists who can send you a copy.

We will be holding online Zoom sessions, which will be advertised in advance, and details about how to access this will be available via our website and in our surgeries. There will also be a video clip on our website providing more detail.

We hope that patients will see the benefit of these proposed changes; we feel that they will allow us to continue to provide the best level of care to our patient population.

Yours sincerely

Dr Simon Wooding Dr Philip Rathbone GP Partner GP Partner

Frequently Asked Questions

These questions have been prepared to help answer some of the questions you may have about the proposed permanent closure of Woolsthorpe Surgery, and the move to NHS East Leicestershire and Rutland Clinical Commissioning Group.

Questions relating to the permanent closure of Woolsthorpe Surgery:

Will there be more GP sessions or appointments at Stackyard Surgery to compensate for the closure of the branch surgery? Yes, Stackyard will have additional GP sessions – the total GP sessions will equal what is currently available at Stackyard and Woolsthorpe surgeries.

Will appointments be offered at the weekend? Our extended hours is currently offered on a Saturday at either our Stackyard Surgery or at Long Clawson Surgery and this will remain the same.

Will we still be able to get same-day appointments at Stackyard Surgery? Yes, same day appointments will be available at Stackyard Surgery.

How many patients are registered at each surgery? Woolsthorpe Surgery has 1648 registered patients and Stackyard Surgery has 2111 registered patients.

What would happen to the building at Woolsthorpe Surgery if the proposed closure goes ahead? We currently rent the Woolsthorpe building, so are unsure what plans the landlord may have for this building.

Is the closure of Woolsthorpe due to saving costs? No, the closure of Woolsthorpe Surgery site is due to the reception and waiting area being very small, which means that it is not possible to ensure safe social distancing, and patients and staff attending the building would be subject to an unacceptable increased risk of infection. As the risk from Covid-19 is likely to be with us for many months - possibly years - this risk is not going to disappear soon. Covid-19 has heightened everyone’s awareness about the risk of infection and many of us are working to adopt new ways of keeping people safe. Also, the car park at Woolsthorpe Surgery has recently been declared unsafe by the local council. Whilst patients and staff have previously been able to use it, from a health and safety perspective we do not feel now we can ask you to use the car park.

Will there be more car parking spaces at Stackyard Surgery should the branch surgery close? Stackyard Surgery has a generous sized car park and disability bays.

Will I still be able to order and collect my medicines as I do now? You will be able to order and collect your prescription as previously, either online, via email or by post. If you did this in person at Woolsthorpe surgery, you will be able to do this at Stackyard Surgery.

How long will the consultation last? The consultation period is 8 weeks and closes on Tuesday 27 October 2020.

How can people feedback their views? By completing our survey, which is available online or by contacting the surgery via email, telephone or by post.

Were patients and the public involved with the questionnaire design? The questionnaire was shared with the Practice Patient Participation Group for their consideration and comments before it was finalised.

Has the decision already been made on the future of the Woolsthorpe Surgery? No, the decision is not finalised. Along with our proposal, all feedback we receive from the survey will be taken into consideration and a decision will be made by Lincolnshire Clinical Commissioning Group.

Will I need to re-register with my GP if Woolsthorpe Surgery site closes? You will not need to do anything unless you wish to register with a new practice which covers your address.

Questions relating to the administrative move to NHS East Leicestershire and Rutland Clinical Commissioning Group:

Why do we need to move administratively to another Clinical Commissioning Group? Woolsthorpe Surgery and Stackyard Surgery became part of Vale Medical Group several years ago, which is located in NHS East Leicestershire and Rutland Clinical Commissioning Group. Since then, Stackyard Surgery has continued to work well across both Lincolnshire and East Leicestershire and Rutland Clinical Commissioning Groups. More recently when Primary Care Networks (PCNs) were being formed, it was agreed by all parties that Stackyard and Woolsthorpe Surgeries should form part of Melton Syston Vale PCN and this sits in East Leicestershire and Rutland Clinical Commissioning Group.

As a patient, how does this affect me? The purpose of this is to make it much easier to administer the practices and to provide more effective patient care. There will also be a change to providers for community services and this should have a beneficial effect for you, as it will mean that we will be able to access primary care services in Leicestershire that are currently not available to you - e.g. X-ray services.

If I have existing follow-up appointments within Lincolnshire or wish to be referred to Lincolnshire, am I able to still access this? With regards to out-patient appointments these should be completely unaffected as a pathway of care has already started. With regards to new referrals, patients have the right to choose the provider of any consultant-led care.

Will I still be able to use the walk-in Xray department at Grantham Hospital? Grantham Walk-in service is not operational. It is an appointment only system. Xrays, by appointment only, will be available at either Grantham or Melton Mowbray.

Proposal to Close Woolsthorpe Surgery and Move the Stackyard Surgery to NHS East Leicestershire and Rutland Clinical Commissioning Group Executive Summary

The public consultation was undertaken between 1st September 2020 and 27th October 2020.

Consultation letters were sent to all households of registered patients and all Stakeholders (local parish Councils, MPs, Pharmacies and GP Practices). It was also published on our website, Facebook page and within the surgery. Registered patients were invited to complete a survey which was available online (Survey Monkey or in paper format. Patients were also given the option to email, telephone or speak to us in person).

We received 104 online responses, 18 paper surveys and 16 emails/letters. The Practice also held 2 online live events, which were attended by 23 patients in total.

Background: The aim is to understand our patients’ feelings regarding making permanent the temporary closure of Woolsthorpe branch surgery and the move of Stackyard and Woolsthorpe Surgery to East Leicestershire and Rutland Clinical Commissioning Group (ELRCCG).

Respondent Profiles: 74% of respondents were patients registered at Woolsthorpe Surgery, the remaining patients were registered at Stackyard Surgery. 25% of respondents lived within one mile of Woolsthorpe Surgery. The highest percentage, 37.5%, lived between 2-5 miles away from the Surgery, indicating that they travel to the Surgery by means of transport.

Out of 116 patients who provided their postcode, 51.7% lived in NG32 1 area, 21.5% lived in NG13 0 area, 7.7% lived in LE14 4 area, 5.2% lived in NG13 8 area, 4.3% lived in NG31 7 area, NG13 9, NG32 2, NG33, NG31 6 each had 1.7% living in that area, with LE14 2 and NG34 1 each having 0.9% living in that postcode area. One respondent (0.9%) entered an incorrect postcode.

Background Woolsthorpe Surgery building was temporarily closed in March 2020. This was as a direct consequence of the COVID-19 pandemic because it was no longer viable to provide safe care from the building, due to lack of space to accommodate social distancing and, therefore, the potential risk of coronavirus infection.

As a result of Woolsthorpe Surgery’s closure in March, we have been providing all GP services from Stackyard Surgery at Croxton Kerrial.

Respondent Profiles This map shows the location of the 116 patients who, in their survey response, provided their postcode.

NG32 = 53.4% (62) NG13 = 23.2% (27) NG32 1 = 51.7% (60) NG13 0 = 21.5% (25) NG32 2 = 1.7% (2) NG13 9 = 1.7% (2)

NG34 = 0.9% (1) NG32 NG34 NG13 NG31 •• NG33 LE14 LE14 = 8.72% (10) LE14 2 = 0.9% (1) NG31 = 11.2% (13) LE14 4 = 7.8% (9) NG31 6 = 1.7% (2) NG31 7 = 4.3% (5) NG31 8 = 5.2% (6)

• Woolsthorpe Surgery • Stackyard Surgery NG33 = 1.7% (2) Having reviewed the patient and stakeholder feedback received during the public consultation period. The Practice noticed the following main trends in topics:  Travel  Medication

 Access to hospital services  Appointments  Online access  Premises

 Other We also received correspondence from Woolsthorpe Parish Council, their main concerns in relation to the closure being: • The present surgery can be made Covid-secure with a revision of layout • The car park surface can be remedied and is not a prerequisite for the provision of medical services • The closure will severely impact on the most vulnerable in the community who will be unable to attend or encounter severe difficulty in attending Stackyard Surgery and impact greenhouse emissions by necessitating unnecessary car journeys each month And, in relation to a move from Lincs CCG to ELRCCG being: • Cause longer journeys to attend hospital than is the case at present • Leicester Hospital is not readily accessible by public transport • Specialised services may be compromised • The current provision of prescription drugs is not guaranteed

The Health Scrutiny Committee also raised some concerns relating to:

 Access and public transport  Facilities at Woolsthorpe Surgery – making the car park safe and adapting the building  Management of future patient consultations Travel

The main concerns highlighted were patients who were unable to drive. There is, and always has been, very limited public transport in our rural practice area. There was a lot of concern regarding rural roads during the winter months and the increased distance to Stackyard surgery. Using AA route planner, the distance (using rural roads) is 3.6 miles. However, there is a main A road route which is 6.3 miles; this would help mitigate the use of rural roads.

The introduction of new working practices, including telephone and internet consultations, has resulted in a huge reduction in the number of face-to-face contacts at the Practice. We estimate the number of attendances has been cut by 80%. This has been delivered with no reduction in our responsiveness or service quality and is protecting the environment from patient journeys, as well as saving the patients having to travel to see a GP.

We have contacted Lincolnshire County Council (LCC) regarding voluntary community car schemes that may be available for our patients and there is an operational group within the area, based at Grantham. This information will be passed to the Parish Council, along with contact details for the forum lead at LCC, who can work the Parish Council should they wish to set up a transport scheme. We also plan to discuss this further at our next PPG meeting.

Our home visiting service will remain unchanged and be accessible to those patients with a clinical need.

Our survey showed that 89% of our patients had access to a car to travel to Stackyard Surgery. Some patients raised concerns about car parking at Stackyard. There are designated disabled parking bays, which are available for any patient with mobility issues or feeling very unwell, frail or elderly, right outside the surgery door, accessed by level flooring. Our Woolsthorpe branch, unfortunately, does not have these facilities.

The main car park at Stackyard currently accommodates 15 cars. Stackyard also has additional staff parking near the surgery. Again, with the reduction of patients attending the building, this would be ample parking. Woolsthorpe car park has been deemed unsafe and, therefore, Woolsthorpe does not benefit from car parking.

Woolsthorpe surgery has 387 patients who reside within the village itself, the remaining 3366 patients registered at Stackyard and Woolsthorpe surgery, have to travel to attend the surgery. Some of these patients may now have to travel slightly further to the surgery, whilst some will have to travel slightly less. Approximately how far do you live from your practice? Responses Less than 1 mile 24% 30 1 to 2 miles 13% 16 2 to 5 miles 37% 45 5 to 10 miles 23% 28 More than 10 miles 0% 0 No answer 1% 1 No response 2% 2

Which transport options are currently available How do you usually travel to your practice? to you for travelling to the surgery? Responses Responses Walk 21% 26 Walk 20% 25 Car 89% 108 Car 75% 92 Bus 7% 8 Bus 0% 0 Taxi 12% 15 Taxi 0% 0 Bicycle 11% 14 Bicycle 1% 1 Friend or relative 15% 18 Friend or relative 1% 1 Community transport 0% 0 Community transport 0% 0 Other 2% 3 Other 1% 1 No response 1% 1 No response 2% 2 Medication

The main concern highlighted was multiple journeys to order and collect medication. The surgery operates an online ordering service for medication. 57% of patients use online prescription ordering, the remaining 43% may order via email, drop off repeat slip, post repeat slip or telephone.

The surgery is looking to enhance its delivery service which may include designated medication collection points, manned by a member of staff, enabling patients also to hand in repeat medication requests. This would then reduce the need for patients to travel to collect medication or personally drop off repeat slips.

With the regard to a delivery service/collection point, we wrote to Woolsthorpe Parish Council on 12 October 2020 which included an invitation to discuss with a senior dispenser, options for improving medication supplies in Woolsthorpe but, to date, we have not received a response.

We have, however, proceeded to investigate this option and have sought advice from the Dispensing Doctors Association (DDA), about the issues behind any such scheme. We plan to implement a trial scheme in the new year.

The surgery has installed a secure post box on the outside of the building to enable patients to drop off their repeat slips without the need to enter the building

Appointments

One of the major concerns raised by patients, was the loss of the Open Access surgery. This was a system whereby patients did not need to book an appointment but could just arrive at the surgery between the times of 8:30am and 11:00am and wait to be seen by a GP. Unfortunately, this service is no longer safe or practical due to COVID and other respiratory infections. This is not a service that will be re-instated at any of our surgeries going forward.

The other concern seemed to be around Stackyard coping with increased patient numbers. All Woolsthorpe staff have been deployed to Stackyard and this would continue if the closure becomes permanent. Stackyard has room to provide the clinics which were being run at Woolsthorpe, alongside the clinics being provided by Stackyard. Stackyard also has the capacity to create an additional consulting room so, in the future, would be able to provide additional clinics, if needed.

There was some concern about additional waiting times to speak to a GP but, since the clinical capacity has been doubled at Stackyard, there would be no impact.

52% of our patients who completed the survey, stated a mix of male and female GPs was important, if Woolsthorpe was to close permanently, this could be offered. Before the temporary closure, there was only one GP at each site, since closure the surgery has provided two GPs at Stackyard.

82% of patients who answered the survey, felt it was important that appointments were offered at a convenient time. With the introduction of online consultation (along with telephone consultations), this provides greater flexibility for patients who are working, have caring duties or have small children.

Appointments (cont)

What is important to you when accessing GP services? (Tick all that apply)

Responses

Mix of male and female GPs 52% 62

Distance from home 70% 83

Range of services 66% 78

Access such as free parking 49% 58

Recommendations from NHS Choices or friend/relative 12% 14

Appointments offered at convenient time 82% 98

Other (please specify) 18% 22

No response 2% 3 Online

There were some concerns from patients regarding people who may not have access to online services – they may not own a computer or may not possess technological capabilities.

The surgery provides proxy access so, a patient may nominate someone else to have online access to order their medication and to make appointments for them, if required.

The Practice has some staff who are “super users” and these staff can provide support and guidance to patients regarding the initial online access set up.

Any patient who cannot access online facilities can telephone or email the Practice to order repeats or book appointments etc. Access to hospital services

In relation to the move to East Leicestershire and Rutland Clinical Commissioning Group (ELRCCG), the concerns related to continuation of care within secondary care or whether hospital services would still be available within Lincolnshire if a patient so wished.

With regard to outpatient appointments, these should be completely unaffected, as a pathway of care has already started. With regards to new referrals, patients have the right to choose the provider of any consultant-led care.

Grantham walk-in service is not operational. It is an appointment only system. X-rays, by appointment only, will be available at either Grantham or Melton.

71.3% of patients completing the survey understood the reasons behind the prospect of moving to ELRCCG.

26.8% of patients felt it would be beneficial to transfer but the highest percentage (44.6%) didn’t know, with 19.6% of patients thinking the move would not have any effect.

Approximately 60% of all patients registered at Stackyard and Woolsthorpe surgery reside within Leicestershire and services are provided by Leicestershire County Council. To what extent do you understand the How beneficial or not do you think the reasons why we are proposing to move our move to NHS East Leicestershire and administration from NHS Lincolnshire CCG Rutland CCG will be for patients and the to NHS East Leicestershire and Rutland staff of the Vale Group? CCG? Responses Responses Very beneficial 10% 12 Fully understand 37% 45 Quite beneficial 15% 18 Partially understand 30% 37 Not very beneficial 8% 10 Don’t really understand 14% 17 Not beneficial at all 16% 19 Don’t understand at all 11% 14 Don’t know 41% 50 Don’t know 2% 2 Comments 2% 3 No response 6% 7 No response 8% 10

To what extent do you think patients will be affected if Stackyard Surgery is moved to NHS East Leicestershire and Rutland CCG? Responses Very affected 17% 21 Quite affected 17% 20 Not that affected 11% 13 Not affected at all 7% 9 Don’t know 37% 45 Comments 3% 4 No response 8% 10 Other

This section was quite varied but the main theme surrounded respondents to the survey thinking that the surgery wished to close Woolsthorpe permanently because of financial reasons, and that the practice had renegade on its promise (in 2017) of keeping the surgery open.

Since 2017, technology has moved on - with the use of online and telephone triage, there is not the need to have 2 sites. In 2017, and indeed until the pandemic and the new ways of working, closing Woolsthorpe was not a consideration.

Not cost saving for the Practice, rent and rates are reimbursed, staffing remains the same and all IT equipment is provided by the CCG.

Patients were also concerned that Stackyard staff would not know them and refer to them as Woolsthorpe patients.

Woolsthorpe staff have been deployed to Stackyard surgery, therefore staffing has doubled (along with clinical provision).

The telephone welcome message has changed to “Stackyard and Woolsthorpe Surgery”.

Concerns were raised that the decision had already been made and some patients did not receive a consultation letter.

Following the Public Consultation, a final decision will be made by the PCCC at a public meeting.

Public consultation letters were sent to each household, not each individual patient. It was realised early that some households had been excluded but this was rectified immediately.

We have been made aware that a petition against the closure of Woolsthorpe Surgery has been sent to the Lincs CCG and we understand that 163 signatures have been obtained. It is not clear if these signatories are all our patients or what particular concerns they have, so we are unable to address them Premises

It was suggested by some patients that the Practice should expand Woolsthorpe Surgery to enable it to remain open. Unfortunately, Woolsthorpe Surgery is not owned by the Practice and, to this date, we have not been able to secure a lease with the landlord. This means that the Practice is unable to make alterations or improvements to the building.

To make the building Covid-secure, major structural alterations to increase the size of the waiting/reception area would be necessary but this would result in a decrease in clinical space. In reality, the only practical solution would be to have a new surgery built to a modern specification. For the reasons stated above, such an expensive option would not be feasible, given that we have existing modern premises that can provide all necessary primary care services with our new working practices.

The Practice does not own or have any lease arrangements pertaining to the car park adjacent to Woolsthorpe Surgery. For this reason, we have no direct responsibility for the car park but we do have a responsibility for the safety of our patients who may use it.

Stackyard Surgery is owned by the Practice and undergoes regular maintenance and improvements.

Several patients also commented that they understood the reasons why the Practice felt Woolsthorpe building was unsafe and impractical in light of COVID and the new ways of working.

Equalities Monitoring Under the provisions of the Equality Act 2010, all NHS organisations are required to demonstrate that their processes are fair, and they are not discriminating or disadvantaging anyone because of their age, disability, gender reassignment status, marriage or civil partnership status, pregnancy or maternity, race, religion or belief, sex or sexual orientation.

Gender Responses Ethnicity Responses Age Responses Indian 0% 0 16-24 0% 0 Male 31% 38 Pakistani 0% 0

Chinese 0% 0 25-29 1% 1 Female 52% 64 Bangladeshi 0% 0 Any other Asian background 0% 0 30-34 2% 3 Intersex 0% 0 Caribbean 0% 0 African 0% 0 35-39 4% 5 Non-binary 0% 0 Any other Black background 1% 1 40-44 2% 3 White and Black Caribbean 0% 0 Prefer not to say 1% 2 45-49 7% 8 White and Black African 0% 0 Prefer to self- 0% 0 White and Asian 0% 0 50-54 6% 7 identity Any other Mixed background 1% 1 No response 16% 20 White - 55-59 7% 9 Welsh/English/Scottish/Nort 81% 99 hern Irish/British 60-64 14% 17 Irish 0% 0 65+ 43% 52 Gypsy or Irish Traveller 0% 0

Any other White background 2% 3 Prefer not to say 0% 0 Arab 0% 0 Any other Ethnic Group 1% 1 No response 14% 17 Prefer not to say 2% 2 No response 12% 15 Religion or beliefs Responses No religion 23% 28 Atheist 1% 1 Have you gone through any part or Buddhist 0% 0 process or do you intend to bring Christian (including Church of England, your physical sex appearance, Catholic, Protestant and all other Christian 54% 66 and/or your gender role, more in denominations line with your gender identity? Hindu 0% 0 Responses Jain 0% 0 Yes 0% 0 Jewish 0% 0 No 79% 97 Muslim 0% 0 Prefer not to say 1% 1 Sikh 0% 0 No response 20% 24 Any other Religion 1% 1 Prefer not to say 7% 8 No response 14% 18

Are your day-to-day activities limited because of a health If yes, do you have a: problem or disability which has lasted, or is expected to Responses last, at least 12 months? Physical impairment 16% 19 Responses Sensory impairment 1% 1 Yes, limited a little 21% 25 Mental health condition 2% 3 Yes, limited a lot 7% 9 Learning Disability/Difficulty 0% 0 No 54% 66 Long-standing illness 8% 10 Prefer not to say 4% 5 No response 14% 17 Other 8% 10 No response 65% 79 Sexual Orientation Responses Are you pregnant or have given birth in Bisexual 0% 0 the last 26 weeks? Gay 1% 1 Responses Heterosexual 71% 87 Yes 1% 1 Lesbian 1% 1 No 80% 98 Prefer not to say 6% 7 Prefer not to say 1% 1 No response 18% 22 Prefer to self-identify 1% 1 No response 20% 25

Do you look after, or give any help or support to family members, friends, neighbours or others because of either long-term physical or mental ill-health/disability, or problems related to old age? Responses Yes 13% 16 No 63% 77 Prefer not to say 3% 3 No response 21% 26 Appendices

• Copy of letter sent all households • Original FAQs • FAQs following on from the two Consultation online meetings

Online Consultation Questions from 5th October 2020

Is there any point in putting our concerns over to you? There are so many This is a public consultation and we are asking for the views of our reasons it should not be closed and using COVID as an excuse is not a viable patients and stakeholders about our proposals. Our application will be excuse. presented, together with a report highlighting the views received, to the Lincolnshire Clinical Commissioning Group at their Primary Care Commissioning Committee meeting for a final decision on both proposals. This meeting will be open to the public. In the event of an emergency in Woolsthorpe, which A and E would we call? Patients would continue to dial 999 in event of an emergency. There is no longer A&E available at Grantham but there is an Urgent Treatment Centre (UTC). Can Stackyard cope with the increase in patient numbers? Yes, Stackyard Surgery has a consulting room which was largely under- utilised. 80-90% of contacts are now virtual and we have doubled the appointments of available clinicians at Stackyard Surgery to accommodate the 1600 Woolsthorpe patients, in addition to 2124 Stackyard patients. Having visited several times the car park has been dangerous for a long time. Yes. We received a letter from South Kesteven District Council in February As I have been led to believe the car park is not the responsibility of the 2020 informing us that the car park was unsafe and we responded that we Surgery. Is that correct? neither own or lease the car park adjacent to Woolsthorpe Surgery.

Stackyard surgery is a far superior building and I believe it was purpose built. Stackyard Surgery was purpose-built in 2004 and is owned by the Partners of Vale Medical Group, whereas Woolsthorpe Surgery is leased by the Partners. Will the meeting be available on line later to review? Meetings are available to view via our website alongside FAQs from both events. Do you not think that supplying and calculating all your data on the lockdown Since COVID, we have had to quickly adapt to new ways of working and period is very unfair and unrealistic? move towards the total triage model, as instructed by the Department of Health (Matt Hancock). This model is now the future way in which primary care will be delivered in the UK. Whilst COVID-19 expedited the move to total triage, this was pre-mandated prior to COVID-19. Please don’t forget that Woolsthorpe surgery is also a 'purpose' built surgery. Woolsthorpe Surgery is not owned by the Practice, so we are unable to The reception area and pharmacy area are much bigger and in separate areas. make changes to the fabric of the building. Stackyard Surgery is owned by the Practice and benefits from a separate Reception area to the Dispensary and also has a segregated Waiting Room. Stackyard Surgery has designated Disabled Parking outside the front door and has a level access. The Surgery has multiple consulting rooms to allow for a GPs and other clinicians.

Online Consultation Questions from 7th October 2020

I have reviewed the meeting content from Monday. The practice has only Thank you for this comment. communicated a proposed plan for closure as a solution rather than suggesting the possibility of alternative approaches to the problem. It is important to understand that our proposal to close Woolsthorpe surgery is as a result of a major change in appointment management The sole reason for closure of the surgery is given as ‘lack of space to with the introduction of telephone, internet and video consultations. This provide safe care during the current pandemic. You have not indicated means that the number of people who need to attend the surgery whether any consideration was given to ideas/plans to overcome this building is very low. single area of concern. Do you accept, on the face of it, with a little planning and forethought, it would be possible to overcome the problem in We estimate the reduction has been around 80%. All the necessary respect of space at Woolsthorpe but which may not be as easy to face-to-face activity can be met at Croxton with consolidation of our introduce at Croxton? clinical and administrative services on this site. It is therefore difficult to justify the ongoing use of the Woolsthorpe surgery – we have already Brainstorming: utilised capacity but, as far as structural work, we iterate that the building does not belong to us.  Separate entry/exit is available at Woolsthorpe. Is this available at Croxton? Handing out medication by delivery to patients at the rear or We note the comments about the Stackyard building but, as the number front of the building without compromise. Or through the window in the of individuals who need to attend in person will be limited as a result of dispensing area. the aforementioned changes in appointment activity, we believe that  Single consulting room/nurses room. Staggering appointment times to there will be few problems. This has certainly been our experience of minimise use of the waiting room. running the new arrangements over the past 6 months.  Utilising spare capacity by relocating storage, etc.  Increasing the size or capacity of the waiting area by any available means. Have any of these aspects received consideration?

The current layout of Stackyard includes:

 Issues with access. (one entry exit point?)  Issues re proximity of reception and meds dispensing (the suggestion of providing this through the waiting area on Monday would put further pressure on the waiting room and reduce capacity for patients waiting for appointments with GP or nurse) Passing from waiting room to consulting room and egress involves a crossover between patients socially distancing for medication and the reception area.  Access from car park to surgery includes 9 (narrow) steps where socially distancing is all but impossible.

The statistics provided on the slide presentation give rise to some concern.

Slide 1: Of 387 patients who live in Woolsthorpe, the age demographic You are correct that there was an error in the numbers on the slides totals only 222 indicating that 165 patients are unaccounted for. shown on Monday. This should have been corrected for today's Slide 2: 485 telephone calls from 186 patients but no indication of which presentation. The telephone consultation slide was broken into age demographic was responsible for what percentage of calls. Age UK have groups, so hopefully your query has been addressed. As the numbers of suggested that older people who have had the facility to see their doctor, face-to-face appointments arising from the telephone appointments is so face to face for all their life, will struggle to adapt to telephone triage for low, it is difficult to justify the ongoing use of the building in Woolsthorpe. example, because they have hearing problems. (slides attached)

Consequently they may not want or have the capacity to consult their GP when an issue arises.

This appears to be borne out between the split of age demographic on slide 1 (assuming the split element is correct ie even split between under 60 and over 60) and the reduced incidence of over 60 on slide 2 in respect of the number of consultation calls).

Slide 3: Appears to confirm the point raised re Slide 2 with a higher percentage pre 60 (62%) than post 60 (38%) resulting in appointments.

The figures, admittedly, only covering Woolsthorpe based patients (but that is all I have to base any observation on) equate to .4 per week day patient appointments and .79 per week day nurse appointments. This would not appear to indicate any problem regarding space.

As far as travel to The Stackyard is concerned, (CO2 emissions) no Dr Wooding answered this in his presentation (available to view online). mention has been made of the number of trips necessitated by able Overall we believe we are saving about 45 car journeys per day in the bodied patients who travel 6 to 12 miles round trip (depending on the route new system. taken but still incorporating travel along country roads) to collect medication on a regular basis.

How many patients ‘from Woolsthorpe alone’ have monthly repeat We currently provide a medication delivery service for our patients and collections? Are you content/prepared to increase pressure on the have approached Woolsthorpe Parish Council to work with us in delivery service to bring medication to patients in adverse weather expanding this service within the village, as well as working with the local conditions which may occur during the winter months? Although the community, if there is additional requirement. shortest route between the two surgeries is little more than 3 miles this entails travel along winding, hilly and in places very narrow and exposed country roads. Perhaps not an issue during the summer months but much The practice will always continue to provide face-to-face appointments more so during a potentially dark winter morning or afternoon, with when they are clinically necessary. For those patients who have a possible adverse weather conditions. genuine medical need, our home visiting service will remain unchanged. However, our experience has shown that 80-90% of GP contacts can be What you are saying about carbon footprint is misleading. The fact that managed effectively and safely by remote consultation, allowing patients fewer people see a GP face to face will reduce carbon, yes. But the fact to remain in the comfort of their own home. We have received positive remains that if prescriptions were available from Woolsthorpe there would feedback about this new way of working. be fewer journeys to collect, as most can be collected on foot. It is very misleading to try to disguise this by talking about the change in appointments. Prescription collection and appointments are quite different.

In 2017, when the proposal to form the Group was first instigated, one of We have been looking into voluntary car schemes and have contacted the points raised was regarding travel for those without access to their Grantham Area Community Transport (leaving an answerphone message own transport. It was acknowledged as an issue at the time. It does not and emailing via their website). We will also be discussing appear to have become any the less so in the intervening period. I transport/travel with our PPG. cannot find any public transport option which provides direct travel between Woolsthorpe and Croxton on any sort of convenient level. Indirect travel via Grantham can take up to 90 minutes one way. Taxi /car sharing especially during the pandemic may not be an option, especially to high risk patients, (shielding is merely 'paused' at this stage) The only other option I have been able to find is a community bus service which requires booking, but this doesn’t appear to provide travel between Woolsthorpe and Croxton. How are you proposing to overcome this?

Woolsthorpe has had a surgery for over 100 years - the current building The surgery building in Woolsthorpe is not owned by the practice so this has ample room for expansion if necessary - even before Stackyard not an option for us. In addition, due to the number of face-to-face Surgery was built, could this not have been considered? appointments have been significantly reduced by our new ways of working, expansion of the surgery would not be a feasible option.

My partner and I have registered for on-line GP consultations, but are not You need to follow the links to Engage Consult which is available on our sure how it works after that. Do we have to download anything to our Practice website. Please click here for How to sign up to use Engage and computer, such as Skype for example? Perhaps you could clarify. click here to find out How to send an online message to the GP. If we do a video consultation with you, we will send you a link via text message to enable the consultation to take place – nothing needs to be downloaded.

At the end of July, the National Health Executive indicated that demand Matt Hancock (Secretary of State for Health) stated in a speech at the for face-to- face consultations is on the rise, with an increase of 10 end of July that ‘better tech means better healthcare’, and that he wanted times as many requests in comparison to demand for telephone to ‘double down on the huge advances we’ve made in technology within consultations. Prof Martin Marshall, Chair of the Royal College of GPs NHS and social care’. said 'Once more normal service resumes in General Practice, patients who want face to face appointments will be able to have them.’ How Speaking on the future of the NHS, he said that remote consultations does this equate with your proposal to close Woolsthorpe surgery and have proved popular with doctors and that they free up clinician time. He which diminishes the opportunity and availability of face to face also said: ‘The feedback from this transformation has been hugely appointments to patients of the surgery? positive especially from doctors in rural areas who say how it could save long travel times both for doctors and patients. So from now on, all You should be in no doubt that telephone consultations are not an consultations should be teleconsultations unless there’s a compelling effective substitute for face to face appointments. It is a great shame clinical reason not to.’ (Pulse July 2020) that you are accepting that the telephone is to be considered the norm for the future. The Practice will continue to provide face-to-face appointments to any patient when clinically appropriate, as has been the case throughout the pandemic so far. Going forward, we will continue to offer appointments via video, email, telephone and face-to- face consultations which will accommodate the needs of our patients over the differing demographic groups. Why did you not use zoom? The NHS use Teams as it is more secure and more sophisticated to be able to provide these types of quite complex live online events. The ability to logon from the practice website should have been straightforward What about referrals where will we be sent? With regards to out-patient appointments these should be completely unaffected if a pathway of care has already started. With regards to new referrals, patients have the right to choose the provider of any consultant- led care. We all want to keep our services as local as possible, I’ve used Stackyard To clarify, that is approximately 4 patients per day from Woolsthorpe. We and its better in my opinion than Woolsthorpe, we can’t keep everything in will be looking to expand the delivery service or working with the local every village, much as it would make it easier, can you think about offering community to look at other options and have already informally a medication delivery service? approached Woolsthorpe Parish Council for their input. This was also discussed in Dr Wooding’s presentation. (available on our website) Some patients can have their prescriptions delivered, what happens if you cannot drive and don't have anybody that can collect, especially if like myself and those who have to pay for their prescription, what happens then?

You said only 4 patients drive regularly from Woolsthorpe to collect prescriptions – at 16:42 on 2 October there were 4 people in a queue waiting to pick up prescriptions. The indication that the car-park has been declared unsafe by the local We initially approached the Belvoir Estate regarding the car park and we council would not appear to be an issue for ambulatory patients of believe they have contacted the landlord of Woolsthorpe Surgery. Woolsthorpe visiting Woolsthorpe surgery. If this is an issue has any consideration been given to seeking a remote facility as at Croxton?

I am not aware that there has been any observable degradation in the state of the car park over the years and which also services the Village Hall and the rear of a number of houses on the Main Street.

There does not appear to be any prohibition notices posted or warning signs indicating the car park is unserviceable. During the period of surgery closure, notwithstanding the Grace and Favour status of the car park

Has any contact been made with the car park owner to remedy the situation or any approach to the local or village Parish Councils to consider options available to make the car park any less unsafe? I am firmly against closure. We appreciate your concern and it is noted.

Equality Impact Assessment (EIA) Stackyard and Woolsthorpe Surgery

Contents

Title Page

EIA Stage 1 Assessment:  Introduction  Template EIA Stage 2 Assessment  Introduction  Template

Appendices:-  Appendix 1 – Highlights of the Equality Act 2010

Stage 1: Equality Impact Assessment – Initial Screening

Introduction

This screening document is the first stage in a two-stage process to take a systematic approach to assessing the equality impact of an activity/project. An activity/project may mean a:-

 policy review or policy development  business case  business plan  project initiation  decision to implement a service  decision to decommission a service.

This template has been developed to enable a Stage 1 initial screening to be carried out to support the process of reviewing an activity or project or when proposing new activities or projects.

It is recommended that EIA’s be undertaken as an integral part of any review or development process, so that any potential adverse impact on different protected characteristics can be identified from the outset, and measures can be proposed as part of the ongoing work of the activity or project. The first stage process is not onerous, and should only take a small amount of time and completed alongside the activity or project.

If Stage 1 assessment does not highlight any adverse impact, you do not need to go to the Stage 2. Just separate the completed stage 1 assessment and include this information with the documentation relating to your activity/project.

If the Stage 1 screening of your activity/project highlights an adverse impact on particular protected characteristics and/or populations more than others, then you will need to complete the more indepth Stage 2 process from page 8 onwards.

Stage 1: Equality Impact Assessment – Initial Screening

Name of the Activity/Project: Closure of Branch site – Woolsthorpe Surgery – and move of Stackyard and Woolsthorpe Surgery from LincsCCG to ELRCCG Name of Lead: Rachael Ashworth/Dr Simon Wooding

Is it a new or review of an New existing activity/project?

Date Screening October 2020 Commenced:

1. Baseline Information

Please give a brief description and overview of the activity/project, including the following details as per the box below: a) Overview and description – Stackyard & Woolsthorpe Surgery currently consists of the main site, Stackyard Surgery at Croxton Kerrial and a branch site, Woolsthorpe surgery at Woolsthorpe by Belvoir. The two sites are located 3.6 miles apart in a rural location. The practice is looking at a proposal to make permanent the temporary close of its branch site. It is also proposing to move Stackyard and Woolsthorpe Surgery from Lincolnshire CCG to East Leicestershire and Rutland CCG. b) Aims and objectives – closure of the branch site and move Stackyard and Woolsthorpe Surgery to ELRCCG; to identify any potential disadvantages to patients and stakeholders and mitigate where possible. c) Anticipated outcomes / benefits - There are a number of benefits to be gained in making permanent the temporary closure of Woolsthorpe surgery branch site and move to ELRCCG. These include:

 Consolidation of services and equipment  Better access to the facility for disabled visitors/modern purpose built facility  Ability for choice of clinician – gender/specialities  Ability to access Nursing procedures daily  Ability to provide improved access to range of clinical staff and explore more innovative ways of working such as online consultations  Ability to maximise clinical capacity and practice premises for the benefit of patients  Savings to the NHS purse  No lone working for staff and clinicians – reduction in feelings of isolation by staff  Consolidation/streamlining of administrative procedures d) Timescale for implementation – Public consultation closes 27th October 2020, PCCC committee December/January. 4

2. Impact of activity/project on different protected characteristics

Protected groups are defined by the nine characteristics protected by the Equality Act 2010. Please identify (by ticking) the anticipated impact this activity/project will have on the following protected characteristics/population groups.

Note: this question considers the likely impact on people with a protected characteristic vs people who do not share that particular characteristic (e.g. older people vs working-age adults; LGBT people vs heterosexual people etc.)

Group Positive No Impact Adverse Impact (or neutral impact impact) Age (e.g. Children, young adults and older   people) There is likely to be no direct impact relating to age. Impact may arise from lack of transport for various age groups – the practice is looking at options to mitigate this (volunteer car scheme/deliver of medication etc. The frail population are unlikely to be impacted as the home visiting service will remain unchanged. As 80-90% of consultations are now provided remotely, the impact could be positive as no need to travel to the surgery and wait to be seen. More Nurse appointments will become available ie daily – this has not been previously available to Woolsthorpe Surgery. Disability (e.g. physical, sensory, mental impairment and learning disability) 

Stackyard site has facilities for disabled patients i.e. parking outside the door, toilets/alarm pull cords and downstairs consulting rooms, access to the surgery is via no steps or ramps. Woolsthorpe surgery does not have the benefit of disabled access or facilities. If a patient attending Woolsthorpe wishes to access the building, they need to ring the doorbell so that a member of staff can manually place a metal ramp over the doorstep to enable wheelchair access – therefore the access at Stackyard would provide better access and independence for Disabled patients. The launch of E-consult and AccuRx enables patients to write down their questions or answers during a consultation. According to Shout, 51% of patients with autism are more comfortable texting than talking about private things, this would be a positive impact for those patients with Autism. More Nurse appointments will become available ie daily – this has not been previously available to Woolsthorpe Surgery. Gender re-assignment (e.g. Transgendered  people) Services will remain the same, however because the clinicians will be only running clinics from the Stackyard premises the surgery will be able to offer more of a choice of clinician (male/female) so this may be a positive impact. More Nurse appointments will become available ie daily – this has not been previously available to Woolsthorpe Surgery. Marriage and civil partnership (note – marriage and civil partnership is only a protected  characteristic in terms of work related activities and NOT service provision) Given that there will be no change to how the service operates the impact on patients will be neutral.

Pregnancy and maternity  Services will remain the same, however because the clinicians will be only running clinics from the Stackyard premises the surgery will be able to offer more of a choice of clinician (male/female) so this may be a positive impact. More Nurse appointments will become available ie daily – this has not been previously available to Woolsthorpe Surgery. Race including nationality and ethnicity (e.g. including New Arrivals and Gypsies and  Travellers) Services will remain the same, however because the clinicians will be only running clinics from the Stackyard premises, the surgery will be able to offer more of a choice of clinician (male/female) so this may be a positive impact. During the consultation process all communications have been offered in different languages and there was a live translation service available on the online live events. The consultation decision will also be made available in different languages. More Nurse appointments will become available ie daily – this has not been previously available to Woolsthorpe Surgery. Religion/belief   Services will remain the same, however because the clinicians will be only running clinics from the Stackyard premises the surgery will be able to offer more of a choice of clinician (male/female) so this may be a positive impact. More Nurse appointments will become available ie daily – this has not been previously available to Woolsthorpe Surgery. Sex (male/female)   Services will remain the same, however because the clinicians will be only running clinics from the Stackyard premises the surgery will be able to offer more of a choice of clinician (male/female) so this may be a positive impact. More Nurse appointments will become available ie daily – this has not been previously available to Woolsthorpe Surgery. Sexual orientation (e.g. Lesbian, gay or  bisexual people etc.) Services will remain the same, however because the clinicians will be only running clinics from the Stackyard premises the surgery will be able to offer more of a choice of clinician (male/female) so this may be a positive impact. More Nurse appointments will become available ie daily – this has not been previously available to Woolsthorpe Surgery. Other (e.g. Homeless people, Carers etc., please specify) Carers – A bigger practice team will  provide a greater support network for carers. Flexibility to offer longer appointment times and more choice for patients who need to attend with a carer. Digital and remote consultations could also be a positive impact for carers and they will be able to access healthcare without having to leave their caring duties.

Deprived Communities - Flexibility of appointments and the range of services will increase. It has been identified that no direct public transport is available between Stackyard and Woolsthorpe, however, we are looking   at volunteer schemes that may be available. There are only 387 registered patients residing in Woolsthorpe that could potentially be impacted by lack of transport – all other patients to the site had to travel by private transport. Digital and remote consultations could also be a positive impact for patients without transport, as they will be able to access healthcare without having to leave their homes. Notes:-  if people with or without a particular characteristic will benefit equally, then that is a neutral impact  If people with or without a particular characteristic will neither benefit nor experience a detriment, then that is no impact  If you claim a positive impact, it is important to explain how the identified group is likely to benefit over and above those who do not share their characteristic e.g., how will LGB people benefit over and above heterosexual people? (An adverse or negative impact is the opposite of this). If you indicate that there is a positive benefit or a negative impact, explain your reasoning.

Note: A move to ELRCCG is likely to be of neutral benefit impact on any of the protected characteristics, as patients will still have the same patient choice as previously.

3. Which part/s of the public sector duty is the activity/project relevant to? Please tick as necessary and provide brief explanation as to how (see appendix 1 for details of the law).

Eliminate unlawful discrimination, harassment and  - Operationally, patients victimisation and other conduct prohibited by the Equality will receive the same level Act 2010. of service that they (E.g. How does the policy/practice address risks for particular currently receive with the protected characteristics?) offer of accessing more services than are currently available. Therefore no impact on any protected group. Advance equality of opportunity between people who  - Increased choice of share a protected characteristic and those who do not male and female clinicians. (E.g. How is this facilitated for particular protected characteristics?)

Foster good relations between people who share a  - Via robust protected characteristic and those who do not engagement and (E.g. How is this facilitated for particular protected communication. characteristics?)

4. Summary report and actions Having completed all sections above, in light of the proposed activity/project, please summarise your findings and consider any actions that would support the reduction of any adverse impact that may have been identified in point 2.

Evidence Summary Report and Actions Patients currently accessing services at Woolsthorpe branch site may be negatively impacted if they do not have access to private transport. The practice is actively looking to work with the local Parish Council to expand the delivery service for collection of medication and also discussing with the local council regarding any volunteer car schemes available to our patient population.

With new ways of working since COVID19, the impact to any patients without private transport is likely to be reduced, as 80-90% of patient contact is conducted remotely. When the practice reviewed the consulting behaviour over the last 6 months, since the branch site had been temporarily closed, only 3-4 patients per week had necessitated face to face consultation with the practice.

A move to ELRCCG is likely to be of neutral benefit impact on any of the protected characteristics, as patients will still have the same patient choice as previously.

5. Evaluation of Stage 1 – Initial Screening From the information provided in this Stage 1 screening, please indicate, by ticking, whether a Stage 2 assessment will or will not be necessary and provide the rationale for your answer. You may want to consult with your Equality, Diversity and human rights lead and/or your Manager to assess whether the information you have supplied in Stage 1 initial screening process is sufficient and your evaluation of whether you should go to stage 2 is adequate for the activity or project.

Yes No Please proceed to Stage 2 Assessment: Please indicate rationale Yes

Sign-off Signed Date Activity/project Lead –checked

Senior Manager/Leader – checked 29.01.2021

Approved by (name of committee)

Please note:-  STOP HERE if the Stage 1 assessment does not highlight any adverse impact. You do not need to go to the Stage 2. Just separate the completed Stage 1 assessment and include this information with the documentation of your activity/project.  Once approved it is recommended that this information is stored with all documentation relating to the activity/project as evidence of the Stage 1 EIA screening having been undertaken.  To show transparency, it is recommended that the Stage 1 information is published via appropriate methods, e.g. as attachment to documents relating to the activity/project, references in relevant reports/notes of meetings, information on organisation website etc.  Any review of the activity/project should, alongside it, instigate a review of the EIA information  On completion a copy of this form should also be forwarded to your Equality, Diversity and Human Rights Lead for reference.

If a Stage 2 Assessment is required: If the Stage 1 screening of your activity/project highlights an adverse impact on particular protected characteristics and/or populations more than others, and you have concluded that a ‘Full Assessment’ needs to be carried out, then you will need to go through the questions stated in Stage 2 – pages 8 to 11. Stage 2: Full Equality Impact Assessment

Introduction

A Stage 2 – Full Equality Impact Assessment (EIA) is based on results of the Stage 1 screening of the activity/project.

If the Stage 1 screening of your activity/project highlights an adverse impact on particular protected characteristics and/or populations more than others and you have concluded that a ‘Full Assessment’ needs to be carried out, then you will need to go through the questions stated in this Stage 2 assessment and collect relevant evidence to support your answers.

The Full EIA helps you to:  Further investigate the issues that may adversely impact on certain protected characteristics/populations more than others by collecting and analysing additional information/data e.g. on local demographics, services etc., relating to the activity/project.  Consult with those protected groups that may be more affected by the activity/project, to ascertain their views on the impact of the activity/project and how adverse impact can be addressed.

 Propose solutions to overcoming adversity amongst certain groups/protected characteristics.  Develop action plans relating to the activity/project to support implementation of different activities to address adverse impact identified.

Stage 2: Full Equality Impact Assessment

1. What is the equality profile of the population i.e. service users/patients and/or workforce that is intended to benefit from the activity/project? (By collecting and analysing demographic data of protected characteristics relating to patients/service users and/or workforce, within the geographical area concerned, the CCG will be able to identify the groups that may be adversely affected at a greater proportion to others). Patient demographics of patients currently registered at the Woolsthorpe branch: Age Males Females 00-09 78 61 10-19 109 87 20-29 62 70 30-39 69 74 40-49 103 125 50-59 139 142 60-69 110 109 70-79 90 106 80-89 31 40 90-99 6 6 100+ 0 0

The majority of patients currently registered at Woolsthorpe Branch have English as a first language, however the following languages are also in use:

Language No of Patients Polish 14 Russian 1 Lithuanian 1 Ukrainian 2 BSL 1

2. From the profile analysis, summarise the likely populations/groups identified that may face adversity as a result of the proposed activity/project. Patients who are unable to access private transport across any of the age groups.

3. What consultation/engagement activities have taken place or will need to take place with these populations/groups to address adverse impact? Audit of patients using telephone triage to ensure there has been no adverse effect on their healthcare. See Appendix A

Telephone questionnaire to patients who have used telephone triage and online consultation services to obtain their views and see if there are any recurrent issues. Results will be available in February.

Dispensary review to formulate a protocol for patients who usually collect medications from Woolsthorpe or drop off their repeat orders to Woolsthorpe, to enable them to use a drop off/collection point. The SOP is written for patients using the drop off/collection point for medication. The trial of this service is commencing 17 February 2021 and will, initially, run for a period of 2 months. This will be advertised to our patients via Dispensary, Facebook and our website.

Looking at transport issues and have communicated with Woolsthorpe Parish Council (letter dated 05.10.2020) but the Practice cannot mitigate for the continuing reduction in provision of rural public transport.

4. What other research has been or will need to be carried out to help you with the assessment? Contact with local voluntary car schemes to see if they are able to provide assistance to our patient group. Discussion with the PPG regarding “drop off/collection” point for patients wishing to collect medication or drop of repeat orders. PPG Meeting on 10 November 2020, to canvas any interest from the PPG. See Appendix B

5. Results of consultation/research (what does it tell you about the adverse impacts?) The main adverse impact appears to be transport, for patients without access to a vehicle who live in Woolsthorpe village. Patients who live in all other villages already had to travel to Woolsthorpe Surgery or Stackyard Surgery, as public transport has never been available. From our survey results, over 75% of our patients travel by car to the surgery, with over 70% of patients living more than 1 mile away and, therefore, would be unlikely to walk to the surgery for an appointment. Also in our survey, 89% of our patients have responded that they have access to a car and 15% have an option to use a friend or relative for transport to the surgery. (Also see Stage 2.3, Para 4 and Appendix B)

6. Conclusions – What steps will you take in response to the findings of your impact assessment? (Summarise your findings of the stage 2 impact assessment below).

6.1 No major change Your impact assessment demonstrates that the activity/project is robust and the evidence shows no potential for discrimination and that you have taken all appropriate opportunities to advance equality and foster good relations between groups.

6.2 Adjust the activity/project. This involves taking steps to remove barriers or to better advance equality. It can mean introducing measures to mitigate the potential effect

6.3 Continue the activity/project This means adopting your proposals, despite any adverse effect or missed opportunities to advance equality, provided you have satisfied yourself that it does not unlawfully discriminate. We wish to continue with our proposal to close Woolsthorpe (branch) Surgery and also move to East Leicestershire and Rutland CCG (ELRCCG). Although transport has been identified as an impact, we are actively working towards solutions (see 7)

6.4 Stop and remove the activity/project If there are adverse effects that are not justified and cannot be mitigated, you will want to consider stopping the activity/project altogether. If an activity/project shows unlawful discrimination it must be removed or changed

7. Action planning (state actions to address any adverse impact to enable you to move forward with your activity/project). You may use the example action plan template below

Impact/Issue Key Actions or Anticipated Timescales Lead Officer identified Justification to outcome. Will this Resources address remove negative impact/issues impact?

Medication  Increase Yes 03/12 Dispensary Collection delivery Lead service  Implement collection point in Woolsthorpe Transport to Investigate Potentially 3-6/12 PPG/Parish Surgery volunteer car Council/Surgery schemes staff

8. Sign-off Signed Date Activity/project Lead – checked

Senior Manager/Leader – checked 29.01.2021

Approved by (name of committee)

Please note:-  Once approved it is recommended that this information is stored with all documentation relating to the activity/project as evidence that Stage 2 EIA has been undertaken.  To show transparency, it is recommended that the Stage 2 information is published via appropriate methods, e.g. as attachment to documents relating to the activity/project, references in relevant reports/notes of meetings and consultation exercises, information on website etc.  Any review of the activity/project should, alongside it, instigate a review of the EIA information.  On completion a copy of this form should also be forwarded to your Equality, Diversity and Human Rights Lead for reference.

APPENDIX 1: HIGHLIGHTS OF THE EQUALITY ACT 2010

The Equality Act 2010 outlaws direct and indirect discrimination, including less favourable treatment, harassment and victimisation of people based upon their protected characteristics. The Act applies to all individuals, providers of services and employers.

Direct discrimination means less favourable treatment of a person compared with another person because of a protected characteristic.

Indirect discrimination means the use of an apparently neutral practice, provision or criterion which puts people with a particular protected characteristic at a disadvantage compared with others who do not share that characteristic, and applying the practice, provision or criterion cannot be objectively justified.

The public sector equality duty, arising from Section 149(1) of the Act, applies to public authorities, such as Clinical Commissioning Groups. A public authority must, in the exercise of its functions, have due regard to the need to:- a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act; b) advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; c) foster good relations between persons who share a relevant protected characteristic and persons who do not share it.

Advancing equality of opportunity involves:

 Removing or minimising disadvantage experienced by people due to their personal characteristics  Meeting the needs of people with protected characteristics  Encouraging people with protected characteristics to participate in public life or in other activities where their participation is disproportionately low.

Fostering good relations involves:  Tackling prejudice, with relevant information and reducing stigma, and  Promoting understanding between people who share a protected characteristic and others who do not.

Due Regard: Having due regard entails considering the above three aims of the PSED in all the decision making as in:-  How we act as an employer  Developing, reviewing and evaluating policies  Designing, delivering and reviewing services  Procuring and commissioning  Providing equitable access to services

The legislation acknowledges that in some circumstances compliance with the PSED may involve treating some persons more favourably than others, but not where this would be prohibited by other provisions of the Act.

APPENDIX A AUDIT

An assessment of GP Telephone Consultations during the 2020 Covid-19 Pandemic

By Dr Kate Rice

Objectives The objective of this audit was to assess my telephone consultations during the first 3 months of the Covid-19 pandemic. Due to the government advice to minimise clinical staff to patient contact due to the Covid pandemic I did all my work from home. I was also on the vulnerable list so working from home was advisable with the information we had at the time. My work included at least four sessions per week of telephone and video consultations.

Criteria All telephone consultations carried out by me during April, May and June 2020 were included.

Process I looked at the number of telephone/video consultations I made and the number for which I felt a face-to-face appointment following my call was necessary. I asked my GP and ANP colleagues if my requests for face-to-face appointments had been appropriate and I calculated the number of those face-to-face interactions which went on to test positive for Covid within 2 weeks. I also looked at how many of my telephone call patients were seen in A&E or died within a week of my consultation, using as a surrogate marker that I should have requested a face-to-face appointment with the patient.

Results A total of 879 telephone consultations over 3 months were carried out. Six of these were converted to face-to-face appointments. There were no positive Covid tests within the cohort of patients who were deemed to require a face-to-face appointment and no patients died or were seen I A&E within a week of my telephone call. All of the patients with Covid symptoms were signposted to the appropriate service to obtain a Covid test and were either managed at home or at hospital. None of the patients who went on to have face-to-face appointments with my colleagues had typical Covid symptoms and none of them tested positive for Covid within 2 weeks of the face-to-face consultation.

My colleagues felt that all the conversions to face-to-face appointments were appropriate because either the patient definitely needed a physical assessment or it was too difficult to make a safe assessment on the telephone.

No. of face- No. of No. of No. of face-to- No. converted to-face patients seen patients who No. of face to face-to- patients in A&E within died within 1 telephone appointments face testing 1 week of my week of my calls felt to be appointments positive for telephone telephone inappropriate Covid call call

April – 199 0 0 0 0 0

May – 264 5 0 0 0 0

June – 416 1 0 0 0 0

Face-to-face Referrals Indication 1. Severe sciatic symptoms 2. Intractable headache May 3. Chronic breathlessness (Covid –ve test) 4. Shoulder injection (osteoarthritis) 5. Shoulder injection (inflammatory arthritis) June 1. GI bleed

Limitations The limitations of this audit includes how to collate all Covid positive tests as there may have been some which were not relayed to our practice. This audit did not look at patient satisfaction with the telephone service provided and is something that could be included in any further telephone audit.

Conclusion This audit suggests that telephone consultation is a safe and effective way to manage General Practice demand. Any future audit on telephone consulting should include a patient satisfaction survey.

APPENDIX B

COMMUNITY CAR SCHEMES AND COMMUNITY TRANSPORT SCHEMES

Lincolnshire County Council operates a Community Car Scheme and there are currently (at November 2020) 17 car schemes which run under the forum. Some are community based with Parish Councils or PPGs and others are charitable based.

Lincolnshire helps schemes by undertaking DBS checks and some online training for all volunteers. Each scheme is organised and run independently and the Council have no control over them but the forum helps to ensure that any schemes operating are doing so in a compliant manner.

Sam Heron is currently (November 2020) the lead for the forum, so any queries can be fielded via Sam initially.

Lincolnshire County Council Transport Services Crown House Grantham Street LINCOLN LN2 1BD

Tel: 01522 553022 Email: [email protected]

Grantham Area Community transport is an organisation which provides a service driving vulnerable and disadvantaged people to medical and other appointments. It is a volunteer car scheme provided by volunteer drivers. The people who can use this service are the young or elderly, disabled or otherwise disadvantaged - anyone who is unable to use public transport or where no public transport is available.

Originally operating out of St Barnabas Hospice in Grantham, the contact telephone system has temporarily moved to Louth since Covid restrictions meant that they could not operate from Hospice premises.

Tel: 01507 609535

PRIVATE PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Date of Meeting: 10 February 2021 Agenda item: 8

Title of Report: Learning Disability Health Check Update Report Author and Title: Nick Blake, Head of Transformation & Delivery (South) Appendices: Appendix 1–Learning Disability Health Check Update Summary

1. Purpose of the Report (including link to objectives)

This report aims to update the Committee on progress in delivering Learning Disability Health Checks.

2. Recommendations

The Committee is recommended to review the report.

3. Executive Summary

Introduction & background People with learning disabilities (LD) have are more likely to have poorer health outcomes than other people, in part due to an increased likelihood that they are living with an undetected health condition. Annual Health Checks can identify undetected health conditions early, ensure the appropriateness of ongoing treatments and establish trust and continuity of care. An important element of LD Health Checks is agreeing a personalised health care plan to support positive health outcomes.

Recent guidance - Implementing phase 3 of the NHS response to the COVID-19 - states GPs must see 67% of people on their learning disability register for an annual health check by 31 March 2021. NHS Lincolnshire CCG has set a stretch target of 80% receiving an annual health check by 31 March 2021.

In 2019/20 Lincolnshire practices delivered 2,312 annual health checks to people with a learning disability equating to 48% of the total Learning Disability register for the County. There was significant variation in delivery across practices, ranging for 0% to 95% (it is worth noting that delivering LD health checks is not mandatory and some practices did not sign up to the scheme last year and so delivery is recorded as 0%).

Improving delivery and reducing unwarranted variation Work is well underway to support and enable practices to deliver health checks with a focus on practices projected to deliver below the 67% target. The three main areas of focus are:  Communication – supporting patients, GP practices, and system partners access and deliver health checks with key messages and by sharing good practice  Data – ensuring accurate data capture and reporting supports performance management

 Delivery – working with GP practices and system partners to optimise the use of available resources and capacity

Update and current position Based on data available through a number of sources including detail on planned delivery from practices:

 Performance up to the end of December 2020 shows 1,749 health checks delivered  This equates to 40% of the total LD Register  Projecting through to year end based on reported practice plans gives expected achievement of 71%

Communication work is ongoing: next steps include the development of a CCG web page on Learning Disabilities, regular social media content to support key messages and the development of promotional videos with experts by experience to encourage people to request and attend a health check.

Data monitoring and reporting is in place although this requires using and comparing data from a number of sources, comparing this data with NHSE held data indicates the local approach gives and accurate view of performance.

Delivery is being supported by a range of professional from across the system:  LPFT’s Physical Health Learning Disability Team  Dr Sue Protheroe (supporting in West Locality)  1 FTE additional nurse capacity starting 8 February  Additional GP capacity – available, start date to be confirmed

Work is underway with Lincolnshire County Council and LINCA to pilot delivery of some elements of health checks in residential care homes by care home staff. This should support patient outcomes by improving access to a health check and support GP practices by providing additional capacity to complete a proportion of the health check. Following piloting at one site and review the intention is for rapid roll out across the County.

For a breakdown of delivery at Primary Care Network level please see the Appendix 1.

Quality and experience This report has focused on delivery of the 67% target, it is important to stress that work on improving the experience and quality of health checks alongside improving the quality of patient health care action plans forms an important part of this programme.

Guidance to GP practices and the development of person centred and integrated approaches to supporting health outcomes for people with a learning disability will be a priority focus and further developed into 2021/22.

4. Management of Conflicts of Interest

None identified.

5. Finance, QIPP and Resource Implications

Additional funding has been awarded by NHSE to support the programme and provide additional capacity within the system in year (2020/21):

Capacity £000s Care home pilot 5 Clinical capacity (nurse and GP) 38 TOTAL 43

6. Legal/NHS Constitution Considerations

None identified.

7. Analysis of Risk including Assessments

Risk of non-delivery is included within the programme risk management approach.

Please state if the risk is on the CCG Risk Register. Yes No x

8. Outline engagement – clinical, stakeholder and public/patient

Engagement with GP practices and system partners is managed through the LD Health Checks Group. Engagement with experts by experience has been undertaken through the LD Partnership Board and Healthy Lifestyles Working Group.

9. Outcome of Impact Assessments

Not applicable, monitoring of delivery of Health Checks to patient groups with protected characteristics and BAME patients in particular is underway.

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process:

Finance x Commissioning Contracting Medicines Optimisation Clinical Leads x Quality x Safeguarding Other

11. Report previously presented at: Not applicable.

12. For further information or for any enquiries relating to this report, please contact

Nick Blake, email: [email protected]; telephone: 07767 006346.

Appendix 1 – Learning Disability Health Check Update Summary

Cumulative LDHC Delivery 2020/21 (as at 28 January 2021)  Actual delivery of 1,749 HCs (40% of total LD Register)  Projecting year end achievement of 71% (+2% on position reported on 20 January)  Eclipse data extraction and S1 data triangulation scheduled for w/c 1 Feb to confirm January delivery

Chart 1: Cumulative LD Health Checks delivered in 2020/21 (Quarter 4 projected)

Table 1: LD Health Check Delivery by PCN by Q3 showing change from November and Projection

Risk/issue Mitigation Who Comments Covid wave 2 impacts on delivery Covid capacity funding NB Capacity funding available to practices Support from system partners (LPFT) LPFT LD team are offering support to practices Virtual health checks.

Practice’s don’t engage Comms campaign SH Generally positive engagement across practices, some Support from PCNs and Clinical Leads NB practices not engaging but targeted approaches are Recruit GP LD champions . underway. Clinical Execs are supporting.

Comms and guidance to be shared with practice LD Champions directly.

Data quality issues impact on reporting Data quality review underway SC Use of multiple data sources is reducing risk (reasonable Improving data quality is a quick win NB correlation across data sources). Work with practice data leads to review and agree how best to implement improvements. PCN covid vaccination programme impacts Covid capacity funding SC Covid vaccination programme has impacted on primary on capacity and delivery CCG funded support NB care and CCG capacity to some extent, however, data Review and sharing of ‘unclaimed’ ES indicates progress in delivery. payments data to support practice income.

Staff self-isolation / shielding impacts on PCN / joint support NB OPEL sitrep reporting with assist with early view on practice capacity Covid capacity funding NTL capacity issues. Join t working approaches with LPFT and LCC. Outbreaks in practices has impacted on delivery, additional capacity (LPFT, agency etc) will mitigate. BAME access to LDHC Data indicates good LDHC delivery for NB SC Ongoing review of demographic information. BAME community – data is limited and needs to be kept under review.

Table 2: LDHC Programme Risk log

PRIVATE PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Date of Meeting: 10th February 2021 Agenda item: 9

Title of Report: Practice Access Report Author and Alaina Foy, Delivery Director / supporting PC cell Title: Appendices: Appendix 1 – Guidance Issued to Practices

1. Purpose of the Report (including link to objectives)

Following the issues raised around patient access to General Practice an initial briefing paper was discussed at the last Primary Care Commissioning Committee (PCCC) which included details of a recent audit carried out by the Primary Care team. The outcome of the audit was presented at the meeting and assurances where given to further investigate the concerns raised.

This report provides an update on the progress made with regards the issues highlighted and the development of a programme to support improved access.

2. Recommendations

The Primary care Commissioning Committee is asked to note the progress made with regards developing an improvement plan that addresses the issues highlighted from the feedback by Healthwatch and the subsequent audit with regards access to GP.

3. Executive Summary

The Primary care team are working with colleagues from Healthwatch to progress the development of a Programme Brief which will be presented at the next PCCC meeting this will include:

 Review of Online Consultation  Align data from various software systems to better understand General Practice Activity  Review the impact of general practice telephony systems on patient access

4. Management of Conflicts of Interest

N/A .

5. Finance, QIPP and Resource Implications

N/A

6. Legal/NHS Constitution Considerations

N/A at this time.

7. Analysis of Risk including Assessments

Issues highlighted through this report will be incorporated into the PCCC risk register

Please state if the risk is on the CCG Risk Register. Yes X No

8. Outline engagement – clinical, stakeholder and public/patient

N/A at this time. Patient and public engagement will be important to support future development of standards

9. Outcome of Impact Assessments

N/A

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process:

Finance Commissioning X Contracting Medicines Optimisation Clinical Leads Quality X Safeguarding Other

11. Report previously presented at: N/A

12. For further information or for any enquiries relating to this report, please contact Alaina Foy, Delivery Director / supporting PC cell Mobile: 07972113536

[email protected]

Patient Access

1. Introduction

2. Additional audit feedback

Practice Telephony Systems

At the last meeting it was reported that 76% of calls were being answered by the practice staff within 5 minutes. The audit did however, highlight that 4 out of the 85 practices experienced a technical fault at the time of calling. Further calls were made to these practices as agreed within practice peak hours (i.e between 8:00 am -9:30am) the previous issues reported are detailed below along with the updated position following the re-call highlighted in red as follows:

 Practice 1 the phone continuously rang out when the option for appointment was selected – Call answered 16 minutes wait  Practice 2 following several attempts we could not get through on the number provided – Call answered 1:03 minute wait  Practice 3 the option to speak to a reception was selected line rang out and eventually disconnected - Call answered 1:04 minute wait  Practice 4 tried to call the practice over a 30 minute period and line was continually engaged - Call answered 1:55 minute wait

We also recalled the 5 practices who had the longest wait time and again called them within practice peak hours, all 5 practices had a reduced waiting time, although this can vary and is influenced by on the day demand.

It is acknowledged that the current telephony system remains a constraint and that at peak times during the day patients will experience lengthy delays before being able to speak to a member of the reception team. As we are now delivering the total triage model within primary care this will also put an additional strain on current capacity and system capabilities as this is a telephone triage service.

The above review further reinforces the observation that performance is directly affected by level of demand and can vary depending on the time of day a patient makes contact with a practice.

Website

Feedback had been received from Healthwatch that whilst online consultation was being offered by most practices, some practices at times had switched the service off.

A further audit was undertaken to determine for the 65 practices where it was reported that the service was ‘live’ that this was in fact live and accessible through the practice website. The audit which took place on 19th January concluded that all 65 practices had live links for patients to access. It should be noted that on occasions, if practices are struggling to meet demand, there is the option to only have the service available during practice opening hours, this was agreed by the CCG to support practices experiencing capacity pressures. Practices also have the option to de-activate the service over the weekend to avoid building up a backlog.

As previously reported a further 15 practices have expressed an interest in on-line consultation which the digital team have now procured on behalf of those practices and will be working with them on implementation. For the 5 practices who have not signed up to online consultation as previous reported alternative systems are in place which ensures that patients receive the same level of service.

Users groups, to develop consistency of approach, will be established during March 2021

3. GP Website Review – COVID-19 Vaccination Information – 19/01/2021

Volunteers from Healthwatch Lincolnshire carried out a review of Lincolnshire GP websites to see if the sites showed up-to-date information on the COVID-19 vaccination programme. Below is a summary of their findings.

Method

86 websites were reviewed online between 14/01/21 and 18/01/21 by 5 volunteers.

Results

68 (79%) websites had information about the vaccination programme.

18 (21%) did not have any information.

56 (65%) websites displayed the information where it could be easily found.

34 (40%) of those had information as a Pop Up on the Homepage or on the Homepage itself.

Conclusion

The volunteers felt that, 47 (55%) websites had enough information to inform their patients of the current situation regarding vaccinations.

4.Progress against key actions to improve patient access

4.1 Overview

Developing Programme Brief re Patient Access

Engagement with Healthwatch - a meeting has been arranged for the 2nd February to discuss the outcome of both audits and agree next steps. We will also be discussing how we can work together to ensure patient engagement.

4.2 Action Update

4.2.1 GP Websites – Primary Care Coms team to develop a guide for practices to use to develop their websites. This will include sharing examples of best practice in terms of number of links, lay out and providing scripts that practices can use.

Feb 2021

UPDATE: Arrangements in place to develop the guidance with work ongoing throughout February. One of the key priorities is the messaging around the vaccination sites and the options available to patients. This will be used as the first test.

4.2.2 The PC team will complete a further review of the 10% of practices where the answer time was >10 minutes or there were technical issues will be completed.

Feb 2021

UPDATE: A further review has taken place which identified those practices who had experienced a technical difficulty and for the practices where a wait of over 10 minutes was experienced. Outcome detailed above.

4.2.3 Digital Group to establish User Groups for Ask My GP & E-Consult, gather information and develop a draft protocol. Also doing a comparison against both systems.

March 2021

UPDATE: A Programme Brief is currently being developed this work stream will form part of the Programme brief.

4.2.4 The PC team will gather Information regarding existing telephone systems / contracts etc to inform the development of a plan to establish the infrastructure that would be required to support capacity / demand management across PCNs and the wider Lincolnshire system.

June 2021

UPDATE : This work will be managed jointly through the primary care programme and the system digital group. A progress update will be include as part of the primary care access programme feedback to PCCC

4.2.5 The PC team will work with Healthwatch to engage patients and the public to gather information that will inform future development of standards that will support improved patient experience when accessing primary care

June 2021

UPDATE: Meeting arranged for 2nd February with Healthwatch.

The Primary Care team will provide a summary report to the PCCC of changes to service provision resulting from COVID 19

Ongoing

5. National guidance regarding primary care activity as part of managing Covid

A letter was issued by NSHE/I dated the 7th January which supported practices to pause certain service as in wave 1 if required. The current position is that Primary Care are committed to continuing to deliver the full range of services to patients. A priority list has been agreed and should a practice identify a capacity risk due to an increase in demand they are able to pause services in line with the agreed guidance. A copy of the guidance has been included as Appendix 1.

Next steps

Development of Programme Brief which will be presented at the next PCCC meeting this will include:

DCA Community Services (Enhanced Services) Delivery Guidance:

Continue but consider at risk patients and community or 'cold site' management; consider Ambulatory Leg Ulcers extending period between treatments if clinically appropriate. Lincolnshire Treatment Room Continue

D-Dimer Continue Updated 12/01/21. Agreed by Exec GPs on 13/01/21. Continue in accordance with guidance shared by Specialised Drug Monitoring secondary care.

Continue for patients not suitable for switching to INR DOAC's

Guidance for adjusting delivery of non-care services in a Primary Care setting as part of the Covid- Ring and Vault Continue 19 Response. The principle is that Primary Care should free up capacity to increase the ability of services to meet the core needs of their patients. Enhanced Services are, by definition, over and above core, but most are essential in maintaining the health and wellbeing of the population and reduction in delivery needs to be managed carefully based on clinical need and risk to patients. Gonaderelins Use 3 months supply. Face to face care should be offered following screening for Covid-19 risk factors.

Minor Injury Continue

Phlebotomy Continue KEY

Use Advice & Guidance to ask if 24 hour ECG Continue to deliver; consider where and by whom they will be provided; 24 hour ECG needed consider reduced frequency of treatment if clinically appropriate

Only urgent ECGs to be carried out (will be ECG Only deliver if clinically necessary; postpone service as appropriate needed if referring to Rapid Access Clinic)

Revert to home monitoring. Use of patient Postponed nationally or recommended to deliver only in exceptional ABPM information leaflet with 7 day recording sheet circumstances

Ear Syringing Stop

Spirometry Stop

Minor Surgery Continuation only if clinically necessary

BMA is discussing with NHSE/I that it be re- Dispensing Services Quality Scheme suspended.

Special Allocation Scheme Continue

Learning Disabilities Continue but by telephone if apropriate

ULHT advice is to give oral preparations to cover, ideally the same type as the LARC. Information regarding Contraceptive advice during Covid is LARC available at https://www.fsrh.org/documents/fsrh-position- essential-srh-services-during-covid-19-march- 2020/

Out of Area Registration Continue

Immunisations and Vaccinations Continue

PUBLIC PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Date of Meeting: 10 February 2021 Agenda item: 12

Title of Report: Finance Performance Report – December 2020 Report Author and Linda Brining, Senior Finance Manager, Lincolnshire CCG Title: Appendices: Appendix A - Primary Care Financial Performance Report as at 31 December 2020

1. Purpose of the Report (including link to objectives)

The Committee is asked to review the Financial Performance Report to 31st December 2020 in relation to Primary Care expenditure.

2. Recommendations

The Committee is asked to consider and note the reported Primary Care financial position to 31st December 2020.

3. Executive Summary

This report sets out the financial position to 31 December 2020 (Month 09).

Year to Date (Apr - Dec) Forecast Outturn (Apr - Mar) Co-Commissioning Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m GMS 53.6 53.6 0.0 71.6 71.6 0.0 PMS 2.2 2.2 0.0 2.8 2.8 0.0 APMS 2.2 2.2 0.0 3.0 3.0 0.0 Direct Enhanced Services 1.0 1.0 0.0 1.3 1.3 0.0 QOF 8.9 8.9 0.0 12.0 11.9 0.1 Premises 8.2 8.4 -0.2 11.0 11.3 -0.3 Dispensing & Prescribing Fees 9.3 9.7 -0.4 12.4 12.6 -0.2 Other Services 1.9 2.1 -0.2 3.4 3.7 -0.3 Primary Care Network 7.6 7.7 -0.1 10.1 10.9 -0.8 Prior Year 0.0 -0.5 0.5 0.0 -0.5 0.5 Total 94.9 95.3 -0.4 127.6 128.6 -0.8

The full year budget for Co-commissioning is £127.6m and at month 9 the forecasted expenditure is £128.6m. The over spend is, in part, due to additional costs for the Primary Care Network (PCN) Clinical Directors in Q4. A prior year benefit of £0.5m is reducing the impact of other increased costs.

4. Management of Conflicts of Interest None

5. Finance, QIPP and Resource Implications The report identifies the financial position and considers risks to the overall financial performance for Primary Care.

6. Legal/NHS Constitution Considerations None

7. Analysis of Risk including Assessments

This section should identify known or potential risks and how these are being mitigated, including conflicts of interest.

Please state if the risk is on the CCG Risk Register. Yes No x

8. Outline engagement – clinical, stakeholder and public/patient Not applicable

9. Outcome of Impact Assessments Not applicable

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process:

Finance x Commissioning Contracting Medicines Optimisation Clinical Leads Quality Safeguarding Other

11. Report previously presented at: Not applicable

12. For further information or for any enquiries relating to this report, please contact Linda Brining – [email protected] 07816 534894

Primary Care Financial Performance Report as at 31 December 2020

1. Current Performance

Co-Commissioning expenditure

The CCG has received £2.155m for the COVID-19 Capacity Expansion Fund, included within Other Services, the non-recurrent allocation supports general practice in delivery of seven priority goals. Funding of £2 per weighted patient (£1.7m) is to be made directly to practices.

GP Personally Administrated Drugs costs (Dispensing & Prescribing fees) have increased due to the larger vaccination programme. Costs in October 2020 compared with October 2019 were 30% higher. NHSEI have raised this issue with the DoH on behalf of CCGs.

The over spend in Primary Care Networks is mostly due to the increase in the Clinical Director payment for Q4, as directed in the January 7 letter Freeing up practices to support COVID vaccination. The funding provided to PCNs increased from 0.25wte to 1.0wte equivalent to £0.4m for Jan-Mar, the CCG hasn’t received an additional allocation to support this.

The CCG has reported at month 9 the full utilisation of the additional roles reimbursement scheme (ARRS). Total funding available to PCNs of £7.13 per weighted patient is unlikely to be maximised. The finance team are working closely with Heads of Transformation to confirm the anticipated expenditure and this will be reported at month 10.

Prior year accruals for 2019/20 expenditure were higher than required and have provided a non-recurrent benefit of £0.5m within the Delegated Commissioning budget.

Other Primary Care expenditure

PCN running costs (£1.50 per head), which sit outside of the Delegated Commissioning expenditure, were £0.9m at month 9.

A total of £2.0m has been paid to general practice in relation to Covid-19 reimbursements; this includes bank holiday payments, backfill for practice staff absence and PPE/Consumables per the CCG additionality claims guidance.

PRIVATE PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Date of Meeting: 10th February 2021 Agenda item: 13

Title of Report: Primary Care Risk Register Report Author and Sarah-Jane Mills, Chief Operating Officer, West locality Title: Appendices: N/A

1. Purpose of the Report (including link to objectives)

The Primary Care risk register provides the current assessment of risks that may impact on the delivery of primary care services across Lincolnshire.

2. Recommendations

The Primary Care Commissioning Committee is asked to:

 Consider the risk register and plans to mitigate identified risks  Note that the management of a number of key risks will only be achieved through the development of a comprehensive primary care strategy.  The foundation of the primary care strategy requires the rapid development of Primary care networks.

3. Executive Summary

The risk register has been reviewed and updated by the risk owners. The following is a summary of the reviews by risk:-

001 – Impact of Covid – Whilst there are a number of outstanding local business continuity plans the risk has been reduced to reflect current level of demand on primary care and the confidence that core principles have been established to manage any outbreaks.

002 – Quality – The level of risk has been maintained due to the impact on primary care provision associated with the practice that is currently assessed as inadequate by the CQC. The locality team are working to develop a longer term plan to manage the key issues.

003 – Primary Care Business model – The level of risk has been maintained. Mitigation plans are in place to manage local loss of primary care provision but there is a requirement to develop a longer term arrangement that secures the provision of primary care activities across the county. The core principles of the strategy are linked to the development of Primary Care Networks which will require strong and effective collaboration between practices and the development of a contractual framework that promotes population health management.

004 – Primary Care Network development – The level of risk has been maintained. The establishment of the PCN alliance is a positive development. An assessment of key elements for future development will be commissioned to support the next phase.

005 – Practice withdrawal from total triage – This risk has been maintained. The PC digital group will focus on establishing arrangements to support continuous improvement.

006 – Recruitment to additional roles – This risk has been reduced following the establishment of a planning group and joint working with PCN managers to develop a workforce plan.

007 – Capital – This risk has been reduced following the establishment of the primary care estates group and associated development of a capital estates strategy which will be informed by the assessment of need that is currently underway.

008 – Learning Disability health checks – This risk has been reduced following the development of a comprehensive plan to support delivery. There is a requirement to review the current commissioning arrangements to support population coverage as part of the wider health improvement plan.

009 – Flu vaccinations – This risk has been reduced as the 50-54 flu vaccination programme is underway.

010 – Primary Care Team – management of contract issues – This risk has been maintained as the current arrangements are interim as part of the CCG response to managing the Covid pandemic

011 - Access to primary care – This risk has been increased to reflect the feedback that patients are finding access to primary care harder following the introduction of total triage – both IT and phone. The primary care team are currently developing a programme brief to address the issues highlighted.

012 – Covid vaccination programme – This is a new risk added following the establishment of the Covid vaccination programme in Dec 2020.

013 – Primary Care transformation programme – This risk has been maintained as the LTP refresh has been paused to release resource to support the management of the Covid pandemic and Covid vaccination programme.

4. Management of Conflicts of Interest

None

5. Finance, QIPP and Resource Implications

Risk mitigation is likely to require significant investment

6. Legal/NHS Constitution Considerations

The CCG are required to ensure the effective provision of primary care

7. Analysis of Risk including Assessments

This section should identify known or potential risks and how these are being mitigated, including conflicts of interest.

Please state if the risk is on the CCG Risk Register. Yes X No

8. Outline engagement – clinical, stakeholder and public/patient

The development and review of the risk register reflects the feedback from key stakeholders.

Arrangements to ensure that feedback from HealthWatch are incorporated into the review of the risk register have been established.

9. Outcome of Impact Assessments

N / A

10. Assurance Departments/Organisations who will be affected have been consulted

Insert details of the departments you have worked with or consulted during the process:

Finance x Commissioning x Contracting x Medicines Optimisation Clinical Leads x Quality x Safeguarding Other

11. Report previously presented at:

Primary Care Operational Group

12. For further information or for any enquiries relating to this report, please contact

Sarah-Jane Mills Chief Operating Officer West Locality

[email protected]

Tel: 01522 515381 Mob: 07870 898428

Sarah-Jane Mills Pam Palmer Andy Rix Jacqui Bunce Sarah-Jane Mills Sarah-Jane Mills Sarah-Jane Mills Sarah-Jane Mills Martin Fahy Sarah-Jane Mills Lead

010 009 008 007 006 005 004 003 002 001 NEW RISK REF

Exec Exec Exec Estates Group Exec Exec Exec Exec Exec Exec RESPONSIBLE COMMITTEE practices exposed to financial risk. exposed topractices financial leaving - allocations 106 sectionto be pulleddownfrom funding development supporttofutureenablecapital processes of lack and to funds to106 sectiontimelycompletedsecure a manner, failure in managementCare notcontract beingissues Primary in resultmay This notprocesses.andtheto new havingestablisharrangements / capacity coveredCareteamdue divertedtobeingPrimary to support COVID 19 previouslythatsupported functions risk bya notNHSEThereare is campaign beunable to provide will extended that practices risk a Thereflu is healthannual checks. their toaccess supporttodifficulty enable learning residentsa with beunable to provide Care will appropriatethat Primary risk a There is Communityrequiredto support deliveryHubs the term plan. of long the tofacilitate development funding CareEstates andPrimary of revenueand capital that be insufficient there risk a There will is reimbursement roleadditional thefor funding nationalfrom Lincolnshire for income of loss a anddevelop care primary MDTwithin working toability / tothereduced leading identifiedtermcapacity plan in long that tobePCNwon'ttherisk ableto recruit a Thereroles additional is working. newtoof waythisassociated outnotdid provide adequate the managementtimechange for responsea tothe rolepandemic.The as COVID-19 rapid care primary to these as access solutions weretointroducedfacilitate rapidly total triage using from withdraw will that practice risk a There 1. is requiredtosupport deliverythe term plan of long networks developcare won't that Primary risk atthe a Therepace is practices individual becomes unsustainable services for care that delivery primary the risk model of a for Therebusiness is bythe CCG commissioned safety services patientand care experienceprimary in quality, in failure therea patientpossibleis if of harm risk a There is thedown of relaxationlock national the in postCCG area occurs COVIDwave 19 of 2nd a if provision todisruptionserviceadditional of risk further a andpandemic management ongoing the of resultof COVID a 19 disrupted as be will services care primary to core that access risk a There is PRINCIPALRISK 1. A full list of key issues has beenkey Carehas byTeam.theof compiled issues Primary list Afull 1. tosupport development plans. practices with linking local Leads of Locality 3. Team. CCGFluPlanning Care of partFluteam establishedas Primary working 2. plan. CCGflu 1. system partnerstosupport the Work across programme 4. requiremaypersonalisedsupport.who teamssupported Locality byNeighbourhood3. to looking identify individuals Leads healthchecks. establishedCCG group to2. support development arrangements to facilitate of reviewed uptake.poor toof identify areas uptake Data2019/20 1. regarding during developments. care primary small befor available still will the to bein capital spendingreviewincludedBAU Novemberdue in 2020. theonexpectedincludedalthough notpilot.programme The a is Cavell Programme South beenhave Lincoln andalso Louth, Gainsborough Primary/CommunityHubs. theon ETTFfrom onfocuses andthe programme follow is which Programme the beenCavellfor Inpilotaddition HIP.Sleafordhas a identifiedProgramme as tobetheon included governmentsforward go InfrastructureHealth will theinterdependencies deliveryservice henceand for the estate required.work This demonstrateand care primary including sectors all include requirements.will This estates its developingCase for system is a StrategicBusiness Outline Lincolnshire pharmacists SMRs,clinical where there for recruitment currentare gaps throughtosecuredbeingOptumsupportAdditional the support is 4. deliverythe of Lead. CareProgramme Primary andCare Lead Workforce Lead,STPWorkforcePrimary PCNManagers, CCGLocality meetsPCN,Care Group Workforce monthlymembership from Primary has and 3. NWRS(monthlysubmission). of part as reportPCNsstaffing ARRS 2. pharmacists SMRs,clinical where there for recruitment currentare gaps throughtosecuredbeingOptumsupportAdditional the support is deliverythe of deliveryARRS. against and plans Themonitors Lead. group Care Programme Primary & Lead Workforce weeklya attendedThere Group ARRSLocality is Transformation, 1. of by Heads issues. potential managing support in and external signals for Digital NHSE/I& withrelationship Close working 3. issues. early for toscan Lead Care Digital Primary with place in is Closerelationship/interface 2. receivemonthly Group a Carereport Digital usage.on Primary 1. Managers Practice and Directors bothwith theirclosely Clinical work PCNmanagers 5. meetCCGPCNandleadsManagers monthly 4. a onbasis themember a of Alliance Provider is PCN Alliance 3. supportthetravel theof deliveryandthedirection strategic of LTP Development 2. thedevelopedbeing currentlyare PCNs for will plans which priorities. meetPCN Alliance weekly/monthly a on to 1. oversee basis deliveryPCNDES of undergoregulatoryreviewsannualby the CarePractices Commission. Quality 3. practices. of group a coverContinuity which toBusiness PCNs agree Plans, All 2. Continuityhave Business Plans Practices 1. thevia provided risk to supportIncreasedandpractices is CCG 3. guidance sources number of a from arising practices to intelligenceindividual relating reviewsboth datasoft andlocalities in Group CareAssurance Quality Primary 2. theand qualityteam gatheredleads information by locality using assessmentperpractice risk Quality 1. team meetweekcare timesescalation Thea 2. primary of to3 review issues pressure. of areas regards toobtain feedback basis with regular a on practices with link leads Locality 1. effective) be will controls confidence gives Assurance materialising. risk a prevent should (Controls ASSURANCES& KEYCONTROLS service disruption service of risk toincreasing to provide framework warning early OPEL 2. provision care toprimary access tocore maintain bethatsuspendedthe services recan order of plan in Refresh 1. ASSURANCES& GAPSINCONTROLS 2 Resources tosupport the Resources load work additional 2 toAdeveloparrangementsplan 1. local None toundertake requiredChecks.Healthlevel of Morecapability andlevel detailed 1. capacity practice review of estate care Detailedongoingprimary exisiting review of recruitmentretention& maturenotPCNssystema yetworkforce re as working throughtotalotheravailableAbility resource tomeans maximise Totaltriage toimplement practices requiring Contractualspecification 1. practices memberpractices betweenrealtionships of spectrum a theirThereandPCNs is 2. progress Currently to1. measuretheresystem-wideno process is PCN or topractices assigned Level(OPEL) Escalation Pressure Operationalno There is pandemic supportto Covid 19 staff consequence ongoing of a as ( practices supportdayreviewto wider individual and qualityteams to locality support day-to- across capacity Staffing indicated.level concerns high unless - practices individual regarding regulators Routinereportsfrom access to primary care should service provision bedisruptedprovision service by should care toprimary access havecontinuity plans been 2.Business updated tosupport sustained service tocore maintain plans local of mobilisation rapid and Lincolnshire delivery care across to ensure primary oversight (SOC) of System of part operationas control cell care Maintainprimary 1. materialises) ( MITIGATIONS Primary care team address individual issues as they as arise issues team individual address care Primary Supporting2. partnershipworking. plans. review of Regular 1. whererequired toavailablesupport practices is capacity Additional clinical 4. capacity care primary supportingCovid expansionfunding 3. Implementation 2. datareal-timecaptureto monitor delivery. of practice. good reviewsharing and including PCNsupportto practices 1. development.and issues premises generalpractice estatesandattendance in finance leads toreview supportand MonthlyCareEstates meetingPrimary relevantwith locality, Conversationshave been EMAS& heldLPFT with respectively. mental health communitysupportparamedics. & including 2021/22, for roles newconversationsearlyreARRS Having 4. Leads. CCGLocality & HoTs with closely working PCNmanagers 3. issues. deputy & Chair todiscuss Chair meeting PCNAPCNandPCNManagersAlliance,with Regular 2. PCNs.and practices re Managers Locality from tofrom hear CareDeliverythe members areof Primary Lead Group Programme Care Primary & CareLead Workforce Primary CCGHoTs, GPs, 1. published Reviewwhenis the contract 2. newGP capaility implmentdigital where opportunityTocontinueto practices towith 1. work allows tobe developedPlan Apractices andjoint OD PCNs 2. across lookdeliveryPCNsatservice PCN footprint model a on 1. the of UrgentCare Dashboard. part form also will providers care Primary Q4. early practices in development in outbetestedrolled andis framework will and OPEL The about provide practice. information the a which robustness of enablesissues softer the This respective of monitoring practices. meetingsbetweenThere theirandregular are Leads CCGLocality information available assessment of ensure going on staff Locality regulators. approachedthe has whistle-blower wherecomplaint/ a or concern levels of high CQCfor from information receipt of in still The CCGis PCCC.& throughPCQAG practices of monitoring Ongoing required. if leads theirwithlocalities work would beenpatients.It has demandCOVID agreed in 19 that practices required in due thatbe toincrease paused services ancould if toidentifyagreed to support practices was guidance vaccination theto Following support NHSE/ICOVID3. Freeing practices up COVID19 Mitigations are measures to limit harm if, despite controls, a risk risk a controls, despite if, harm limit to measures are Mitigations service provision is maintained is provision service toactivitiesensure that core clinical re-prioritise rapidly been has Guidance developed2. to to support practices key all partners for cards action supportedDevelopframework 1. by agreeandOPEL ACTIONPLAN arrangements to minimise disruption. arrangements tominimise supportkey whereandactivitiesnegotiation necessary of toensure processes that Reviewof 2. the CCGcan addressed.areresponsibility of Development1. arrangementsto ensureof the key areas directionnationalon Waiting uptakedeliveryand Identify 3. targettodeliverywithimprove areas plans otherLD,with services engagementandpeopleComms care, 2. primary with Implement 1. approach datareal-timemonitoring summary: development, in Adetailedis plan programme in completebythe28 SleafordOBC Tocomplete by31 thebid HIP Developfuturerecruitment planning funding. DevelopARRS tojointmaximise CCG/PCN approach a progress. developmentcontinue tolook buttodownand makewill needs COVIDhavevaccinations and this slowed that of work.part be pickedas up will but not clarified, is Thethe contract timeline new for GP understandingopoortunitiesandimprovement for Careto devleopDigital of DirectorNHSXand Director Transformation Digital thewith Work closely Regional 2021/22 development Q1 be in re-ignited will downand needs COVIDhavevaccinations and this slowed CareDevelopStrategicthe approach of partPrimary as Complete 2. toActionsupport Cards the OPEL framework Develop 1. OPEL generalpractice constituentgovernancewith processes practices. ContinuetoPCNdevelopDirectors withwork quality havepressures commenceoncepandemicpassed. 2. scheduledto re- is visits practice of Ensureprogramme 1. st March 2021. To 2021. March th February 2021 31/12/2020 2021 March - Jan Nov2020 27 place in Dataapproach monitoring 3. Nov 13 place PCNlevelInitial delivery in 2. plans Nov2020 17 begin comms and finalised plan Programme 1. by28 SleafordOBC Tocomplete the 2021. March Tocomplete by31 thebid HIP 2021/22 intoQ1 throughout& Q4 Ongoing Contract newwithGP Q4 Review in 31/06/2021 toActionbeplan completed Q4 31-Mar-21 20-Nov-20 TIMELINE th February 2021 st 3 3 3 3 3 3 3 4 3 3 LIKELIHOOD on adding to risk log 3 3 4 3 4 3 3 3 3 4 IMPACT on adding to risk log 9 9 12 9 12 9 9 12 9 12 Risk score on adding to the risk register business continuity approaches is underway. continuityis business approaches been has completed. Workto develop teamand resilience CareTeam Primary within leadresponsibilities of Allocation getupdate.nationalan weuntil downto9 12 been has from re-assessed score Risk Lincolnshire. the within pandemicand Covid vaccine needtobedepending re-assessed theon situationcurrent tobe thewill vaccinated is risk group this informed areCCGs determination. local Once not for given is nationallyand extendedbethiscomplete thefor will vaccination group havecohorts been eligible completed. Theahead togo dependent otheris onceall vaccine theon of availability year group the 50-64 for The starting extended campaign flu 68.8% / 49.1% CCG/ Lincs 72.8% / South51.9% / 72.5% / South 51.5% West / 70.1% / 51.0% West / 63.2% / 44.1% East/ @risk 50-64 50-64/ All Locality/ follows: as is range 64 thethe in uptake50- locality overall each vaccination for for Thethat individuals. extendedshow figures current cohort letters –were ‘call’ nationaleligible sent tovaccinations all the beenextended has offering made in Progress flu cohort February. in available is capacity County, GP and nursing further the providedbeing across is capacity Additionalclinical setting. residentialcare a in people living for in supportaccess anticpatedwill and is roll-out rapid underway Carehome - project pilotis deliveryintoQ4. on impact may programme vaccination PCN covid out of roll and care primary in demandon Covid capacity andimpact Weeklyupdates todeliveryonCCGprogramme. Exec of delivery.programme supporting NeighbourhoodandLCC,LPFT engagedTeamsare and projection.performance toandsupportsitreps monitoring practice alongside Systemand available Eclipse time 1 data extractusing Real monitored. havelevel plans been Practice reviewed beingareand progressed. developments practice for being are cases business level CCGwheresupportatpractice outline Ongoing 2021. estate care January relation to in primary in Programme providedSubmission tosupport the NationalData Gathering theandPCNs deliverythe of toDES.Lincolnshire potentialtheunderspend be tobenefitutilised maximise can toanyhow CCG and as PCNs with approach strategic a up working currently is CareProgramme The Primary Region have been by submitted off signed and 2020/21 for Plans coverage.Total Triage increase and to NHSD/Xandmaintaining their member practices PCNs,all with working leadis Digital CareProgramme The Primary identifydevelopment PCNlevel needs atspecific Subsequently TermPlan.theto be possible Long will it baseddeliveryon for, of toPCNs aim provide thefor vision PCCCanddeveloping strategy.will in This care the primary between ongoing PCNs Care WorkProgramme, is Primary throuhout ongoing remain Q4 will work This OPEL. care primary together working CCGLMC,andarePCNs todevelop the concerns. quality/clinical due toEstatesrather ratings than issues risk high Practices 2 X Improvement).Require 3 (x CCG.CQCwith& ratings risk good 86) out of (82 Practices of otherwise majority 16; rating risk inadequate - 1 x practice the report.of parturgent care forms theSOCtoensure datathatcollection care the primary with closely working Careanalystis Primary approach.wide which06/11/2020 we are ensuring aligns to the system beavailable the Framework of Opel will draft First UPDATE 3 2 2 2 3 3 3 4 3 3 LIKLIHOOD (CURRENT) 3 2 4 2 3 3 3 3 3 3 IMPACT (CURRENT) 9 4 8 4 9 9 9 12 9 9 Current risk score Mills Sarah-Jane Brewster Shona Blake Nick StarbuckSarah MartinKay MartinKay MartinKay Kay/HOTS Martin WendyMartin FoyAlaina RISK OWNER 02/02/2021 02/02/2021 02/02/2021 02/02/2021 02/02/2021 02/02/2021 02/02/2021 02/02/2021 02/02/2021 02/02/2021 LAST UPDATED Sarah-Jane Mills Sarah-Jane Mills Sarah-Jane Mills Lead

13 012 011 NEW RISK REF

Exec Exec Exec RESPONSIBLE COMMITTEE required across primary care. primary requiredacross changed the understandingof of thetrueof because scale of lack not bedelivered will integratedtermplan long communitycare that therisk developmentand a Theretransformation is the of consequencesthe of Covid pandemic the managing theof of resultimpact a as increased is risk This acutecare. requiring andunwell patientstermmanagement.condition in result becoming could This to completelong withcare associated activities primary within capacity reducethe that therisk will a programme ThereCovid vaccination is agenda. werenot changes to digitisation abletosupportbe a place put in meantbehaviourand This that workflow level associated skilled staff. notdid needattention reduceor andactivity which the higher skills of week COVID phase,period10 toinitial support remote during working technologyimplemented of resultrapidly being a overas a is risk This care. toprimary toimprove access fails consult E that theimplementrisk technology a There rapid / of i.e. is Ask GP my PRINCIPALRISK 2. System read-across toactivity.Systemidentify 2. potentialin read-across shifts thewith detaillevelrequired. of provide us will takingThis currentlyplace. is refresh Self-assessmentLTP and 1. deteriorationmonitored. of regularly arehighestrisk assessmentto ensure risk that patientshave at thecompletedGP clinical 2. a termmanagementcondition long activities. been has providedtocore expansionfunding maintain to GP support practices 1. toensure system-wideBoard knowledge Digital intomembershipdeveloptheandto identifylinks issues Lincolnshire This solutions. practice has Delivery Care Digital which Group Primary Establishmenta 2. of PCNsand practices individual with Managerto closely Care work Digital Primary Establishmenta 1. of effective) be will controls confidence gives Assurance materialising. risk a prevent should (Controls ASSURANCES& KEYCONTROLS intergrated Datanotappointments3. re is consultationcontacts on-lineand Noautomaticfeedback2. loop. Nopatientexperience1. and impact information ASSURANCES& GAPSINCONTROLS we do not have a clear understanding of any shifts in activity. in anyshifts understanding wenotdo of have clear a developedbeingcurrentlySystem 1. is modelling thereforeand period extendedan requiredfor theis programme Covid vaccination if activities to underpincare the Plans primary 3. delivery core of termpartnerstomanagementconditionsupport long otherwithand care primary Collaborativeacross 2. working practices Data1. tomonitoractivity across Deliveryparticular. in Group feeddirect intoprovidesthea This Care CCGtheand Primary issues. of aboutrangeprovide a oninformation the which practice enablesissues softer the This respective of monitoring practices. meetingsbetweenThere theirandregular are Leads CCGLocality materialises) ( MITIGATIONS 3.PCNdevelopment assessmentto be commissioned then enableto will thedo us across. read which submittedbeingSelf-assessmentsare 2. bythe 03/11/2020 Group. Planning the of 3 partPhase Careis Primary 1. maintained toactivitiesensureis provision thatservice core clinical prioritise been has 3.Guidance developed re- to rapidly to support practices risks manage arrangementsto mitigate / to agree local practices withwork teamenables itto care theidentify information trends primary and not live is althoughthis - information performance Reviewof 2. pressure toof identify areas practices with Close working 1. Mitigations are measures to limit harm if, despite controls, a risk risk a controls, despite if, harm limit to measures are Mitigations or prefer otherprefercommunication or modes of those arrangementspatientsfor don'thavewho access technologybenefits of provideand alternative tooptimiseplan the a includes which care toprimary Develop tosupport improved brief access programme a Identifythetheand impact.issues ACTIONPLAN 2. Read-across of system plans.of Read-across 2. Reviewsystem1. modelling. management improvementsarrangementsto in support self establishing including - termconditions long of managementand monitoring arrangementsresilientfor key& WorkPCNswith 3. partnersto develop more activity of timesupportmonitoring real arrangements that will todevelop colleagues care Workprimary with2. practices. individual with plans deteriorationtrends toof orderdevelop in mitgation Strengthen1. toidentifymonitoring any performance care primary Integrateactivitydata to enable understandingacross 21/22 - Q121/22 - Q121/22 - 2021/22 Q1 TIMELINE 4 3 3 LIKELIHOOD on adding to risk log 3 4 3 IMPACT on adding to risk log 12 12 9 Risk score on adding to the risk register current COVIDcurrent situation. dueholdoncurrently to the is WorkRefresh theon LTP Decemeber2020 establishmentthe in programme of Covid vaccination added newtorisk thethe a PCCCis following This theprogramme out teh of vaccination roll havebeenre-focusedto andrespond resources to COVID 19 have group beenresources The digital as unable to progress todevelop delivery themodel. local usedtechnologyto improve patient is supoprt andGP care therequired to of detailsensureactions include that will Thewhich teamPC developing brief are programme a care. primary across issues completedaccess auditof an TheteamPC have reviewed healthwatchfeedback and from UPDATE 4 3 4 LIKLIHOOD (CURRENT) 3 4 3 IMPACT (CURRENT) 12 12 12 Current risk score MartinKay FoyAlaina FoyAlaina RISK OWNER 02/02/2021 02/02/2021 02/02/2021 LAST UPDATED