Meeting in Common of the North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups’ Primary Care Commissioning Committees – Held in Public Tuesday 8 January 2019, 09.30am – 11.00 The Bridge Centre, Birches Head Road, Birches Head, ST2 8DD Agenda Decision / Enc./ Agenda To Note/ Item Item description Table / No Discussion/ Presenter Pres. Information Welcome and Apologies for Absence: 1 North Staffordshire CCG: Stoke-on-Trent CCG: Declarations of Interest North Staffordshire CCG & Stoke-on-Trent CCG : If any member of the Committee or invited attendee has any pecuniary 2 interest, in any contract, proposed contract or other matter under consideration at this meeting he/she shall disclose the fact to the Chairman Verbal To Note and shall not take part in the consideration or discussion of the matter or vote Mwo on any question with respect to it unless agreed by the Chairman and 9.30 am members of the committee (10 mins) Confirmation of Quoracy (following consideration of interests declared pertaining to the agenda) 3 North Staffordshire CCG Stoke-on-Trent CCG
Minutes from: Public Meeting In Common Of The North Staffordshire and Stoke-On- 4 Trent Clinical Commissioning Groups’ Primary Care Commissioning To Note / Committee Tuesday 4 December 2018 Enc. 4.1 Decision Action List and Matters Arising Enc. 4.2 5 Assurance & Governance Andy Access for Primary Care for Homeless People Enc 5.1 Meakin 5.1 Discussion Pres 9.40 (20 mins) LM 5.2 Primary Care Risk Register Enc. 5.2 Assurance 10.00 (10 mins) AH 5.3 Delegated Budget Update Enc. 5.3 Assurance 10.10 (10 mins) SJ 5.4 Hanley Primary Care Hub Enc. 5.4 Information 10.20 (10 mins) SJ/TCo Assurance/ 5.5 GPFV High Impact Changes Enc 5.5 10.30 Information (15 mins)
NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes
NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE
6 Any Other Business
Questions from the Public Verbal PD Any other key issues Verbal Information 10.45 Committee Effectiveness Enc. 6.1 (15 mins)
DATE/TIME OF NEXT MEETING: Date Time Venue Chair 9.30 am The Bridge Centre, Birches Head Road, Birches Head, ST2 4 February 2019 MWo 8DD
NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes
NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE
Public Meeting of the North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups’ Primary Care Commissioning Committees held in Common Tuesday 4 December 2018, 10.00am – 11.30 Waddington Suite, Bet365 Stadium, Stanley Matthews Way, ST4 4EG Unconfirmed Minutes
8 8 8 8 8 8 8 8 8 1 1 1 1 1 1 1 1 1 y c
20 20 20 20 20 20 20 20 20 a / / / / / / / / / r Members: Quo 10/04 01/05 05/06 03/07 07/08 04/09 02/10 06/11 04/12 Present: North Staffordshire CCG Voting Members: Peter Dartford PD Lay Member – Patient and Public ✓ ✓ ✓ ✓ x ✓ ✓ ✓ Involvement (meeting chair) Mike Edgley ME Lay Member ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Neil McFadden NMcF Lay Member – Governance ✓ ✓ x ✓ ✓ x ✓ ✓ Stoke-on-Trent CCG Voting Members: Tim Bevington TB Lay Member ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ John Howard JH Lay Member – Governance ✓ ✓ x ✓ ✓ x ✓ ✓ Margy Woodhead MWo Lay Member – Patient and Public ✓ x x ✓ ✓ ✓ ✓ ✓ Involvement CCGs’ Voting Members: Lynn Millar LM Director of Primary Care and Medicines ✓ ✓ ✓ ✓ x ✓ ✓ ✓ Optimisation Alistair Mulvey AM Chief Finance Officer ✓ ✓ ✓ ✓ ✓ ✓ x A Manir Hussain MH Deputy Director of Primary Care and x x x ✓ ✓ ✓ ✓ A Medicines Optimisation Mark Seaton MS Managing Director – North Locality x ✓ ✓ x ✓ x ✓ x Marcus Warnes MWa Accountable Officer ✓ ✓ ✓ ✓ ✓ ✓ ✓ A In attendance: North Staffordshire and Stoke-on-Trent CCGs: Dr Waheed Abbasi WA Clinical Director – Mental Health and x x ✓ x x x X ✓ Specialist Groups Nicola Austerberry NA Primary Care Lead ✓ x ✓ ✓ ✓ x X x Jessica Chaplin JC Executive Assistant (Minutes) ✓ ✓ ✓ ✓ ✓ ✓ ✓ x Dr Lorna Clarson LCl Clinical Director – Partnerships and ✓ ✓ x ✓ ✓ ✓ ✓ ✓ Engagement Anna Collins AC Head of Communications and ✓ x x x x x X x Engagement Dr Steve Fawcett SF Medical Director ✓ x ✓ x ✓ x X A Dr John Gilby JG Clinical Director – Primary Care ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Dr Latif Hussain LH Non-Executive GP Board Member ✓ x ✓ ✓ ✓ ✓ ✓ ✓ Sarah Jeffery SJ Head of Primary Care Development - - ✓ x ✓ ✓ ✓ x commenced in post June 18 Mel Mahon MM Head of Primary Care Commissioning - - ✓ x x ✓ ✓ x Commenced in post June 18 Vicky Oxford VO Senior Commissioning Manager ✓ ✓ ✓ ✓ ✓ x X x Paul Winter PW Deputy Director of Corporate Governance, - - - - ✓ ✓ X x Communications and Engagement Vanessa Ridout VR Executive Assistant (minutes) ✓ Tracey Cox TCo Primary Care Development Lead ✓ Teresa McGougan TMc Strategic Improvement Lead for Nursing & ✓ ✓ Quality NHS England Rebecca Woods RW Head of Primary Care ✓ x x x ✓ ✓ ✓ ✓ Wendy Henson WH Primary Care Lead ✓ ✓ x ✓ ✓ x x x Terry Chikurhune TC Primary Care Lead ✓ ✓ ✓ ✓ x ✓ ✓ ✓
NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 1
Public/Observers Simmy Aktar SA Healthwatch Stoke-on-Trent x ✓ x ✓ ✓ ✓ X ✓ Jackie Owen JO Healthwatch Staffordshire ✓ ✓ x x ✓ x ✓ A Dr Paul Scott PS North Staffordshire LMC Chair x ✓ ✓ ✓ x ✓ ✓ ✓ Dr Harald Van-Der HVL North Staffordshire LMC Secretary ✓ x ✓ x x ✓ X ✓ Linden 1 members of public/press in attendance 2018/DEC 1. Welcome and Apologies for absence Action /117 PD welcomed members to the December public meeting of the North Staffordshire and Stoke-on- Trent CCG Primary Care Commissioning Committees held in Common.
Apologies were duly received and noted as above.
2018/DEC 2. Members’ Declarations of Interest /118 No further declarations of interests made extraordinary to items declared on the CCGs’ Declaration of Interest Register.
2018/DEC 3. Confirmation of Quoracy /119 The meeting was confirmed as not quorate for both North Staffordshire CCG and Stoke-on-Trent CCG Primary Care Commissioning Committees due to there being no finance representative at the meeting.
2018/DEC 4. Minutes, Action Sheet and Matters Arising /120 Minutes from the meeting held on Tuesday 2 October 2018 The minutes from the meeting held on 2 October 2018 were duly received and approved as a true and accurate account of discussions once the following amendments had been made:
Page 7, Item 6.4 Social Prescribing Second paragraph - to remove the wording ‘through a TUPE arrangement’
Actions from the meeting held on Tuesday 2 October 2018 PC delegated budget – LM advised that SJ will be undertaking a full review on GPFV finance and an update would be submitted to the January meeting
Action: PC Delegated Budget update to be presented to the January committee SJ
Matters Arising None
2018/DEC 5.1 Primary Care Risk Register /121 The meeting were presented with the Primary Care Risk Register for North Staffordshire CCG and Stoke-on-Trent CCGs.
LM informed the Committee that there has been a new risk included on the register. This relates to GP IT issues with a score of 16. The Committee were advised that there has been 4/5 major incidents in the last 6 weeks. These incidents relate to IT system with some being national issues relating to software updates and some local issues which are being investigated through the Health Informatics Service (HIS). The response from the HIS is that some incidents are inevitable i.e. cyber attaches however there needs to be a better response in terms of communication to practices and business continuity.
A full investigation into the incidents is being undertaken with a full report coming back to the Committee in January including an action plan on how to manage incidents going forward.
NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 2
Action: AH to provide a report on the IT investigation to the January Committee AH
HVL questioned that due to fragmentation and multiple organisations involved in IT there is no accountability and asked where the responsibility lies when there are incidents.
AH responded by saying that the CCG commission the HIS to provide network applications but then they have external providers who have connections with BT. There is variation on which links
go into which site depending on practice and so potentially there are different providers involved. The expectation however is that the HIS manages these relationships and if they are unable to resolve problems at 3rd level then these are cascade upwards.
LM highlighted that the risk on the register is around major incidents and that in terms of accountability the CCG have a contract with the CSU for managing the HIS, she acknowledged that the whole relationship needs to be reviewed but advised the HIS is ultimately accountable. The shared service works across Staffordshire and this also needs to be reviewed. The CCG is responsible for the IT general practice model, the CSU manages the contract.
PS referred to business continuity plans in general practice and highlighted that when the system does go down it impacts on being able to see patients and to provide prescriptions. The issue is around communication to practices as the system doesn’t say when it is going down. EMIS does not seem viable and can be slow and needs to be reviewed.
LM asked members that in terms of the risk do they feel that the detail captures the essence of the risk on the register. Members felt that it probably did not and that 16 understate the risk however this is the maximum score that can be given.
JH raised that in respect of risk A160 this was now RAG rated as Green that MEGs are still under development along with the divisional committees and felt that the risk should not been green. LM agreed that there is work in progress and would move the risk to amber RAG rating while work progresses.
MWo raised concern around the issue logs which are currently under development corporately and was keen that the committee were aware of any issues that could potentially turn into a full risk. LM agreed that the confidential risk register would be brought back to future meetings.
Action: Confidential Risk register to be submitted to the Committee LM
To conclude, the North Staffordshire CCG Primary Care Commissioning Committee received and noted the Primary Care Risk Register; and Stoke-on-Trent CCG Primary Care Commissioning Committee received and noted the Primary Care Risk Register.
2018/DEC 5.2 Digital Presentation /122 Andy Hadley, Digital Programme Lead across the 6 CCGs gave a presentation on the digital programme to the Committee.
The presentation covered: • EReferrals • Document Management • Windows 10 • Online Consultations • GP Online – NHS App • Wifi Rollout • HSCN Network speed • NHS GP Lloyd George Records
AH also informed the committee that the CCGs have received over £4m in bids with potentially another £700k this year.
NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 3
TB commented that he was impressed with the programme of work that is ongoing around digital inclusion and recognised that there is a task that patients take advantage of the new ways of using this technology whilst recognising that staff as well as patients are comfortable and confident with new schemes are being set up as this is also around freeing up staff resources.
TB also asked whether there was any further updated on the integrated care records. AH advised that he was at a meeting last Thursday and the feedback was still that the tool needs to be procured, the spec is nearly finalised but will need to go out for procurement in the new year. There are lessons learnt from the previous procurement and there is a more robust process and better specification in place this time and AH was confident that the vision will be delivered that it set out to do. AH would provide a further update in January.
In terms of Docman10 AH advised that another days training has been put in place to ensure that when the system is implemented that practice are given the right level of support. The GP IT team have invested in year to provide office training and EMIS training and are looking to invest going forward to keep a digitally enabled workforce also.
PD also highlighted the need to do some public engagement around digital systems and to ensure patients are aware of the digital systems that are in place and how they can use the apps ensuring they are NHS apps and not commercial companies. AH advised that NHSE and Digital are key in developing the new NHS app which will support citizens in knowing which apps are accredited for use as there are a lot on the market available to use and it can be difficult to know what is best.
JH asked about data sharing agreements as although they can be more difficult, some schemes are logical and if there is no data sharing agreements the schemes could fail. AH acknowledged that this is massive challenge but advised that there is a specific work stream set up to ensure information is provided locally and that there is an adequate data sharing agreement in place to share patient information. The core question is around do we need one, how do we implement it and how do we get support.
LM thanked AH for his work on the Digital programme and in attracting money for Staffordshire which is one of the most advanced counties in the area in respect of this programme.
Members RECEIVED the presentation.
2018/DEC 5.3 Primary Care Delegated Budgets /123 There was no finance representative at the Committee. LM advised members that there is a significant financial risk in the budget. Factored into the forecast is the national GMS pay uplift. There is a risk to the Stoke on Trent budget around lease costs and these are being dealt with outside the meeting. Finance will bring provide an updated report would come back to the January meeting
JH commented that as a Committee it should be noted how disappointed members were that there was no finance representative at the meeting to present the finance report. Whilst it was acknowledge the capacity issues in the finance team the committee needs to be signed on financial issues. LM agreed to raise this issue with AM.
Members RECEIVED the presentation
2018/DEC 5.4. NHSE Merger Policy /124 Terry Chikurhune presented the report to the committee and highlighted that Merger Policy applies to all requests for all GP merger requests. There are two elements to the policy; flexibility around enabling GP practices to come together and issues of the Commissioners to consider when any such proposal is made are the benefits to patients and the financial implications of the practice merger. The emphasis for any merger is around access for patients and ensuring that when practices are proposing to merge they may be restricting patient choice and need to be conscious of this. In terms of mergers there needs to be engagement with patients and the commissioners have a
NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 4
duty to ensure that services are being delivered sufficiently.
The Policy lists the most common ways in which practices can come together. There are 4 models which most mergers fall under.
PD advised that the report had been submitted to the Committee as it was unclear what the gift of the committee was with a question around how to move forward with practice mergers. LM also commented that once the Primary Care Strategy has been refreshed that practice mergers will become a core component. Whilst the document is very technical there are also other things to be considered such as development, clear transition for bringing practices together.
HVL asked whether the policy was a national policy as he wasn’t aware of option 4. TCh confirmed that it was and that practices cannot become a limited company as this can only be considered under APMS contracts. Nationally it would be discouraged to look at limited companies.
WA also raised that when considering mergers there needs to be assurance around what practices say they will deliver and what is being delivered. There needs to be mechanisms in place to monitor mergers for the first 6 months. TCh responded to say that practices are referred to the CCG to hold discussions on what the expectations would be. Within the policy the commissioner would ask for a business case for any practices coming together which would articulate engagement with patients, opening hours and which practice takes over the new contract. This would be required in order that a decision could be made to support or not.
MWo also raised that the QIA and EIA process needs to be implemented within the process to measure the quality and equality impact of these issues and highlighted that these are not mentioned in the document under public engagement and these should be made in advance of any decision being made. RW confirmed that this is contained within the document.
With regard to section 7.11.30 this relates to Regulation 72 of the PCR 2015 contract, JG asked whether there was any sight on the modified contracts as if some mergers are potentially new contracts out for procurement then members need to know. . PS also raised that across the country the public feedback on practices is usually less for larger practices and highest for smaller practices. He is also aware that practices that are collapsing the most are the bigger practices and whilst noting that there is a merger policy from NHSE asked whether there was a de-merger process. LM confirmed that these issues would be included in the strategy going forward. Where a practice does experience problems then the commissioner would step in. TC also confirmed that a merger requires only one contract to remain and the others to be terminated and therefore once a decision to merge has been made and the practices concerned have come together, the merger
It was highlighted that there is an obligation on chairs and executives that when papers are brought forward that all elements are completed i.e. QIA and EIAs in order that informed decisions can be made as part of the process.
LM informed members that in terms of contract management, work is ongoing to improve the processes and the advised that the auditors will be looking at Quarter 4 and will make recommendations on what can be done better. Some mergers have happened quickly but QIAs and EIAs need to be done and will be incorporated into the review.
Members RECEIVED the report.
2018/DEC 6.1 Primary Care Quality Report /125 Tracey Cox presented the Quality Report to the Committee and highlighted the following to members: North Staffordshire CCG • The CQC, on their website, have combined Midway and Lyme Valley Medical Centres, this is incorrect as they are two separate practices residing in one building. The ratings have been combined and the CCG are challenging the CQC and will be meeting with them to discuss later
NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 5
today. • The CQC published on 16 October that the Betley practice now has a rating of good overall. Stoke on Trent CCG • Two inspection ratings have been published. Cobridge Surgery is rated good overall. There had been an error in that the surgery was rated good overall in September 2015 and not requires improvement, the practice is rated as good overall for 2018. • Harley Street medical centre is now rated good overall.
In terms of the quality dashboard: • Two practices in North Staffordshire are currently on level 3 monitoring. Regular meetings are taking place with the practices and actions are being taken to address the issues. • One practice in Stoke on Trent is on level 1 and the practice are being supported.
TCo advised the committee that the Primary Care team have been undertaking visits across all CCGs to discuss specific Long Term Conditions (LTCs). The three LTCs include respiratory, diabetes and circulatory. Engagement with the practices around LTCs will take place to ensure they are using the appropriate pathways. Practices are doing really well and reports will be sent out to practices with further detail on activity and spend.
The National GP Patient survey results for 2018 were published in August 2018 relating to data collection in January to March 2018. The questionnaire was significantly redeveloped ahead of the fieldwork to reflect changes in primary care services in England as set out in the GPFV. Therefore trends form previous years cannot be presented as results are not comparable. Individual GP results have been reviewed in line with the dashboard review meeting and results will be highlighted to individual practices as a result of this.
TB commented on the differences across the whole of Staffordshire for quality. TC commented that a 360 degree report also covers a number of areas and both these tools will be used when undertaking quality visits with practices. LM highlighted that in the south the practices also have a ‘Plan on a Page’ and the CCG could be looking to use the same in the north which can be used for localities to peer review themselves. These are then factored into the membership agreement and reported through localities on areas where improvements can be made. LM is looking to roll this out across the whole of Staffordshire.
LH highlighted that issues should be picked early and asked whether this was the case. LM recognised that this was a fair point and has had a conversation with LC, JG and the LMC about reviewing all practice through quality visits and also has the support of the intensive support team and CQC but there would be times when speedy actions have to take place.
Members RECEIVED the report.
2018/DEC 7. Any other Business /126 Questions from the Public No questions received from members of the public.
Any other Key Issues No further issues raised.
Committee Effectiveness 1. Did we achieve what we set out to do linking back to the Agenda? An agenda item was missing and there was no representative from finance and so the meeting was not quorate. It was noted that papers would normally be presented by an officer of the CCG. 2. Was the information presented appropriate/easy to understand? Yes 3. Was the information received in a timely manner prior to the meeting? Do we need to inform our decision? Yes/No 4. Do we need any more information / require a further progress report at a later date? Agreed actions captured in the minutes? - Actions incorporated within the minutes. The minutes from the last meeting need to be reaffirmed in January when the meeting will be quorate.
NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 6
5. Were there any risks raised in the meeting that should be captured in the risk register? Will escalate risk around engagement. No Date and Time of next meeting Date Time Location Chair Tuesday 8 January 2019 09.30am Bridge Centre, Birches Head Road, Birches Head ST2 MWo 8DD All parties should note that the minutes of the meeting are for record purposes only. Any action required should be noted by the parties concerned during the course of the meeting and actions carried out promptly without waiting for the issue of the minutes. These minutes are signed as being a true record of the meeting, subject to any necessary amendments being made, which will, if any, be recorded in the following meeting’s minutes.
Signed: ...... Position: ...... Date:......
NS Accountable Officer: Marcus Warnes SOT Accountable Officer: Marcus Warnes NS Clinical Chair: Dr Alison Bradley SOT Clinical Chair: Dr Ruth Chambers OBE 7
Enclosure 4.2 Action Tracker from September meeting of North Staffordshire and Stoke-on-Trent CCG Primary Care Commissioning Committees’ Public Session
MEETING Responsible AGENDA ITEM Action Outcome / update DATE Officer Actions from October 2018 meeting
Minutes/actionsheet and matters PC Delegated Budget update to be presented Update to be provided under 04/12/2018 Sarah Jeffery arriving to the January committee item 5.5 on the agenda
AH to provide a report on the IT investigation 04/12/2018 Primary Care Risk Register Andy Hadley Item deferred until February to the January committee
Confidential Risk Register to be submitted to Included on the confidential 04/12/2018 Primary Care Risk Register Lynn Millar the confidential session agenda
Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
REPORT TO:
North Staffordshire & Stoke on Trent CCGs
Enclosure: 5.1
Report to: Primary Care Commissioning Committee Meetings in Common
Title: Access to Primary Care for Homeless People
Meeting Date: 8 January 2019
Executive Lead(s): Exec Sign-Off Y/N Author(s): VOICES Healthwatch Anna Collins Y Expert Citizens Keele University
Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): Lorna Clarson
Action Required (select): Decision Discussion X For Assurance / For Information
Purpose of the Paper (Key Points + Executive Summary):
The purpose of the report is to inform the committee about the degree to which patient registration for general practice conforms to the operating principles as set out by NHS England in the context of people experiencing homelessness in Stoke-on-Trent.
The report is based on primary research conducted by final year medical students from Keele University as part of a student placement scheme. They followed the direction and methodology designed by VOICES, Expert Citizens, and Healthwatch for an earlier research project to understand the impact of actions taken in the interim.
The research takes the form of a mystery shopping exercise where a person acting as a support worker attempts to register an individual with a general practitioner that is of no fixed abode and is unable to provide ID. This is a typical scenario for someone experiencing homelessness and particularly street homelessness.
The objective of the report and presentation is to ascertain the appetite of the CCG in making common cause with the authors (VOICES, Healthwatch, and Expert Citizens) in addressing the recommendations set out in the report, or indeed, identifying other action which the committee believes would be effective to improve access to primary care registration for the homeless.
As partner organisations feeding in to the Committee post hoc on work conducted through their normal business, they have not conducted a quality or equality impact assessment. However, this report would certainly be pertinent to both assessments should the committee decide to offer instruction to CCG officers in further work on this matter.
1 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register):
Implications: Legal and/or Risk CQC Patient Safety Patient Engagement Financial Sustainability Workforce / Training
Key Requirements: Yes No 1. Has a Quality Impact Assessment been completed? X Please provide detail within the body of the report
2. Has an Equality Impact Assessment been completed? X Please provide detail within the body of the report as to these considerations:
• Can you confirm an Equality Impact & Risk Assessment (EIRA: stage 1 & 2) has been completed; if not, what is the rationale for non-completion?
• Which if any of the nine Protected Groups were targeted for engagement and feedback to CCGs, and why those?
• Summarise any disaggregated feedback from local Protected Group reps about any negative impacts arising / recommendations (e.g. service improvements)
• What mitigation / re-shaping of services resulted for people from local Protected Groups (along the lines of ‘You Said: We Listened, We Did’?)
• Explain any ‘objective justification’ considerations, if applicable
Key Requirements: Yes No 3. Has Engagement activity taken place with Stakeholders / Practices / X Communities / Public and Patients Please provide detail within the body of the report
Recommendations / Action Required:
The Primary Care Commissioning Committee is asked to:
• Consider the content of the report and its recommendations
2
National context
• Big Lottery Fund • £112m over 8 years • 12 areas • Systems change • Lived experience • National evaluation Multiple needs
• Combinations of: • Homelessness • Mental ill-health • Addiction • History of offending behaviour • Also: • Not engaged in services Service coordination
• Initial engagement • Immediate offer of help • Personal budget • Assertive advocacy • Service coordination plan • Safety and wellbeing plan • Start with people’s strengths Expert Citizens
• People with lived experience • Community Interest Company • Raising awareness • Platform for consultation • Insight Evaluation • Insight Awards • Peer mentor service Expert Citizen Insight
• Amplifying the voice of people with lived experience • Evaluating services against the ‘insight’ standards • Run a national ‘positive practice’ awards • Assist commissioners with consultations • Promote empathy, combat stigma and discrimination Healthwatch
Healthwatch Stoke-on-Trent is the independent champion for health and social care in Stoke-on-Trent. Our job is to give you a voice and support the interests of local people in how services are run and planned.
“The majority of patients will not find it difficult to produce ID / residence documentation, however there will be some patients who do live in the Patient practice area, but are legitimately unable to produce any of the listed documentation. Registration: Examples of this may be; Standard • People fleeing domestic violence staying with friends or family • People living on a boat, in unstable accommodation or street homeless Operating • People staying long term with friends but who aren’t receiving bills • People working in exploitative situations whose’ employer has taken Principles for their documents • People who have submitted their documents to the Home Office as part Primary Medical of an application • People trafficked into the country who had their documents taken on Care (General arrival • Children born in the UK to parents without documentation” Practice) Page 8 n = 45 Reasons cited for not registering a homeless patient: • “we cannot register someone with no paperwork” • “we don’t take anyone until they prove who they are” • “cannot accept anyone without ID” • “cannot accept anyone outside of the catchment area” • “go to a practice that deals with NFA patients” And finally … • a practice had declined to accept a patient registration as they did not “want his sort in here” Address
Out of the 40 practices
• 5 practices happy to use VOICES address
• 2 practices reluctant to use their own address
• 5 practices happy to use their own address
• 10 practices would not register clients who were not residing in the area
• Commissioners make formal contact to remind practices of patient registration principles as they relate to people experiencing homelessness • Devise a registration tool or check sheet for practices to use with patients that present with no ID • Provide awareness training on homelessness for practice staff and managers Recommendations and offer QUESTIONS www.voicesofstoke.org.uk www.expertcitizens.org.uk Steve’s story
• Rough sleeping and begging • Alcohol dependent • Intrusive and repetitive thoughts • High levels of anxiety • Serious concerns about mental health • Estranged from family • Experienced abuse from the public • High use of A&E and emergency services • Police receiving complaints • History of abandoning accommodation Steve’s story
• Bright and articulate • Successful business manager • Previously a home owner • Previously in a long-term relationship • Proud father with child at university • Diverse interests Steve’s story
• Secured access to supported accommodation • Accessed benefits and advice • Reengaged with GP, secured a CPN • Police were moving towards enforcement • Worked with the police to help approach • Maintained tenancy • Engaged better with services • Has since moved to other accommodation with more support Jane’s story
• Chaotic behaviour • Pregnant when referred to VOICES • Continuing to use substances • Poor mental and physical health • Frequent use of blue light services • Abusive relationships Jane’s story
• VOICES worked with drug and alcohol services • Secured funding for and access to a specialist service (out of area) • Engaged well in that service • Became drug and alcohol free • Remained in service with child • Closely monitored by social care • Accommodation secured • Has maintained custody and accommodation Dave’s story
• Father died, grief stricken • Evicted from property • Unstable housing situation • Heavy drinking, peer pressure • Chaotic behaviour • Cycle of hostels, eviction, and street homelessness • High frequency blue light usage Dave’s story
• Secured rented property • Assisted to establish the home • Accessed community detox • Six weeks later, volunteering • Completed Peer Mentor training • Made rapid progress • Secured full-time employment Our local partnership Our formal partnership: Associated organisations: • Arch • CDAS • Aspire Housing • Emmaus Potteries • Brighter Futures (lead partner) • Gingerbread • Citizens Advice • Healthwatch Stoke • Stoke-on-Trent City Council • NSCH NHS Trust • Expert Citizens • Staffordshire Probation • Office of the Police & Crime Commissioner • Clinical Commissioning • Saltbox Group • Staffordshire Housing Association • Faith based groups • Staffordshire Police • Plus more… • North Staffs YMCA
Expert Citizens CIC
Access to Primary Care Services for Patients with “No Fixed Abode”:
March 2018
A follow-up of The Gatekeeper’s Report Acknowledgements
Expert Citizens C.I.C. would like to thank the primary health care centres that took part and those who took time to respond, Healthwatch Stoke-on-Trent and VOICES. A special thanks to GP Students; Sara Day, Rachel Morris, Rebecca Charles, Luke Bradshaw, Kajetan Karlikowski.
2 Introduction
Expert Citizens are a Community Interest Company who work to make services an even better experience for those needing support in Stoke- on-Trent. We all have experience of multiple needs: homelessness, offending behaviours, addiction, mental ill-health and poverty. As ambassadors, we use our experience and insight to raise awareness of multiple needs and to reduce stigma and stereotyping. Working alongside VOICES, Expert Citizens encourage local decision- makers to firstly listen and learn from lived experience. Expert Citizens have told their stories to a wider audience via BBC Radio 4, ITV, The Guardian and in the national and local press.
Over the past 18 Months, the Expert Citizens have been host to 2 rotations Darren Murinas of 5, year 5 GP students from Keele University. The first rotation - August to December 2017, conducted research to gauge the reach of the GP cards produced as learning from the original report. These cards were distributed Chief Executive across the city for those who were finding it difficult to register with a Expert Citizens C.I.C. GP. The cards state that the person wanting to register does not require identification or an address to register.
The second rotation, December 2017 to March 2018, reviewed findings Rachele Hine from the first rotation and studied the Gatekeepers report (2016). Together with Expert Citizens, they agreed to duplicate the mystery shopping exercise. Using the same script as in Gatekeepers (2016) the student group evidenced Operations Director their findings as a direct result in the following report. Expert Citizens C.I.C.
3 Table of Contents
Introduction ...... 3 Acknowledgements ...... 4 Aims & Objectives ...... 4 Methodology ...... 4 Results ...... 5 The number of Primary Care Services that would accept NFA Patients ...... 5 Barriers to registering NFA Patients ...... 6 Forms of Identification ...... 6 Address/Care of Address ...... 7 Lack of Knowledge of Front-of-House Staff ...... 8 Stigma associated with NFA patients...... 8 Exploring operating procedures at Primary Care Services who register NFA Patients...... 9 Recommendations ...... 10 Evaluation ...... 10 Handover & Future Developments ...... 11 References ...... 11 Summary ...... 12 Appendix 1: Mystery Shopping Exercise Script ...... 13 Appendix 2: Raw Data Set ...... 14 Appendix 3: Email sent to Practices who register NFA Patients unconditionally ...... 16 Appendix 4: Transcript of Meeting with Belgrave Medical Practice ...... 17 Appendix 5: Email received following publication of the Gatekeeper’s Report (2016) ...... 19 Appendix 6: Guidance on registering NFA Patients (Local Medical Committee and the Clinical Commissioning Group) ...... 20
4 Aims & Objectives Methodology
This project aims to evaluate access to This project was conducted in three primary care services for patients with stages. A “mystery shopper” exercise no fixed abode (NFA) and to establish was conducted by the group; all 52 if there has been any change in the General Practices across Stoke-on- willingness of primary care services to Trent were contacted via telephone accept NFA patients compared to the using a script formulated from the Gatekeepers Report (2016)4. Gatekeeper’s Report (2016)4. We recorded quantitative data regarding Our objectives were: which practices registered patients with 1. To establish the number of primary no fixed abode, and how many accepted care services that would accept NFA patients with no identification (ID). patients in Stoke-on-Trent. We collected direct quotes from the telephone conversations, which provided 2. To identify barriers to NFA patients qualitative data. registering with a primary care service. Following data collection, we contacted 3. To explore operating procedures for the primary care services who accepted registering NFA patients at primary NFA patients without ID. An email was care services who accept NFA. sent asking if they could provide more information regarding their procedures for registering NFA patients, and the number of registered NFA patients at their practice. We also asked the practices to take part in a discussion about their procedures and any barriers they have faced. Once the data had been collected it was analysed using Microsoft Excel.
5 Results
Can I register a NFA client at your practice? The number of Primary Care Services that would accept NFA Patients
We gained contact with 45 general practices in Stoke-on-Trent. The reasons for the reduction in number compared to the original report included practices shutting down, telephone lines not 62% 11% working and practices merging together. Out of 45 general practices, 40 (89%) of these were willing to accept patients with no fixed abode. However, when asked to qualify any restrictions regarding registration policies, the number of practices who were willing to register NFA patients without any restrictions dropped to 12 (27%) which is the same as in the Gatekeepers Report4. The other 28 practices impose various restrictions which would potentially prevent NFA patients from registering. 27%
Firm Yes
Conditional Yes
No
Figure 1:
Willingness of Primary Care Services in Stoke-on-Trent to accept NFA patients.
6
The number of Primary Care accept VOICES as an alternative. 9% of Services that would accept practices stated they were happy to use NFA Patients their own address as a care of address. It was identified that many practices Forms of Identification would only accept an NFA patient if In order to register an NFA patient, 17 they were “residing” in the area, or if practices required identification. Non- their care of address (VOICES included) photographic ID was accepted at 10 was within their catchment area. Ten of these practices, and suggestions practices would not register clients who included a utility bill with address, were not residing in the area. Despite benefits letter from the Department explanations that anyone who is of for Work & Pensions (DWP), or birth no fixed abode cannot prove they are certificate. The remaining 7 practices or are not “residing” within an area, required a form of photographic ID. these practices were unwilling to allow registration. The requirement for an NFA patient to provide ID is a major barrier to accessing healthcare. Many NFA patients do not have ID, and do not have the financial means to buy one. Even providing a letter from the DWP will soon become impossible as the department has decided to stop issuing letters. For many NFA patients, a lack of ID will make it difficult to access any community healthcare. It seemed under-appreciated that NFA patients might not have ID.
Address/Care of Address The requirement for patients to have an address was also identified as barrier to registering. The mystery shopper exercise revealed that practices had differing policies regarding this issue. We assessed the willingness of each practice regarding the use of their own address or whether they would accept VOICES as a care of address. Out of the 40 practices who accepted NFA patients, 5 practices were happy to use VOICES as a care of address. Two of the practices expressed reluctance to use their own address but would
7
Care of Address Lack of Knowledge of Front-of-House Staff Five practices said they would not register NFA patients. Reasons cited included: “we cannot register someone with no 36% 24% paperwork”, “we don’t take anyone until they prove who they are”, “cannot accept anyone without ID”, “cannot accept anyone outside of the catchment area” and “go to a practice that deals with NFA patients”. Interestingly, those who said no did not defer to the Practice Manager when giving this information. This highlights that the barriers faced by NFA patients may be unknown to Practice Management. Many of the practices that accepted NFA patients had to consult the Practice Manager for a definitive answer. This highlights a lack of knowledge of reception staff 14% regarding procedures. 17% 9%
Stigma associated with NFA patients Needed in area Generally, practices did not identify NFA patients as being an issue themselves. In Unsure a meeting where personal experiences were shared; a practice had declined to accept a patient registration as they did VOICES not “want his sort in here”. In this case, they were referring to the stigma of drug Surgery and alcohol abuse despite this not being applicable to the patient in question. In contrast, other practices have said Not needed - unspecified NFA patients were generally pleasant. One practice highlighted that no NFA patients had been removed from their list whilst they had previously removed Figure 2: patients with fixed addresses.
Practice responses to care of address.
8 Exploring operating procedures for their staff on the approach that they at Primary Care Services who should be taking when registering an register NFA Patients NFA patient. A third practice provided us with the guidelines they use that We then contacted the 12 practices that should be available to all practices from were willing to register NFA patients the Local Medical Committee and the unconditionally by email. This was to Clinical Commissioning Group. They also establish the number of registered expressed their concern that this was NFA patients at each practice, and to not followed by other surgeries. invite them to participate in an informal It is clear that there is guidance discussion of their operating procedures available, however, practices seem and barriers to registering NFA patients. unaware of its existence. This appears to We received three responses. be leading to restriction for NFA patients The number of NFA patients currently through no fault of their own. registered at the practices who responded varied from zero to three patients. This low number shows that the registration of an NFA patient is not a common scenario encountered by reception staff, particularly considering that these numbers are from practices who routinely accept NFA patients. It is likely that the front-of-house staff at the practices who are less flexible in registering NFA patients do not frequently encounter an NFA patient. This might account for the lack of knowledge of front-of-house staff. Three practices provided further information. Belgrave Medical Centre gave permission for their meeting notes to be used in the project context. They did not express concern with registering NFA patients, however, they mentioned that there may be reluctance in other practices due to uncertainty and lack of awareness of guidelines. This practice did not have any trouble in finding appropriate guidance for registering NFA patients. Another practice, who wished to remain anonymous, provided us with an email they received following publication of the Gatekeepers Report4. They stated that this was a reminder
9 Recommendations Evaluation
We have identified recommendations The data collection for this report was which would improve access to primary performed in three stages. We used care services for NFA patients. a number of different methods which provided a mixture of quantitative and An email could be sent to all primary qualitative data for analysis. care centres in Stoke-on-Trent detailing: The script for the mystery shopper • Results of this project exercise has a clear structure which is • Existing guidance for registering easy to follow. It is the same as the one NFA patients used in the Gatekeeper’s Report which made the data collection standardised Considering the lack of knowledge of and hence results comparable4. front-of-house staff regarding policies for registering NFA patients, a training The sample size of 45 practices covers session provided by VOICES might raise the majority of the total of 52 in Stoke- awareness and understanding of the on-Trent and so is significant at a local issues, and provide an opportunity for level. However, on a national level, this education, as well as providing a safe sample size provides limited statistical and non-judgemental environment in power for making inferences about which any concerns or questions could access to primary care for NFA patients be raised and addressed by the in the 7,613 practices in England5. VOICES team. Despite this, it is worth noting that healthcare practice across all of the NHS services in England is standardised, and hence the poor access for NFA 7,613 patients in Stoke-on-Trent might be Practices echoed across the country. It would be in England worthwhile repeating this project on a larger scale which could reveal that this phenomenon is a nationwide problem, rather than just a local issue. Another limitation is the poor response rate (3 out of 12) we received from the identified practices that register NFA patients. As we made contact via email, it is possible that a proportion never received or read this email due to being accidentally omitted or redirected to a SPAM folder. Had we used other methods of communication, such as Data telephone or visits to each practice, we sampled from might have been able to achieve a better 45 out of 52 response rate, and hence a better insight Practices in Stoke-on-Trent Stoke-on-Trent overall.
10 Handover & References Future Developments
Info - Expert Citizens [Internet]. Expert Citizens. 2018. [Accessed 15 March 2018]. This project has the potential to be Available from: developed and expanded by further www.expertcitizens.org.uk/info/ groups, including VOICES and Expert
Citizens in the following ways:
• Make contact with practices who Service Coordination - Voices of Stoke do not register NFA patients to [Internet]. Voices of Stoke. 2018 [cited 15 educate and explore their difficulties March 2018]. • Analyse relationship between social Available from: deprivation and acceptance of NFA www.voicesofstoke.org.uk/service/ patients
• Devise a flow-chart or hint sheet BMA - Patient registration [Internet]. for practices to use when registering Bma.org.uk. 2018 [cited 15 March 2018]. NFA patients Available from: • Plan and run a training session for www.bma.org.uk/advice/employment/ Practice Managers on the gp-practices/service-provision/patient- registration of NFA patients registration-for-gp-practices
Expert Citizens, VOICES and Healthwatch Stoke-on-Trent. Gatekeepers: Access to Primary Care for those with Multiple Needs [Internet]. Stoke-on-Trent; 2018. Available from: www.voicesofstoke.org.uk/wp-content/ uploads/2018/02/Gatekeepers_REPORT. pdf
[Internet]. Bma.org.uk. 2018 [cited 20 March 2018]. Available from: www.bma.org.uk/-/media/files/pdfs/ news%20views%20analysis/press%20 briefings/general-practice.pdf
11 Summary
Expert Citizens C.I.C. hope to share learning from both reports through awareness sessions and learning opportunities, relating to the registration of patients with no fixed abode. This will include learning from the NHS England Guidelines. We would also like to enhance awareness of the GP cards by making these more widely available and equipping frontline staff, including reception staff, with the knowledge and confidence to successfully register all patients of no fixed abode.
I do not need a fixed address I have a right to register & receive I do not need identification treatment from a GP practice My immigration status does not matter My NHS Number (If known) If I have any registering or accessing a GP practice my local Healthwatch can direct me to advice See the Patient Registration Standard Operating Principles for Primary Care 01782 683080
12 Appendix 1: Mystery Shopping Exercise Script
“Hi, my name is , I work at VOICES. I am just ringing to see if it would be possible to register somone I am supporting who is homeless”
“Yes, if he “Yes, but he “No, we will has a care of “Yes” will need ID” not accept” address”
“I am sorry, he does not have any “I am sorry, “Can you ID. Can you he does not recommend recommend have one” anywhere?” what I should do?”
Offers Answers Answers Declines Surgery Log Advice Log Advice Address
“Thank you, I will see if my “Thank you. customer wants to register “Thank you. Goodbye” here. If he does, I will be in Goodbye” touch”
13 Appendix 2: Raw Data Set
Contact NFA Accepted ID Accepted Additional Notes Made To speak to the practice manager as there is no ID .”we 1 Yes Receptionist Unsure Not needed do take homeless pts”. I asked if we could use VOICES as NFA she was unsure and will call back (will follow up) Go to a practive that deals with NFA --> Dr ready at 2 Yes No Yes Shelton? If he’s used NHS before or registered with another GP he 3 Yes Yes - Voices Not needed can sign up, can have someone who works for VOICES to vouch for him
4 Yes Yes Not needed Surgery address used
5 Yes Yes Not needed GP/VOICES as address
“Can’t refuse to see anybody, if urgent go to walk in.” To 6 Yes Yes Unsure ring back Tuesday “Need to be registered closer to VOICES address” was asked where he slept last night. suggested health and 7 Yes Yes - Only in area Not needed well being clinic in Hanley walk in. Said ring back too to see what the practice manager says “we don’t take anyone until they prove who they 8 Yes No Needed are”...”can’t register with no address”... “ring back after wednesday”
9 Yes Yes Not needed Yes just speak to the manager
“Can’t register someone with no paperwork” “can never say we will take you on, to any patient” go to walk 10 Yes No Needed in centre. Told to ring back to speak to the practive manager
11 No - - Couldn’t get through will try again
12 SHUT DOWN N/A N/A
Unsure if no ID or care of address - recommended 13 Yes Yes Ideally Passport coming into surgery and discussing Dr preferences Will accept Post Office card if claiming benefits. Had to 14 Yes - Reluctant Yes Needs some ask manager, care of address they are unsure about and will sort when client comes in to the practice Will have to re-register as a temporary patient each time 15 Yes Yes, only as temporary No they need to be seen
16 Yes Yes Not needed Offers practice as c/o address
Offers practice as c/o address but reluctant to accept out of area patients. Had to ask PM, would not say no to NFA 17 Yes Yes No, but need NI number patient but says they are normally allocated them from a service called Registrations Not needed but ideally Need to use VOICES as care of address - fine that it is out 18 Yes Yes - See Practice Manager bring something with date of area of birth Joined with 19 N/A N/A Dr Shah Had to ask, asked to come in and discuss address 20 Yes Yes Not needed problem but will register
21 No - - Goes through to Adderley Green/Dr B Patel
Offers practice as c/o address but wants to register with 22 Yes Yes Not needed Dr Kulkarni in same health centre as his list is smaller Yes - come to surgery to fill Surgery volunteer as c/o address with mobile number for 23 Yes in forms with ID/letter with a friend so that can be contacted by surgery. name on eg. benefits letter YES- come to surgery to fill in forms asked if prev. 24 Yes GP in uk- so long as can No c/o address required give nhs number no other documents required
25 No To ring back
NO- if ID cannot accept- may accept with birth 26 Yes certificate but still not certain.
14 Contact NFA Accepted ID Accepted Additional Notes Made Yes but only as last resort due to catchment- ID and 27 Yes c/o address not an issue in such a case.
28 No DOES NOT CONNECT WILL RETRY
29 No DOES NOT CONNECT WILL RETRY
Yes- Form needed to be completed plus birth Not essential but any 30 Yes certificate/letter with additional info welcome name on Need to come into practice, complete forms and 31 Yes provide a letter of recommendation from VOICES with serviceusers name. Process takes 48 hours. Forms in practice c/o Need to provide a contact number of patient or friend/ 32 Yes surgery accepted relative/mentor
33 Yes Yes Not Needed Needs to come to the surgery to register
Only if within their area (Stoke isn’t), to register would need to come to the surgery to give them their details, 34 Yes Yes Not Needed Recommended 2 surgeries (Foden street and Stoke Health Photo ID (any) Plus utility 35 Yes Yes Recommended trying Haymarket Health Centre bill required as a minimum. Was told some of their GPs have left and so not at capacity at the moment and won’t be taking any new 36 Yes Not taking any new patients N/A patients on for a while (recommended Belgrave Medical Centre) Their policy is such that to register, would need to get a doctor’s apointment but they’re fully booked for the coming weeks. Receptionist wasn’t familiar with their 37 Yes - - surgery’s policy on registering homeless and the practice manager wasn’t available to advise. Recommended to try with Willowbank Surgery. Must have a proof of adress that’s in their catchment area 38 Yes No N/A (recommended trying Hanley walk in centre) Would need to come in to practice to fill in a registration 39 Yes Yes Yes (Photo ID) form and book a Nurse appointment for a health check. Only if residing within area; would need to come to the surgery to fill in a fregistration orm (advised to try Stoke 40 Yes Yes Not Needed Health Centre as it may be more practical if he resides in Stoke) c/o address required, but could use that of VOICES (but not their), would need to come to the surgery with a 41 Yes Yes Not Needed letter from VOICES confirming they’re happy to act as his c/o and he’d need to fill in a registration form whilst there. c/o address required, advised for him to come to the practice to go through the registration forms and to see 42 Yes Yes Not Needed if they can work something out wrt his c/o; didn’t give a straight answer if could use their or VOICE’s address as c/o would need to use VOICES as c/o address and would only 43 Yes Yes Not Needed accept if VOICES address was in area would only accept if this practice was the practice 44 Yes Yes - Disclaimer Not Needed they were registered at before they became homeless, otherwise wouldnt accept
45 - Yes Yes - Photo ID Only if residing within area
46 Yes Yes No Only if residing within area
Can register without photoID at PMs discretion - would 47 Yes Yes (Goes through practice) Yes Photo ID need a face to face visit to register and takes 2-3days Need some form of proof eg benefits letter, PM would 48 Yes Yes Yes need to see face to face Was happy to register them over the phone - will see all 49 Yes Yes No homeless patients without ID or a c/o address - but the more info the better
50 Yes Yes Yes Photo ID Only if residing within area
51 Yes Yes Yes Photo ID Only if residing within area
Would need some proof that they are who they say they 52 Yes Yes Yes are, eg benefits letter etc - would not accept letter from voices and pt would also need to attend to fill in forms
15 Appendix 3: Email sent to Practices who register NFA Patients unconditionally
Dear Sir/Madam, Following on from this, we would love to organise a short meeting with I am writing to you on behalf of VOICES your Practice Manager/GP Partner to of Stoke, a charity organisation that discuss your protocols for registering supports citizens of Stoke-on-Trent NFA patients. Your contribution, with with multiple needs. We have recently your permission, will form part of the conducted some market research project report and ongoing strategies to regarding access to primary care improve access to primary care services. services for patients with no fixed abode (NFA). If you would be happy to be involved, please contact us via this email and we We were delighted to find that your can take things forward. practice responded very positively to our market research and were happy to register patients with no fixed abode. This positively reflects the work we have Hoping to hear from you soon, been doing to improve access to primary care services for these patients. We would like to thank you for your ongoing Best wishes flexibility in registering NFA patients. Following on from our market research, we are making contact with the practices that responding positively in the hope of gaining insight into your protocols for NFA patients, and why you as a practice are confident in registering these patients. We will use this information to educate other practices in the area, in order to hopefully improve access to primary care services for NFA patients. We hope that they will be able to follow on from your good example and implement similar protocols. Would you be happy to provide us with the number of patients with no fixed abode that you currently have registered at your practice? We would not need any identifiable information, just the total number of NFA patients.
16 Appendix 4: Transcript of Meeting with Belgrave Medical Practice
Attendance: Rachel Morris, Kajetan Q: Are there any barriers Karlikowski, Practice Manager associated with patients who and Assistant Practice Manager of have NFA? Belgrave Medical Practice. A: It has never been an issue. We have Permission obtained to use quotes never removed a patient from the with names. practice list whereas we have done with patients with a fixed abode. With all patients, there are three warnings Q: How are patients with NFA issued for patients who do not attend registered in the practice? appointments, after this they are removed from the list. A: We ask all patients to fill in the standard registration form with two All patients have one warning for forms of ID. Patients with NFA therefore unpleasant behaviour, then are removed have difficulties with this, so we ask if this reoccurs. for as much information as possible. Location is not a problem - Examples of this can be previous home we understand patients may not address, previous GP, a phone number necessarily be in the catchment area all so they can be contacted and if the the time, we still treat them. Some of our patient has a preferred address they patients are “sofa surfers”. would like the GP to be contacted on. If they have no address we can use, we use the practice address. Q: Are patients with NFA treated any differently? Q: What training/information have A: If anything, we are more lenient as you received regarding patients they are more vulnerable. We sometimes with NFA? give them a cup of tea and some biscuits, so we know they have had at A: Reception staff are trained in least something to eat. We offer health registering new patients of all reviews too. backgrounds during their 4-week induction period. We receive guidance from the CCG and local medical committee.
17
Q: How many patients with NFA are registered? A: 3 plus (one recently deceased).
Q: Do you offer any other services? A: we don’t have an enhanced service for drug misusers. They are usually under the drug and alcohol team in willow banks - Longton.
Q: What patients can you refuse from your practice? A: If they are out of area (with exception NFA) • If they try to re-register after being removed from the practice list.
Q: Why aren’t all GP’s allowing patients with NFA to register? A: perhaps lack of awareness and guidelines, • Reluctance • Uncertainty of what it involves.
Cannot recall getting an email about Gatekeepers.
18 Appendix 5: Email received following publication of the Gatekeeper’s Report (2016)
Dear Colleague
Following the publication of the report: I have suggested to the homelessness Gatekeepers; Access to Primary Care for project that we strive to make those with Multiple Needs (Healthwatch individuals aware of their NHS number Stoke on Trent and VOICES, 2016), to make ad hoc medical interventions we have been working with various clinically safe for all concerned but organizations around the difficulties 100% penetration of this idea will not homeless individuals face in accessing be achieved. I would welcome any new primary care services. suggestions on how we can meet the needs of this group of patients and want Although there is a lot of excellent to thank everyone in anticipation of support for this group taking place their continuing efforts in meeting their in primary care, there is anecdotal health needs. evidence that individuals are being denied access on the basis of having If you have any doubts about registering no home address, and on occasions are patients please refer to the document being signposted to the other services Patient Registration Standard Operating many miles away that would involve Principles for Primary Medical Care transport costs that they may not be (General Practice) (NHSE, 2015) which able to meet, or more concerning, have will provide you with the guidance you involved the patient walking many miles. need (attached for information). I am sure you would agree that this is not in the interests of this cohort of vulnerable patients, although there is an Warm Regards appreciation of the difficulties practices face in dealing with requests for review at short notice without access to the relevant medical records. I would like to remind practices that it is possible to register patients without a formal address and not having an address is not a reason to refuse registration of a patient. Of course, we can also see patients under the “emergency treatment necessary” initiative as a one off.
19
Expert Citizens CIC
Expert Citizens C.I.C. Floor 1, Federation House Station Road, Stoke on Trent. ST4 2SA
01782 450760 [email protected] www.expertcitizens.org.uk
Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
REPORT TO: North Staffordshire & Stoke on Trent CCGs
Enclosure: 5.2
Report to: Primary Care Commissioning Committee Meetings in Common
Title: Primary Care Risk Register
Meeting Date: 8 January 2019
Executive Lead(s): Exec Sign-Off Y/N Author(s): Sally Young, Director of Corporate Y Tracey Revill, Governance Manager Services, Governance & Comms
Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): N/A N (internal CCG work programme)
Action Required (select): Decision Discussion For Assurance / For Information
Purpose of the Paper (Key Points + Executive Summary):
This paper provides an update to the Primary Care Commissioning Committee about the risk register for those risks that the committee has oversight of. The attached register highlights all risks currently on the register as of 8 January 2019.
The Audit Committee meetings in common discussed the full risk register at the December meeting and in particular about the contents of the register and how this should be improved, comments which have been echoed in other CCG sub-committees.
The Audit Committees were not assured by some of the mitigating actions as recorded, and that many of the updates were not timely and scores are not decreasing (suggesting that the mitigations as listed were not making much difference). Members have asked that the risks themselves include detail of the consequences of not managing each risk. The Audit Committees have also asked that Executive Directors attend future meetings to present their risks and Directors will be receiving invitations to do so.
The management and mitigation of risk is a key part of demonstrating we are an effective organisation and it is worrying that the Audit Committees are not assured with how we are currently doing this. It is important this is remedied quickly. So the Accountable Officer has agreed with the Director of Corporate Services, Governance & Comms that the following various steps are to be put in place to ensure the Risk Register is managed effectively, with appropriate mitigations:
• Exec Directors to review their risks, in particular the wording and appropriateness of the risk, as well as mitigating actions recorded. Internal Audit want to see evidence identified as part of the mitigations (e.g. Board reports / papers regarding the risk)
- The Governing Body Risk Register report’s front cover is to be replaced with a more detailed paper to include the following changes - Scores for individual risks and the reasons, along with new risks and risks recommended for
1 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
closure
- More narrative to explain this will be written in Board report format (as per Quality or Finance reports)
- The Corporate Risk Register for risks scoring 12+ will be presented in a font that is legible, as will the Board Assurance Framework (BAF) once this developed and agreed by February
- This report will be developed by the Governance Team, however Execs should be prepared to provide detail of their particular risks in the meeting if requested by Governing Bodies
• Each Governing Body, formal Sub-Committee, Divisional Committees, the Turn-Around Board and Exec Management Team (EMT) meetings will include an agenda item at the end of the agenda for new risks identified during the meeting. These new risks will be incorporated into the Register by the Governance Team with appropriate Exec Director input.
• The new Risk Strategy set out how the Single Leadership Team (SLT) would review risks on a monthly basis. Unfortunately given the pressure on the agenda this has not happened, and therefore the pan-Directorate Risk Group will be re-instated to ensure the management of risk is reviewed in detail on a monthly basis.
• The Risk Register is shortly about to move onto a new electronic system (Datix), which should make it easier to update. The Governance Team will provide any support necessary to Execs and their Risk Owners to ensure that people are able to use the system and remain aware of the requirement for consistent risk assessment (scoring and mitigating actions / consequences description).
As noted above the development and agreement of a combined BAF is targeted before the end of the financial year; pending the finalisation of formally agreed objectives - a draft set has been developed for initial SLT discussion, and it is anticipated that the new OD provider will set up a formal session with Governing Bodies to develop longer-term objectives.
Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register): N/A – all risks are covered within the register.
Implications: Legal and/or Risk Joint working legalities c/o CCG governance Frameworks, Committee TORs etc CQC N/A Patient Safety Risk, assurance + clinical governance duties of CCG Quality Committees Patient Engagement Risk, assurance + clinical governance duties of CCG Quality Committees Financial Risk, assurance + financial governance duties of CCG Committees Sustainability A positive governance culture secures ownership of the transformation agenda Workforce / Training Risk awareness + process training delivered as part of the OD agenda
Key Requirements: Yes No 1. Has a Quality Impact Assessment been completed? N/A Please provide detail within the body of the report
2 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
2. Has an Equality Impact Assessment been completed? N/A Please provide detail within the body of the report as to these considerations:
• Can you confirm an Equality Impact & Risk Assessment (EIRA: stage 1 & 2) has been completed; if not, what is the rationale for non-completion?
• Which if any of the nine Protected Groups were targeted for engagement and feedback to CCGs, and why those?
• Summarise any disaggregated feedback from local Protected Group reps about any negative impacts arising / recommendations (e.g. service improvements)
• What mitigation / re-shaping of services resulted for people from local Protected Groups (along the lines of ‘You Said: We Listened, We Did’?)
• Explain any ‘objective justification’ considerations, if applicable
Key Requirements: Yes No 3. Has Engagement activity taken place with Stakeholders / Practices / N/A Communities / Public and Patients Please provide detail within the body of the report
Recommendations / Action Required:
The North Staffordshire and Stoke-on-Trent CCG Primary Care Commissioning Committee is asked to:
(1) Note that assurances for risks scoring 12 and above have been sought and the register has been updated accordingly
(2) Review and make any comments regarding the content of the Risk Register and identify if they require any further assurances in regard to the risks recorded
3 Version Control CCG CORPORATE RISK REGISTER (Clinical and Non Clinical Risks) Version 20 Author North Staffs and Stoke-on-Trent CCGs Primary Care Committee Date 03/01/2019 Recommend Closure
SCOPE OF RISK NATURE OF RISK STAKEHOLDERS INHERENT RISK TREATMENT & CONTROL MECHANISMS TARGET RESIDUAL Action Risk Directorate Trend CCG inc CONSEQUENCE (Risk Type) (Org Name) SCORE (Initial Mitigating Actions to reduce to TARGET RISK SCORE - to be supplied). SCORE SCORE (L Completion Date Owner(s)
Risk Ref Risk (Risk Description) (L x C) (Including any policy or strategy implications) (L x C) x C)
WORKFORCE: Clinical, Operational and Financial risks. Challenge North Staffordshire CCG 16 Updated 03 January 2019 16 Lynn Millar, Lynn Millar, Director of North Staffordshire CCG GP RECRUITMENT AND RETENTION: Failure to stabilise in delivery of constitutional targets which may Stoke-on-Trent C CG (4x4) Risk Owner has advised that there is no further update to add to those given on 26 September 2018. (4x4) Director of Primary Care Stoke-on-Trent CCG General Practice due to national shortage of GPs / impact on patient care and performance. Failure Cannock Chase CCG Updated 26th September 2018 Primary Care Cannock Chase CCG Practice Nurses. This shortage also spans health and to support and develop sustainable Primary Care Stafford and Surrounds CCG 1. Workforce plans and action plan developed by GPFV Workforce Programme - approved by NHSE workforce plan, includes recruitment and retention, Stafford and Surrounds CCG social care, in particular community nurses and other and General Practice. South East Staffordshire and international recruitment, training and development, new workforce models, Marketing Northern Staffordshire in partnership with BJM. South East Staffordshire and staff which may impact across the Staffordshire Seisdon Peninsula CCG 2. Workforce presentation to September PCC to provide assurance of delivery again plan. Seisdon Peninsula CCG footprint. East Staffordshire CCG 3. International recruitment scheme in progress. Task and Finish Group established. East Staffordshire CCG 4. North Staffs GP Federation successful in becoming one of the 11 national GP Career Plus Pilot sites. Advised further allocation of funding to be distributed, There is also a risk that due to the national workforce but no clarification of actual figures given at present. Figures scheduled to be released by end of May 2018 / beginning of June 2018. shortage, which spans health and social care in 5. Resilience funding bids approved to support new workforce models in practices - report to October 2018 PCC for assurance. =
A1.54 particular community nurses and other staff, this may 6. Releasing Time to Care - 990 care navigators trained to direct patients to appropriate services. impact across the Staffordshire footprint. 7. Releasing Time to Care - Brighton and Hove workflow training rolled out to practices. Evaluation to commence, along with sharing best practice events to encourage wider update. GP WTE trajectory 545 wte compare to a 595 wte target. 8. Practice Manager development funding plan continues to be rolled out via the Staffordshire training hub. 80 GP retirements expected within 3 years and 40 9. Baseline Exercise for workforce at Locality Level underway vacancies over 18 months.
Higher than average GP to patient ratios, particularly in Stoke-on-Trent and Stafford and Surrounds.
INVESTMENT Operational, Clinical and reputational risk. Failure North Staffordshire CCG 9 Update December 2019: 4 Melanie Lynn Millar, Director of North Staffordshire CCG LOCAL ENHANCED SERVICES to support and develop sustainable Primary Care Stoke-on-Trent CCG (3x3) 1. Primary Care investment review is now underway, with a supporting strategy being developed as part of the overall PC strategy. 2X2) Mahon, Head Primary Care Stoke-on-Trent CCG Variation in investment and service provision leading to and General Practice. 2. The following LES's have been prioritised and have action plans in place, proposed changes to be implemented by April 2019: of inequity for patients and poor outcomes. - Anticoagulation Commissioni - Spirometry ng (Planned There is a requirement to review all LESs to ensure that - Wound Care Care) they meet local need and there is equitable access to - Shared Care services by practice populations and services are of high - Elderly Care Local Improvement Scheme (LIS) North only quality and are cost effective. 3. PC investment steering groups have been established and met once, will continue to meet monthly throughout the review. A1.55 4. All initial engagement meetings have been completed across the 6 CCGs The risk is that these services have not been reviewed 5. All investments are now being managed and overseen centrally by the Head of PC Commissioning for sometime and there is a need to be assured of the Propose risk is closed above requirements. Updated 28th September 2018 1. Primary Care Investment implementation plan has been developed to outline the timeline and process for reviewing the current funding arrangements. Including LES, LIS, QIFs etc. This will be presented to the September PCC for approval. 2. Task and Finish Group established to oversee LES review. 3. Review will prioritise LESs where there is greatest risk to service delivery e.g. ACM, wound care, DMARDs. INVESTMENT Operational, Clinical and reputational risk. North Staffordshire CCG 16 Updated 03 January 2019 12 Manir Lynn Millar, Director of North Staffordshire CCG DELEGATED BUDGET Stoke-on-Trent CCG (4x4) 5. Social prescribing up and running from January 2019. (3x4) Hussain, Primary Care Stoke-on-Trent CCG Failure to invest in primary care resulting in an 6. Other cost pressures are now being factored in and a new budget forecast outturn is in development. Deputy underspend in the delegated commissioning budget and Updated 28th September 2018 Director of a lack of investment in primary care. Failure to spend 1. July 2018: Proposal presented to PCC outlining the budget, the current commitments and expected cost pressures. The Committee approved the current Primary Care the budget highlights a lack of planning in Primary Care spending principles and next steps. and poses a significant reputational risk to the CCG. 2. PLT proposal to be presented in September 2018.
3. Process and criteria for funding to be presented in October 2018. A1.56 4. Social prescribing project is likely to slip which will mean the allocation will not be fully spent, therefore proposal to invest into other projects include winter and practice leadership will be developed by October 2018.
ESTATES Clinical, Operational, Financial and reputational North Staffordshire CCG 9 Updated 03 January 2019 9 Manir Lynn Millar, Director of North Staffordshire CCG PRACTICE LEASES risks. Failure to support and develop sustainable Stoke-on-Trent CCG (3x3) Head of Primary Care Development has reviewed this risk and there is no further update at this time. (3x3) Hussain, Primary Care Stoke-on-Trent CCG Current lease arrangements pose problems for Primary Care and General Practice. Updated 28th September 2018 Deputy partnership model in terms of retirements and 1. Short term Lease review completed August 2018. Director of attracting new partners. 2. Clinical model for General Practice to be developed as part of Primary Care Strategy which will inform the future estates requirements and lease Primary Care = A1.57 UPDATE - 25/09/2018 - Emergent Risk in regards to arrangements. historical lease arrangements which may result in 3. Ambition to move to larger list sizes and development of new business models as described in the STP NMC Programme. Link to primary care strategy to financial impact on the CCGs describe roadmap.
QUALITY Failure to identify quality / safety risks impacting North Staffordshire CCG 16 Updated 03 January 2019 12 Sarah Jeffery, Lynn Millar, Director of North Staffordshire CCG OUTPATIENT REFERRALS, ADMISSIONS AND A&E on patient outcomes / patient experience. Stoke-on-Trent CCG (4x4) 5. In SOT and NS a review of the QIF programme is underway to ensure this meets with differing variation. (3x4) Head of Primary Care Stoke-on-Trent CCG ACTIVITY Updated 28th September 2018 Primary Care Known variation across Practices within the CCGs which 1. Quality visits underway targeting high referring Practices and poor outcomes. is leading to potentially higher than expected outpatient 2. Task and Finish Group in place to put in place single benchmarking dashboard and reporting process in place to monitor practice performance. A1.58 referrals, admissions and A&E activity. There is potential 3. Links to LES review which will aim to improve access to local enhanced services so all patients have equity. inequitable service provision. 4. Protect Learning Time Programme developed and first session delivered
ACCESS Clinical, Operational, Financial and reputational North Staffordshire CCG 9 Updated December 2018 9 Melanie Lynn Millar, Director of North Staffordshire CCG EXTENDED HOURS PROVISION: Requirement for risks. Risk of inadequate care for the population. Stoke-on-Trent CCG (3x3) 1. Extended Access services were commissioned across all 6 CCG on the 1st September 2019. This service included an element of additionality which allowed (3x3) Mahon, Head Primary Care Stoke-on-Trent CCG extended hours provision within primary care for both practices to work differently together to help prevent this risk from becoming an issue. To date the CCG has not received any reports that risk has become an of CCGs may adversely affect both resilience and quality of issue, and based on informal feedback from some practices, this service has helped practices in terms of resilience and ensuring patients have better access Commissioni care, resulting in inadequate care for the population. to appointments in general practice. ng (Planned =
Propose risk is closed and reduced to a score of 4. Care) A1.59 Previous Update 1. On track to procure and deliver extended access by 1st September 2018 in partnership with the North Staffs Federation. 2. Contract award approved by Governing Body - August 2018. A1.61 A1.60 Risk Ref View. to planCCGs' to deliver and support 5GP Year Forward PRIMARY CARE 5GP YEAR FORWARD VIEW: Failure by RESULTING IN FAILURE TO SUPPORT SUSTAINABLE OF LACK SINGLE, STRATEGIC PLAN FOR PRIMARY CARE PRIMARY CARE STRATEGY clinical commissioning. by memberGP practices and a lack of clinical input into LOCALITIES: Resulting in a lack of with engagement and FAILURE TOCCGS' ENGAGE WITH PRIMARY CARE VIA ENGAGEMENT inc CONSEQUENCE (Risk Description) SCOPE OF RISK risks. Clinical, Operational, Financial and reputational commissioning. practices, and a lack of clinical input into clinical lack of with engagement and by memberGP Clinical, Operational and reputational risks. Risk of NATURE OF RISK (Risk Type) Stoke-on-Trent CCG North Staffordshire CCG Stoke-on-Trent CCG North Staffordshire CCG STAKEHOLDERS STAKEHOLDERS (Org Name) (Org INHERENT SCORE (L (L x C) (4x4) (3x2) 16 6 4. Primary Plan Care reviewingInvestment current and future funding will be presented to the Primary Care Commissioning Committee in October 2018. 3. processEngagement to develop the clinical model with stakeholders will commence September 2018. GPFV PMO and assurance tothrough PCC highlight reporting. 2. GPFV implementation plan in place and will continue to deliver transform primary care to deliver sustainable general practice. Governance through NHSE Primary Care Commissioning Committee 03/07/18. 1. Proposal to develop a single primary forcare strategy Staffordshire including details of forinvestment 2018/19 and longer term investment approved by 28thUpdated September 2018 5. Primary GroupCare Strategy established, organisational development are and events being engagement planned for January and February 2019. 201903Updated January Updatesurvey. to September 2018 PCC. 4. Review of 360 results survey underway. An action plan will be developed with the andComms Committee Engagement to address identifiedissues by the 3. continue.visits Engagement 2. ofManagement completeChange and staff in place to support of engagement practices. 1. Primary Care Delivery Group re-established. 28thUpdated September 2018 established. The Primary Care Committee has requested that this risk is increased from 4 (2x) to 6 (3x2) until the newly formed Membership GroupsEngagement are 5. Meeting arranged to discuss the Membership GroupEngagement (MEG) onmeetings 02 January 2019. 201903Updated January (Initial Mitigating Actions to reduce to TARGET RISK SCORE - to be supplied). (Including any policy (Including any or strategy implications) RISK TREATMENT & CONTROL MECHANISMS TARGET (L x C) SCORE SCORE (L RESIDUAL (3x2) (3x2) x C) 6 6 Completion Date Action Primary Care Head of Sarah Jeffery, Owner(s) Risk Primary Care Lynn Millar, Director of Primary Care Lynn Millar, Director of Directorate Trend Stoke-on-Trent CCG North Staffordshire CCG Stoke-on-Trent CCG North Staffordshire CCG CCG Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group REPORT TO:
North Staffordshire & Stoke on Trent CCGs
Enclosure: 5.3
Report to: Primary Care Commissioning Committee Meetings in Common
Title: Delegated Commissioning Month 8 2018/19
Meeting Date: 8 January 2019
Executive Lead(s): Exec Sign-Off Y/N Author(s): Alistair Mulvey Anne Perry
Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): N/A N/A
Action Required (select): Decision Discussion For Assurance / For Information √
Purpose of the Paper (Key Points + Executive Summary):
To inform the Board of the Month 8 position for North Staffordshire and Stoke on Trent CCG’s – underspends of £77k and £181k respectively - and the continued forecast of a year-end breakeven position.
This paper provides an update on performance against the primary care budgets as at Month 8.
The Committee is asked to note the financial position at Month 8.
Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register):
Implications: Legal and/or Risk CQC Patient Safety Patient Engagement Financial Sustainability Workforce / Training
1 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
Key Requirements: Yes No 1. Has a Quality Impact Assessment been completed? √ Please provide detail within the body of the report
2. Has an Equality Impact Assessment been completed? √ Please provide detail within the body of the report as to these considerations:
• Can you confirm an Equality Impact & Risk Assessment (EIRA: stage 1 & 2) has been completed; if not, what is the rationale for non-completion?
• Which if any of the nine Protected Groups were targeted for engagement and feedback to CCGs, and why those?
• Summarise any disaggregated feedback from local Protected Group reps about any negative impacts arising / recommendations (e.g. service improvements)
• What mitigation / re-shaping of services resulted for people from local Protected Groups (along the lines of ‘You Said: We Listened, We Did’?)
• Explain any ‘objective justification’ considerations, if applicable
Key Requirements: Yes No 3. Has Engagement activity taken place with Stakeholders / Practices / √ Communities / Public and Patients Please provide detail within the body of the report
Recommendations / Action Required:
The Primary Care Committee Name is asked to receive the report.
2 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
• Introduction
The Primary Care Commissioning Committee has responsibility for monitoring the primary care delegated budgets and this report presents an update on the current and forecast financial position of the delegated budgets at Month 8. Although the committee does not have responsibility for the other CCG primary care commissioning budgets, an update is also included within this report for information only.
• Primary Care Delegated Budgets – NHS North Staffordshire CCG
The increase in Global Sum has now been actioned and practices have been reimbursed backdated to 1st April. This has led to a year to date overspend of £252k partially mitigated by a £86k underspend on the Demographic Growth.
Enhanced services are currently reporting a year to date underspend of £68k, due to Minor Surgery and the Violent Patients service, Seniority payments are currently £14k underspent whilst premises are overspent by £13k.
Reserves are contributing £175k to the Month 8 position giving an overall underspend of £77k.
We are continuing to forecast a breakeven position and will continue to work closely with our NHSE colleagues to ensure material movements are captured and reported.
• Primary Care Delegated Budgets – NHS Stoke on Trent CCG
The increase in Global Sum has now been actioned and practices have been reimbursed backdated to 1st April. This has led to a year to date overspend of £635k partially mitigated by a £93k underspend on the Demographic Growth.
Enhanced services are currently reporting a year to date underspend of £5k, due to the Violent Patients service overspend of £46k mitigated by underspends on both the Extended Access and Minor Surgery services.
Premises are reporting an over-spend of £219k due to Willowbank rent.
Reserves are contributing £785k to the Month 8 position giving an overall underspend of £181k.
We are continuing to forecast a breakeven position and will continue to work closely with our NHSE colleagues to ensure material movements are captured and reported.
3 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
4 North Staffs CCG Primary Medical Services - Delegated Budgets 2018/19 Month 8
Year To Date Forecast Budget Actual Variance Budget Actual Variance £'000s £'000s £'000s £'000s £'000s £'000s Core contracts GMS 12,349 12,601 252 18,524 18,524 0 PMS 389 389 1 583 583 0 APMS 518 519 1 777 777 0 PMS Reinvestment 293 293 0 440 440 0 Demographic Growth 86 0 -86 129 129 0 13,635 13,802 167 20,453 20,453 0
Enhanced Services Extended Hours 106 103 -3 159 159 0 LD Health Checks 65 65 0 131 131 0 Minor Surgery 130 105 -25 195 195 0 Violent Patients 42 2 -41 64 64 0 343 275 -68 547 547 0
Other Services Dispensing & Prescribing 572 572 0 901 901 0 CQC Fees 140 141 1 140 140 0 Locums 122 122 0 183 183 0 Seniority 121 107 -14 244 244 0 Named GP for Safeguarding 17 17 0 25 25 0 Medical Fees 8 8 0 11 11 0
Premises Rents 1,564 1,591 27 2,375 2,375 0 Rates 280 263 -18 319 319 0 Water Rates 26 30 4 39 39 0 Clinical Waste 48 48 0 72 72 0 1,918 1,931 13 2,805 2,805 0
QOF 1,433 1,433 0 3,072 3,072 0
Reserves 0.5% Contingency Reserve 0 0 0 145 145 0 Balance to Allocation Reserve Discretionary 175 0 -175 260 260 0 Indemnity Startpoint 0 0 0 111 111 0 Indemnity budget moved to CCG re GPFV 0 0 0 -222 -222 0 Inflation 5 5 0 7 7 0 Prior Year Balances 0 0 0 0 0 0 179 5 -175 300 300 0 Sub Total 18,488 18,411 -77 28,681 28,681 0
18,488 18,411 -77 28,681 28,681 0 Stoke on Trent CCG Primary Medical Services - Delegated Budgets 2018/19 Month 8
Year To Date Forecast Budget Actual Variance Budget Actual Variance £'000s £'000s £'000s £'000s £'000s £'000s Core contracts GMS 14,364 14,929 566 21,543 21,535 -8 PMS 1,075 1,144 69 1,613 1,613 0 PMS Reinvestment 378 378 0 567 567 0 Demographic Growth 97 4 -93 146 146 0 18,967 19,361 394 28,448 28,440 -8
Enhanced Services Extended Hours 123 99 -24 184 184 0 LD Health Checks 126 126 0 252 252 0 Minor Surgery 180 153 -27 270 270 0 Violent Patients 10 56 46 16 16 0 439 433 -5 721 721 0
Other Services Dispensing & Prescribing 153 153 0 231 231 0 CQC Fees 187 184 -2 187 187 0 Locums 139 162 23 209 209 0 Seniority 128 106 -21 259 259 0 Named GP for Safeguarding 17 14 -3 25 33 8 Medical Fees 19 19 0 29 29 0 642 639 -4 939 947 8
Premises Rents 2,452 2,656 203 3,724 3,724 0 Rates 348 358 10 416 416 0 Water Rates 32 37 5 49 49 0 Clinical Waste 66 66 0 99 99 0 2,898 3,117 219 4,287 4,287 0
QOF 1,827 1,827 0 3,915 3,915 0
Reserves 0.5% Contingency Reserve 0 0 0 197 197 0 Balance to Allocation Reserve Discretionary 785 0 -785 1,180 1,180 0 Indemnity Startpoint 0 0 0 148 148 0 Indemnity budget moved to CCG re GPFV 0 0 0 -296 -296 0 Inflation 16 16 0 24 24 0 Prior Year Balances 0 0 0 0 0 0
Sub Total 25,574 25,393 -181 39,562 39,562 0
25,574 25,393 -181 39,562 39,562 0 North Staffordshire CCG Primary Care - Commissioning Budgets 2018/19 Month 8
Year To Date Forecast Budget Actual Variance Budget Actual Variance £'000s £'000s £'000s £'000s £'000s £'000s Enhanced Services Anti-coagulation 8 17 9 12 26 14 Basket of care / Treatment Room Services 156 153 -3 233 230 -4 Nursing Homes 115 85 -30 172 124 -48 GTT 30 25 -4 45 38 -6 Shared Care 0 0 0 0 0 0 Intra Partum Care 0 0 0 0 0 0 Multiple Sclerosis 0 0 0 0 0 0 Phlebotomy 0 0 0 0 0 0 Primary Care Offer 0 0 0 0 0 0 Other Enhanced Services 5 4 -2 8 11 3 435 290 -145 653 438 -216
GP Forward View Investments Transformational Support 215 216 0 331 324 -7 Care Navigators 0 1 1 37 37 0 Improving Access 353 353 0 883 883 0 Online consultation Software 0 0 0 73 73 0 Other GPFV 0 0 0 0 0 0
Other Primary Care Budgets Admission Avoidance LIS 872 862 -10 1,309 1,294 -15 Other Primary Care Schemes 205 177 -28 436 281 -155 Other Primary Care Schemes 4 4 0 1,472 1,321 -152 Other Primary Care Schemes 221 0 -221 331 0 -331 Other Primary Care Schemes 430 181 -249 2,239 1,602 -637 Prior Year Balances 0 48 48 0 48 48 1,628 1,418 -210 4,102 3,433 -670
2,632 2,278 -354 6,079 5,186 -892 Stoke On Trent CCG Primary Care - Commissioning Budgets 2018/19 Month 8
Year To Date Forecast Budget Actual Variance Budget Actual Variance £'000s £'000s £'000s £'000s £'000s £'000s Enhanced Services Anti-coagulation 37 35 -2 55 55 0 Basket of care / Treatment Room Services 207 208 0 311 311 0 Nursing Homes 30 37 7 45 45 0 Near Patient Testing 0 4 4 0 0 0 GTT 62 61 -1 93 93 0 Extended Hours Access 196 0 -196 293 0 -293 Shared Care 42 37 -5 62 62 0 Primary Care Offer 40 1 -39 60 1 -59 Other Enhanced Services -375 92 467 -562 141 703 238 473 235 357 708 351
GP Forward View Investments Transformational Support 293 294 1 440 440 0 Care Navigators 0 0 0 49 49 0 Improving Access 469 469 0 1,166 1,166 0 Online consultation Software 0 0 0 97 97 0 762 762 1 1,752 1,752 0
Other Primary Care Budgets Admission Avoidance LIS 1,163 1,158 -5 1,745 1,745 0 Membership and Transformation Scheme 292 302 10 880 880 0 QIF 592 593 0 1,195 889 -306 Other Primary Care Schemes 199 189 -9 298 291 -7 Other Primary Care Schemes 202 188 -14 304 254 -49 Other Primary Care Schemes 0 3 3 0 0 0 Other Primary Care Schemes 401 380 -21 601 545 -56 Prior Year Balances 0 139 139 0 142 142 2,448 2,571 123 4,421 4,201 -220
3,448 3,806 358 6,530 6,660 131 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
REPORT TO:
Stoke on Trent and North Staffordshire Clinical Commissioning Groups
Enclosure: 5.4
Report to: Primary Care Commissioning Committees Meetings in Common
Title: Hanley Primary Care Access Hub
Meeting Date: 8 January 2019
Executive Lead(s): Exec Sign-Off Y/N Author(s): Lynn Millar Y Sarah Jeffery
Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): Dr John Gilby Y EPCC and urgent and emergency care
Action Required (select): Decision Discussion For Information X
Purpose of the Paper (Key Points + Executive Summary):
The Primary Care Commissioning Committee is asked to:
1) Note the content of this report
The Hanley Primary Care Access Hub is an APMS contract which provides walk in primary care services 7 days a week, 8am – 8pm, 365 days a year. The service is based in Hanley City Centre.
The provider meets the key performance indicators within their current contract terms.
Overall, patient satisfaction and engagement in regards to the service is positive.
The service on average has over two and a half thousand contacts per month. Should the service be removed there is a risk that some of these patients would attend the local accident and emergency department.
There is evidence that hard to reach groups access the service who struggle to gain access to other primary care medical services.
In order to continue to provide a continuous, safe, sustainable service to the population of Stoke-on- Trent the contract for Hanley Primary Care Access Hub will continue via a Voluntary Ex Ante Transparency (VEAT) notice for a minimum period of 2 years (December 2018 – Dec 2020). This allows time for the future of the service to be included as part of the ‘Together We’re Better’ STP pre consultation engagement which is due to begin in May 2019 with formal consultation in 2020, and will include simplifying urgent and emergency care systems. The CCG has been advised that due to the significant impact of this service on local patients a consultation will have to take place before any change can be made, and this cannot be done in isolation to the STP consultation programme.
1 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register):
Implications: Legal and/or Risk Nil CQC Nil Provides safe effective services – removal could de-stabilise access for Patient Safety particular cohorts of patients in hard to reach groups Patient Patient engagement has been undertaken and is positive in regards to the Engagement service Service is funded through the Stoke on Trent primary care delegated Financial commissioning budget Continuous service will ensure other services are not put under pressure. Sustainability Wider public consultation will determine the need for services in the future as part of the STP plans Workforce / Nil Training
Key Requirements: Yes No 1. Has a Quality Impact Assessment been completed? X Please provide detail within the body of the report
2. Has an Equality Impact Assessment been completed? X Please provide detail within the body of the report as to these considerations:
• Can you confirm an Equality Impact & Risk Assessment (EIRA: stage 1 & 2) has been completed; if not, what is the rationale for non-completion?
• Which if any of the nine Protected Groups were targeted for engagement and feedback to CCGs, and why those?
• Summarise any disaggregated feedback from local Protected Group reps about any negative impacts arising / recommendations (e.g. service improvements)
• What mitigation / re-shaping of services resulted for people from local Protected Groups (along the lines of ‘You Said: We Listened, We Did’?)
• Explain any ‘objective justification’ considerations, if applicable
Key Requirements: Yes No 3. Has Engagement activity taken place with Stakeholders / Practices / X Communities / Public and Patients Please provide detail within the body of the report
Recommendations / Action Required: The Primary Care Commissioning Committee is asked to:
Note the contents of this Report
2 Future of Hanley Primary Care Access Hub (PCAH)
1.0 Background and context
The Hanley Walk-in Centre (HWC) commenced on 31 March 2009 and was originally an APMS contract under the ‘Darzi model’. This comprised of a registered list size as well as operating a walk in element of 8am – 8pm, 7 days a week, (365 days per year) for unregistered patients. The contract holder was Care UK.
In July 2016, Care UK provided notice on the contract to end on 31 March 2017. This notice was then extended to June 2017 to allow the CCG more time in developing an options appraisal.
A paper was presented to the North Staffordshire and Stoke on Trent commissioning and Planning Committee on 29 November 2016 whereby a collective consensus was made by the executive team to undertake a list dispersal for the registered element of the contract but to keep the walk-in services. In terms of the walk-in element, Care UK did not wish to provide this so a Voluntary Ex Ante Transparency (VEAT) recommendation was made for a ‘pilot’ arrangement to be undertaken for a 12 month period.
A 12 month pilot was therefore commissioned under an APMS standard contract from 1st July 2017 to be delivered by the North Staffordshire GP Federation and would be known as the Hanley Primary Care Access Hub (Hanley PCAH). North Staffordshire GP Federation have continued to provide the service despite there not being a contract in place since 30 June 2018.
2.0 Current position and issues
2.1 Contract
The contract with the North Staffordshire GP Federation for the Hanley PCAH expired in June 2018. The contract value is £1,409,796 (breakdown within appendix A) and currently being funded from the Stoke on Trent primary care delegated commissioning budget. The contract also had an arrangement to reimburse the rental value (breakdown within appendix A).
3.0 Current contract and patient feedback
3.1 Contract
The contract expired June 2018. The current provider is continuing to provide the services and have indicated they will continue to do should the CCG wish. Currently the service meets all of its key performance indicators as set out in the contract.
The Hanley PCAH is seeing between 2,000 and 2,800 patients per month. Extended access also offers approximately 30,000 additional appointments per annum for the Stoke on Trent population as a whole.
3.2 Patient feedback
A patient engagement exercise was undertaken in January/February 2018. This survey is attached as appendix B. Over 80% of responders rated the service as either good or very good. Less than 4% rated the service as poor. Overall the service is received as positive.
A report produced by the CCGs in 2017 following extensive engagement with homeless people and charities about the barriers for homeless people in accessing health services and also a recent press report demonstrated that hard to reach groups (i.e. homeless) in Stoke on Trent specifically had significant difficulty in obtaining access to primary care medical services. Therefore, this should be a further consideration in relation to the options for the Hanley PCAH. However, it is
1 also important to note that as part of the delegated commissioning function, CCG/NHSE are writing to general practices to remind them of contractual responsibilities in relation to this.
4.0 Recommendations/options
4.1 Contract
In order to continue to provide a continuous sustainable service to the population of Stoke On Trent has been agreed that the contract for Hanley Primary Care Access Hub is awarded via a VEAT notice for a minimum period of 2 years to North Staffordshire GP Federation (December 2018 – Dec 2020). This will then allow time for the future of the service to be included as part of the Together We’re Better STP pre consultation engagement which is due to begin in May 2019 with formal consultation in 2020, and which will include simplifying urgent and emergency care systems. The CCG has been advised that due to significant impact of this service on local patients a consultation will have to take place before any change can be made, and this cannot be done in isolation to the STP consultation programme. This will also give the provider a timeframe in which to negotiate any future lease arrangements with the landlord.
2
Appendix A
Contract Value Breakdown (extract from contract schedule 4) Stoke on Trent CCG £1,209,641+ £186,155(subject to change as below) + £14,000 (subject to TUPE if applicable as per below Total £1,409,796 Total Contract Value The contact value is £1,209,641 which includes £25,000 for start-up costs (the start-up costs are excluded from the 12 monthly payments as this will be paid as an upfront payment in month1) A 12 month breakdown of equal payments for the sum of £98,7820.08 will be raised as via invoice as part of the agreement Additional premises Funds £186,155 split over 12 months of equal payments of £15,512.91 The above value is subject to change following further guidance from NHSE. Once guidance has been received and values have been agreed, commissioners will vary the revised values into this contact to support premise funds. Please note this will result in either a decrease to current premise funds values or no change Additional payment if £14,000 if applicable, this will be agreed by commissioners at the end of the applicable at the end of the contract term. Please note these funds may not be released if TUPE does contract term for not apply. redundancy costs. This sum will be released if required due to TUPE, for staff from Care UK to the GP federation
3
Appendix B Hanley Primary Care Access Hub – Public Engagement
Background Hanley Primary Care Access Hub was previously known as Hanley Health and Wellbeing Centre but changed identity when the North Staffs GP Federation took over service delivery in July 2017.
If assessed as appropriate, patients can see a GP or Advanced Nurse Practitioner from 8am-8pm seven days per week, 365 days a year. Prior to the changes in July, patients were guaranteed access to a Nurse Practitioner appointment, not a GP.
Stoke-on-Trent Clinical Commissioning Group (CCG) would like to review how the service is being used and what patients think about the service since the changes that were made in July 2017.
Engagement Methodology To gain feedback and views, the CCG developed an on-line survey. This was promoted through CCG newsletters, a press release and social media, as well as being shared with partner organisations and the voluntary sector. A hard copy survey, based at the hub, was also used to gather opinions.
The survey was open between 24 January and 25 February 2018.
Survey Results A total of 314 people completed the full survey and the results are set out below.
Question 1
(316 people took part in the survey but 2 people who completed the online survey were not walk-in patients, so did not complete questions after question 1).
4
Question 2
For ‘Other’ above:- 15 people mentioned specific conditions and illnesses 14 people mentioned aches/pain 6 people - infections, 6 people – rash 4 people – inflammation 4 people – did not specify or state and the remaining
Question 3
For ‘Other’ above:-
8 people mentioned Haywood, Haywood walk-in centre or Lyme Valley/Newcastle walk-in
3 people tried their own GP
3 others mentioned the opticians, Shelton care and paramedics
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Question 4
For ‘Other’ above:-
7 people mentioned that their GP was closed or it was the weekend
4 people – advised by their GP surgery, 3 people – convenient
2 people – nearby
6 people mentioned other things such as
• “less waiting time”, • “They are very helpful all the time” • “My GP is full and can't get me in for another 9 days” • “needed medication”
Question 5
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Question 6
Over 80% of respondents rated the experience as either good or very good. Less than 4% rated it as poor or quite poor.
Questions 7 to 10 gave the public the opportunity to answer in their own words. The main themes which emerged are set out below.
Question 7: What is good about the Hanley Health and Wellbeing Walk-in Centre?
Ease of access and availability of appointments: 117 people / 52.9%* (*of those who answered) appreciated this with comments such as:
“Easy access as it is in the middle of the city centre”
“Easily available if unable to see own GP”
“Being able to have my son checked over when there is no appointments at his regular gp”
Excellent staff: 84 people / 38.0%* (*of those who answered) commented positively on the staff with remarks such as:
“Friendly caring, empathetic reception (same with triage-a good listener)”
“Friendly reception, lovely nurses and doctor”
“It's caring and friendly”
“Everybody is helpful and polite”
Convenience: 39 people / 17.6%* mentioned the convenience of the hub:
“The fact I can just come in and wait” “Local to areas/university”
“Convenient and not far from where I live”
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Good/efficient service: 33 people / 14.9%* mentioned that the hub offers a good or efficient service:
“Excellent service”
“Medical care and advice is consistent”
11 people (5%*) mentioned the pleasant environment and there were 19 other comments, which included 3 people reflecting that it was good ease pressure on other services, then other comments, such as:-
“Tell you how long wait and every time I or my children come in we don't go over out time”
“Reasuring when you have ill children”
“Getting to see a doctor rather than a nurse led service”
Question 8: What is not so good or could be done better?
Long waits: Most comments – 51 people / 53.7%* (*of those commenting) were about long waiting times, although some people did appreciate the reason for this.
“Waiting times are ridiculous”
“waiting is always long but that is to be expected with it being a walk in”
“There was a wait but this was due to me having to be seen by the GP which was an understandable wait and I really needed to see the GP.”
Staffing: There were 11 comments / 11.0%* about staffing, with people mostly expressing the need for more staff:
“needs more gp considering own gp's are sending patient to here”
“more doctors to see patients”
Environment: there were 9 comments / 9.5%* about the environment ranging from :
“Due to the long waiting times, the TV being on would help due to some disruptive/ inconsiderate patients in the waiting room.”
“Toilets are a little smelly.”
6 people mentioned parking and there were 17 other comments, which included 2 people referring to opening hours, then other comments. A flavour of these (some of which are also coded in some of the above, due to multiple themes) include:
8
“Opens at 8am. Noone went through to see someone for at least 10 minutes. 111 advised me I could see a GP I saw a nurse despite me telling the receptionist what 111 had advised with the symptoms I had.”
“….on our visit only appears to be two Doctors and one advanced Nurse on considering the population of Stoke-on-Trent. The closing of community beds and health need in the area and not enough medics on duty.”
“When seeing the triage nurse I felt like she was being extremely nasty and she brought me to tears”
“Referrals to hospital if needed, bloods done here, scans etc.”
“some times need to be seen by two different doctors”
Question 9: Are there any ways in which you think the service could be improved?
Staffing: 25 people felt that staffing levels could be improved:
“As always- more staff ease the pressure/workload on everybody”
“Due to the number of patients waiting to be seen I think having additional doctors being available at peak times would shorten the wait time”
Waiting time: 16 people felt the service could be improved by shorter waiting times:
“Only waiting time - everything else cool”
“Reduce waiting time”
Question 10: Is there anything else you’d like to share?
There was only one negative comment (which was about the music being too loud); 13 people commented with positive feedback. Examples include:
“Having used the service on a Saturday evening I was very pleased with my visit. The GP did worry me though when I still had to go to A&E as I was trying everything not to go there!”
“I attended with my daughter on a Sunday evening, she was seen by a Nurse and a GP all within 20 minutes. I would highly recommend patients attending the Hanley Primary Care Access Hub.”
“My daughter became ill and I struggled to get into my own GP and was advised to come here. The team were great, very greatful for everything.”
“I think this is a really good service which ensures patients can be seen by a doctor.”
Question 11: Are you registered with a GP practice? The analysis of GP practices can be found as Appendix 1 of this document.
9
Demographic information Participants’ responses to questions about ethnicity, background, age etc can be found in Appendix 2 of this document. 9 March 2018
10
Appendix 1
Please specify which GP Practice you are registered with:
Furlong Medical Centre 22 Belgrave Medical Centre 3 Moorcroft Medical Centre 17 Cambridge House Surgery 3 Harley Street Medical Centre (& Staffs Uni) 15 Middleport Medical Centre 3 Brook Meldical Centre 13 Werrington Village Surgery 3 Millrise Medical Practice 13 Brinsley Avenue Practice 2 Tunstall Primary Care Centre (& Packmoor) 11 Dr Borse & Partners (Meir Primary Care Centre) 2 Birches Head Medical Centre (& Hulton House) 11 Cr Chadalavada & Partners (Abbey Surgery) 2 Five Towns GP Surgery 9 Apsley House (Cobridge Health Centre) 2 Hanley Health Centre 8 Longton Health Centre (Dr Patel) 2 Glebedale Medical Practice 8 Hartshill Medical Centre 2 Haymarket Health Centre 8 Kidsgrove Medical Centre (Dr Harbidge) 2 Willow Bank Surgery 7 Biddulph Doctors 2 Longton Hall Surgery 6 Miller Street Surgery 2 Moss Green Surgery 6 Alton Surgery 1 Cobridge Surgery 6 Audley Health Centre 1 Norfolk Street Surgery 6 Heathcote Street (Chesterton Surgery) 1 Potteries Medical Centre 5 Dr Mir’s Surgery (Blurton Health Centre) 1 Adderley Green Surgery 5 Kingsbridge Medical Practice 1 Foden Street Surgery 5 Midway Medical Centre 1 Baddeley Green Surgery 5 Milehouse Medical Practice 1 Meir Park Surgery (& Weston Coyney) 5 R J Mitchell Medical Centre 1 Lucie Wedgwood Health Centre 4 Snowhill Medical Centre 1 Trent Vale Medical Practice 4 Talke Clinic 1 Mayfield Surgery 4 Tean Surgery 1 Merton Street Surgery 3 Trenthams Mews Medical Centre 1 Goldenhill Medical Centre 3 Trinity Medical Centre 1 Drs Shah & Talpur (Hanford Health Centre) 3 Wolstanton Medical Centre 1 Dunrobin Street Medical Centre 3 Other (please specify) 36 Orchard Surgery (& Endon) 3 Not registered 10
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Appendix 2
Demographics
What is your ethnic group/background?
Response Response % Total English, Welsh, Scottish, Northern Irish, British 80.0% 227 Pakistani 6.0% 17 Other European 2.8% 8 White and Black Caribbean 2.1% 6 Any other ethnic or nationality background not listed 2.1% 6 Polish 1.8% 5 African 1.8% 5 Prefer not to say 1.4% 4 Black British 0.4% 1 White Irish 0.4% 1 Bangladeshi 0.4% 1 White and Black African 0.4% 1 Indian 0.4% 1 Caribbean 0.4% 1
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14
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Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
REPORT TO:
North Staffordshire CCG and Stoke on Trent CCG
Enclosure: 5.5
Report to: Primary Care Commissioning Committee Meetings in Common
Title: GP Forward View – 10 High Impact Actions Plan
Meeting Date: 8 January 2019
Executive Lead(s): Exec Sign-Off Y/N Author(s): Tracey Cox – Primary Care Lynn Millar – Executive Director of Development Lead Primary Care and Medicines Y Charlotte Harper – Primary Care Optimisation Development Nurse Andy Hadley – Digital Lead
Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): Y – Enhancing Primary and Community Care
Action Required (select): Decision Discussion For Assurance / For Information
Purpose of the Paper (Key Points + Executive Summary): 1. Introduction
This paper provides an update on the current status, funding and future plans for delivery of General Practice Forward View (GPFV) specifically related to the 10 High Impact Actions for:
- North Staffordshire Clinical Commissioning Group - Stoke on Trent Clinical Commissioning Group
2. Active Signposting and Document Management (Workflow)
Funding from NHS England (NHSE) was allocated to CCGs for the purpose of supporting the training of reception and clerical staff in GP practices to undertake active signposting and document management (workflow optimisation). Appendix 1 provides a detailed summary for each of the 2 CCGs for these specific elements.
These have been two areas of major focus for practices and active signposting is expected to be well embedded by the end of the financial year in most localities. An evaluation of workflow is currently underway through an online survey with a report expected back at membership boards and Primary Care Commissioning Committee in January 2019.
The CCGs have invested this funding into primary care training and are on plan to spend the allocated funds in the following ways:
(i) ongoing staff training events (ii) provider licences
1 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
(iii) backfill for focused support (iv) access to online training resources (v) advertising and communication materials to support patients understand of signposting
A summary of staff currently trained per CCG is shown below (as at end of November 2018):-
CCG Active Signposting Document management/ Workflow (Staff trained) (Staff Trained) NS CCG 408 / 536 staff 26 staff (across 20 practices) SOT CCG (across 63 practices) 30 staff (across 26 practices)
3. Delivery Plan (Appendix 2) provides an update on current status of the 10 High Impact Actions and future delivery plans/timescales. A number of these work streams have been undertaken without investment however, it is recognised that opportunities for practices to work collaboratively within their locality and/or with other localities may lead to greater economies of scale, shared use of resources, common learning and approaches. This is at the discretion of individual practices.
The CCGs are awaiting final confirmation of exact funding for 2019/20 from NHSE. However, the CCGs have partial plans as outlined in the attached delivery plan and are committed to spending the funding. The primary care team are working closely with practices and localities to finalise 2019/20 plans.
Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register): N/A
Implications: • Legal and/or Risk Approved providers used for basis of delivery of training • CQC Not applicable • Patient Safety Processes in line with delivery of high quality and safe patient care • Patient Signposting patients to appropriate and available services Engagement Information has been collated and is in line with NHSE monthly returns. • Financial Funding is received from NHS England as part of GP Forward View. • Sustainability Supports the GP Forward View of sustainable General Practice • Workforce / Staff are receiving the appropriate ongoing training and support to deliver Training these initiatives • Key Requirements: Yes No 1. Has a Quality Impact Assessment been completed? Please provide detail within the body of the report
2. Has an Equality Impact Assessment been completed? Please provide detail within the body of the report as to these N/A considerations:
• Can you confirm an Equality Impact & Risk Assessment (EIRA: stage 1 & 2) has been completed; if not, what is the rationale for non-completion?
• Which if any of the nine Protected Groups were targeted for engagement and feedback to CCGs, and why those?
2 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group
• Summarise any disaggregated feedback from local Protected Group reps about any negative impacts arising / recommendations (e.g. service improvements)
• What mitigation / re-shaping of services resulted for people from local Protected Groups (along the lines of ‘You Said: We Listened, We Did’?)
• Explain any ‘objective justification’ considerations, if applicable
Key Requirements: Yes No 3. Has Engagement activity taken place with Stakeholders / Practices / Communities / Public and Patients Please provide detail within the body of the report • Recommendations / Action Required:
• The Primary Care Committee is asked to: Review the paper for information providing an up to date position on delivery of the 10 high impact actions and be provided with assurance on how funding has been invested.
3 North Staffs
1. Does the practice have any staff 3. Headcount of staff trained to code and 2. Headcount of staff trained in active signposting, to ascertain the 4. Headcount of staff trained/recruited as a combination trained/recruited as care navigators/ action incoming clinical correspondence Registered population patient’s need and signpost them to the most appropriate person or of both roles? (This is separate to the headcount of staff Practice Code & Name signposters or to manage (code and action) without reference to a GP where service, referring to a local directory of services? from questions 2 and 3, refer to the guidance if unsure.) incoming clinical correspondence? appropriate?
M83005 HEATHCOTE STREET SURGERY 5,174 Yes 7 0 0 M83007 THE VILLAGE SURGERY 7,260 Yes 10 0 0 M83011 WERRINGTON VILLAGE SURGERY 7,938 Yes 8 0 0 M83012 LEEK HEALTH CENTRE 8,102 Yes 8 1 0 M83015 MOSS LANE SURGERY 7,060 Yes 7 1 0 M83017 ASHLEY SURGERY 4,192 Yes 5 1 0 M83023 KIDSGROVE MEDICAL CENTRE 9,227 Yes 13 0 0 M83025 MILLER STREET SURGERY 6,557 Yes 9 0 0 M83034 SILVERDALE MEDICAL CENTRE 12,202 Yes 16 0 0 M83046 BIDDULPH VALLEY SURGERY 9,909 Yes 13 0 0 M83054 AUDLEY HEALTH CENTRE 10,070 Yes 13 2 0 M83056 WOLSTANTON MEDICAL CENTRE 11,254 Yes 12 1 0 M83067 LYME VALLEY MEDICAL CENTRE 5,469 Yes 8 0 0 M83071 PARK MEDICAL CENTRE 12,436 Yes 14 0 0 M83079 DR J GREIG & PARTNERS 8,937 Yes 9 2 0 M83084 DR ROBINSON & PARTNERS 6,848 No 0 0 0 M83089 BIDDULPH DOCTORS 10,991 Yes 10 1 0 M83096 DR KS UPTON'S PRACTICE 6,160 Yes 9 0 0 M83103 DR P CRAVEN'S PRACTICE 4,146 Yes 0 1 0 M83108 DR DO YATES' PRACTICE 7,410 Yes 8 1 0 M83121 TEAN SURGERY 6,148 Yes 12 1 0 M83122 WATERHOUSES MEDICAL PRACT 3,007 No 0 0 0 M83140 HIGHERLAND SURGERY 4,479 Yes 8 1 0 M83141 KINGSBRIDGE MEDICAL CENTRE 8,700 Yes 10 1 0 M83640 ALTON SURGERY 2,615 Yes 2 2 0 M83665 R J MITCHELL MEDICAL CENTRE 4,439 Yes 14 1 0 M83670 KEELE PRACTICE 7,136 Yes 0 1 0 M83691 BETLEY SURGERY 1,902 Yes 0 1 0 M83697 MILEHOUSE MEDICAL PRACTICE 2,576 Yes 5 2 0 M83701 TALKE PITS CLINIC 3,970 Yes 8 2 0 M83723 LOOMER ROAD SURGERY 7,633 Yes 10 1 0 Y02570 MIDWAY MEDICAL CENTRE 3,441 Yes 8 2 0
Additional Information A. 255 training licenses have been shared across 26/32 of our North Staffordshire practices so that online training can be completed by reception staff B. 5 face to face training events have taken place: those that have had online training met the providers, gained an understanding of the services that they are signposting and saw a demonstration MIDOS and the template they will be using
C. 4 customer care training events ran in March 2018. Bespoke training sessions offered in practice for those unable to access large events. This continues to be offered and has resulted in further practices going live and reporting data.
D. 2 super user events ran in September, representation from 18 practices across NS and SOT. Event focused on creating champions from those already working well in the new role. Best practice shared, tools shared to enable improving the service further by supporting their peers. The event will be repeated in the Autumn for the remaining 28 practices who are live. Super user group events are facilitated by West Wakefied as part of original platinum package that included 10 events. E. Templates and MIDOS access has been rolled out to all participating practices. Once the staff have attended the events they can begin navigating patients. We currently have 21 fully live practices in North Staffordshire.
F. We have 63 out of 76 North Staffordshire and Stoke-on-Trent practices participating in this project. For the remaining practices visits are in the process of being made and in -house training provided by a super user. In-house training has been provided by the Project Manager to date, going forward the super-users will be able to provide this to their peers and funded for their time out of practice.
G. 408/536 staff have completed the online Care Navigation training H. Construction of Care Navigation dashboard in February 2018, it provides monthly information on the levels of navigation occurring in practice. Practices received an intial report in March 18 that including activity to date. In June they received their Quarter 1 update and will receive a quarterly report from the DQSs going forward. 62% of our practices have fully embraced this new way of working. 46/76 practices in Stoke and North Staffordshire are actively reporting data. I. Sept 17 - Augt 18: 11,638 signposts have been made, of which 96% were accepted by patients J. An estimated 1,822 hours of GP time has been saved K. The data shows that the highest signposts made are to Nurse Practitioners (6573), then Haywood Walk in Centre (1180), Community Pharmacy (934) and Nurse Triage (494) L. In October we will pilot Walk in my shoes facilitated by the Community Pharmacist from the LPC in one North Stafforsdire Practice. The pilot will see a Nurse Practitioner and a Receptionist spend a session within their local Community Pharmacy and then vice versa. This will be rolled out if the data identifies an improvement in signposts to Community Pharmacy.
North Staffs & Stoke
Practices expected to receive training this year Number of staff expected to attend the training Who is expected to provide training? Cost of training
408 staff have completed online West Wakefield signposting training. Care Navigation: Five provider workshops and four bespoke customer A super user event ran on the 28th August 2018 care training sessions have taken place since June 2017- attended by a representative from 18 practices. Super user group events are facilitated by West March18. The event will be repeated in the Autumn for the Wakefied as part of our original platinum package 46/76 practices in Stoke and North Staffordshire are remaining 28 practices. that included 10 events. actively reporting data. Super user groups - costs for training is covered through Wakefield package In-house training has been provided by the Project A super user event ran on the 28th August 2018 already paid. Workflow redirection: Manager to date, going forward the super-users attended by a representative from 18 practices. The 49/76 trainined. 9 started training. 4 already have will be able to provide this to their peers and event will be repeated in the Autumn for the remaining a system in place. 2 declined. Remaining have funded for their time out of practice. 28 practices who are live. technical issues or made no decision. Training 61/76 practices showed initial interest. So for the already paid for. remaining 17 practices visits are in the process of being made and in -house training provided by a super user.
Connection with other GPFV initiatives e.g. Primary Care Networks, Details of other expenditure e.g. backfill costs. How is the CCG maximising value? Extended Access 1. Backfill for staff at 1st super user event £586.80
2. Second event for 28 representatives - £912.80
3. 2 Super user groups costs for venue and refreshments £1,467.50
4. The CCG commisioned Health Watch Stoke to complete an evaluation around how patients feel with regard to being questioned by reception staff. Cost £2,818 There has been a strong media campaign suppported through the Communications 5. The project is suppported by a local Community Pharmacist via the Team, including press releases, radio interviews, and a twitter and face book Local Pharmacy Committee for 6 months. £2,400. This has improved the campaign. The results have shown from September 2017 -August 2018 29,140 The Care Navigation template is due to be incorporated into local extended relationships between practice and highlighted challenges with the signposts have been made across North Staffordshire and Stoke-on-Trent, with an access provision. Community Pharmacy that are being resolved as a result. estimated 4,380 GP hours saved. Evaluation and learning will be shared across localities. 6. Two pilots of "Walk in my shoes" due to commence in October 2018. Approximately costing £505.20
7. Inhouse training provided by a super user to the 17/61 practices unable to access the initial large scale events £415.65
8. Independent evaluation of the patient experience of the Care Navigation pathway £5-10,000 Total:19,105.90
North Staffs CCG 2016/17 2017/18 2018/19 2019/20 Funding available 19,000 37,000 37,000 Funding spent/planned 19,000 26,216.48 8,143.975 (allocated)
Stoke on Trent CCG 2016/17 2017/18 2018/19 2019/20 Funding available 25,000 49,000 49,000 Funding spent/planned 21,614 26,216.48 10,961.95 (allocated) Stoke on Trent
1. Does the practice have any staff 3. Headcount of staff trained 4. Headcount of staff trained/recruited as trained/recruited as care 2. Headcount of staff trained in active signposting, to ascertain the to code and action incoming a combination of both roles? (This is Practice Code & Name Registered population navigators/ signposters or to patient’s need and signpost them to the most appropriate person or clinical correspondence separate to the headcount of staff from manage (code and action) service, referring to a local directory of services? without reference to a GP questions 2 and 3, refer to the guidance if incoming clinical correspondence? where appropriate? unsure.)
M83004 MAYFIELD SURGERY 10,930 Yes 5 1 0 M83014 TRENT VALE MEDICAL PRACTICE 9,165 Yes 11 1 0 M83021 FURLONG MEDICAL CENTRE 10,022 Yes 11 1 0 M83028 GLEBEDALE MEDICAL PRACTICE 7,938 Yes 6 1 0 M83038 ORCHARD SURGERY 10,665 Yes 10 0 0 M83047 MEIR PARK & WESTON COYNEY MEDICAL PRACTICE 6,682 Yes 7 1 0 M83061 MILLRISE MEDICAL PRACTICE 8,044 Yes 10 1 0 M83066 HARTSHILL MEDICAL CENTRE 7,224 Yes 0 1 0 M83068 BELGRAVE MEDICAL CENTRE 12,065 Yes 17 1 0 M83075 NORFOLK STREET SURGERY 8,423 Yes 7 0 0 M83076 HARLEY STREET MEDICAL CTR 8,858 Yes 12 1 0 M83082 THE HAYMARKET HEALTH CTR 13,772 Yes 10 1 0 M83090 DUNROBIN STREET MEDICAL CENTRE 5,332 Yes 7 1 0 M83094 BROOK MEDICAL CENTRE 14,421 Yes 14 1 0 M83100 DR P D MILES AND DR R VALASAPALLI 3,941 Yes 4 0 0 M83102 POTTERIES MEDICAL CENTRE 5,160 No 0 0 0 M83123 BIRCHES HEAD MEDICAL CTR. 7,427 Yes 10 0 0 M83126 LONGTON HALL SURGERY 6,575 Yes 8 1 0 M83127 COBRIDGE SURGERY 5,238 Yes 5 0 0 M83128 MERTON SURGERY 4,098 Yes 0 1 0 M83134 THE SURGERY FODEN STREET 3,597 Yes 9 2 0 M83138 DRS SHAH & TALPUR 7,039 Yes 5 0 0 M83143 GOLDENHILL MEDICAL CENTRE 4,657 Yes 2 0 0 M83146 THE MOORCROFT MEDICAL CTR 8,217 Yes 24 0 0 M83601 BRINSLEY AVENUE PRACTICE 4,857 Yes 0 1 0 M83619 DRS REES & LEFROY 2,038 No 0 0 0 M83623 SNOWHILL MEDICAL CENTRE 4,368 Yes 6 0 0 M83624 CAMBRIDGE HOUSE 2,743 Yes 6 0 0 M83625 DR VSR CHADALAVADA 7,278 Yes 9 2 0 M83627 APSLEY SURGERY 6,052 Yes 11 1 0 M83632 TRINITY MEDICAL CENTRE 4,372 Yes 3 0 0 M83650 TUNSTALL PRIMARY CARE CENTRE 11,665 Yes 13 2 0 M83661 ADDERLEY GREEN SURGERY 5,100 Yes 9 1 0 M83682 LUCIE WEDGWOOD HEALTH CTR 5,922 Yes 4 1 0 M83700 FIVE TOWNS GP SURGERY 4,723 Yes 0 1 0 M83709 BADDELEY GREEN SURGERY 5,520 Yes 7 1 0 M83711 TRENTHAM MEWS MEDICAL CENTRE 3,520 No 0 0 0 M83712 PRACTICE OF DR AK SINHA 2,545 Yes 5 1 0 M83713 DR H P BORSE & PARTNER 4,860 Yes 5 0 0 M83714 PRACTICE OF DR SB KULKARNI 1,199 No 0 0 0 M83725 PRACTICE OF DR JA MIR 3,241 Yes 7 1 0 Y00592 MOSS GREEN SURGERY 7,352 No 0 0 0 Y02521 WILLOW BANK SURGERY 11,206 Yes 12 2 0 Y02867 MIDDLEPORT MEDICAL CENTRE 4,455 Yes 2 0 0
Additional Information A. 312 training licenses have been shared across 37 of our Stoke practices so that online training can be completed by the soon to be Care Navigators B. 5 face to face training events have taken place: those that have had the online training met the providers, gained an understanding of the services that they are signposting and saw a demonstration of MIDOS and the template they will be using C. 4 customer care training events ran in March 18. Bespoke training sessions provided in practice to those unable to access large events. Resulted in further pratices going live and reporting activity.
D. 2 super user events ran in September, representation from 18 practices across NS and SOT. Event focused on creating champions from those already working well in the new role. Best practice shared, tools shared to enable improving the service further by supporting their peers. The event will be repeated in the Autumn for the remaining 28 practices who are live. Super user group events are facilitated by West Wakefied as part of original platinum package that included 10 events. E. Templates and MIDOS access has been rolled out to all participating practices. Once the staff have attended the events they begin navigating patients. F. We currently have 26 fully live practices. For the remaining practices visits are in the process of being made and in -house training provided by a super user. In-house training has been provided by the Project Manager to date, going forward the super-users will be able to provide this to their peers and funded for their time out of practice. G. 408/536 have completed the online Care Navigation training across both Stoke-on-Trent and North Staffordshire. H. Construction of Care Navigation dashboard in February 2018, provides monthly information on the levels of navigation occurring in practice. Practices received an intial report in March 18 that including activity to date. In June they received their Quarter 1 update and will receive a quarterly report from the DQSs going forward. Over 50% of our practices have fully embraced this new way of working.
I. Sept 17 - Aug 18: 17,502 signposts were made, with a 95% level of patient acceptance J. An estimated 2,558 GP hours saved K. The highest number of signposts have been made to Nurse Practitioner (7654), Community Pharmacy (2602), Nurse Triage (2191) and 1759 Walk in Centre L. We have a Community Pharmacist from the LPC supporting work around increasing the Nurse Practitioners understanding of the Minor Ailments scheme and the role of Community Pharmacy, in order for them to support Care Navigators in their signposting in practice and in turn increase the levels of signposts to that service. M. In October we will pilot Walk in my shoes facilitated by the Community Pharmacist from the LPC. The pilot will see a Nurse Practitioner and a Receptionist from a Stoke practice spend a session within their local Community Pharmacy and then vice versa. This will be rolled out if the data identifies an improvement in signposts to Community Pharmacy. N. Healthwatch Stoke completed an evaluation on the level of patient satisfaction about the level of interchange required between patient and receptionist. The report found "that people are largely comfortable discussing details of their condition with the GP receptionist.." 78.7% agreed they were comfortable and the remaining 9.6% neutral about the issue. The second phase of the project evaluation will consider the patient experience of the pathway they experienced and is estimated to take approximately 2-3 months. O. Workflow: 49/76 trainined. 9 started training. 4 already have a system in place. 2 declined. Remaining have technical issues or made no decision. Training already paid for.
Other expenses: See breakdown as per North Staffs
North Staffs & Stoke Practices expected to receive training this year Number of staff expected to attend the training Who is expected to provide training? Cost of training
408 staff have completed online West Wakefield signposting training. Care Navigation: Five provider workshops and four bespoke customer care training A super user event ran on the 28th August 2018 sessions have taken place since June 2017-March18. attended by a representative from 18 practices. Super user group events are facilitated by West 46/76 practices in Stoke and North Staffordshire are actively The event will be repeated in the Autumn for the Wakefied as part of our original platinum package reporting data. remaining 28 practices. that included 10 events. Super user groups - costs for training is covered A super user event ran on the 28th August 2018 attended by a In-house training has been provided by the through Wakefield package already paid. representative from 18 practices. The event will be repeated in the Workflow redirection: Project Manager to date, going forward the super- Autumn for the remaining 28 practices who are live. 49/76 trained. 9 started training. 4 already have users will be able to provide this to their peers 61/76 practices showed initial interest. So for the remaining 17 a system in place. 2 declined. Remaining have and funded for their time out of practice. practices visits are in the process of being made and in -house technical issues or made no decision. Training training provided by a super user. already paid for.
Details of other expenditure e.g. backfill costs. How is the CCG maximising value? Connection with other GPFV initiatives e.g. Primary 1. Backfill for staff at 1st super user event £586.80
2. Second event for 28 representatives - £912.80
3. 2 Super user groups costs for venue and refreshments £1,467.50 The CCG commisioned Health Watch Stoke to complete an evaluation around how patients feel with regard to being questioned by reception staff. Cost £2,818
4. The project is suppported by a local Community Pharmacist via the Local Pharmacy There has been a strong media campaign suppported through the Committee for 6 months. £2,400 This has improved the relationships between practice and Communications Team, including press releases, radio interviews, and a highlighted challenges with the Community Pharmacy that are being resolved as a result. twitter and face book campaign. The results have shown from September The Care Navigation template is due to be incorporated 2017 -August 2018 29,140 signposts have been made across North into local extended access provision. 5. Two pilots of "Walk in my shoes" due to commence in October 2018. This will fund a Staffordshire and Stoke-on-Trent, with an estimated 4,380 GP hours saved. Pharmacist, a receptionist and a Nurse Practitioner for a session in the pharmacy or practice Evaluation and learning will be shared across localities. to gain an understanding of the others role. Approximately costing £505.20
6. Inhouse training provided by a super user to the 17/61 practices unable to access the initial large scale events £415.65
7. Independent evaluation of the patient experience of the Care Navigation pathway £5- 10,000 Total:19,105.90
North Staffs CCG 2016/17 2017/18 2018/19 2019/20 Funding available 19,000 37,000 37,000 Funding spent/planned 19,000 26,216.48 8,143.975 (allocated)
Stoke on Trent CCG 2016/17 2017/18 2018/19 2019/20 Funding available 25,000 49,000 49,000 Funding spent/planned 21,614 26,216.48 10,961.95 (allocated)
NORTH STAFFS AND STOKE ON TRENT CCGs Delivery of the 10 High Impact Actions – Status and next steps (as at 19/12/18)
Introduction: The General Practice Forward View represents a step change in the level of investment and support for general practice. The 10 high Impact Actions are a collection of ways to improve workload and improve care through working smarter, not harder.
10 High Impact Progress to Date (Current Status) Intended Action / Next Steps (including evaluation) Timescale Changes • 408 staff have completed recognised and approved West Wakefield signposting training online across 63 practices
• • Comprehensive report on current status and funding spend / Five provider workshops and four bespoke Report to be shared with planned to be submitted to Primary Care Committee customer care training sessions have taken Committee in January 2019 place since June 2017- March18
• 48/75 practices in Stoke and North Staffordshire are actively reporting data • The reporting dashboard will be monitored to see if the signposts from practice to community pharmacy have increased as a result of the improved understanding of the service • Reporting will be monitored to see if there is a decrease in the • A “Walk in My Shoes” pilot with community Care number of internal signposts to the Nurse Practitioner as the pharmacy has occurred in one Stoke and one Jan 2019 Navigation receptionists confidence grows to signpost to the community North Staffordshire practice pharmacist • If this is the case then this training will be offered to other practices that have low numbers of community pharmacy signposts and where the service is available locally
• Super user training is to be offered to the remaining 28 practices who are actively signposting • A super user event took place on the 28th • The super users will create peer support within practice and August 2018 attended by a representative from utilise the skills of individuals where care navigation is working March 2019 18 practices well across the patch, with supported backfill • Visits are planned for the remaining 17 practices who have had online training but are not actively signposting. In-house training will be offered by a super user.
10 High Impact Progress to Date (Current Status) Intended Action / Next Steps (including evaluation) Timescale Changes Data Quality Specialists (DQS) download monthly data and share quarterly performance reports with practices (monthly with CCG). The practice report details the activity of individual navigators and where signposts are being made. The CCG receives locality • Dashboard developed to measure the impact of reports detailing activity and access to the dashboard. High levels the scheme. March 2019 of internal signposting to Nurse Practitioners was identified which is
where the need for the Community Pharmacy pilot originated to improve the understanding of the minor ailments scheme within practice to increase signposts to them and further release GP capacity. All Dr Ruth Chambers (in her role as Clinical Chair & Individual reports have been sent to practices c/o Dr Ruth Staffordshire STP clinical lead for technology Chambers, which highlight long term condition rates at the practice Reports issued October 2018 enabled care services) is involved in various work in and provide technology solutions / apps that may be beneficial for
New regards to technology enabled care. An options patients with these conditions. Practices can promote these to
Consultation paper was submitted last year on different models of patients. These have also been incorporated into action learning
Types consultation to the STP who recommended this be sets for practice nurses to utilise through long term condition clinics.
endorsed by the Staffordshire Digital Design 22 January 2018 Authority (SDDA) A workshop is being held for practices to come together to hear more about these opportunities.
A digital conference was held in November in Birmingham to share 2019/20 – TBC learning.
Digital programme lead continues to review other suppliers who have emerged onto the market to ensure the area is piloting Use of Skype / E-consultations in Care Homes: products that suit the objectives of the programme. New • 28 care homes in North Staffs are using Skype consultation consultations with their linked Practices CCG is working with NHSE to support the new 111 app to types • 20% of practices have either had EMIS online understand how both primary care and urgent and emergency care triage or e-Consult implemented to-date systems can integrate. Staffordshire will be piloting four practices in early phases of development
More practices are due on board to pilot a solution up to January Online consultations – First phase 2019. due to be complete Jan 2019.
New LMC have been looking at usefulness of group consultation To consider a pilot of group consultations TBC in 2019 consultations types
10 High Impact Progress to Date (Current Status) Intended Action / Next Steps (including evaluation) Timescale Changes APEX licence extended until Match 2019 pending resolving ongoing DNA reporting is the main feature on APEX reporting and data quality issues. Meeting on 15/11/18 to discuss Capacity and Demand tool that practices are licence extension. utilising in house. (Currently available to EMIS Meeting held on 26/10/18 with developer. Priority practices to be Reduce DNAs practices only – 68 out of 76 practices). The contacted and supported. Communication being developed with practice is able to identify DNA’s to staff members th Edenbridge for practices around improved home page, benefits of To be issued by 9 Nov. and time and days etc. use, testimonials etc. Awaiting user usage report for analysis.
The CCG funds all practices to send text messaging reminders for appointment as a minimum through EMIS. Some practices fund other suppliers e.g. Text messaging reminders are proven to be useful for reducing MJOG which provides additional benefits such as DNAs. To continue to engage with practices regarding the can accept replies from patients regarding health usefulness of MJOG. Reduce DNAs promotion
Primary care team will consider examples of other schemes July 2019 The following practices currently use MJOG nationally to reduce DNAs to share learning with practices locally. (advanced texting reminder system): North Staffs: 11 Stoke on Trent: 20 All • Practice Manager Training delivered for 17/18 via allocation of bursaries and ‘coaching and mentoring for success training’ with further networking sessions being planned for quarter 4 of 18/19. Practice Manager Development Fund. • PM update course being planned for February/March 2019 in Comprehensive programme developed. relation to 18/19 funding. • Practice Nurse Development through the GPN 10 Point Plan. Staffordshire training hub has supported • Practice Nurse Facilitator in post to support Practice Nursing. procurement of training at scale relating to 17/18 • Develop the PLT programme in place – including in-house and external funding. Feb / March 2019 team training • Wider workforce roles – e.g. Clinical Pharmacists CCG commissioning a PM update course with 18/19 funding. The newly qualified nurse incentive has gained some interest with 4 recruited in practice and now on fundamental programme.
NHS England scheme for Clinical Pharmacists in General Practice continues and further waves are expected through the end of 2018 and early 2019. https://www.england.nhs.uk/gp/gpfv/workforce/building-the-general- practice-workforce/cp-gp/. The CCG isn’t involved in this directly but
10 High Impact Progress to Date (Current Status) Intended Action / Next Steps (including evaluation) Timescale Changes can support practices in any applications where necessary.
Staffordshire wide offer issued to localities to develop workforce plan in 2018/19. Resilience funding panel took place in June 2018. Workshops will take place next Develop the 18/19 funding is targeted towards workforce to year to showcase new workforce team Deep dive on previous resilience funding to be completed by NHSE. support practices and localities to develop a plan. roles/models. Case studies produced on the use and impact of resilience funding for 17/18 and 18/19. Continue to deliver on the GPN 10 point plan. 6 month plan implementation plan (Sept 18 – March 19) involves the following 10 point plan priorities:
1. Support access to educational programmes to deliver national priorities as set out by the GPFV: • Align PLT topics for the 6 CCGs • GPFV spend Asthma training- introduction to asthma / update in asthma (across the 6 CCGs for Spring 2019)
2. Extend Leadership roles: • Share leadership opportunities via NHS leadership academy GPN 10 Point implementation plan developed and opportunities /Edward Jenna – share in newsletter HEE submitted to NHSE in March 2018 and is updated opportunities/RCN opportunities Develop the quarterly. March 2019 • Applied for £6,000 GPN 10 point plan money to fund two team bespoke workshops: GPN 10 point plan deep dive undertaken in Step One - Finding your VOICE November with NHSE GPFV Umbrella Group. o o Step Two - Using your VOICE
3. Develop healthcare support workers, apprenticeships and nursing associate career pathways
Agreed standardised approach from PCNFs across 6 CCGs: • Recommend completion of the care certification • Recommend the HCA Award • Recommend the RCGP competencies. Aim to standardise training to incorporate all aspects of the competencies • Recommend District Nursing and General Practice Nursing service framework from HEE
10 High Impact Progress to Date (Current Status) Intended Action / Next Steps (including evaluation) Timescale Changes
Aim to get all HCAs up to deliver the following: • Influenza/pneumococcal vaccines • B12 • Simple wound care • Health & wellbeing assessment for new patient health checks/NHS health checks and the healthy lifestyles aspects of LTC reviews
Training & Education: LWAB spend – £20,000 has been identified for the upskilling of the HCSWs. £10,000 for North Staffs and Stoke and £10,000 for the rest of Staffordshire. A discussion with the training hub and GP North Federation has agreed wound care, diabetes and general upskilling. Training is booked for spring 2019. Nursing Associate:
• Now part of Education and training group – agreed training licenses for Maths and English. This is the start in the pathway to Nurse Associate. • CCG/GP Fed/MPFT/UHM agreed working party around HCSW apprenticeship model) • Attending the partnership steering group at UHNM around Nursing Associate. (Dec 18)
LDP – report and development plan to be produced taking into Locality Development Programme (LDP) – first account the recommendations in the report and following “diagnostic” phase completed to understand the engagement with localities. readiness of practices to work at scale and to Develop the identify programme of support tailored to the needs Jan-March 2019 team CCG work ongoing with CSU strategy unit to support locality of each geographical area. (Commissioned by CSU organisational development Strategy Unit). Results presented to STP and
membership/locality boards. Also see Developing QI expertise section. Learning and Development sub-group agrees a calendar of large scale events delivered throughout the year for all staff groups L&D programme for North Staffs and Stoke is in including the GP update and Nurse update in February and March Develop the place. 2019. team The North Staffs GP Federation also supply training
such as ‘7 updates in a day’ for admin staff. It has supported General practice Nurses in Independent Prescribing and Physical assessment in two academic intakes, the
10 High Impact Progress to Date (Current Status) Intended Action / Next Steps (including evaluation) Timescale Changes next being January 2019 releasing GP capacity and improving the patient experience in long term condition management.
Bursaries remain available to all staff groups to apply for to support improvements in patient care and upskilling of staff. This has included the Practice Manager AMSPAR training supporting succession planning and resilience in practice.
It also supports the organisation of a bi-monthly PLT for GPs/GPNs/HCAs and administrative staff. • The primary care team will liaise with practices yet to engage to discuss the benefits of the workflow optimisation training. To also explore opportunities for hubs to centralise workflow. • Workflow optimisation training has taken place • Survey results to be reviewed by CCG at workshop held on across the CCG – including face to face and 15/11/18 attended by South Staffs practice reps. Productive Training to be completed by 31 online training places (varying by practice). • Further workshop to be arranged for Northern Staffs practices Work flows Mar 19 • Evaluation of the workflow optimisation before end March 2019 implementation to date has taken place. • Clarification of data streams available required, request to Data Quality team to ascertain what data is available within practice clinical systems. Email sent to Care Unbound Ltd asking if Dashboard can be made available. BMA workshop to be held later in the year. Subject areas to be covered • empowering people to do the right thing. 2019 • Premises management GP Resilience funds for 2018/19 in relation to Personal • Contracts and payments. workforce have been offered to all practices through Productivity the GP Federation. An additional 2 practices have Time management and team management events to be planned. received a further offer for submitted projects. Provider to be sourced. Practice Managers Association or 2019 Thornfields to be considered. Also, see ‘Developing the Team’ above.
Expressions of interest sent to Practice managers for funding Personal contribution to AMSPAR Diploma. Antoinette Bourne (date TBC) Productivity
• Extended Access model delivered at scale North Staffordshire GP Federation is looking to appoint an • Care Navigation and Workflow Optimisation Operations Manager to cover extended access. Partnership developed at scale across the practices / working localities Federation looking at developing a collective approach / model • Local incentive schemes (LIS) delivered at scale working with MPFT and Combined Health care. TBC
10 High Impact Progress to Date (Current Status) Intended Action / Next Steps (including evaluation) Timescale Changes • Back office functions shared • Joint staff employed across practices • Primary care working in partnership with community/social/mental health provider and other examples include working with voluntary sector and organisations such as local leisure centres and schools
VAST have been delivering a social prescribing project model since 2015 – funded by the CCG. VCS hub is funded to 30/9/18 so there are concerns about how this The service is within Care Navigation, GP referrals will affect care navigation. VAST will need clarity on what happens are increasing and many good working links have in terms of the developing model and the work already carried out been formed throughout N Staffs. Any further by the VCS hub. developments of SP will benefit from the ground
work already carried out.
Social Funding awarded by PCC from Delegated Prescribing Commissioning underspend for Stoke on Trent. Stoke-on-Trent CCG to roll out social prescribing pilot across a Phase 1 will commence in Operating model, evaluation process and early number of GP practice sites. Quarter 4 18/19. implementer localities proposed.
Weekly meetings of the extensivist service ongoing. There have been approx. 60 patients contacted so far. The team determines the level of support Ongoing Ongoing needed and all parties contribute where they can.
Communication and Engagement team are supporting this national Support Self Supported by Care navigation and TECS around campaign week. This year’s theme is health literacy and the 14-20th November 2018 care prevention and social prescribing strapline is Understanding Self Care for Life.
10 High Impact Progress to Date (Current Status) Intended Action / Next Steps (including evaluation) Timescale Changes
In line with NHS-E guidance on reducing prescribing of Over-the- counter medicines the Medicine Optimisation Team will be implementing the locally agreed policy on OTC medicines. The policy and link to NHS-E documents can be found Support Self Pharmacy first promoted / reducing prescribing over here: http://sharenet/dept/mdsmgmt/Pages/default.aspx care the counter Medicines (OTC) It is identified that the Pharmacy First minor ailment service may contradict this local policy and therefore although the service continues across Staffordshire at present there will be a review prior to April 2019.
“Help us Help you” campaign supported by Messages will be shared which explain what Self Care means, on Support Self Communication and Engagement team as part of top of the self-care messages the CCG will be sharing throughout Ongoing throughout care winter and flu campaign. Resource packs issued to the Winter e.g. in social media packs sent to partner organisations Winter 2018/19 practices for winter 2018. and sent out with web and TV banners. 21 practices have completed the Productive General Practice Quickstart programme and a further 8 Develop QI practices are underway in terms of a further cohort Continue with the cohort of 8 practices. April 2019 Expertise that was agreed in November 2018.
Role will support the co-ordination of the learning from the Quality Improvement Facilitator working with LMC Develop QI resilience training programmes and QI pack / repository of and GP Federation has been appointed. Ongoing in 2019 Expertise resources to be developed to maintain practices and support other Commenced September 2018 practices.
Other notes: • The CCG is in close links with RCGP GPFV ambassador in terms of any GPFV presentations and papers • Monthly data and update reports on GPFV progress are submitted to NHSE. • CCG attend monthly “checkpoint” meeting with NHSE. • NHSE Regional GPFV newsletter is shared with practices via CCG practice newsletter. • The CCG will share learning and case studies from practices via the CCG practice newsletter and practice manager/locality meetings
Information available from: 10 high impact actions to release time for care https://www.england.nhs.uk/gp/gpfv/redesign/gpdp/ 1. Active signposting: Provides patients with a first point of contact which directs them to the most appropriate source of help. Web and app-based portals can provide self-help and self-management resources as well as signposting to the most appropriate professional.
2. New consultation types: Introduce new communication methods for some consultations, such as phone and email, improving continuity and convenience for the patient, and reducing clinical contact time 3. Reduce Did Not Attend (DNAs): Maximise the use of appointment slots and improve continuity by reducing DNAs. Changes may include redesigning the appointment system, encouraging patients to write appointment cards themselves, issuing appointment reminders by text message, and making it quick for patients to cancel or rearrange an appointment. 4. Develop the team: Broaden the workforce in order to reduce demand for GP time and connect the patient directly with the most appropriate professional. 5. Productive work flows: Introduce new ways of working which enable staff to work smarter, not harder. 6. Personal productivity: Support staff to develop their personal resilience and learn specific skills that enable them to work in the most efficient way possible. 7. Partnership working: Create partnerships and collaborations with other practices and providers in the local health and social care system. 8. Social prescribing: Use referral and signposting to non-medical services in the community that increase wellbeing and independence. 9. Support self-care: Take every opportunity to support people to play a greater role in their own health and care with methods of signposting patients to sources of information, advice and support in the community. 10. Develop QI expertise: Develop a specialist team of facilitators to support service redesign and continuous quality improvement.
NORTH STAFFORDSHIRE AND STOKE-ON-TRENT CLINICAL COMMISSIONING GROUPS’ MEETING IN COMMON - Governance Template
To be completed by the Chair(s) of the Committee:
Name of Committee: Primary Care Commissioning Committee Meeting in Common
Name of Chair(s): Peter Dartford
Date: 4 December 2018
Question Answer
Did we achieve what we set out to do; linking back to the agenda
Was the information presented appropriate / easy to understand?
Was the information received in a timely manner prior to the meeting?
Do we need to inform any of our decisions
Do we need any more information / require a further progress report at a future date?
Agreed actions captured in the minutes
Were there any risks raised in the meeting that should be captured on the risk register?