Agenda
Chair: Eleri de Gilbert Enquiries to: [email protected]
Meeting Agenda (Public Session)
Primary Care Commissioning Committee Wednesday 21 October 2020 9:00-10:35 Zoom Meeting
Time Item Presenter Reference 09:00 Introductory Items 1. Welcome, introductions and apologies Eleri de Gilbert PCC/20/111 2. Confirmation of quoracy Eleri de Gilbert PCC/20/112 3. Declarations of interest for any item on the agenda Eleri de Gilbert PCC/20/113 4. Management of any real or perceived conflicts of Eleri de Gilbert PCC/20/114 interest 5. Questions from the public Eleri de Gilbert PCC/20/115 6. Minutes from the meeting held on 16 September 2020 Eleri de Gilbert PCC/20/116 7. Action log and matters arising from the meeting held on Eleri de Gilbert PCC/20/117 16 September 2020 8. Actions arising from the Governing Body meeting held Eleri de Gilbert PCC/20/118 on 7 October 2020 09:05 Committee Business 9. Committee Work Programme Eleri de Gilbert PCC/20/119 09:10 Covid-19 Recovery and Planning 10. Overview of GP Practice Additional Expenses in Joe Lunn PCC/20/120 Relation to COVID-19 09:20 Items for Assurance 11. Primary Care Estates Update Lynne Sharpe PCC/20/121 12. Primary Care Enhanced Services Review Lynette Daws PCC/20/122 13. Leen View Surgery Boundary Reduction Joe Lunn PCC/20/123 14. Giltbrook Surgery Boundary Reduction Joe Lunn PCC/20/124 15. GP Contract Letter 1 October 2020 Joe Lunn PCC/20/125 10:00 Strategy, Planning and Service Transformation 16. Primary Care Networks (PCN) Delivery: Additional Helen Griffiths PCC/20/126 Roles Unclaimed Fund Process 10:15 Financial Management 17. Finance Report Andrew Morton PCC/20/127 10:25 Risk Management 18. Risk Report Eleri de Gilbert PCC/20/128 Page 1 of 2
09:00-10:40-21/10/20 1 of 101 Agenda
10:30 Closing Items 19. Any other business Eleri de Gilbert PCC/20/129 20. Key messages to escalate to the Governing Body Eleri de Gilbert PCC/20/130 21. Date of next meeting: Eleri de Gilbert PCC/20/131 18/11/2020 Zoom Meeting Confidential Motion: The Primary Care Commissioning Committee will resolve that representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960)
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2 of 101 09:00-10:40-21/10/20 Declarations of interest for any item on the agenda
Register of Declared Interests
• As required by section 14O of the NHS Act 2006 (as amended), the CCG has made arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the CCG will be taken and seen to be taken without being unduly influenced by external or private interests.
• This document is extracted, for the purposes of this meeting, from the CCG’s full Register of Declared Interests (which is publically available on the CCG’s website). This document was extracted on 9 October 2020 but has been checked against the full register prior to the meeting to ensure accuracy .
• The register is reviewed in advance of the meeting to ensure the consideration of any known interests in relation to the meeting agenda. Where necessary (for example, where there is a direct financial interest), members may be fully excluded from participating in an item and this will include them not receiving the paper(s) in advance of the meeting.
• Members and attendees are reminded that they can raise an interest at the beginning of, or during discussion of, an item if they realise that they do have a (potential) interest that hasn’t already been declared.
• Expired interests (as greyed out on the register) will remain on the register for six months following the date of expiry.
Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest
(Name of the DateTo:
organisation Interests DateFrom:
and nature of Professional
Non-financial Non-financial
business) InterestIndirect
FinancialInterest PersonalInterests
09:00-10:40-21/10/20 AINSWORTH, David Locality Director Mid-Notts Erewash Borough Council Lay Member of the 01/01/2019 Present This interest will be kept under review Remuneration Committee and specific actions determined as required.
AINSWORTH, David Locality Director Mid-Notts Consultancy Ad hoc nurse consultancy to 01/03/2019 Present This interest will be kept under review provider organisations and specific actions determined as required.
AINSWORTH, David Locality Director Mid-Notts Saxon Cross Surgery Registered Patient Present This interest will be kept under review and specific actions determined as - required - as a general guide, the individual should be able to participate in AUDIS, Adrian NHS England/NHS No relevant interests declared Not applicable Notdiscussions applicable relating to this practice but Improvement - - Commissioning Manager
BEEBE, Shaun Non-Executive Director University of Nottingham Senior manager with the Present This interest will be kept under review University of Nottingham and specific actions determined as - required.
BEEBE, Shaun Non-Executive Director Nottingham University Hospitals Patient in Ophthalmology Present This interest will be kept under review NHS Trust - and specific actions determined as required. BURNETT, Danni Deputy Chief Nurse NHS England and Improvement Spouse employed as Senior 01/07/2018 Present This interest will be kept under review Delivery and Improvement Lead and specific actions determined as required. BURNETT, Danni Deputy Chief Nurse Nottingham and Nottinghamshire Family member employed as 01/07/2018 Present This interest will be kept under review CCGs Head of Service Improvement and specific actions determined as and BCF required. BURNETT, Danni Deputy Chief Nurse Nottingham and Nottinghamshire Famiy member employed as Present This interest will be kept under review CCG Primary Care Commissioning - and specific actions determined as Manager required. 3 of 101 3 of 4 of 101 4 of Declarations of interest for any item on the agenda
Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest
(Name of the DateTo:
organisation Interests DateFrom:
and nature of Professional
Non-financial Non-financial
business) InterestIndirect
FinancialInterest PersonalInterests BURNETT, Danni Deputy Chief Nurse NEMS Community Benefit Services Family member employed as 01/07/2018 Present This interest will be kept under review Ltd Finance Accountant and specific actions determined as required. BURNETT, Danni Deputy Chief Nurse Academic Health Science Network Family member employed in 01/07/2018 Present This interest will be kept under review Project Team and specific actions determined as required. BURNETT, Danni Deputy Chief Nurse Castle Healthcare Practice Registered Patient 01/07/2018 Present This interest will be kept under review and specific actions determined as required - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
CALLAGHAN, Fiona Locality Director - South Radcliffe on Trent Health Centre Registered Patient Present This interest will be kept under review Nottinghamshire and specific actions determined as required - as a general guide, the
09:00-10:40-21/10/20 - individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
CAWLEY, Michael Operational Director of Castle Healthcare Practice Registered Patient Present This interest will be kept under review Finance and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
COSTER-HOLLIS, Daisy May Interim Head of Corporate St Georges Medical Practice Registered patient Present This interest will be kept under review Governance and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
COSTER-HOLLIS, Daisy May Interim Head of Corporate Browne Jacobson Substantively employed; Present Involvement in commissioning work Governance seconded to Nottingham and relevant to Browne Jacobson will be kept - Nottinghamshire CCG on an under review and specific actions interim basis determined as required. DADGE, Lucy Chief Commissioning Officer Mid Nottinghamshire and Greater Director 01/10/2017 Present This interest will be kept under review Nottingham Lift Co (public sector) and specific actions determined as required. DADGE, Lucy Chief Commissioning Officer Pelham Homes Ltd – Housing Director 01/01/2008 Present This interest will be kept under review provider subsidiary of and specific actions determined as Nottinghamshire Community required. Housing Association DADGE, Lucy Chief Commissioning Officer 3Sixty Care Ltd – GP Federation, Chair 01/01/2017 Present This interest will be kept under review Northamptonshire and specific actions determined as required. DADGE, Lucy Chief Commissioning Officer First for Wellbeing Community Director 01/12/2016 Present This interest will be kept under review Interest Company (Health and and specific actions determined as Wellbeing Company) required. Declarations of interest for any item on the agenda
Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest
(Name of the DateTo:
organisation Interests DateFrom:
and nature of Professional
Non-financial Non-financial
business) InterestIndirect
FinancialInterest PersonalInterests DADGE, Lucy Chief Commissioning Officer Valley Road Surgery Registered Patient 19/06/1905 Present This interest will be kept under review and specific actions determined as required - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
DADGE, Lucy Chief Commissioning Officer Nottingham Schools Trust Chair and Trustee 01/11/2017 Present This interest will be kept under review and specific actions determined as required. DADGE, Lucy Chief Commissioning Officer Primary Integrated Community Daughter has a temporary 01/09/2020 Present This interest will be kept under review Services (PICS) Ltd working contract with PICS (as a and specific actions determined as Band 2 administrator) for the required. period 1st September to 2nd November 2020. DAWS, Lynette Head of Primary Care Rivergreen Medical Centre Family members are registered Present This interest will be kept under review
09:00-10:40-21/10/20 patients and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
DE GILBERT, Eleri Non-Executive Director Middleton Lodge Surgery Individual and spouse registered Present This interest will be kept under review patients at this practice and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
DE GILBERT, Eleri Non-Executive Director Rise Park Practice Son and Daughter in Law 18/10/2019 Present This interest will be kept under review registered patients and specific actions determined as required. DE GILBERT, Eleri Non-Executive Director Nottingham Bench Justice of the Peace Present This interest will be kept under review - and specific actions determined as required. DE GILBERT, Eleri Non-Executive Director Major Oak Medical Practice, Son, daughter in law and Present This interest will be kept under review Edwinstowe grandchild registered patients and specific actions determined as - required.
GASCOIGNE, Sian Head of Corporate Nottingham University Hospitals Husband is the Integration 01/08/2019 Present This interest will be kept under review Assurance NHS Trust Manager and specific actions determined as required.
GASCGOIGNE, Sian Head of Corporate Radcliffe Health Centre Patient Father is a member 01/01/2019 Present This interest will be kept under review Assurance Participation Group and specific actions determined as required. 5 of 101 5 of 6 of 101 6 of Declarations of interest for any item on the agenda
Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest
(Name of the DateTo:
organisation Interests DateFrom:
and nature of Professional
Non-financial Non-financial
business) InterestIndirect
FinancialInterest PersonalInterests GASCGOIGNE, Sian Head of Corporate Nottinghamshire Healthwatch Father is a volunteer 01/01/2019 Present This interest will be kept under review Assurance and specific actions determined as required.
GASCGOIGNE, Sian Head of Corporate Castle Healthcare Practice Registered Patient Present This interest will be kept under review Assurance and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
GASKILL, Esther Head of Quality Intelligence Mapperley and Victoria Practice Registered Patient Present This interest will be kept under review and specific actions determined as required - as a general guide, the - individual should be able to participate in
09:00-10:40-21/10/20 discussions relating to this practice but be excluded from decision-making.
GRIFFITHS, Helen Associate Director of Primary Musters Medical Practice Registered Patient 01/04/2013 Present This interest will be kept under review Care Networks and specific actions determined as required - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
GRIFFITHS, Helen Associate Director of Primary Castle Healthcare Practice Spouse is GP Partner 01/10/2015 Present To be excluded from all commissioning Care Networks (Rushcliffe Practice) decisions (including procurement activities and contract management arrangements) relating to services that are currently, or could be, provided by this practice GRIFFITHS, Helen Associate Director of Primary Embankment Primary Care Centre Spouse is Director 01/10/2015 Present This interest will be kept under review Care Networks and specific actions determined as required. GRIFFITHS, Helen Associate Director of Primary NEMS Healthcare Ltd Spouse is shareholder 01/04/2013 Present This interest will be kept under review Care Networks and specific actions determined as required. GRIFFITHS, Helen Associate Director of Primary Partners Health LLP Spouse is a member 01/10/2015 Present This interest will be kept under review Care Networks and specific actions determined as required. GRIFFITHS, Helen Associate Director of Primary Principia Multi-specialty Community Spouse is a member 01/10/2015 Present This interest will be kept under review Care Networks Provider and specific actions determined as required. GRIFFITHS, Helen Associate Director of Primary Nottingham Forest Football Club Spouse is a Doctor for club 01/04/2013 Present This interest will be kept under review Care Networks and specific actions determined as required. Declarations of interest for any item on the agenda
Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest
(Name of the DateTo:
organisation Interests DateFrom:
and nature of Professional
Non-financial Non-financial
business) InterestIndirect
FinancialInterest PersonalInterests LUNN, Joe Interim Associate Director of Kirkby Community Primary Care Registered Patient Present This interest will be kept under review Primary Care Centre and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
STRATTON, Dr Richard GP Representative Belvoir Health Group GP Partner 01/08/2012 Present To be excluded from all commissioning decisions (including procurement activities and contract management arrangements) relating to services that are currently, or could be, provided by GP Practices. STRATTON, Dr Richard GP Representative Partners Health LLP - a GP member and is entitled to 01/11/2015 Present To be excluded from all commissioning membership organisation of general receive profit shares (although decisions (including procurement practices in Rushcliffe. Provider of profit shares are not currently activities and contract management
09:00-10:40-21/10/20 extended access service and non- paid out to members). Also acts arrangements) in relation to services core provider for Rushcliffe PCN in an advisory capacity to currently provided by Partners Health and employer for additional roles Partners Health Board which is LLP; and Services where it is believed staff for the PCN not remunerated. that Partners Health LLP could be an interested bidder.
SUNDERLAND, Sue Non-Executive Director Joint Audit Risk Assurance Chair 01/04/2018 Present This interest will be kept under review Committee, Police and Crime and specific actions determined as Commissioner (JARAC) for required. Derbyshire / Derbyshire Constabulary SUNDERLAND, Sue Non-Executive Director NHS Bassetlaw CCG Governing Body Lay Member 16/12/2015 Present This interest will be kept under review and specific actions determined as required.
SUNDERLAND, Sue Non-Executive Director Inclusion Healthcare Social Non-Executive Director 16/12/2015 Present This interest will be kept under review Enterprise CIC (Leicester City) and specific actions determined as required.
TILLING, Michelle Locality Director - City No relevant interests declared Not applicable Not applicable - -
TRIMBLE, Dr Ian Independent GP Advisor Occasional consultancy work for Occasional consultancy work for 01/10/2016 Present This interest will be kept under review other CCGs other CCGs and specific actions determined as required.
TRIMBLE, Dr Ian Independent GP Advisor Unity Surgery, Mapperley Registered Patient Present This interest will be kept under review and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making. 7 of 101 7 of 8 of 101 8 of Declarations of interest for any item on the agenda
Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest
(Name of the DateTo:
organisation Interests DateFrom:
and nature of Professional
Non-financial Non-financial
business) InterestIndirect
FinancialInterest PersonalInterests TRIMBLE, Dr Ian Independent GP Advisor National Advisory Committee for Independent GP Advisor 01/04/2013 Present This interest will be kept under review Resource Allocation and specific actions determined as required - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making.
WRIGHT, Michael LMC Representative, CEO Practice Support Services Limited - Support service as for profit 01/04/2016 Present This interest will be kept under review Nottinghamshire subsidiary of LMC and specific actions determined as required. WRIGHT, Michael LMC Representative, CEO LMC Buying Groups Federation Manager 01/04/2016 Present This interest will be kept under review and specific actions determined as required. WRIGHT, Michael LMC Representative, CEO GP-S coaching and mentoring Support service as for profit 01/04/2016 Present This interest will be kept under review subsidiary of LMC and specific actions determined as required.
09:00-10:40-21/10/20 WRIGHT, Michael LMC Representative, CEO Nottinghamshire GP Phoenix Manager 01/04/2016 Present This interest will be kept under review Programme and specific actions determined as required. WRIGHT, Michael LMC Representative, CEO Castle Healthcare Practice Registered Patient 30/09/2016 Present This interest will be kept under review and specific actions determined as required. WRIGHT, Michael LMC Representative, CEO Notspar and Trent Valley Surgery Chair 01/04/2016 Present This interest will be kept under review Special Allocation Schemes (violent and specific actions determined as patient schemes) required. Management of any real or perceived conflicts of interest
Managing Conflicts of Interest at Meetings
1. A “conflict of interest” is defined as a “set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”.
2. An individual does not need to exploit their position or obtain an actual benefit, financial or otherwise, for a conflict of interest to occur. In fact, a perception of wrongdoing, impaired judgement, or undue influence can be as detrimental as any of them actually occurring. It is important to manage these perceived conflicts in order to maintain public trust.
3. Conflicts of interest include: Financial interests: where an individual may get direct financial benefits from the consequences of a commissioning decision. Non-financial professional interests: where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their reputation or status or promoting their professional career. Non-financial personal interests: where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. Indirect interests: where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision. The above categories are not exhaustive and each situation must be considered on a case by case basis.
4. In advance of any meeting of the Committee, consideration will be given as to whether conflicts of interest are likely to arise in relation to any agenda item and how they should be managed. This may include steps to be taken prior to the meeting, such as ensuring that supporting papers for a particular agenda item are not sent to conflicted individuals.
5. At the beginning of each formal meeting, Committee members and co-opted advisors will be required to declare any interests that relate specifically to a particular issue under consideration. If the existence of an interest becomes apparent during a meeting, then this must be declared at the point at which it arises. Any such declaration will be formally recorded in the minutes for the meeting.
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6. The Chair of the Committee (or Deputy Chair in their absence, or where the Chair of the Committee is conflicted) will determine how declared interests should be managed, which is likely to involve one the following actions: Requiring the individual to withdraw from the meeting for that part of the discussion if the conflict could be seen as detrimental to the Committee’s decision-making arrangements. Allowing the individual to participate in the discussion, but not the decision-making process. Allowing full participation in discussion and the decision-making process, as the potential conflict is not perceived to be material or detrimental to the Committee’s decision-making arrangements.
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10 of 101 09:00-10:40-21/10/20 Minutes from the meeting held on 16 September 2020
NHS Nottingham and Nottinghamshire Clinical Commissioning Group Public Session of the Primary Care Commissioning Committee Unratified minutes of the meeting held on 16/09/2020, 09.00 – 09:55 Zoom Meeting
Members present: Eleri de Gilbert Non-Executive Director (Chair) Shaun Beebe Non-Executive Director Danielle Burnett Deputy Chief Nurse Michael Cawley Operational Director of Finance Lucy Dadge Chief Commissioning Officer Helen Griffiths Associate Director of Primary Care Networks Joe Lunn Interim Associate Director of Primary Care Sue Sunderland Non-Executive Director Dr Ian Trimble Independent GP Advisor In attendance: Helen Brocklebank-Clark Corporate Governance Officer (minutes) Daisy May Coster-Hollis Interim Head of Corporate Governance Siân Gascoigne Head of Corporate Assurance Esther Gaskill Head of Quality – Primary Care Michelle Tilling Locality Director, Nottingham City (item PCC/20/104) Dianne Wells Contract Manager, NHS England/Improvement GP Hub Michael Wright Chief Executive, Nottinghamshire Local Medical Committee Apologies: Adrian Audis Commissioning Manager, NHS England/Improvement GP Hub Lynette Daws Head of Primary Care Dr Richard Stratton GP Representative
Cumulative Record of Members’ Attendance (2020/21) Name Possible Actual Name Possible Actual Shaun Beebe 6 6 Joe Lunn 6 5 Michael Cawley 6 6 Dr Richard Stratton 6 5 Lucy Dadge 6 6 Sue Sunderland 6 6 Eleri de Gilbert 6 6 Dr Ian Trimble 6 6 Helen Griffiths 6 5 Danielle Burnett 6 3
Introductory Items PCC 20 096 Welcome and Apologies Eleri de Gilbert welcomed everyone to the public session of the Primary Care Commissioning Committee meeting, which was being held virtually due to the Covid-19 pandemic.
Apologies were noted as above.
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PCC 20 097 Confirmation of Quoracy The meeting was declared quorate PCC 20 098 Declaration of interest for any item on the shared agenda No interests were declared in relation to any item on the agenda. The Chair reminded members of their responsibility to highlight any interests should they transpire as a result of discussions during the meeting.
PCC 20 099 Management of any real or perceived conflicts of interest As no conflicts of interest had been identified, this item was not necessary for the meeting.
PCC 20 100 Questions from the public No questions had been received from members of the public.
PCC 20 101 Minutes from the meeting held on 19 August 2020 It was agreed that the minutes were an accurate record of the meeting.
PCC 20 102 Action log and matters arising from the meeting held on 19 August 2020 There were no actions outstanding. The action relating to the work programme was not yet due; the required changes would be included in the second iteration which is to be presented to the October meeting. There were no matters arising.
COVID-19 Recovery and Planning PCC 20 103 COVID-19 GP Practice Additional Expenses’ Joe Lunn presented the item and highlighted the following points: a) The paper provides a summary overview of the Covid-19 additional expense claims for August 2020 as the costs are currently in the process of being finalised. b) Sixty practices submitted claims during August, totaling £187,336.33. Of this total £117,481.21 has been suggested for approval at the initial review stage, and is subject to change. c) The total sum of outstanding claims for March to July currently stands at £90,323.57, which is a reduction of £21,389.45. d) On 4 August 2020, a letter was published by NHS England and NHS Improvement (NHSEI) which offered updated guidance on the Covid-19 support fund. The letter outlined instructions for commissioners on the acceptance of claims and introduced caps on staffing costs, which will impact on the number of claims received moving forward.
The following points were made in discussion: e) Clarification was sought as to the impact on practices of the updated NHSEI claiming criteria. It was explained that the CCG and Local Medical Committee (LMC) were working closely to understand the impact, however, it would potentially limit the use of the roving GP and Practice Manager scheme, and locums, as the cost had been capped at £200 a session. In addition, from the 1 August 2020 the use of additional staffing capacity over and above usual levels will no longer be supported for reimbursement. f) The importance of GPs submitting claims in a timely manner to ensure
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reimbursement was emphasised, as the six week deadline for claiming March to July expenses as detailed in the 4 August 2020 letter had now passed. g) A communication was being drafted for circulation to practices as a prompt to submit outstanding claims.
The Primary Care Commissioning Committee: NOTED the information for assurance purposes.
Items for Approval PCC 20 104 Nottingham City First Contact Physiotherapists Michelle Tilling presented the item and highlighted the following: a) Under the Primary Care Network Contract Directed Enhanced Service (PCN DES), funding is made available to PCNs through the Additional Roles Reimbursement Scheme (ARRS) to recruit additional staff members across a range of specific roles. One of these roles is First Contact Physiotherapists (FCPs). b) FCPs are physiotherapists with enhanced skills who are able to see patients with musculoskeletal (MSK) issues directly without needing a referral from their GP; this is a role anticipated to be much sought after through the Covid-19 recovery phase as numbers of people experiencing MSK issues is anticipated to increase. c) In contrast to previous versions of the PCN DES, the most recent version, released on 31 March 2020, limited the number of FCPs a PCN was eligible to be reimbursed for to “one WTE per PCN where the PCN’s patients number 99,999 or less”. However, “the commissioner may waive any limits in Table 1 where this is agreed by the PCN, the commissioner, and the relevant Integrated Care System”. d) The Committee is asked to apply this waiver to allow Bulwell and Top Valley PCN and BACHS PCN to continue their plans to recruit up to 2.0 Whole Time Equivalent (WTE) FCPs (for each PCN) in the year 2020/21. e) In addition, the Committee is asked to consider agreeing in principle that if any further requests are made to increase the number of WTE First Contact Physiotherapists (above the 1.0 WTE cap) they will have approval from the committee in-line with previous recommendations. Although it is unlikely that further requests will be received as the PCN workforce plans were submitted on 31 August 2020.
The following points were made in discussion: f) It was emphasised that the national allocation for roles and reimbursements for 2020/21 had still not been confirmed; as such a decision to approve this request was made at risk to the CCG and would be counter to the current instructions given by NHSEI. g) Clarification was received that the Committee had delegated responsibility for waiving the limits detailed within the DES to best meet the needs of its population. h) Although it was recognised that the allocation for roles and reimbursements had not been received, support was expressed for applying the waiver as there was a recognised need for these roles, the Committee has previously approved similar requests from other PCNs, and the appointment of FCPs would ease
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pressure on the wider system, including secondary care. i) It was confirmed that although the CCG was not in receipt of the roles and responsibilities allocation, the City PCNs continued to work within the ARRS budget as defined by NHSEI. j) Members were assured that PCNs had reviewed their workforce requirements, and were using their budgets to appoint the roles required to meet the needs of their respective populations, for example, community paramedic roles. k) Assurance was received that NHSEI had provided assurance at the Primary Care Transformation Board around funding, explaining that they were hoping to provide a quantum of the block allocation in the coming weeks. l) The financial risk to the CCG was recognised, however it was agreed that a pragmatic approach needed to be taken and the request to allow Bulwell and Top Valley PCN and BACHS PCN to continue their plans to recruit up to 2.0 Whole Time Equivalent (WTE) FCPs (for each PCN) in the year 2020/21 was approved. m) Members felt that given the current financial arrangements any further applications to increase the number of WTE First Contact Physiotherapists would need to be submitted to the Committee for consideration.
The Primary Care Commissioning Committee: APPROVED the increase in number of WTE First Contact Physiotherapists eligible to be reimbursed to the Bulwell and Top Valley PCN under the Additional Roles Reimbursement Scheme for 2020/21 from 1.0 WTE to 2.0 WTE. APPROVED the increase in number of WTE First Contact Physiotherapists eligible to be reimbursed to the BACHS PCN under the Additional Roles Reimbursement Scheme for 2020/21 from 1.0 WTE to 2.0 WTE. CONSIDERED agreeing in principle that if any further requests are made to increase the number of WTE First Contact Physiotherapists (above the 1.0 WTE cap) they will have approval from the committee in-line with previous recommendations and concluded that any further requests would need submitting to the committee for consideration. Strategy, Planning and Service Transformation PCC 20 105 Primary Care Network (PCN) delivery Helen Griffiths presented the item and highlighted the following points: a) This paper provides an overview of the development of the PCNs within Nottingham and Nottinghamshire over the past 12 months. b) PCNs were established on 1 July 2019 with specific aims, which included the stabilisation of general practice, the dissolution of the historic divide between primary and community health services and to help reduce health inequalities. c) The achievement of the identified aims has been challenging over the last six months as the system has been focused on responding to the Covid-19 pandemic, however, the teams have continued to work hard and all deadlines have been met. d) PCNs have successfully fostered relationships with key partner organisations with the inclusion of Community Service Teams, Community Pharmacy, Mental Health care teams, and District Councils in PCN meetings. e) In terms of workforce, 100 staff have joined the PCNs over the last year, with another 100 expected to join in the next six months. The first set of PCN
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workforce plans was submitted by the 31 August 2020 deadline, with a subsequent submission detailing indicative intentions through to 2023/24 to be submitted by 31 October 2020. f) In the first year the PCNs received additional funds to support two roles; Clinical Pharmacists and Social Prescribing Link Workers, both of which have had an active role in the primary care system. g) Meetings have been scheduled over the next two weeks to look at specific ARRS reimbursements and identify any unclaimed money for reallocation. A further update on this will be received at the October meeting. h) One of the key priorities for the PCNs has been to deliver Extended Access Hours, this has been successfully delivered through face to face, telephone, video and online consultations with a range of healthcare professionals. i) There has been a keen focus on organisational development and leadership in the first year with the delivery of a comprehensive, local Leadership Programme for the Clinical Directors and the development of a network of networks; an approach which has been recognised nationally. j) The establishment of Clinical Management Centres (CMCs) contributed to the fostering of closer working across practices in response to the Covid-19 pandemic, enabling informed and rapid decisions to support patient care. The CMCs remain in a state of readiness should they be required to respond to a surge in Covid-19 cases during the winter period. k) Four key challenges have been flagged at a national level and are not unique to the Nottingham and Nottinghamshire system. They relate to: i. Finance and Transformation; there is a continued push to deliver the transformation programme, without confirmation of receipt of the corresponding funds. ii. Workforce; the recruitment of 100 staff in the last year alone has been labour intensive and time consuming. Additionally there has been a challenge around the availability of staff within the workforce market and the transition into a primary care environment. The CCG is working closely with the LMC and GP Federations to support the embedment of the new roles and continued support of staff. iii. Information Technology (IT) Infrastructure; there has not been any allocated funding nationally to support the provision of IT equipment, heightened by the requirement for agile working in response to Covid-19. Some funding has been secured through the Estates and Technology Transformation Fund (ETTF); however the risk remains that as more roles are appointed within PCNs over the coming year these ETTF funds will not be sufficient to support equipment requirements. iv. Estates; as the transformation of primary and community care takes place and more roles develop within the PCNs the primary care estate will increase. Early discussions with the PCNs are taking place to start to understand this need based on emerging priorities which will then be incorporated into the Primary Care Estates Strategy. l) The CCG awaits details from NHSEI on the requirements of the PCN Dashboard, PCN Prospectus and Investment and Impact Fund, and is in a state of readiness to implement these once the information becomes available. m) Key areas of focus for year two will be continued collaborative working;
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enhancement of multidisciplinary models of working; improved access; implementation of Population Health Management; and establishment of a broader workforce, including recruitment of Mental Health Practitioners and Emergency Care Paramedics. n) Population Health Management, in particular, will be key for the four new specifications going live in April 2021; Cardio Vascular disease; tackling inequalities; Anticipatory care and Personalised care. o) The CCG will continue to support the PCNs to deliver a significant agenda, with a key focus on identifying efficiencies and delivering economies of scale. The following points were made in discussion: p) Members thanked Helen for the helpful report and resource pack, and recognised the positive progress PCNs have made given the challenges experienced over the last six months. q) Clarification was received that although limited detail had been received in relation to the national PCN dashboard, once it was available work would take place with the CCG’s Performance and Quality teams to manage the interface between the national and local dashboards to produce a comprehensive resource that meets the national requirements. r) It was emphasised that the work done at the outset to configure the PCNs has enabled a level of stability across Nottingham and Nottinghamshire which is in contrast to other areas of the country. s) It was noted that although the introduction of a PCN dashboard and the Impact and Investment will provide metrics for measuring performance, there is a need to ensure governance and accountability structures are established in the coming months. An update on the governance arrangements would be included in the March quarterly update. t) The addition of a case study was noted as helpful and it was noted that this would continue to be included in the quarterly updates received by the Committee. u) Members extended their thanks to the PCNs, Clinical Directors, and locality teams for the work they have done in establishing stable networks through a challenging time, recognising that to some extent the Covid-19 pandemic has galvanised relationships and the establishment of effective working practices.
The Primary Care Commissioning Committee: NOTED the progress and development of the newly formed PCNs. NOTED AND CONSIDERED the on-going priorities and considerations for 2020/21. THANKED the PCNs and Locality teams for the progress made in extremely challenging circumstances Financial Management PCC 20 106 Finance Report Michael Cawley presented the item and highlighted the following points: a) The revised financial regime introduced for months one to four has been extended through months five and six. However the message remains consistent; the year to date financial position for the CCG is showing an overspend position of £1.94 million. This is comprised of a shortfall in expected funding allocations of £0.61m and an overspend in co-commissioning categories
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of £1.34m driven by decisions taken in relation to enhanced services, additional PCN roles commitments from 2019/20, the Quality and Outcomes Framework, Alternative Provider Medical services contract costs and practices transferring from Personal Medical Services to General Medical Services contracts. b) The key risk remains that the CCG does not receive sufficient funding for spend incurred. Until this national allocation is confirmed there remains a tension between the allocations yet to be received and current/future spend. Any investment commitment that is non Covid-19 related is done so at risk to the CCG and counter to the current instructions given by NHSEI. c) The CCG continues to report a breakeven position for Primary Care Co- Commissioning based on the assumption of an allocation being provided by NHSEI.
The following points were made in discussion: d) Members noted the continued risk to the CCG’s financial position and approved the report.
The Primary Care Commissioning Committee: NOTED the contents of the Primary Care Commissioning Finance Report. APPROVED the Primary Care Commissioning Finance Report as at August 2020. Risk Management PCC 20 107 Risk Report Siân Gascoigne presented this paper and highlighted the following points: a) There are five risks relating to the Committee’s responsibilities, all of which have been reviewed by the Head of Corporate Assurance, Chief Commissioning Officer and the Interim Associate Director of Primary Care since the last meeting. b) Following the last meeting the narrative for risk RR 032 relating to the recruitment and retention of primary care workforce has been amended and the risk score reduced. However, following the PCN Delivery Update the narrative would be amended further to reflect the challenges associated with workforce capacity, supply and transition into primary care.
The following points were made in discussion: c) Members were supportive of further amending the narrative of risk RR 032 for consideration at the October meeting. d) Discussion took place regarding whether there was a risk to primary care workforce associated with Covid-19 testing capacity. It was noted that in the last week Operational Pressures Escalation Levels (OPEL) reports did indicate that some practices were starting to experience an increase in staff absence due to waiting for tests for themselves or family members which would enable a return to work. This was anticipated to increase, and a communication confirming the internal number for staff testing was being regularly circulated via TeamNet. e) It was agreed that the narrative of risk RR 126 relating to the impact of Covid-19 on primary care services would be reconsidered in light of this emerging issue.
The Committee: COMMENTED on the risks shown within the paper (including the high/red risk)
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and those at Appendix A: and AGREED that the narrative of risk RR 032 and RR 126 would be reviewed and amended in light of discussions at the meeting. Closing Items PCC 20 108 Any other business No other business was raised.
PCC 20 109 Key messages to escalate to the Governing Body The Committee: Approved the increase in number of Whole Time Equivalent (WTE) First Contact Physiotherapists eligible to be reimbursed to the Bulwell and Top Valley PCN and BACHS PCN under the Additional Roles Reimbursement Scheme for 2020/21 from 1.0 WTE to 2.0 WTE (per PCN). Noted the progress and development of the newly formed PCNs over the last year, and the priorities for 2021/22 and recognised the national challenges associated with Finance and Transformation; Information Technology, estates and workforce. Reviewed the revised narrative and risk score for RR 032 relating to the recruitment and retention of primary care workforce and agreed that the narrative would be further amended to reflect the challenges associated with workforce capacity, supply and transition in to primary care experienced by Primary Care Networks (PCNs) during recruitment. Additionally, the narrative of risk RR 126 relating to the impact of Covid-19 on primary care services would be reviewed in light of an emerging issue associated with staff absence whilst waiting for Covid- 19 tests for themselves or family members.
PCC 20 110 Date of next meeting: 21/10/2020 Zoom Meeting Confidential Motion: The Primary Care Commissioning Committee resolved that representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960)
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18 of 101 09:00-10:40-21/10/20 Action Log and matters arising from the meeting held on 16 September 2020
Primary Care Commissioning Committee Action Log from the public Committee meeting held on 16 September 2020
MEETING AGENDA AGENDA ITEM ACTION LEAD DATE TO BE COMMENT DATE REFERENCE COMPLETED
ACTIONS OUTSTANDING
No actions outstanding
09:00-10:40-21/10/20 ACTIONS ONGOING/NOT YET DUE
No actions ongoing/not yet due
ACTIONS COMPLETED
19/08/2020 PCC 20 082 Draft Annual Work Siân Gascoigne to update the Siân 21/10/2020 These updates have been Programme and Committee Work Programme to Gascoigne reflected in the
Terms of confirm the date for the GP Committee's work Reference Forward View and GP Provision programme presented at update/s and consider how best the October 2020 meeting. to reflect primary care Information Primary Care IT updates Management and Technology. will inform the already scheduled updates relating to the DAIT Strategy.
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19 of 101 19 20 of 101 20 Actions arising from the Governing Body meeting held on 7 October 2020
Primary Care Commissioning Committee OPEN ACTION LOG from the Governing Body on 7 October 2020
MEETING CCG AGENDA AGENDA ITEM ACTION LEAD DATE TO BE COMMENT DATE REFERENCE COMPLETED
ACTIONS OUTSTANDING
No actions outstanding 09:00-10:40-21/10/20 ACTIONS ONGOING/NOT DUE
No actions ongoing/not due
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Committee Work Programme
Meeting Title: Primary Care Commissioning Date: 21 October 2020 Committee (Open Session)
Paper Title: Primary Care Commissioning Paper Reference: PCC 20 119 Committee Work Programme 2020-22
Sponsor: Not applicable Attachments/ A: 2020/22 Primary Appendices: Care Presenter: Eleri de Gilbert, Non-Executive Director Commissioning (Chair) Committee Work Programme
Summary Approve ☒ Endorse ☐ Review ☐ Receive/Note for: ☐ Purpose: Assurance Information
Executive Summary Following presentation of the initial work programme at the Primary Care Commissioning Committee meeting in August, the purpose of this report is to present an updated work programme for review and approval. The updated work programme now reflects the anticipated timings of the General Practice Forward View (GPFV) updates and is cross-referenced with the CCG’s Merger Benefits Realisation Plan. The work programme will be kept under review in line with the Nottingham and Nottinghamshire response to the COVID-19 pandemic and potential resultant changes to the CCG’s governance arrangements in response to the emergency situation. The final work programme for 2020/22 is attached at Appendix A. Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Establishment of a Strategic Commissioner ☒
Financial Management ☒ Wider system architecture development (e.g. ☒ ICP, PCN development) Performance Management ☒ Cultural and/or Organisational Development ☒
Strategic Planning ☒ Procurement and/or Contract Management ☒ Conflicts of Interest: ☒ No conflict identified
Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (EQIA)
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Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (DPIA) Risk(s): No risks are identified within this report. Confidentiality: ☒No Recommendation(s): The Primary Care Commissioning Committee is requested to: 1. APPROVE its final 2020/22 Work Programme.
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Appendix A – 2020/22 Primary Care Commissioning Committee Work Programme
Please Note: All reporting timeframes are currently indicative and subject to review and confirmation.
Agenda Item/ Purpose 2020/21 2021/22 19 16 21 18 16 20 17 17 21 19 16 21
Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul COVID-19 Response COVID-19 Restoration and Recovery To present a range of updates in relation to the CCG’s restoration and recovery plans in response to COVID-19. COVID-19 Related GP Practice Additional Expenses To present a monthly update on COVID-19 related additional expenses 09:00-10:40-21/10/20 throughout 2020/21. Exact reporting requirements will be kept under review during the course of the period. Strategy, Planning and Service Transformation Primary Care Network (PCN) Delivery To present updates in relation to PCN development and the PCN Directed Enhanced Services (DES) implementation. Primary Care Workforce Planning To present updates in relation to the delivery of the Primary Care Workforce Strategy. This will include reporting on approved GP Retention Scheme applications. Primary Care Estates Strategy To present updates in relation to the delivery of the Primary Care Estates Strategy, including strategic estates planning and management. Primary Care Digital Strategy To present updates in relation to the delivery of the Primary Care Digital Strategy.
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Agenda Item/ Purpose 2020/21 2021/22 19 16 21 18 16 20 17 17 21 19 16 21
Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul General Practice Forward View (GPFV) To present the latest position in relation to GPFV planning and delivery1. Commissioning, Procurement and Contract Management Enhanced Services To present the annual enhanced services commissioning proposal for consideration and approval. Local Incentive Schemes To present Local Incentive Schemes for GP practices, in addition to or as an alternative to the national framework, for consideration and approval. 09:00-10:40-21/10/20 Primary Care Hub Memorandum of Understanding (MoU) and Handbook To present the Primary Care Hub MoU and Handbook for review and approval and to receive assurance in relation to the associated delivery requirements. Quality Improvement Quality Report To present a quarterly assurance report regarding the monitoring of quality performance, and improvement, of primary care medical services. This report will support delivery of the CCG’s Benefits Realisation Plan. More specifically, benefit reference 059: Improved quality assurance through integrated shared approach with our ICPs/PCNs. GP Patient Survey To present an analysis of the results from the national GP patient survey. Financial Management Finance Report To present a bi-monthly update on the position of the delegated funds, in accordance with business rules and national guidance.
1 Note: Reporting requirements will be reflected once known, following receipt of national guidance. Page 4
Committee Work Programme
Agenda Item/ Purpose 2020/21 2021/22 19 16 21 18 16 20 17 17 21 19 16 21
Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Risk Management Risk Report To present routine updates on risks relating to the Committee’s responsibilities for scrutiny and review of the management actions being implemented to mitigate the risks. Committee Business Committee Work Programme To present an annual work programme for consideration and agreement that sets out a coherent cycle of business for the next year of meetings in
09:00-10:40-21/10/20 line with the Committee’s terms of reference. Committee Effectiveness Review To receive the output from the Primary Care Commissioning Committee’s effectiveness review for 2020/21. Committee Annual Report To consider and agree an annual report to be presented to the Governing Body to provide assurance that the Committee is effectively discharging its responsibilities.
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25 of 101 25 Overview of GP Practice Additional Expenses in Relation to COVID-19
Meeting Title: Primary Care Commissioning Committee Date: 21 October 2020 (Open Session)
Paper Title: Overview of GP Practice Additional Paper Reference: PCC 20 120
Expenses in Relation to COVID-19
Sponsor: Joe Lunn, Interim Associate Director of Attachments/ Primary Care Appendices: Presenter: Joe Lunn, Interim Associate Director of Primary Care
Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for: ☒ Assurance Information
Executive Summary Arrangements for Discharging Delegated Functions Delegated function 3 – Management of the delegated funds
This paper provides an overview of the COVID-19 additional expense claims for August 2020. This is a further update to the previous paper which was presented in September. As the figures presented in the September paper were provisional, this paper will now provide the full summary of the approved costs for August 2020 relating to COVID-19.
Relevant CCG priorities/objectives: Compliance with Statutory Duties ☐ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☐ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (DPIA) Risk(s): There are no risks identified with this paper. Confidentiality: Page 1 of 4
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☒No Recommendation(s): 1. The Committee is asked to NOTE the information for assurance purposes.
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GP Practice Additional Expenses due to COVID 19 Pressures
1. Background and Payment Summaries Since the COVID-19 outbreak, additional pressures and costs have been placed on General Practice in order for them to respond to the needs of patients whilst maintaining a safe environment for their staff and patients.
On the 3 April 2020, a message was distributed to practices via TeamNet outlining a process for which practices could claim back additional expenses from the CCG in relation to costs incurred due to COVID-19. This process has continued through the months of May, June and July.
NHS England and NHS Improvement published a letter on 4 August 2020, offering updated guidance in relation to the COVID-19 support fund. The letter outlined instructions for commissioners on acceptable claims and introduced caps on staffing costs. The summary changes were presented to the committee in September 2020.
Practices claims for additional expenses incurred due to COVID-19 pressures were; backfill for staff and GPs who are ill or self-isolating, additional Personal Protective Equipment (PPE) or cleaning items. To be approved under the reimbursement arrangement, the costs must be additional to the practice’s regular outgoings, be appropriate and necessary in dealing with the COVID-19 outbreak. GP locum claims are capped at a rate of £200 a session and non-clinical staff reimbursements are capped in line with the individual’s contractual hourly and overtime rates as paid to them on the February 2020 payroll. From 1 August, additional overtime over and above usual staffing activity will not be supported.
The CCG is currently supporting additional costs as a result of COVID-19 at risk. The CCG is able to reclaim all eligible expenditure from NHS England where able to evidence costs are appropriate and satisfies guidance.
1.1 Overview of Claims Submitted in August Practices were asked to submit their August expenses by 3 September 2020 in order to receive timely payment. Only claims dated between 1 March and 31 August would be accepted for this submission and practices were required to submit backing rationale and evidence of spend with their claim along with the declaration form issued by NHS England and NHS Improvement.
Summary of August Claims: 60 practices submitted claims The total cost of the claims submitted was £187,336.33; this is a significant reduction on the amount for previous months. From this total, £113,682.76 has been approved for payment. The monthly breakdown is as follows:
o £961.43 relates to March claims. The total sum of paid March claims now stands at £198,759.20 o £21,943.31 relates to April claims. The total sum of paid April claims now stands at £790,919.37 o £4,352.20 relates to May claims. The total sum of paid May claims now stands at £440,460.13 o £14,089.46 relates to June claims. The total sum of paid June claims now stands at £306,479.07 o £41,064.74 relates to July claims. The total sum of paid July claims now stands at £336,481.15
Across all claims dated 1 March – 31 August a total of £131,440.20 worth of items remains outstanding.
Claims were withheld from payment due to the following reasons: No backing evidence of spend was provided The claims falls outside of the new guidance from NHS England and NHS Improvement Practices did not submit forms correctly Practices did not provide appropriate rationale for the claim The CCG are awaiting further supporting evidence to allow a review of clinical need for appropriate medical equipment to be undertaken Following clinical review the item may or may not be deemed as appropriate or necessary in relation to COVID-19
Where the above information has since been provided the costs have been made payable. From the outstanding items remaining, a review will continue to be undertaken to ascertain the required information Page 3 of 4
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needed and whether the costs can be paid or rejected.
1.3 Total Spend Breakdown of claims paid in August A breakdown of the spend in each claim category is listed below: Area of Spend Cost for August Cleaning Resources £14,999.80 Equipment Costs £4,535.59 Estates Costs £0 Laundry Costs £0 PPE £19,294.43 Postage Costs £0 Printing/Stationary £789.13 Scrubs £462.35 Telephony Charges £7,373.66 Admin Staffing (Including Practice Manager Time) £11,097.68 GP Partner and Salaried Staffing £10,479.70 Nursing Staff Costs £4,849.39 GP Locum Costs £30,629.17 Cleaning Staff (Additional Expense) £310.86 COVID Expenses - Other £8,861.00 (N.B this table is based on the categorisation of items by individual practices).
From the 18 September, items dated between 1 March and 30 July will no longer be accepted as new claims. However the Primary Care team will continue to reconcile outstanding claims submitted before this deadline.
The deadline for September claim submissions was 5 October 2020. 46 Practices submitted claims at a total cost of £97,619.03. From this total £62,144.24 has been suggested for payment at the initial review stage, although this cost is subject to change through the final approvals process.
Future claim requirements will be cascaded to practices via TeamNet.
2. Summary The total amount approved so far for August 2020 is £113,682.76 and was paid to practices in September 2020. There has been a significant reduction in claims this month due to new guidance and restrictions on claimable items published by NHS England and NHS Improvement.
The total sum of outstanding claims is £131,440.20.
£470,255.90 has been reconciled from previous submissions between March and August.
On-going liaison is taking place with practices where deductions from their original claims have been made. When practices provide further information and evidence, deeming the claim payable, they will be considered for future payment.
The maximum payable for this month’s claims is £187,336.33.
3. Recommendation
The Committee is asked to NOTE the information provided for assurance purposes.
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09:00-10:40-21/10/20 29 of 101 Primary Care Estates Update
Meeting Title: Primary Care Commissioning Committee Date: 21 October 2020 (Open Session)
Paper Title: Primary Care Estates Update Paper Reference: PCC 20 121
Sponsor: Lucy Dadge, Chief Commissioning Officer Attachments/ Appendices: Presenter: Lynne Sharp, Associate Director of Estates
Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for: ☒ ∑ Assurance ∑ Information
Executive Summary This paper provides an update on primary care estates and the on-going work related to COVID-19. It also updates on progress made on business as usual projects providing a timeline for the Outline Business Cases and an update on the two Estates and Technology Transformation Fund (ETTF) capital schemes. Relevant CCG priorities/objectives: Compliance with Statutory Duties ☐ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☐ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☐ Strategic Planning ☒ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (EQIA)
Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (DPIA)
Risk(s): ∑ No risks identified Confidentiality: ☒No Recommendation(s):
1. The Primary Care Committee is asked to NOTE the Primary Care Estates Update.
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Primary Care Estates Update
Introduction
The purpose of this paper is to bring members of the Primary Care Commissioning Committee up to date with developments in primary care estates across the CCG over the last four months.
The paper will cover the following areas:
∑ COVID19 preparations for the second spike ∑ Business as usual: - Primary Care Data Gathering Pilot - Schemes and Proposals Coronavirus (COVID-19)
Readiness Risk Assessments – carpet replacement
Following the agreement to fund carpet replacement in clinical areas, the estates team has been working with the locality teams to support practices obtain quotations for the work. So far progress has been slow however quotes are starting to come in now. The team has managed to reach agreement to replace carpet in three rooms at Bull Farm however, which was not identified through the risk assessment process. This will be done under lifecycle replacement at no cost to the practice or CCG.
Clinical Management Centres (CMCs)
CMCs were set up at the end of March in response to the national lockdown and immediate cessation of non-essential services. For a second spike, the situation is likely to be less predictable, in that services will want to continue as long as possible within their usual accommodation. The point at which an area escalates into a CMC will vary and may happen suddenly as factors combine to create an unmanageable situation. However, there is now a blue print for the establishment of CMCs and how they will operate. Lessons learned from earlier in the year will stand services – both primary care and other provider services in good stead. The estates team is working with all providers to create a master plan of services in each CMC location detailing where they could move to or other alternative arrangements in the event that a CMC is mobilised and services have to make way at short notice.
Lynne Sharp Associate Director of Estates PCCC 21 October 2020 1
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Business as Usual
Primary Care Data Gathering Programme
This programme started in November 2019 with the CCG electing to be an early implementer. However, the impact of COVID on delivery of the programme nationally has been significant. A key area to progress the completion of the data fields was the facet surveys. Due to the resources needed from primary care to facilitate this and the general over subscription nationally, these will now be deferred until spring 2021 and will be completed over two financial years. This is disappointing in that the pilot work was intended to be the foundation of a Primary Care Estates Strategy and this was the reason for being an early implementer. In the meantime, missing data is being collected as the team comes across it and is logging it on a change log so that the CCG is in a good position to resume the pilot next year.
Leased Premises
From the last meeting the Committee asked for an update on the number of premises that were leased across the patch. It should be noted that a lease arrangement is between a practice and a landlord therefore the CCG is not a party to these agreements and does not always have copies. With that caveat, the best information available at the moment is as follows:
Leased Premises
Buildings Premises 3PD, other (includes Owner CHP ICP Practices (includes NHSPS landlord multi- Occupied (LIFT) branches) leased occupancy)
City 48 53* 48 19 11 6 16 (4)
Mid 39 44 44 19 5 5 15 (4) Notts
South 39 50 47 28 9 4 9 (2) Notts
Total 126 147 139 66 25 15 40 (10)
* Includes one prac ce where premises details unknown
Outline Business Cases
From the last Estates update the Committee asked for timescales for the OBC completion and on-going delivery plan. This work has inevitably been affected by the COVID pandemic
Lynne Sharp Associate Director of Estates PCCC 21 October 2020 2
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and expected funding announcements in spring did not happen. It is quite possible now that they will not happen through the autumn budget either so the below dates must be taken as indicative only. They do however give some indication of the programme and its overall timescale:
Completion of Outline Business Case (OBC) March 2021
Approval of OBC April – June 2021
Full Business Case (FBC) July 2021 – June 2022
Approval of FBC July – September 2022
Acquire Site October 2022
12 month build programme November 2022 – November 2023
Mobilisation January 2024
Estates and Technology Transformation Fund (ETTF)
ETTF is now in its final year however due to the uncertainty around the impact that COVID 19 would have on build projects the budget was split over 2020/21 and 2021/22. Schemes that were in the pipeline to progress and complete in 2020/21 were nominally allocated against each year depending on the certainty of delivery. The following two improvement grant schemes are in progress: ∑ Rise Park – is a large extension to the existing premise as well as creating an admin hub in a refurbished manse house that currently belongs to the Church located on the same site. The practice has now reached agreement with the Church over the sale of the building. The works for this scheme were previously tendered in February this year but due to the poor-quality specification and the beginning of COVID the process was considered void. The practice has worked closely with the CCG and LIFTco to produce a specification that minimises the number of provisional sums included giving cost certainty. The tenders have been returned and reviewed. A preferred contractor has been identified although the costs have come back higher than anticipated and the CGG is working with NHSE/I to address this. Once the capital is secured then the due diligence will be submitted to NHSE/I for review and the relevant approval documentation completed for sign off. The DV has been instructed to produce the initial VFM assessment of the rent. The scheme spend is split across both financial years and will complete in May 2021. ∑ Deer Park – is located in Wollaton Vale Health Centre which is owned by NHS Property Services. The original scheme was a large extension to the health centre where two practices operated out of however space became available due to the retirement of the single hander GP who co-located in the building. The CCG is responsible for paying the void costs on the vacant space, so the plans were revised to an internal reconfiguration. The practice has an expired lease, NHSPS must honour the terms which will remain until Lynne Sharp Associate Director of Estates PCCC 21 October 2020 3
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a new lease is signed. For the works to take place the practice must sign up to a new lease which includes the current space as well as the new rooms and ‘clear’ outstanding debt. The practice has been working with the CCG and NHSE/I to come to an agreement over the debt but have faced difficulty in getting an accurate breakdown of the outstanding balance from NHSPS. This has now been received and is being reviewed, draft Heads of Terms are also expected imminently. The plans have been finalised and signed off in principle by the practice. Budget costings for the works have been shared which will enable the PID to be completed and the DV to be instructed. The scheme is profiled to spend in 2021/22.
Recommendation
The Primary Care Commissioning Committee is asked to NOTE the Primary Care Estates Update.
Lynne Sharp Associate Director of Estates PCCC 21 October 2020 4
34 of 101 09:00-10:40-21/10/20 Primary Care Enhanced Services Review
Meeting Title: Primary Care Commissioning Committee Date: 21 October 2020 (Open Session)
Paper Title: Primary Care Enhanced Services Review Paper Reference: PCC 20 122
Sponsor: Joe Lunn, Associate Director of Primary Attachments/ Presenter: Care Appendices: Lynette Daws, Head of Primary Care
Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for: ☒ Assurance Information
Executive Summary Arrangements for Discharging Delegated Functions Delegated function 5 – Decisions in relation to enhanced services
Primary Care Local Enhanced Services were offered to all Nottingham and Nottinghamshire practices as a two year contract with the commitment to review services (at nine months) and present the outcome to the PCCC in December 2020. The purpose of this paper is to set out the scope and timetable for the review of Primary Care Local Enhanced Services.
Relevant CCG priorities/objectives: Compliance with Statutory Duties ☐ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☒ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (DPIA) Risk(s): No risks identified Confidentiality:
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☒No Recommendation(s): 1. To NOTE the scope and timeline for the review of Primary Care Enhanced Services.
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Review of Primary Care Local Enhanced Services: Scope & Timescales
1. Introduction
The Primary Care Commissioning Committees’ of the predecessor CCGs approved the direct award of a two year contract to the GP practices of Nottingham & Nottinghamshire CCG to deliver a range of Primary Care Local Enhanced Services from 1 April 2020. It was agreed that there would be a review during quarter three, the outcome of which is to be presented to the Committee at its December 2020 meeting.
Primary Care Local Enhanced Services (LESs) are schemes that meet the identified needs and priorities of the local population, commissioned and managed by CCGs and delivered by GP practices to their registered population. The services to be delivered are over and above essential services, additional services and out-of-hours services as set out in the GP contract. Practices are commissioned to provide services to their registered patients with no option for inter-practice referrals. Sign up to deliver LESs is voluntary, practices are not mandated to provide them.
2. Budget
Due to COVID-19 and the subsequent lockdown, some services were suspended, delivered remotely rather than face to face at the practice or continued due to the nature of the service. The budget will be reviewed taking into account the level of claims in 2019/2020 and 2020/21 (which will be impacted by COVID-19).
The review will consider financial pressures/impacts on budgets; these include but are not limited to:
Shared Care Protocol Monitoring LES: increased requests for transfer of care from secondary and community care to primary care as part of a formal Shared Care Protocol, a shared care agreement or an extended period of monitoring Atypical Populations: consideration of additional LES’ to support practices with these populations Services: review of the funding allocated to existing services
3. Services
Work to align the LESs across the CCG was undertaken in 2019/20 and services rolled out in 2020/21 as part of a two year contract:
Asylum Seekers & Syrian Resettlement Programme Service Enhanced Services Delivery Scheme (ESDS) Homeless Enhanced Service Primary Care Monitoring of Amber 1 Shared Care Protocols and Patients with Stable Prostate Cancer Anticoagulation Monitoring Enhanced Service (Level 2, 3 & 4)
There are still a number of legacy local enhanced services extended by the former CCGs until 31 March 2021 to enable the review of the wider community or acute services to be completed by the Contracts Teams:
South Nottingham Diabetes Services (Nottingham West, Nottingham North & East and Rushcliffe) Mid-Nottinghamshire Gynaecology Core Plus: cervical polyp removal and pessary insertion & fit service
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It is expected that these will be superseded by community based services. Formal notice of contract end date for these services which currently sit within a NHS Standard Contract, issued by the Primary Care Commissioning Team, will be issued in December.
Three Mid-Nottinghamshire Service Level Agreements were also extended to 31 March 2021 to provide alternative service delivery during year one only for the two practices that declined the offer to provide the Enhanced Services Delivery Scheme (ESDS):
Mid-Nottinghamshire Wound Care Service Newark & Sherwood Minor Injury Service Mansfield & Ashfield Minor Injury Service Mansfield & Ashfield Phlebotomy payment
Formal notice of contract end date will be issued in December 2020. The two practices will be given the opportunity to sign up for year two of ESDS. As with City, if these practices decline to sign up to ESDS alternative provision will be made available to their practice population.
Work to align the LESs across the CCG was undertaken in 2019/20 and rolled out in 2020/21. The Interpreter Assisted Appointments LES is however currently offered to Nottingham City practices only in support of the city’s Atypical Population. The option to extend this to county practices will be considered as part of the review and options presented to Committee. A review of Atypical Populations will take place across Nottinghamshire.
Two clinical Standard Operating Procedures (SOPs) that support aligned LES and originally produced by Nottinghamshire County PCT are out of date and need to be reviewed with the support of specialist CCG teams including the Medicines Management Team:
SOP for the Provision of a Community Anticoagulation Service - NHS Nottinghamshire County PCT January 2010, Reviewed by Mid-Nottinghamshire CCGs November 2018 PSA Pathway Guidance for Community Monitoring of Patients with Stable Prostate Cancer Revised Version October 2013
Following feedback from practices the claims process will be reviewed in order to see where further improvements can be made to reduce the administrative burden on practices, whilst still providing robust information to enable the CCG to monitor service delivery.
4. Enhanced Services Delivery Scheme (ESDS)
A meeting has been organised by Dr Ian Trimble, with the CCG Clinical Leads, to commence the review of ESDS. The revised ESDS will be offered to the eight practices that declined to sign up in 2020/21 (six Nottingham City and two Mid-Nottinghamshire practices).
5. Timeline for Review
12th October to 6th November 20 Review each service to agree the focus Consider any new services Liaise with contracting and commissioning teams regarding any impact on other contracts Meet with Finance Team to review each budget line
9th November to 4th December 20 Engage with Primary Care IT regarding automated claims process Continue to meet with Medicines Management Team regarding process for new Shared Care Protocols approved by APC Cost out budget for each service option
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16th December 20 Proposal with options to PCCC for approval
21st to 22nd December 20 Send formal reminder of contract end dates
4th January 21 on-going Update all service specifications Circulate service delivery intentions sign-up sheet to all practices Engage with secondary care clinics (anti-coagulation) for practices changing level of service delivery
February to March 21 Issue contract variations
6. Recommendation
PCCC is asked to NOTE the paper setting out the scope and timeline for the review of Primary Care Enhanced Services. An outcome of the review, including proposals, will be presented to the PCCC in December 2020.
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Meeting Title: Primary Care Commissioning Committee Date: 21 October 2020 (Open Session)
Paper Title: C84043 Leen View Surgery: Permanent Paper Reference: PCC 20 123
Boundary Reduction Request
Sponsor: Joe Lunn, Associate Director of Primary Attachments/ Care Appendices: Presenter: Joe Lunn, Associate Director of Primary Care
Purpose: Approve ☒ Endorse ☐ Review ☐ Receive/Note for: ☒ Assurance Information
Executive Summary Arrangements for Discharging Delegated Functions Delegated function 2 - Plan the primary medical services provider landscape, including considering and making decisions in relation to agreeing variations to the boundaries of GP practices. Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts
In March 2020 the Primary Care Commissioning Committee meetings’ in common of the predecessor CCGs agreed to extend the temporary boundary reduction for Leen View Surgery until 30 September 2020 to align with the introduction of the ‘Enhanced Health in Care Homes’ Network Contract Directed Enhanced Service (DES).
This decision was made with a condition that the practices within the Bulwell and Top Valley Primary Care Network (PCN) and the neighbouring Nottingham West PCN work together to find a longer term solution for the provision of services to the two care homes, Acer Court and Alder House.
A verbal update was presented to the PCCC in September 2020 on the progress with the Care Homes service provision.
The purpose of this paper is to provide the Committee with: 1) An update on the impact of the temporary boundary reduction over the preceding 12 months, and; 2) An update following the PCN interim measures to resolve the provisions to the Acer Court and Alder House care homes.
Obligations of the Commissioner for Decision Making Boundary changes are permitted under section 7.2.1 of the Primary Medical Services Policy and Guidance manual. Please see below the obligations of the commissioner for decision making:
The contractor and the Commissioner must engage in open dialogue concerning the circumstances that have led to the request to change their boundary and discuss the possible implications of the action, i.e. a reducing patient register, an expanding patient register, the financial implications of both and any possible alternative actions that may be taken by either party to enable the practice to maintain its existing practice area.
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Commissioners must consider the application having regard to other practices’ boundaries, patient access to other local services and in general other health service coverage within a location and may seek to involve the public to seek their views.
There are no financial implications associated with this paper.
Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☐ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☒ No ☐ N/A ☐ Boundary Change: An EQIA has been Assessment (EQIA) completed as part of the full consultation Data Protection Impact Yes ☐ No ☐ N/A ☒ There are no Data Protection concerns Assessment (DPIA) associated with this paper. The list closure and boundary change will not impact on how a patient’s personal data will be processed or the practice’s ability to carry out day to day requirements under GDPR. Risk(s): A PCN solution to the provisions of the Acer Court and Alder House care homes is still to be agreed between the Bulwell and Top Valley PCN and Nottingham West PCN. Leen View Surgery continues to provisionally support the 44 patients that reside in the care homes but as the temporary boundary reduction has ended, the demands on the practice could escalate and potentially destabilise the practice. Confidentiality: ☒No Recommendation(s): 1. APPROVE the area B reduction of the practice boundary, as shown on the map as the boundary is covered by 3 other practices 2. DEFER the decision to remove area A of the practice boundary until there has been agreement on GP alignment within the PCN
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Leen View Surgery Application for Boundary Reduction – Progress Update
1. Introduction
The temporary boundary change for the Surgery, approved by the Primary Care Commissioning Committee meetings’ in common of the predecessor CCGs, has now ended and the practice is keen to secure a permanent boundary change, as outlined in the original request. The purpose of this paper is to outline a proposed permanent boundary change.
2. Background
The Primary Care Commissioning Team met with the practice on Thursday 24 September 2020. At this meeting, Dr Preeti Bakshi (Lead GP Partner) confirmed that it is still the intention of the Leen View Surgery to secure a permanent boundary reduction.
The practice informed commissioners of the potential forthcoming retirement of a full time partner at the practice which will have a direct impact on the clinical workload and the capacity to provide safe and high level care to the patients in Bulwell.
The practice advised that one of the nearby golf course sites has been sold for residential development which will potentially increase the list sizes of the Bulwell practices, although it is unknown when the houses will be built.
2.1. List Size Update
The practice’s list size has remained quite static since the boundary reduction, which has helped the practice to stabilise the list over the 12 month period.
Date Raw List Size April 2017 8,916 April 2018 9,172 April 2019 9,555 October 2019 9,339
January 2020 9,365
April 2020 9,418
July 2020 9,392
As of 1st April 2020 the GP: patient ratio was 1:2,668.
2.2. Proposed Area of Reduction
Leen View’s existing boundary covers a proportion of the Highbury Vale and Cinderhill areas but mostly the Bulwell area. The request to reduce area marked A will remove the lower part of the Cinderhill area nearest to the Broxtowe Country Park that covers part of the NG8 6 and NG16 1 postcode areas. This area includes the removal of two care homes, Acer court and Alder House.
Please see the below map which identifies the two areas of reduction for the Leen View Surgery practice boundary:
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The practice included a reduction in area B to be able to concentrate on the Bulwell patients and those that reside in the immediate surrounding areas within the practice boundary. The Bulwell and surrounding areas have a patient density that is between 300 and 750 and covers the NG6 7, NG6 8 and NG6 9 postcode areas.
The reduction of the area marked B will remove part of the central Cinderhill and the Old Basford areas that covers the NG 6 0 postcode with a patient density of below 200, therefore fewer patients registered with Leen View Surgery, in this postcode area. This area consists of residential properties only and includes the Phoenix Park and Cinderhill tube stops.
The Old Basford area is well covered by Lime Tree Surgery, Churchfields Medical Practice and Parkside Medical Centre boundaries as shown in the map below:
Area B
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The 11 neighbouring practices had previously been contacted; the concerns raised by practices related to the removal of area A from the boundary, in particular the care homes, rather than the reduction of area B.
3. Primary Care Network (PCN) Resolution
The practice continues to provide primary care services to 44 patients that reside at the Acer Court and Alder House care homes. Other neighbouring practices are providing services to the remaining patients.
The Committee, at its August meeting, considered the recommended options for the alignment of care homes as set out in the paper ’Implementation Progress – PCN DES Enhanced Health in Care Homes’. Since that meeting the PCNs, supported by the Locality Teams, have drafted a MoU for the provision of resources from the three PCNs impacted by these boarder care homes as an interim measure until practice alignment can be agreed, the deadline for which is March 2021. Leen View Surgery has been advised that until a final decision has been agreed on alignment, the Committee is not in a position to rule on the removal of Acer Court or Alder House from the boundary.
4. Recommendation
The recommendation is that the Committee:
APPROVE the area B reduction of the practice boundary, as shown on the map as the boundary is covered by 3 other practices DEFER the decision to remove area A of the practice boundary until there has been agreement on GP alignment within the PCN
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Meeting Title: Primary Care Commissioning Committee Date: 21 October 2020 (Open Session)
Paper Title: C84667 Giltbrook Surgery: Permanent Paper Reference: PCC 20 124 Boundary Change Request
Sponsor: Joe Lunn, Interim Associate Director of Attachments/ Appendix 1: List of Presenter: Primary Care Appendices: those consulted Appendix 2: Practice Joe Lunn, Interim Associate Director of Boundary Maps by Primary Care Locality Appendix 3: EQIA
Purpose: Approve ☒ Endorse ☐ Review ☐ Receive/Note for: ☒ ∑ Assurance ∑ Information
Executive Summary Arrangements for Discharging Delegated Functions Delegated function 2 - Plan the primary medical services provider landscape, including considering and making decisions in relation to agreeing variations to the boundaries of GP practices. Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts
At the June meeting the Nottingham & Nottinghamshire Primary Care Commissioning Committee (PCCC) approved a temporary boundary reduction for Giltbrook Surgery for a period of three months to 20 September 2020 in line with the list closure approved in September 2019. This would allow time for the Primary Care Commissioning Team to engage and consult in line with commissioner obligations.
The purpose of this paper is to provide the Committee with the outcome of engagement and consultation with neighbouring practices and CCGs; and work undertaken to determine the impact / consequences of approval on the resident population to provide primary care services that offer choice and are accessible.
This paper forms part of the delegated function of “Planning the provider landscape” by agreeing variations to the boundaries of GP practices.
Obligations of the Commissioner for Decision Making Boundary changes are permitted under section 7.2.1 of the Primary Medical Services Policy and Guidance manual. Please see below the obligations of the commissioner for decision making:
The contractor and the Commissioner must engage in open dialogue concerning the circumstances that have led to the request to change their boundary and discuss the possible implications of the action, i.e. a reducing patient register, an expanding patient register, the financial implications of both and any possible alternative actions that may be taken by either party to enable the practice to maintain its existing practice area.
Commissioners must consider the application having regard to other practices’ boundaries, patient access to other local services and in general other health service coverage within a location and may seek to involve the public to seek their views.
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There are no financial implications to the CCG associated with this paper. Relevant CCG priorities/objectives: Compliance with Statutory Duties ☐ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☒ No ☐ N/A ☐ Boundary Change: An EQIA has been Assessment (EQIA) completed as part of the full consultation Data Protection Impact Yes ☐ No ☐ N/A ☒ There are no Data Protection concerns Assessment (DPIA) associated with this application. The list closure and boundary change will not impact on how a patient’s personal data will be processed or the practice’s ability to carry out day to day requirements under the General Data Protection Regulation (GDPR). Risk(s): A risk is that without a change in boundary, Giltbrook Surgery is not fulfilling a condition of the list closure. Confidentiality: ☒No Recommendation(s): 1. The Primary Care Commissioning Committee is asked to APPROVE the application for a permanent boundary reduction with amendments. 2. DEFER the decision for any boundary change at the site of Acer Court and Alder House.
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Giltbrook Surgery Application for Boundary Reduction
1. Introduction
The Primary Care Commissioning Committee (PCCC) approved a 12 month list closure for Giltbrook Surgery. A caveat of this approval was for the Surgery to review its historic boundary and propose a boundary reduction. The purpose of this paper is to outline a proposed permanent boundary change.
2. Background
2.1. List Size Update Since the list closure in September the practice list has reduced by 214 patients. Since the list re- opened, on 20 September 2020, the list has increased by nine patients in two weeks.
Date Raw List Size April 2017 4,495 April 2018 4,711 April 2019 5,009 September 2019 5,096 January 2020 5,039 April 2020 4,966 July 2020 4,948 21 September 2020 4,873 9 October 2020 4,882
As of 1st April 2020 the GP: patient ratio was 1:2,700 (1.84 WTE GPs).
2.2. Proposed Area of Reduction The proposed new boundary (below) is outlined in The map below shows the current registered patient black; the existing boundary outlined in orange. distribution at Giltbrook Surgery.
Based on postcode count data provided by PCSE (17.09.20), there are 196 patients registered at Giltbrook Surgery resident outside the current permanent practice boundary. To support the list
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reduction, the practice will be writing to these patients, in line with the practice policy, giving them notice to register with another practice.
Approximate number of registered patients in the proposed areas of reduction – Total 59:
Eastern Boundary - Nottingham City: Bulwell, Highbury Vale, Old Basford, Bilborough 40 Northern Boundary – Derby & Derbyshire CCG: New Bagthorpe 1 Western Boundary – Derby & Derbyshire CCG: Langley Mill, Langley Cotmanhay, Ilkeston 12 Southern Boundary – Derby & Derbyshire CCG / Nottingham West PCN: Ilkeston, Trowell, 6 Strelley Village
The rational for the changes, as set out in the map above, is to support the practice’s aim to reduce its list size to safely deliver services to its registered population within the confines of limited physical space of the current premises. It would also be an opportunity to align the practice boundary more closely to the Nottingham West Primary Care Network (PCN) footprint and CCG boundary. The existing boundary was set historically by a previous partnership and covers areas of Derbyshire, Nottingham City and Ashfield. It is a much larger boundary in comparison with other local practices.
Although the practice cannot remove the patients currently registered in the areas of reduction, it will allow them to decline new patients resident in these areas now that their list has re-opened, and give them more control over the future list size growth.
The commissioner is obliged to engage and consult, and to consider other practices’ boundaries, practice list closures, patient choice of practices to register with, patient access to local services and in general other health service coverage within a location. This action re-commenced in mid-July as we moved into the restoration & recovery phase of COVID-19. The presentation of this paper has been further delayed by the on-going process to agree the alignment of care homes to GP practices a requirement of the Enhanced Services to Care Homes DES.
Appendix 1 sets out the list of individual’s and practices contacted as part of the required engagement and consultation and any response received.
2.3. Eastern Boundary: Nottingham City PCNs The current boundary covers the wards of Nottingham City: Bulwell, Highbury Vale, Old Basford, Cinderhill, Bilborough and Broxtowe. These areas are well served by GP practices as set out in Appendix 2, Map 1 & 2.
Giltbrook Surgery is looking to reduce their boundary to be closer, but not aligned with, the Nottingham West CCG / PCN boundary.
At its boundary with Nottingham City the practice is looking to actively remove Acer Court and Alder House Care Homes from their contracted boundary. By removing these homes from the tip of the practice boundary, this small area of Nottingham West PCN will have no Nottingham West member practice coverage, only coverage from Nottingham City practices.
To note, the Committee at its August meeting considered the recommended options for the alignment of care homes as set out in the paper ’Implementation Progress – PCN DES Enhanced Health in Care Homes’. Since that meeting the PCNs, supported by the Locality Teams, have drafted a MoU for the provision of resources from the three PCNs impacted by these boarder care homes as an interim measure until practice alignment can be agreed, the deadline for which is March 2021. Giltbrook Surgery has been advised that until a final decision has been agreed on alignment, the Committee is not in a position to rule on the removal of Acer Court or Alder House from the boundary.
Recommendation: PCCC to approve the reduction of the boundary, apart from the removal of Acer Court and Alder House. The decision to be deferred on this part of the boundary until such time as the alignment is agreed between the PCNs with support from the Locality Teams.
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2.4. Northern Boundary: Ashfield South PCN In recognition of this being a rural area, Giltbrook Surgery has proposed an amendment to their boundary to ensure access to and choice of GP services. They are looking to support the rural community of Jacksdale and Jacksdale Surgery by covering those dwellings lining the main road. Within the area of reduction shown on the map in Appendix 2 are New Bagthorpe and the northern outskirts of Bagthorpe. Giltbrook Surgery has indicated they would amend the proposed boundary to include this area if required to ensure GP coverage.
For ease of identifying the boundary, the practice proposes extending their north east boundary to be in line with the M1 as it travels from J27 down to J26. By extending at this point no additional dwellings would be added as this is a rural area with no dwellings currently.
Recommendation: PCCC to approve the proposed boundary changes with the area of New Bagthorpe to remain within the revised boundary as indicated in Appendix 2, Map 3.
2.5. North West & Western Boundary: Derby & Derbyshire CCG The boundary remains largely unchanged at the North West section and will continue to cover Langley Mill and Langley which sit within Derby & Derbyshire CCG. Giltbrook Surgery proposes to reduce the boundary towards the boarder of Derby & Derbyshire CCG and Nottingham & Nottinghamshire CCG at Cotmanhay. This area is well covered by GP practices as set out in Appendix 2, Map 4 & 5.
Recommendation: PCCC to approve the proposed boundary change.
2.6. Southern Boundary: Nottingham West PCN The proposal is to reduce the boundary by moving out of Derby & Derbyshire CCG at Ilkeston Junction, Larklands and Gallows Inn. These areas will continue to have a choice of GP practices to register with and are closer to their home address as set out in Appendix 2, Map 6.
The practice proposes to remove their coverage from Trowell and Strelley Village which are located within the boundary of Nottingham West PCN. Giltbrook Surgery has no patients resident in these areas currently registered. Residents of Trowell would retain partial coverage from two Nottingham West PCN practices and a further five practices located in Derby & Derbyshire all of which are closer than Giltbrook Surgery which is 3.8miles from the centre of Trowell. Strelley Village, 3 miles from Giltbrook Surgery, is situated within the boundary of Bilborough Medical Centre, 0.9 miles away. It’s also covered by three Nottingham City practices however they are between 3.2 and 3.8 miles away
The area surrounding the M1 Trowell Service Station (highlighted in yellow on Appendix 2, Map 6) is rural, with no dwellings. If Giltbrook Surgery is removed from this area of Nottingham West PCN, there would be no GP coverage should future housing developments be proposed.
Recommendation: PCC to not approve the removal of Strelley Village and the area surrounding Trowell Services from the proposed boundary reduction. Whilst Giltbrook Surgery has no registered patients from this area, by removing the practice the areas would have no choice of practice or no practice coverage at all.
3. Recommendation
It is recommended that the Committee: ∑ APPROVE the proposed boundary change, however, the following amendments would apply to ensure patient choice and access to primary care services: o Areas to remain within the practice boundary: New Bagshot, Strelley Village, area surrounding M1 Motorway Service Station –Trowell ∑ DEFER the decision on the boundary at the site of Acer Court & Alder House until agreement on GP alignment.
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Appendix 1
Individuals, Practices and CCGs contacted as part of the consultation process
Request for comment on the Giltbrook Surgery proposed boundary reduction
Eastern Boundary: Nottingham City Practices Impacted Response Received Bulwell & Top Valley PCN St Albans Medical Centre No response received BACHS PCN Broad Oak Medical No response received Practice BACHS PCN Lime Tree Surgery No response received Bulwell & Top Valley PCN Parkside Medical No concerns or objections. Practice remains Practice keen to actively increase their list size at this time Bulwell & Top Valley PCN Leen View Surgery No response received Bulwell & Top Valley PCN Riverlyn Medical Centre No response received BACHS PCN Bilborough Medical No response received Centre BACHS PCN Bilborough Surgery No response received City South PCN Grange Farm Medical No response received Centre Bulwell & Top Valley PCN Springfield Medical No response received Centre Northern Boundary: Mid- Nottinghamshire Ashfield South PCN Jacksdale Medical The practice list has grown significantly over Centre the past couple of years and we too have been in talks with the CCG about reducing our boundary (NB: no formal request received to date). We have unsustainability with our practice list at the moment and would not wish to take on any large number of patients from another practice as this would increase our capacity and demand to unattainable limits. Ashfield South PCN Selston Surgery Dr Basi & Dr Shah have no comment to add Southern Boundary: Nottingham West Clinical Director, Nottingham West PCN Dr Tim Heywood If the directly-affected practices within the PCN have no objections, the PCN’s position would be neutral Nottingham West PCN Abbey Medical Centre No response received Nottingham West PCN Bramcote Surgery No response received Nottingham West PCN Chilwell Valley & Although we are a practice unlikely to be Meadows Practice affected by this boundary change, we would like it to be recorded that we are entirely supportive of this attempt by Giltbrook Surgery to manage their workload issues.
Nottingham West PCN Eastwood Primary Care No response received Centre Nottingham West PCN Hama Medical Centre No response received Nottingham West PCN Hickings Lane Medical No response received Centre Nottingham West PCN Linden Medical Group No response received Nottingham West PCN Newthorpe Medical No objections Centre
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Nottingham West PCN Saxon Cross Surgery No response received Nottingham West PCN The Manor Surgery No response received Nottingham West PCN The Oaks Medical No response received Centre Western Boundary: Derby & Derbyshire CCG GP Commissioning & Development Donna Allen / Hannah There are no residential dwellings or Manager / Head of GP Commissioning Belcher housing planned and no gaps in provision; & Development and the practice will retain the existing patients, then the CCG have no further comments
The practices who could potentially be affected by this change, were copied into the original email for comment, Derby & Derbyshire CCG has not received any responses from the practices Alfreton, Ripley, Crich & Heanor PCN Kelvingrove Medical No response received Centre, Heanor Alfreton, Ripley, Crich & Heanor PCN Parkside Surgery, No response received Alfreton Alfreton, Ripley, Crich & Heanor PCN Jessop Medical Practice, No response received Alfreton Alfreton, Ripley, Crich & Heanor PCN Brooklyn Medical No response received Practice, Heanor Alfreton, Ripley, Crich & Heanor PCN Park Surgery, Heanor No response received Erewash PCN Old Station Surgery, No response received Ilkeston
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Appendix 2: Boundary Maps
Map 1: Eastern Boundary with Nottingham City PCNs Giltbrook Surgery’s current boundary, as it appears on Shape, is represented by the thin blue line forming almost a square across this part of Nottingham City. The proposed reduced boundary is represented by the thick, black line. The thick maroon line represents the Nottingham City / Nottinghamshire County council boarder. To note: RHR Medical Centre boundary has been used to illustrate the boundary of Broad Oak Medical Practice
Areas Impacted Practice Coverage in the Area / Patient’s Choice of Practices Bulwell Leen View Surgery 0.6miles St Albans Medical Centre 0.7miles Giltbrook Surgery Parkside Medical Centre 0.6miles Lime Tree Surgery (partial) 1.5miles 3.2miles Riverlyn Medical Centre 0.6miles Highbury Vale Leen View Surgery 0.6miles St Albans Medical Centre 0.9miles Giltbrook Surgery 4 miles Parkside Medical Centre 0.6miles Lime Tree Surgery (partial) 1 mile Riverlyn Medical Centre 0.6miles Old Basford Lime Tree Surgery 0.7 miles Riverlyn Medical Centre 1.2 miles Giltbrook Surgery Leen View Surgery 1.1 miles St Albans Medical Centre 1.6 miles 4.5miles Parkside Medical Centre 1.1 miles
Cinderhill Lime Tree Surgery 0.4miles Broad Oak Medical Practice (partial) 1.3 Giltbrook Surgery 3.8 Parkside Medical Centre 0.9 miles miles Miles Leen View Surgery 0.9 miles St Albans Medical Centre 1.5 miles Riverlyn Medical Centre 1 mile Bilborough Medical Centre (partial) 1.9miles Grange Farm Medical Centre (partial) 2.2 miles Bilborough Bilborough Medical Centre 0.1 miles Grange Farm Medical Centre 0.4 miles Giltbrook Surgery 3.3 Bilborough Surgery 0.1miles Lime Tree Surgery (partial coverage) 1.8 miles miles Broxtowe / Strelley Bilborough Medical Centre 0.8 miles Lime Tree Surgery 2.1 miles Boarder Broad Oak Medical Practice (partial) 0.7 miles Parkside Medical Centre (partial) 2.7miles Giltbrook Surgery 3 miles Grange Farm Medical Centre (partial) 0.9 miles Page 1 of 6
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Map 2: Acer Court & Alder House Care Homes
The maroon line represents the Nottingham City/County Council and Nottingham West CCG/PCN boundary. Giltbrook Surgery’s proposed reduced boundary is illustrated by the thick black line. Acer Court and Alder House care homes sit outside the proposed practice boundary whist remaining inside the Nottingham West CCG / PCN boundary. The buildings shown within the maroon line to the north of the A610 are part of Phoenix Business Park, the two buildings to the south of the A610, close to the care homes, are a petrol station and small supermarket. There are no private dwellings in these areas.
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Map 3: Northern Boundary with Ashfield South PCN
Giltbrook Surgery proposes to reduce its boundary from the aqua line to the thick black line. In discussions with the Primary Care Commissioning Team, Giltbrook Surgery indicated they would include the area of New Bagthorpe (red line) if required to ensure patient choice and GP coverage as neither Jacksdale Medical Centre nor Selston Surgery boundaries extend this far.
Areas Impacted Practice Coverage in the Area / Patient’s Choice of Practices New Bagthorpe No GP practice coverage Giltbrook Surgery 3.7 miles (nearest – Selston Surgery 0.7 miles)
The nine GP practices of Hucknall, Kirkby-in-Ashfield and Annesley Woodhouse do not cross the M1 at this point and therefore would not provide GP practice coverage.
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Map 4: North West Boundary with Derby & Derbyshire CCG
The proposed Giltbrook Surgery boundary (thick black line) would remain largely unchanged and within Derby & Derbyshire CCG. The blue wavy line represents the Nottingham West CCG/PCN and Nottinghamshire County / Derbyshire County Council boundary.
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Map 5: Western Boundary with Derby & Derbyshire CCG
The proposed Giltbrook Surgery boundary, represented by the thick black line, moves towards the Nottingham West CCG / PCN boundary at Cotmanhay. All areas removed by the proposed boundary change have access to a choice of GP practice
Areas Impacted Practice Coverage in the Area / Patient Choice of Practices Cotmanhay Nottingham West PCN Derby & Derbyshire CCG Giltbrook Surgery 1.7 Hama Medical Centre 2.5 miles Cotmanhay Medical Centre 0.2 miles miles Old Station Surgery, Ilkeston 0.8 miles Ilkeston Health Centre 1.5 miles
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Map 6: Southern Boundary with Derby & Derbyshire CCG and Nottingham West PCN
The area highlighted in yellow will have no GP practice cover if Giltbrook Surgery reduces its boundary. The area sits between J25 & J26 M1 and includes Trowell Motorway Service Station.
Areas Impacted Practice Coverage in the Area / Patient’s Choice of Practices Larklands Giltbrook Dr Webb & Partners, Ilkeston 0.6 miles Ilkeston Health Centre 0.6 miles Surgery 2.7 miles Old Station Street Surgery 1.1 miles Littlewick Medical Centre 0.5 miles Gladstone House Surgery 0.6 miles Strelley Village Bilborough Medical Centre 0.9 miles Sunrise Medical Practice (Ghattaora) 3.4 Giltbrook Surgery 3 miles Greenfields Medical Centre 3.2 miles miles The Alice Medical Centre 3.8 miles Trowell Bramcote Surgery (partial) 1.9 miles Littlewick Medical Centre 1.4 miles Giltbrook Surgery 3.8 Hickings Lane (partial) 1.3 miles Dr Webb & Partners, Ilkeston 1.6 miles miles Ilkeston Health Centre 1.6 miles Gladstone House Surgery 1.6 miles Old Station Street 2.3 miles
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Equality Impact Assessment (EQIA): Primary Care Template
Introduction The purpose of an EQIA is to identify potential positive, negative and neutral impacts of service or policy development, implementation or change; and where possible minimise or eliminate negative consequences whilst maximising opportunities for promoting equality and quality.
In the case of primary care provision, EQIAs as part of the application process for a boundary change, merger, list closure, branch closure or planned closure, enables the practice to think carefully about the likely impact of the change for current and potential service users, in particular people’s different protected characteristics, and take action where appropriate.
The EQIA is designed to: ∑ Enable details of supporting evidence to be recorded ∑ Assess the impact of proposed changes in line with the CCGs’ duty to reduce health inequalities in access to health services and in health outcomes achieved ∑ Assess the impact of proposed changes to services in line with the CCGs’ duty to maintain and improve the three elements of quality (patient safety, patient experience and clinical effectiveness) ∑ Assess whether proposed changes could have a positive, negative or neutral impact, depending on people’s different protected characteristics defined by the Equality Act 2010 ∑ Identify any unlawful discrimination or negative effect on equality for patients/service users, carers and the general public ∑ Consider the impacts on people from relevant inclusion health groups (e.g. carers, homeless people, people experiencing economic or social deprivation) ∑ Identify where any information to inform the assessment is not available, which may indicate that patient engagement is required ∑ Provide a streamlined process and prevent equality and quality risks from being considered in isolation ∑ Determine whether a scheme can proceed, proceed with identified action, or not be progressed.
EQIAs are ‘live’ documents, and as such, are required to be revisited at key stages of development and implementation, particularly following the conclusion of any engagement and consultation activities to inform decision-making.
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The EQIA template is to be completed by the practice(s). Text highlighted in red has been added to provide prompts for the practice and key areas for consideration and inclusion. The document is hyperlinked to a glossary of key terms. The Primary Care Commissioning Team will complete the CCG sections and are available to answer any questions.
Primary Care Commissioning Team, Nottingham & Nottinghamshire CCGs [email protected]
Nottingham City South Nottinghamshire Mid-Nottinghamshire Serena Broughton Georgie Heath Bryony Higgins Primary Care Officer Primary Care Officer Primary Care Officer (Nottingham City) (South Nottinghamshire) (Mid-Notts) Information redacted Information redacted Information redacted
Fiona Warren Rachael Harrold Julie Kent Primary Care Manager Primary Care Manager Primary Care Manager (Nottingham City) (South Nottinghamshire) (Mid-Notts) Information redacted Information redacted Information redacted
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Proposal / Project Title: Giltbrook Surgery Boundary Reduction (Nottingham West PCN)
EQIA Completed By: Rachael Harrold, Primary Care Commissioning Manager
Date EQIA Completed: October 2020
Description of Proposal:
As part of the approval by the Primary Care Commissioning Committee at its February meeting to extend the list closure at the practice for a further six months, Giltbrook Surgery was required to consider a boundary change in order to reduce their growing list size. The proposed reduced boundary will be considered by the Committee at its October meeting.
The current, historic boundary was set by a previous partnership prior to the current partners taking on the contract. The contracted boundary extends beyond the boundary of Nottingham West CCG and the Nottingham West PCN footprint into Derbyshire, Mansfield & Ashfield and Nottingham City. Due to a growing list size and restricted physical capacity, the practice is reporting that its having a negative impact on their ability to provide timely access to services for their patients; growing list size, limited number of appointments and longer waits for an appointment could impact upon patient safety as patients wait longer for appointments or patients seek urgent care as an alternative. The practice is unable to increase its workforce as they are limited with the physical space of their building and are unable to expand.
There are approximately 59 patients registered at Giltbrook Surgery resident in the area of reduction. 199 registered patients are resident outside the current boundary and will be contacted in line with the practice policy requesting they register with a GP practice closer to home.
Although the practice cannot remove the patients currently registered in the areas of reduction, if the proposed boundary reduction were approved, it will allow Giltbrook Surgery to decline new patients resident in these areas now that their list has re-opened, and give them more control over the future list size growth. To note, new family members including babies joining a household located within the area of reduction that is registered at Giltbrook Surgery will be accepted as new patients by the practice.
This EQIA has been written for the recommended permanent boundary that retains New Bagthorpe, Strelley Village and the area surrounding Trowell Service Station (M1) which will ensure GP coverage and choice of GP practice.
The proposed removal of Acer Court & Alder House care homes is recommended to be deferred subject to approval of GP alignment for the purpose of the Enhanced Health to Care Homes (EHCH) DES. This EQIA will consider the impact on the registered population resident in these two care homes on the basis that if they were to remain within the boundary of Giltbrook Surgery or the boundary reduced to no longer cover the home, the residents will continue to have access to core GP services delivered primarily at the home, and receive an enhanced level of care as part of the EHCH DES from a variety of clinicians as part of the Care Home Team. The residents would not be advantaged nor disadvantaged by remaining registered at Giltbrook Surgery or registering at another local practice, as care would be delivered as part of standard GMS services and a defined service specification (EHCH).
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Identify Area Affected (CCG Wide / Locality / Primary Care Network (PCN)): Nottingham & Nottinghamshire CCG ∑ Nottingham City Locality o Bulwell & Top Valley PCN o BACHS PCN o Nottingham City South PCN ∑ Mid-Nottinghamshire Locality o Ashfield South PCN ∑ South Nottingham Locality o Nottingham West Derby & Derbyshire CCG
Details of Any Supporting Evidence: When completing this section a review of the latest evidence should be undertaken. Use the checklist provided for sources of evidence and trusted websites to visit to find evidence. Describe the key findings Evidence checklist of from your evidence search and how they have informed this scheme. web based resources
If you have been unable to find evidence, please describe what you have based this scheme on instead (e.g. activity data, population data, patient experience or public engagement intelligence, clinical opinion etc.):
The proposal will be presented to the Primary Care Commissioning Committee on the 21st October 2020
Giltbrook Surgery: List size changes
Date Raw List Size April 2017 4,495 April 2018 4,711 April 2019 5,009 September 2019 5,096 November 2019 5,068 January 2020 5,039 April 2020 4,966 July 2020 4,948 21 Sept 2020 4,873
Workforce As of 1st April 2020: 1.84 WTE GPs / GP to Patient Ratio 1:2,700.
CQC Rated Outstanding March 2016 o Good: Safe, Effective, Well-Led o Outstanding: Caring, Responsive
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Section 2: Health Inequalities Assessment
What will be the effect of the scheme in terms of reducing health inequalities in outcomes and in access?
Comments/rationale: When completing this section please include the following details, as relevant to the proposal: ∑ Details of the specific under-served people/groups that will benefit from the proposal (i.e. where health inequalities are likely to reduce); ∑ Details of the specific people/groups for which health inequalities are likely to increase and any proposed mitigations.
Patients currently registered at Giltbrook Surgery may see a positive impact following boundary reduction as their ability to access services could be improved due to the practice not accepting new patients from such a wide geographical area and overall accepting fewer new patients. This results in less demand on the number of appointments available to the patient population which could result in patients accessing appointments more quickly. Travel time for home visits would be reduced.
The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
For those new patients moving into the areas no longer covered by Giltbrook Surgery, the majority will have a choice of practices to register with which will predominantly be closer to their home address than Giltbrook Surgery, thereby reducing travel time. Parkside Medical Practice
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(Bulwell & Top Valley PCN) is keen to actively increase their list size.
Whilst Giltbrook Surgery had a large practice boundary there are few registered patients living within the areas of reduction; 59 in total which indicates this practice may not be the practice of choice in those particular areas given the numbers of practices in closer proximity with capacity to register new patients.
The rural areas of New Bagthorpe and Jacksdale will be provided with a choice of practice as Giltbrook Surgery is planning to extend their boundary into these areas in recognition of their rural location and in response to Jacksdale Surgery’s concern about the impact on their list size should Giltbrook Surgery withdraw completely from that area.
It is unlikely given the numbers registered currently at Giltbrook Surgery from the areas of reduction, and the choice of practices, that any one practice would see a large increase in new patient registrations.
Staff working within the practice would be positively impacted from the reduction in demand and work load pressures which could in turn have a positive impact on the service they offer to patients e.g. less sickness, more time to be spent with patients etc.
Section 3: Protected Characteristics and Inclusion Health Groups:
Could the project have a positive or negative impact on people who may, as a result of being in one or more of the following protected characteristic or inclusion health groups, experience barriers when trying to access or use NHS services? In addressing this question, consider whether the scheme could potentially have a positive or negative impact in any of the following areas:
∑ The CCG’s duty to maintain and improve the three elements of quality – patient safety, patient experience and clinical effectiveness ∑ Access to services (including patient choice and physical accessibility – access to and within buildings, public transport routes, parking for disabled people) ∑ Accessibility in terms of communication (availability of spoken language interpreters, British Sign Language Interpreters, hearing loops, translated written information) ∑ Transfers between services (whether between specialties, care settings, or during a person’s life course) ∑ Safeguarding adults and children ∑ Dignity and respect (including privacy) ∑ Person-centered care (whether patients experience the service as culturally competent / welcoming – not just in terms of patients’ race, but also, for example, their gender identity, religion or belief and sexual orientation and whether patients feel that the service considers both their physical and mental health needs. ∑ NICE requirements ∑ Shared decision-making
It is also important to consider the combination of patients’ characteristics and how those combinations may impact on accessibility. An example is the combination of older age, certain types of disability and economic deprivation; potentially limiting access to services if they are not near a patient’s home or easy to get to by public transport. Also, many of the prompts under specific characteristic / health groups may apply to other groups.
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∑ Try to put yourself in patients’ or careers’ shoes ∑ They are accessing health services because they have a physical and/or mental health need ∑ Think about your own experiences, or those of friends or family, when accessing health services. ∑ Not everyone has a regular income, drives, can see or hear, speaks English, is literate or health literate / understands the way health systems work, has a home or safe and supportive networks. Therefore we will all experience access to health services in different ways, often regardless of clinical need.
The Equality Impact Assessment Checklist and Quality Impact Assessment Checklist below will help with your considerations:
EIA Assessment QIA Assessment Checklist July 2020.docxChecklist July 2020.docx
Impact on the protected characteristic of Age:
Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.
The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.
Giltbrook Surgery has no registered patients resident within Acer Court or Alder House Care Homes (as of 9th October). The practice will continue to support and register the residents of Giltbrook Care Home which remains within their boundary
Impact on the protected characteristic of Disability:
Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.
The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.
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Impact on the protected characteristic of Gender re-assignment:
Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.
The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.
Impact on the protected characteristic of Pregnancy and maternity:
Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.
The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.
Impact on the protected characteristic of Race:
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Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.
The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.
Impact on the protected characteristic of Religion or belief:
Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.
The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.
Impact on the protected characteristic of Sex:
Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.
The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.
Impact on the protected characteristic of Sexual orientation:
Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.
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The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.
Impact on people in any of the following Inclusion Health and other Disadvantaged Groups: ∑ Carers ∑ Homeless people ∑ People who misuse drugs ∑ People working in stigmatised occupations (such as sex workers) ∑ New and emerging communities, including refugees and asylum seekers ∑ People experiencing economic or social deprivation, including those who are long-term unemployed / are geographically isolated / have limited family or social networks ∑ Members of the travelling community (who do not belong to an ethnic group recognised under the Equality Act)
Comments/rationale (with an indication of which of the above groups have specifically influenced your impact conclusion): With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.
The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.
New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.
Section 4: Assessment of Likely Impact of Controversy
a) Is the proposal likely to result in controversy due to: ∑ The nature of the service ∑ The patients or carers affected
Highly ☐ Likely ☐ Unlikely ☒ N/A ☐ Likely
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Comments/rationale: It is unlikely the proposal will attract controversy.
As part of list cleansing those patients resident outside the current, large boundary registered with Giltbrook Surgery will be contacted in line with practice policy to advise them to register with a practice closer to home. This is likely to attract a small number of complaints from patients; however it’s unlikely to cause controversy given the small patient numbers.
A small number of complaints may be received from residents moving into the area of reduction, whose neighbours remain registered with Giltbrook Surgery however following the formal process to reduce their practice boundary the new residents will be unable to register with Giltbrook Surgery. This is unlikely to cause controversy given the small patient numbers.
b) Has there been previous controversy around the service resulting in: ∑ Complaints / enquiries - Contact the CCG’s Patient Experience Team: [email protected] ∑ Media coverage - Contact the CCG’s Communications Team: [email protected]
Large ☐ Minimal ☐ None ☒ N/A ☐ Amount Comments/rationale: I am not aware of any in relation to this proposal.
c) Are you aware of any controversy (complaints or media coverage) when this proposal was introduced elsewhere?
Large ☐ Minimal ☐ None ☒ N/A ☐ Amount Comments/rationale: I am not aware of any in relation to this proposal.
d) What engagement activity has been undertaken or planned to gain the views of patients and carers? Comments/rationale: N/A Patients resident within the boundary reduction area will not be asked to register elsewhere.
Section 5: Assessment of the Likely Impact on Privacy
Please review the questions below, answering yes or no, to assess the requirement for a Data Protection Impact Assessment (DPIA).
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The proposal involves processing personal data and: Y / N 1 Evaluation or scoring? N 2 Automated decision-making with significant effects? N 3 Systematic monitoring? N 4 Processing of sensitive data or data of a highly personal nature? N 5 Processing on a large scale? N 6 Processing of data concerning vulnerable data subjects? N 7 Innovative technological or organisational solutions? N 8 Processing that involves preventing data subjects from exercising a right or using a N service or contract? 9 Using systematic and extensive profiling or automated decision-making to make N significant decisions about people? 10 Processing special-category data or criminal-offence data on a large scale? N 11 Systematically monitoring a publicly accessible place on a large scale? N 12 Using innovative technology in combination with any of the criteria in the European N guidelines? 13 Using profiling, automated decision-making or special category data to help make N decisions on someone’s access to a service, opportunity or benefit? 14 Carrying out profiling on a large scale? N 15 Processing biometric or genetic data in combination with any of the criteria in the N European guidelines? 16 Combining, comparing or matching data from multiple sources? N
17 Processing personal data without providing a privacy notice directly to the individual in N combination with any of the criteria in the European guidelines? 18 Processing personal data in a way that involves tracking individuals’ online or offline N location or behaviour, in combination with any of the criteria in the European guidelines? 19 Processing children’s personal data for profiling or automated decision-making or for N marketing purposes, or offer online services directly to them? 20 Processing personal data that could result in a risk of physical harm in the event of a N security breach? 21 There has been a change to the nature, scope, context or purposes of existing personal N data processing?
If you have responded ‘Yes’ to any of the above questions please contact the Information Governance Team regarding completion of a DPIA ([email protected]). Section 6: Impact Assessment Summary and Recommendation
Summary of any impacts / risks identified:
No significant impacts or risks have been identified.
Action/s to be taken to minimise adverse impacts / risks:
Impact Assessment Outcome:
Details of any risks identified and overall comments:
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Recommendation:
*Please provide details of action required:
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GLOSSARY The descriptions for the following terms are worded specifically for this EQIA.
Term Description
Access Access includes the ability of patients to obtain and understand information about their health and health services, as well as being able to access clinical advice and treatment. Patients’ access may be limited by a range of factors such as mobility limitations, cognitive function and language barriers.
Age The protected characteristic of Age refers to being of a specific age or belonging to a particular age range.
Carers Carers may be socially excluded and vulnerable, causing them to experience specific disadvantages, leading them to have poorer predicted health outcomes and a shorter life expectancy than the average population.
Clinical Clinical effectiveness is a component of quality in the NHS. It is the application of the best effectiveness knowledge, derived from research, clinical experience and patient preferences to achieve optimum processes and outcomes of care for patients. The process involves a framework of informing, changing and monitoring practice.
Dignity and Respect This is one of the values incorporated in the NHS Constitution: "We value every person - whether patient, their families or carers, or staff - as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits. We take what others have to say seriously. We are honest and open about our point of view and what we can and cannot do." Respect, dignity, compassion and care should be at the core of how patients and staff are treated - not only because that is the right thing to do, but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported.
Disability The protected characteristic of Disability includes people with physical or mental impairments or illnesses that have a substantial and long-term adverse effect on their ability to carry out normal day- to-day activities. ‘Substantial’ is more than minor or trivial – e.g. it takes much longer than it usually would to complete a daily task like getting dressed. ‘Long-term’ means 12 months or more – e.g. a breathing condition that develops as a result of a lung infection. Someone automatically meets the disability definition under the Equality Act 2010 from the day they are diagnosed with HIV infection, cancer or multiple sclerosis, even if they are currently able to carry out normal day to day activities. A disability can arise from a wide range of impairments which can be: • Sensory impairments, such as those affecting sight or hearing • Mental health conditions • Mental illnesses • Learning disabilities • Organ specific – e.g. respiratory conditions, cardiovascular diseases, stroke • Developmental – e.g. autistic spectrum disorders • Produced by injury to the body, including to the brain • Impairments with fluctuating or recurring effects – e.g. rheumatoid arthritis • Progressive* – e.g. motor neurone disease, muscular dystrophy, and forms of dementia • Auto-immune conditions, such as systemic lupus erythematosis (SLE). *A progressive condition is one that gets worse over time. The Equality Act 2010 covers people who have had a disability in the past – e.g. if a person had a mental health condition in the past which lasted for over 12 months, but has now recovered, they are still protected from discrimination because of that disability. For further information see Equality_Act_2010-disability_definition.pdf
Engagement The range of activities designed and deployed by CCGs to: ∑ Gain the views of patients, service users and carers on commissioning and service delivery ∑ Include patients, service users and carers in considering their own health, care and treatment.
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Term Description
Equality Act 2010 A single piece of legislation that replaced previous anti-discrimination Acts. It simplified the law, removing inconsistencies and making it easier for people to understand and comply with. The Act outlaws direct and indirect discrimination, harassment and victimisation of people with relevant protected characteristics in relevant circumstances and requires that reasonable adjustments be made for disabled people. The Equality Act includes a public sector equality duty (PSED), which applies to public bodies and others carrying out public functions. It supports good decision-making by ensuring public bodies consider how different people will be affected by their activities, helping them to deliver policies and services that are efficient and effective, accessible to all, and which meet different people’s needs.
Evidence Information from research and other sources e.g. activity data, population data, patient experience or public engagement intelligence, clinical opinion, NICE, national strategies, policy documents and reports, evaluation, clinical audit, etc. Evidence-based practice is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values.
Gender re- A person has the protected characteristic of gender reassignment if s/he is proposing to undergo, is assignment undergoing or has undergone a process (or part of a process) for the purpose of reassigning her/his sex by changing physiological, behavioural or other attributes of sex.
Gypsies Roma and A group of people who may be socially excluded and vulnerable, causing them to experience Travellers specific disadvantages, leading them to have poorer predicted health outcomes and a shorter life expectancy than the average population. See also Inclusion Health groups.
Health inequalities Preventable and unjust differences in health status experienced by certain population groups. People in lower socio-economic groups are more likely to experience chronic ill-health and die earlier than those who are more advantaged.
Homeless people A group of people who may be socially excluded and vulnerable, causing them to experience specific disadvantages, leading them to have poorer predicted health outcomes and a shorter life expectancy than the average population. See also Inclusion Health groups.
Inclusion health Groups of people who may be socially excluded and vulnerable, causing them to experience specific groups disadvantages, leading them to have poorer predicted health outcomes and a shorter life expectancy than the average population. These include carers, homeless people, people who misuse drugs, asylum seekers and refugees, Gypsies and Travellers, sex workers, people experiencing economic and social deprivation, people who are long-term unemployed, people who have limited family or social networks and people who are geographically isolated.
Negative impact An effect that could, for example: ∑ Decrease or exclude access to a service or activity ∑ Be detrimental to treatment outcomes ∑ Have an adverse impact on patient experience.
New and emerging A group of people who may be socially excluded and vulnerable, causing them to experience communities, specific disadvantages, leading them to have poorer predicted health outcomes and a shorter life including refugees expectancy than the average population. See also Inclusion Health groups. and asylum seekers
Patient choice Informed decision-making by patients over where/how they receive health care.
Patient experience Patient experience is one of the three components of quality in the NHS. Experience of care, clinical effectiveness and patient safety together make the three key components of quality in the NHS. Good care is linked to positive outcomes for the patient and is also associated with high levels of staff satisfaction. Patient experience means putting the patient and their experience at the heart of quality improvement.
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Term Description
Patient safety The NHS is expected to treat patients in a safe environment and protect them from avoidable harm. Patient safety is one of the three components of quality in the NHS and is defined as the prevention of errors and adverse effects to patients associated with health care. While health care has become more effective it has also become more complex, with greater use of new technologies, medicines and treatments. Patient safety issues are the avoidable errors in healthcare that can cause harm (injury, suffering, disability or death) to patients.
People A group of people who may be socially excluded and vulnerable, causing them to experience experiencing specific disadvantages, leading them to have poorer predicted health outcomes and a shorter life economic and expectancy than the average population. It includes people who are long-term unemployed, or who social deprivation have limited family or social networks. To comply with the Equality Act 2010, CCGs are required to consider how their strategic decisions might help to reduce the inequalities associated with socio- economic disadvantage, such as inequalities in employment, education, health, housing and crime rates. It is for individual CCGs to consider which socio-economic disadvantages it is able to influence.
People who misuse A group of people who may be socially excluded and vulnerable, causing them to experience drugs specific disadvantages, leading them to have poorer predicted health outcomes and a shorter life expectancy than the average population. See also Inclusion Health groups.
Person-centred Person-centred care is the principle of 'shared-decision making' – enabling people to make joint care decisions about their care with their clinicians. It involves putting patients, and their families and carers, at the heart of deciding what is most valuable for individuals with a range of health conditions, rather than clinicians or other health professionals independently deciding what is best.
Positive impact An effect that could, for example: ∑ Increase access to a service or activity ∑ Improve treatment outcomes ∑ Enhance patient experience.
Pregnancy and Pregnancy is the condition of being pregnant or expecting a baby. Maternity refers to the period maternity after the birth, and is linked to maternity leave in the employment context. In the non-work context, protection against maternity discrimination is for 26 weeks after giving birth, and this includes treating a woman unfavourably because she is breastfeeding.
Privacy Interpreted most broadly, privacy is about the integrity of the individual. It therefore encompasses many aspects of the individual’s social needs – privacy of the person, personal information, personal behaviour and personal communications.
Protected The Equality Act 2010 outlines nine protected characteristics - Age, Disability, Gender re- characteristics assignment, Marriage and civil partnership, Pregnancy and maternity, Race, Religion or belief (including no religion or belief), Sex and Sexual orientation. The Equality Act outlaws direct and indirect discrimination, harassment and victimisation of people with relevant* protected characteristics. *Marriage and civil partnership is not a ‘relevant’ protected characteristic. (This distinction applies only in relation to work, not to any other part of the Equality Act 2010) We all have at least five of the nine protected characteristics - age, race, religion or belief/no religion or belief, a sex and a sexual orientation.
Quality The definition of quality in health care, enshrined in law, includes three key components: patient safety, clinical effectiveness and patient experience. The NHS aspires to the highest standards of excellence and professionalism in the provision of high quality care – i.e. care that is safe, clinically effective and focused on providing as positive an experience to service users as possible.
Race This protected characteristic refers to groups of people defined by their colour, nationality (including citizenship), ethnic or national origins.
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Term Description
Religion or belief This protected characteristic includes any religion and any religious or philosophical belief. It also includes a lack of any such religion or belief. A religion need not be mainstream or well-known but it must be identifiable and have a clear structure and belief system. Denominations or sects within religions may be considered a religion. Cults and new religious movements may also be considered religions or beliefs. Belief means any religious or philosophical belief and includes a lack of belief. Religious belief goes beyond beliefs about and adherence to a religion or its central articles of faith and may vary from person to person within the same religion. A belief need not include faith or worship of a god or gods, but must affect how a person lives their life or perceives the world.
Safeguarding adults The Care Act 2014 defines adult safeguarding as protecting an adult’s right to live in safety, free from abuse and neglect with people and organisations working together to prevent and stop both the risks and experience of abuse or neglect. Safeguarding balances the adults right to be safe with their right to make informed choices, whilst at the same time making sure that their wellbeing is promoted including, taking into consideration their views, wishes, feelings and beliefs in deciding on any action (s). The Care Act 2014 defines an adult at risk of harm as: ‘someone who has needs for care and support, and is experiencing, or at risk of, abuse or neglect and is unable to protect themselves’.
Safeguarding Safeguarding children and young people means the actions that are taken to promote their welfare children and protect them from harm, abuse and maltreatment. This includes preventing harm to their health or development, ensuring that they experience safe and effective care as they grow up and enabling them to have the best outcomes. Child protection is part of the safeguarding process and focuses on protecting individual children identified as suffering or likely to suffer significant harm. Safeguarding children and child protection guidance and legislation applies to all children up to the age of 18.
Self-care Also known as self-management. Refers to the key role that individual people have in protecting and managing their own health, choosing appropriate treatments and managing long-term conditions. They may do this independently or in partnership with the healthcare system.
Sex This protected characteristic refers to whether a person considers that they are a man or a woman.
Sexual orientation This protected characteristic refers to whether a person's sexual orientation is towards their own sex, the opposite sex or to both sexes.
Shared decision- Shared decision-making is a process in which patients, when they reach a decision crossroads in making their health care, can review all the treatment options available to them and participate actively with their healthcare professional in making that decision.
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Meeting Title: Primary Care Commissioning Committee Date: 21 October 2020 (Open Session)
Paper Title: GP Contract Letter, 1 October 2020 Paper Reference: PCC 20 125
Sponsor: Joe Lunn, Interim Associate Director of Attachments/ Appendix A: GP Primary Care Appendices: Contract Letter Presenter: Joe Lunn, Interim Associate Director of Appendix B: Primary Care Summary of the GP Contract amendments
Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for: ☒ Assurance Information
Executive Summary Arrangements for Discharging Delegated Functions Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts
On 1 October 2020 NHS England published a GP Contract Letter, which outlined changes to the GP contracts from 1 October 2020. These are amendments to the General Medical Services (GMS)/Personal Medical Services (PMS) Regulations and Alternative Provider Medical Services (APMS) Directions arising from the 2020/21 GP contract agreement (reached with the British Medical Association). Appendix B provides a summary of these amendments.
The Primary Care Commissioning Team will work with GP practices to ensure they are meeting the requirements of these contract amendments.
Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (EQIA)
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Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (DPIA) Risk(s): There are no risks associated with this paper. Confidentiality: ☒ No Recommendation(s): 1. RECEIVE the GP Contract Letter and summary of amendments
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Classification: Official
Publications approval reference: PAR201
Primary Care Strategy and NHS Contracts
NHS England and NHS Improvement, Skipton House, 80 London Road, London, SE1 6LH
30 September 2020
Dear GP practices and their commissioners,
Changes to the GP Contracts from 1 October 2020
We are writing to update you on changes to the GP contracts from 1 October 2020.
A. Amendments to the GMS/PMS Regulations and APMS Directions arising from the 2020/21 GP contract agreement
We have made further changes to the GMS/PMS Regulations to implement the agreements reached with the BMA in the 2020/21 GP contract agreement: https://www.england.nhs.uk/wp-content/uploads/2020/03/update-to-the-gp-contract- agreement-v2-updated.pdf. This includes a new requirement for practices to participate in the Appointments in General Practice data collection. From 1 October, practices are required to record appointments in their appointments book in line with guidance we jointly published with the BMA in August: https://www.england.nhs.uk/wp-content/uploads/2020/08/gpad-guidance.pdf. The Regulations have also been updated to include new and amended requirements in relation to: the NHS Digital Workforce Collection; list cleansing; removal of patients from a practice list because they have moved out of the practice area; removal of patients from a practice list who are violent; patient assignment where the relationship between a patient and a practice has broken down; out of area patient registration where patients have been assigned; subcontracting under the Network Contract DES; and amendments to termination rights where a practice registration with the CQC has been cancelled. Further details are included at Annex A and the new Regulations are here: https://www.legislation.gov.uk/uksi/2020/911/schedule/1/made Further changes to the Regulations will be made by April 2021 to implement the remaining aspects of the 2020/21 deal. This includes amendments to make
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vaccinations and immunisations essential services as well as introduce pay transparency. In addition, we are planning to introduce a new regulatory requirement in January 2021 for practices to record ethnicity data where this is provided. In the meantime, all NHS organisations are asked to proactively review and ensure the completeness of patient ethnicity data by no later than 31 December as per the phase 3 implementation letter1. Ensuring datasets are complete and timely is essential to underpin an understanding of and response to health inequalities.
We have recently received some queries about the requirement introduced on 1 April 2020 for all practices to offer a 6-8 week postnatal check for new mothers. To clarify, these checks need to be led by a GP, who could be supported by additional multidisciplinary professionals within the primary care team with the necessary competencies.
B. Extension of temporary changes to GP contract under the pandemic regulations
The following provisions will continue under the National Health Service (Amendments Relating to the Provision of Primary Care Services During a Pandemic etc.) Regulations 2020 until 31 March 2021 for GP practices in England at the earliest:
• A suspension of the requirement that practices report to commissioners about the Friends and Family Test returns;
• A temporary suspension of the requirement for individual patient consent in certain circumstances, in order to encourage increased use of electronic repeat dispensing (eRD)2. Use of eRD has many benefits for patients, practices and wider systems and this temporary provision aims to make it easier for practices to transfer patients to e-RD in defined circumstances, where this is clinically appropriate.
• A continuation of the temporary increase in the number of appointment slots that practices must make available for direct booking by 111 to 1 slot per 500 patients per day. This is because they remain necessary to support phase 3 of the NHS response, in particular the important role NHS 111 is playing in reducing the face-to-face transmission risk for patients and NHS staff. Under this model, the slots, which will be booked following clinical triage, are not appointments in a traditional sense; instead practices should clinically assess the patients remotely and arrange their ongoing management. This ensures that only those who need further care (in-person or via telephone / video consultation) are presenting to services, and they are managed as appropriate for their clinical condition. GP practices are asked to make sufficient slots available for NHS 111 to refer into; they should
1 https://www.england.nhs.uk/wp-content/uploads/2020/08/C0716_Implementing-phase-3- v1.1.pdf 1
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assess the use of the slots each day and adjust the number to meet demand. This could be fewer than 1 in 500.
C. Statement of Financial Entitlements (SFE)
Two changes have been made to the Statement of Financial Entitlements which will come into effect in early October 2020: • Dispensing Doctors Feescales: The SFE will be updated to include the uplift to the Dispensing Doctors Feescales.
• Dispensary Services Quality Scheme (DSQS). As set out in our 4 September letter2, we have amended the requirements of DSQS this year in light of Covid-19. The SFE now reflects that practices only need to carry out medication reviews for 7.5% of their dispensing patients, focusing on those they consider to be higher-risk, and must do so remotely unless a face to face review is clinically appropriate.
The SFE amendments can be read in full here: https://www.gov.uk/government/publications/nhs-primary-medical-services- directions-2013 A further amendment will be made to the SFE to reflect the revised approach to QOF in 2020/21
D. Publication of new standard contracts
We will shortly publish new standard GMS, PMS and APMS contracts to incorporate all changes to these contracts since October 2019. These standard contracts and contract variations will be available on the NHS E/I website: https://www.england.nhs.uk/gp/investment/gp-contract/ If you have any queries, please contact the GP Contracts Team on: [email protected]
Ed
Ed Waller Director for Primary Care NHS England and NHS Improvement
2 https://www.england.nhs.uk/coronavirus/wp- content/uploads/sites/52/2020/03/C0713-202021-General-Medical-Services-GMS- contract-Quality-and-Outcomes-Framework-QOF-Letter.pdf 2
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Annex A: Further details of the amendments to the GMS Contract and PMS Agreement Regulations from 1 October 2020
From 1 October 2020, the GMS Contract and PMS Agreement Regulations have been amended3 to include the following requirements:
• Appointments in General Practice data collection: From 1 October, practices are required to record appointments in their appointments book in line with guidance we jointly published with the BMA in August: https://www.england.nhs.uk/wp-content/uploads/2020/08/gpad-guidance.pdf.
Further information and advice on improving recording of appointments can be found here: https://www.england.nhs.uk/gp/gpad/
• NHS Digital Workforce Collection: A requirement for practices to participate in monthly, rather than quarterly, updates regarding the NHS Digital Workforce Collection which are vital to understanding the workforce pressures in primary care. Guidance on inputting information through the National Workforce Reporting System is available at: https://digital.nhs.uk/data-and- information/areas-of-interest/workforce/national-workforce-reporting-system- nwrs-workforce-census-module
• List cleansing: A new requirement for practices to support NHS England to fulfil its statutory duties to maintain and accurate and up-to-date list of patients, by complying with reasonable requests for information and updating their patient lists.
• Removal of patients from practice lists because they have moved out of the practice area: An amendment to clarify that when a patient is removed from a practice list because they have moved out of the practice area, once the practice notifies the commissioner of that removal, the patient will continue to be registered with the practice for 30 days (or until they register with another practice) but the contractor will not be required to provide home visits during that period. Patients requiring a home visit during that this 30 day period will be advised either to register with a new local GP practice or access services commissioned locally for out of area registered patients.
• Removal of patients from practice lists who are violent: A clarification that patients should not be removed from a GP practice list if, having been previously removed from a GP practice list and entered into a Special Allocation Scheme for violent patients, they have subsequently been discharged for reintegration into mainstream primary care.
3 https://www.legislation.gov.uk/uksi/2020/911/introduction/made#text%252525252525253Dgeneral%252525 2525252520medical%2525252525252520services 3
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• Patient assignment in instances where the relationship between a practice and patient has broken down: An amendment to the arrangements for patients whose relationship with their practice has broken down and who need to be reassigned to another practice. These patients can now be assigned to a patient list of a practice in whose CCG area the patient resides. In making these assignments, contractors will not be required to provide home visits outside their practice area so it may be necessary to register these patients as an out of area registered patient.
• Out of area patient registration where patients have been assigned. Amendment to allow the provisions for out of area registration to apply to a new patient who has been assigned to a practice in circumstances where that patient resides outside of a practice’s area but within the CCG area of which it is a member, and the practice elects to accept that patient as an out of area patient.
• Sub-contracting under the Network Contract DES. To support Primary Care Networks (PCNs) to deliver the requirements of the Network Contract DES, an amendment has been made to allow onward sub contracting of clinical services provided under the Network Contract DES where permission of the commissioner is granted.
• Termination right: An amendment to allow for the termination of a contract in cases where a practices registration with the Care Quality Commission (CQC) has been cancelled
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Appendix B
Annex A: Further details of the amendments to the GMS Contract and PMS Agreement Regulations from 1 October 2020 From 1 October 2020, the GMS Contract and PMS Agreement Regulations have been amended1 to include the following requirements:
Appointments in General Practice data collection: From 1 October, practices are required to record appointments in their appointments book in line with guidance we jointly published with the BMA in August: https://www.england.nhs.uk/wp-content/uploads/2020/08/gpad-guidance.pdf.
Further information and advice on improving recording of appointments can be found here: https://www.england.nhs.uk/gp/gpad/
NHS Digital Workforce Collection: A requirement for practices to participate in monthly, rather than quarterly, updates regarding the NHS Digital Workforce Collection which are vital to understanding the workforce pressures in primary care. Guidance on inputting information through the National Workforce Reporting System is available at: https://digital.nhs.uk/data-and-information/areas-of- interest/workforce/national-workforce-reporting-system-nwrs-workforce-census-module
List cleansing: A new requirement for practices to support NHS England to fulfil its statutory duties to maintain and accurate and up-to-date list of patients, by complying with reasonable requests for information and updating their patient lists.
Removal of patients from practice lists because they have moved out of the practice area: An amendment to clarify that when a patient is removed from a practice list because they have moved out of the practice area, once the practice notifies the commissioner of that removal, the patient will continue to be registered with the practice for 30 days (or until they register with another practice) but the contractor will not be required to provide home visits during that period. Patients requiring a home visit during that this 30 day period will be advised either to register with a new local GP practice or access services commissioned locally for out of area registered patients.
Removal of patients from practice lists who are violent: A clarification that patients should not be removed from a GP practice list if, having been previously removed from a GP practice list and entered into a Special Allocation Scheme for violent patients, they have subsequently been discharged for reintegration into mainstream primary care.
Patient assignment in instances where the relationship between a practice and patient has broken down: An amendment to the arrangements for patients whose relationship with their practice has broken down and who need to be reassigned to another practice. These patients can now be assigned to a patient list of a practice in whose CCG area the patient resides. In making these assignments, contractors will not be required to provide home visits outside their practice area so it may be necessary to register these patients as an out of area registered patient.
Out of area patient registration where patients have been assigned. Amendment to allow the provisions for out of area registration to apply to a new patient who has been assigned to a practice in circumstances where that patient resides outside of a practice’s area but within the CCG area of which it is a member, and the practice elects to accept that patient as an out of area patient.
Sub-contracting under the Network Contract DES. To support Primary Care Networks (PCNs) to deliver the requirements of the Network Contract DES, an amendment has been made to allow onward sub contracting of clinical services provided under the Network Contract DES where permission of the commissioner is granted.
Termination right: An amendment to allow for the termination of a contract in cases where a practices registration with the Care Quality Commission (CQC) has been cancelled.
1 https://www.legislation.gov.uk/uksi/2020/911/introduction/made#text%252525252525253Dgeneral%2525252525252520medical%25252525252 52520services Page 1 of 1
82 of 101 09:00-10:40-21/10/20 Primary Care Networks (PCN) Delivery: Additional Roles Unclaimed Fund Process
Meeting Title: Primary Care Commissioning Committee Date: 21 October 2020 (Open Session)
Paper Title: Additional Roles Reimbursement Scheme Paper Reference: PCC 20 126 (ARRS) Unclaimed Fund
Sponsor: Lucy Dadge, Chief Commissioning Officer Attachments/ App 1: Contract Appendices: Extract Presenter: Helen Griffiths, Associate Director of Primary care Network Development App 2: Additional Roles Forecast
Purpose: Approve ☒ Endorse ☐ Review ☒ Receive/Note for: ☒ ∑ Assurance ∑ Information
Executive Summary This paper provides details of the contractual requirements for the Primary Care Networks (PCN) Directed Enhanced Services (DES) for the unclaimed fund process for the Additional Roles Reimbursement Scheme. Discussions have been taking place over the past months to ensure that we have considered a fair and transparent process that will ensure that the funds continue to support primary care additional roles for 2020/2021, whilst meeting the requirements of the DES. Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☒ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☒ Development Performance Management ☐ Procurement and/or Contract Management ☐ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (DPIA) Risk(s): Risks are detailed within section five of the report. Confidentiality: ☒No Recommendation(s): Page 1 of 2
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1. APPROVE the proposed process to utilise the projected underspend of the Additional Roles and Reimbursement budget. 2. NOTE the risks associated with the implementation, delivery and required timeframes of the Unclaimed Fund process.
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Primary Care Networks: Unclaimed Fund Process
1. Introduction This paper provides details of the contractual requirements for the Primary Care Networks (PCN) Directed Enhanced Services (DES) for the unclaimed fund process for the Additional Roles Reimbursement Scheme. Discussions have been taking place over the past months to ensure that we have considered a fair and transparent process that will ensure that the funds continue to support primary care additional roles for 2020/2021, whilst meeting the requirements of the DES.
2. Contractual requirements PCNs were required to complete and return to the CCG a workforce plan providing details of their recruitment plans for 2020/21. This workforce plan was shared with the Primary Care Commissioning Committee on 16 September 2020 and with the Local Medical Committee (LMC). As part of this process the Network Contracted Enhanced Services Contract Specification 20/21 – PCN Requirements and Entitlements, March 2020 state that the commissioner must:-
∑ have shared with the PCN and relevant LMCs; and ∑ have agreed with the PCN, by 30 September 2020 an estimation of the amount of financial entitlements in relation to the PCN under the Additional Roles Reimbursement Scheme that the PCN is unlikely to claim by 31 March 2021. This amount is referred to in this Network Contract DES Specification as the “Unclaimed Funding”.
The requirements then go on to state that the
∑ The commissioner must base its estimate of the Unclaimed Funding on the PCN’s workforce planning information that is returned to the commissioner by the 31 August 2020. ∑ Where the PCN agrees the estimate, the PCN acknowledges that the PCN will no longer have the right to claim the Unclaimed Funding and the commissioner may give other PCNs within the commissioner’s boundary the opportunity to bid for the Unclaimed Funding. ∑ Where a commissioner provides the opportunity to PCNs within the commissioner’s boundary to bid for any PCN’s Unclaimed Funding, the commissioner will indicate when and how PCNs may bid. ∑ A PCN acknowledges that if it bids for Unclaimed Funding and is successful, the Unclaimed Funding allocated to the PCN must be used for the purpose of recruiting further Additional Roles in accordance with this Network Contract DES Specification. The PCN and the commissioner acknowledge that any payment of the Unclaimed Funding to the PCN is in addition to the PCN’s allocated Additional Roles Reimbursement Sum.
Please refer to Appendix 1 for the full extract of information taken from the DES requirements section 6.5.
3. Considerations The PCN development team considered how this process could take place. Initial concerns were raised at the potential outcome of a ‘bidding process’ amongst our 20 PCNs and we did not wish to
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encourage a competitive process that may disadvantage those PCNs that are perhaps not in a position at the time to effectively bid.
Initial discussions took place on the 18 June 2020 with CCG Finance colleagues and Integrated Care Partnership (ICP) Clinical leads to discuss the most appropriate approach for these funds to be managed, with a view that we wanted to keep the funds available within Primary Care for the purposes of which they are intended. Initial agreement was for the unclaimed funds to be held centrally within the ICP footprints and for local determination and full engagement of the relevant PCN Clinical Directors.
The Locality Team have taken away this concept to discuss at their Locality Clinical Director meetings and no concerns have been raised.
Conversations on 9 September 2020 and 25 September 2020 with NHS England’s Regional Workforce Lead took place to seek the views of this approach, which was supported and is similar to what is being considered for other areas.
The Local Medical Committee were consulted on the 16 September 2020, who also were in support of this approach and fully supported the funds remaining within Primary Care.
4. Next Steps / Priorities We met with the ICP leads on 29 September 2020 to review the outcome of the workforce plans and confirmed the below process:-
1. All PCN workforce plans to be checked by the CCG Finance team to confirm the costs taking into consideration that not all staff currently employed are at the top of their bands (as calculated on the national return), therefore generating a greater underspend position than the national return suggests. Please refer to Appendix 2 for full details of unclaimed fund. 2. The ICP leads will confirm the estimated financial positions with all PCN Clinical Directors. 3. The ICP leads will work with the PCN Clinical Directors to develop an ICP plan to detail how the underspend will be spent. It is important to reflect that this spend will need to reflect the original intension of the funds. 4. The CCG will discuss the plans with NHS England Regional Team to ensure that they meet the requirements of the scheme. 5. The ICP leads and the Clinical Directors will be advised how to claim the funding against the plans. 6. The funds will be reviewed on a monthly basis based on the additional roles claims forms as submitted by the PCN to ensure that the PCN workforce plans remain on plan. 7. In accordance with the PCN DES Guidance, paragraph 7.4.4, any unused funding in a given financial year cannot be carried forward into subsequent years, and a PCN’s entitlement to that funding in that year will be therefore lost.
5. Risks 1. The PCN may not be successful in their recruitment that will mean a greater underspend than anticipated. 2. The ICP may not be able to spend the funds due to the short timescale.
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6. Recommendations
The Primary Care Commissioning Committee is asked to: 1. APPROVE the proposed process to utilise the projected underspend of the Additional Roles and Reimbursement budget. 2. NOTE the risks associated with the implementation, delivery and required timeframes of the Unclaimed Fund process.
Updated - 14/10/20 V3.0
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Appendix 1
Extract from Network Contract Directed Enhanced Service Contract specification 2020/21 - PCN Requirements and Entitlements March 2020
6.5. PCN Additional Roles planning and redistribution of Additional Roles Reimbursement Scheme funding 6.5.1. A PCN must complete and return to the commissioner a workforce plan, using the agreed national workforce planning template38, providing details of its recruitment plans for 2020/21 by 31 August 2020 and indicative intentions through to 2023/24 by 31 October 2020. 6.5.2. The commissioner must explore, and must endeavour to procure that the local ICS explores, different ways of supporting the PCN to implement the workforce plan through: a. offering CCG or ICS staff support to the PCN to help with coordinating and undertaking recruitment exercises; b. offering collective or batch recruitment across PCNs; c. brokering arrangements to support full-time direct employment of staff by community partners, or to support rotational working across acute and community providers; and d. ensuring the NHS workforce plans for the local system are helpful in supporting PCN’s workforce plan. 6.5.3. The commissioner must: a. have shared with the PCN and relevant LMCs; and b. have agreed with the PCN, by 30 September 2020 an estimation of the amount of financial entitlements in relation to the PCN under the Additional Roles Reimbursement Scheme that the PCN is unlikely to claim by 31 March 2021. This amount is referred to in this Network Contract DES Specification as the “Unclaimed Funding”. 6.5.4. The commissioner must base its estimate of the Unclaimed Funding on the PCN’s workforce planning information that is returned to the commissioner by the 31 August 2020. 6.5.5. Where the PCN agrees the estimate, the PCN acknowledges that the PCN will no longer have the right to claim the Unclaimed Funding and the commissioner may give other PCNs within the commissioner’s boundary the opportunity to bid for the Unclaimed Funding. 6.5.6. Where a commissioner provides the opportunity to PCNs within the commissioner’s boundary to bid for any PCN’s Unclaimed Funding, the commissioner will indicate when and how PCNs may bid. 6.5.7. A PCN acknowledges that if it bids for Unclaimed Funding and is successful, the Unclaimed Funding allocated to the PCN must be used for the purpose of recruiting further Additional Roles in accordance with this Network Contract DES Specification. The PCN and the commissioner acknowledge that any payment of the Unclaimed Funding to the PCN is in addition to the PCN’s allocated Additional Roles Reimbursement Sum. 6.5.8. Where there are one or more bids for the Unclaimed Funding, the commissioner will assess the bids in accordance with the following criteria: a. evidence that a bidding PCN has a recruitment process ready to begin for the Additional Roles to which the Unclaimed Funding relates; b. evidence that a bidding PCN has the resources and capability to undertake further recruitment; and c. whether a bidding PCN is a PCN which: i. had previously indicated in the workforce planning information that it was unlikely to claim its full financial entitlement but considers it is now in a position to recruit; and
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ii. evidences that it is able to meet sections 6.5.8.a and 6.5.8.b d. whether a bidding PCN currently has staff on paid leave e.g. parental leave or sickness leave; e. evidence that a PCN is in an area of higher deprivation39; and f. any other factor that the commissioner, acting reasonably, considers is relevant to its decision. 6.5.9. A bidding PCN acknowledges that: a. the above criteria are in descending order of preference. For the avoidance of doubt, this means that bids satisfying criteria at the top of the list will be preferred over bids that only satisfy criteria further down the list; and b. the commissioner will give preference to a bid which satisfies the criteria in section 6.5.8. c. over all other bids. 6.5.10. The commissioner will notify each PCN of the outcome of its consideration and indicate to any successful bidding PCN the level of funding allocated to the successful bidding PCN. 6.5.11. Notwithstanding that any payments of Unclaimed Funding are not part of the PCN’s allocated Additional Roles Reimbursement Sum and is in addition to the PCN’s allocated Additional Roles Reimbursement Sum, payment of the Unclaimed Funding will be made on the same basis as payments of the PCN’s Additional Roles Reimbursement Sum. 6.5.12. A successful bidding PCN acknowledges that any additional funding allocated to the PCN only relates to the period from the date the PCN was notified that it was successful to 31 March 2021 and that there is no right for the PCN to require a commissioner to continue paying the additional funding after 31 March 2021. 6.5.13. The commissioner will be responsible for monitoring any Additional Roles Reimbursement Scheme funding redistribution. Where there are repeated occurrences of redistribution from and/or to particular PCNs, the commissioner will be responsible for reviewing this in conjunction with the relevant PCNs and, where appropriate, the LMC and ICS, and take appropriate supportive actions.
To read the full PCN Des Guidance please see below link:- https://www.england.nhs.uk/wp-content/uploads/2020/03/network-contract-des-specification- pcn-requirements-entitlements-2020-21.pdf
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Appendix 2
Additional Roles Forecast
Budget Forecast Forecast PCN List Size (based on Spend Variance DES) Mansfield North 63,508 £452,875.55 £435,245.07 -£17,630.47 Rosewood 48,734 £347,522.15 £296,180.34 -£51,341.81 Ashfield North 55,290 £394,272.99 £393,229.44 -£1,043.55 Ashfield South 42,926 £306,105.31 £211,522.89 -£94,582.42 Newark 77,432 £552,167.59 £526,564.11 -£25,603.48 Sherwood 69,582 £496,189.24 £438,343.20 -£57,846.05 MID NOTTS ICP 357,472 2,549,132.83 2,301,085.05 -248,047.79 Arrow Health 41,957 £299,195.37 £320,469.58 £21,274.21 Byron 39,364 £280,704.68 £279,628.92 -£1,075.77 Arnold & Calverton 33,822 £241,184.68 £250,349.39 £9,164.71 Synergy 28,838 £205,643.78 £211,001.15 £5,357.37 Nottm West 106,745 £761,198.60 £646,286.69 -£114,911.90 Rushcliffe 127,448 £908,831.69 £724,908.85 -£183,922.84 SOUTH NOTTS ICP 378,174 2,696,758.79 2,432,644.57 -264,114.22 PCN 1 - Bulwell & Top Valley 47,158 £336,283.70 £300,408.48 -£35,875.22 PCN 3 - BACHS 62,918 £448,668.26 £443,700.66 -£4,967.60 PCN 4 - Radford & Mary Potter 45,451 £324,111.08 £259,503.42 -£64,607.66 PCN 5 - Bestwood & Sherwood 50,446 £359,730.43 £211,288.68 -£148,441.74 PCN 6 - Nottingham City East 69,404 £494,919.92 £449,810.53 -£45,109.39 PCN 7 - City South 36,563 £260,730.75 £139,549.63 -£121,181.13 PCN 8 - Clifton & Meadows 34,462 £245,748.52 £229,689.89 -£16,058.64 PCN U - Unity 35,931 £256,223.96 £214,220.71 -£42,003.25 CITY ICP 382,333 2,726,416.62 2,248,171.99 -478,244.63
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Meeting Title: Primary Care Commissioning Committee Date: 21 October 2020 (Open Session)
Paper Title: Finance Report Month Six Paper Reference: PCC 20 127
Sponsor: Stuart Poynor, Chief Finance Officer Attachments/ - Appendices: Presenter: Andrew Morton – Operational Director of Finance
Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for: ☒ Assurance Information
Executive Summary The overall reported position remains consistent with previous months. The finance report prepared for the Primary Care Commissioning Committee (PCCC) is written in the context of a revised and temporary financial regime implemented by NHS England and Improvement (NHSEI) in response to the current COVID-19 pandemic.
The temporary financial regime initially covered the first four months of the financial year. The release of the “Phase 3” guidance from NHSEI has extended the period to the first six months.
A non-recurrent primary care contracting budget of £76.27m replaced an expected funded budget of £76.3m The shortfall in expected funding is £0.03m. This shortfall in funding along with overspend in co- commissioning categories of £1.05m leads to a total financial pressure on Primary Care Contracting of £1.08m.
The revised PCCC budget of £76.27m for months one to six, can be found in the introductory section of the finance report.
The co-commissioning deficit of £1.05m on the categories of spend, is driven by decisions taken in relation to enhanced services, additional PCN roles commitments from 2019/20, the Quality & Outcomes Framework, Alternative Provider Medical services (APMS) contract costs and finally additional costs associated with practices transferring from Personal Medical Services (PMS) to a General Medical Services (GMS) based contract.
Notwithstanding the above, the CCG continues to report a breakeven position for Primary Care Co- Commissioning based on the assumption of an allocation being provided by NHSEI.
Months seven to twelve, also known as ‘Phase 3’ will also be subject to an amended financial regime, similar to months one to six in that the CCG has again been allocated a non recurrent six month budget but is different in that the allocation provided has been given at a system level made up of the CCG and the three key providers in the Integrated Care System i.e. Nottingham University Hospitals NHS Trust,
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Sherwood Forest Hospitals NHS Foundation Trust and Nottinghamshire Healthcare NHS Foundation Trust. Relevant CCG priorities/objectives: Compliance with Statutory Duties ☐ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☐ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (DPIA) Risk(s): At this point the £1.94m required allocation has not yet been reviewed and actioned by the NHSEI team. Confidentiality: ☒No Recommendation(s): 1. NOTE the contents of the Primary Care Commissioning Finance Report. 2. APPROVE the Primary Care Commissioning Finance Report as at September 2020.
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Primary Care Commissioning Committee – Finance Report – September 2020
Introduction
This Primary Care Commissioning (PCCC) finance report is written in the context of a revised financial regime implemented by NHS England and NHS Improvement (NHSEI) given the current COVID-19 pandemic and resulting crisis.
The previous PCCC finance reports detail the revised financial regime that the CCG is operating in. In brief, the CCG has received a revised allocation from NHSEI (initially for months one to four only, now extended to month six) set with reference to 2019/20 actual costs. This allocation was set on a programme by programme basis. The CCG, in turn, has set a PCC budget giving due regard to the recurrent and non recurrent costs expected to be incurred during the reporting period. NHSEI committed to funding (or top-slicing) any reported variances during this period.
In order to balance back to the allocation set by NHSEI, the CCG has calculated balancing budgets (‘adjustment to NHSEI initial budget’), which for PCC is a negative budget (for the first four months) of £3.043 million.
For PCC the budget position for month six is set out as follows:
A. Month 5 Budget / Financial Position Budget £k Actual £k Variance £k PCC budget (per CCG calculation) £63,306 £64,644 -£1,338 Adjustment to balance to NHSEI initial budget -£607 £0 -£607 Total m4 position £62,699 £64,644 -£1,945
Notes. 1) £482k of the £1,338k adverse variance relates to PCN commitments made by the CCG in 2019/20. 2) Adjustment to NHSEI initial budget represents the difference between what the CCG was expecting to receive compared to what it had received at M4 under the temporary finance regime.
B. M5 Top Up Funding received post M5 finance report, £1.704m comprising: £k two months’ worth of PCN 20/21 commitments (leaving £241k unfunded) £80 2019/20 QOF funding £287 Other top up funding to offset the M5 position. £1,337 Total M5 Top Up Funding received £1,704
C. PCC Budget for m5 and m6 m4 £k m5 £k m6 £k PCC budget (per CCG calc. M6 incl.s the £241k PCN & £287k QOF funding) £50,492 £63,306 £76,296 Restated 'Adjustment to NHSEI budget' -£3,043 -£607 -£31 Total budget £47,449 £62,699 £76,265
The Restated 'Adjustment to NHSEI budget' for m5 & m6 is derived as follows: m4 £k m5 £k m6 £k NHSEI adjustment -£3,043 -£3,804 -£4,565 add funding received following m4 0 £3,197 £3,197 add funding received following m5 £0 £1,337 Net NHSEI balancing Line -£3,043 -£607 -£31
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Month Six Financial Position
The financial position, including the budget as describing above, and the month six actual costs for the initial reporting period is set out below:
The financial position below shows the overall position for NHS Nottingham and Nottinghamshire CCG.
6 Mths YTD YTD Co-Commissioning Category Budget Actual Variance (£m) (£m) (£m) Dispensing/Prescribing Drs 0.97 0.65 0.31 Enhanced Services 2.20 1.96 0.24 General Practice – APMS 3.60 4.54 (0.94) General Practice – GMS 34.24 35.13 (0.89) General Practice – PMS 12.55 11.71 0.84 Other GP Services 0.59 1.06 (0.47) Other Premises costs 1.54 1.60 (0.06) Premises Cost Reimbursement 8.04 7.86 0.18 Primary Care Networks 5.84 6.04 (0.20) QOF 6.73 6.78 (0.05) Subtotal 76.30 77.35 (1.05)
NHSEI Budget Balancing Line (0.03) 0.00 (0.03) Subtotal 76.26 77.35 (1.08)
Anticipated NHSEI Budget Adj 1.08 0.00 1.08 Grand Total 77.35 77.35 0.00
Commentary
The year to date financial position for the CCG is showing a year to date overspend position of £1.08 million.
The negative budget noted above, ie. ‘NHSEI Budget Balancing’ line, is driving £0.03m of the overall position of £1.08m overspend.
The main drivers of the remaining £1.05m overspend are:
Enhanced Services – There are underspends relating to Minor Surgery, following a review in month 3 this has increased in relation Minor Surgery, by basing estimates on what has been claimed so far in the year as well as what was claimed in 19/20. There has also been an additional allocation received from NHSEI for £0.03m in relation to the adverse prior year fallout in relation to Learning Disabilities Health Checks.
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Primary Care Network (PCN) – The overspend position here relates to the Additional Roles commitments from 2019/20 that were agreed to be made available in 2020/21, the adverse variance here has reduced by £0.24m due to NHSEI providing funding for months 1-6 of the value that was agreed to be made available.
QOF (Quality Outcomes Framework) – This line is currently overspending (£0.05m) due to the requirement from NHSEI that no practice would be disadvantaged due to the COVID-19 pandemic in relation to the QOF Achievement and it was agreed that practices would receive this top up payment as long it did not allow practices to achieve more than the maximum number of QOF points available (559). In month six NHSEI have funded £0.29m in relation to this.
General Practice – Alternative Provider Medical Services (APMS) – The adverse position of £0.94m is relating to a number of contracts which are currently being managed by a ‘Caretaker’ arrangement and these make up £0.83m of the overall overspend.. Three of the contracts that are currently under this arrangement will be moving to an APMS contract w.e.f. 01.10.20 and no further caretaking fees will be incurred. The remaining £0.11m variance relates to Broad Oak Medical Practice whereby it transferred from a Personal Medical Services (PMS) practice to an APMS practice w.e.f. 01.07.20 and the opposite effect of this is currently within the ‘General Practice – PMS’ line.
General Practice – General Medical Services (GMS) – The variance has adversely increased this month by £0.29m and this is due to five PMS Contracts having transferred to a GMS contract basis w.e.f. 01.07.20.
General Practice – PMS – The variance on this line has positively increased due to the 5 contracts that have transferred to a GMS contract that were previously PMS and along with PMS contract ending on 30.06.20 and being re-commissioned as an APMS contract as previously reported.
As highlighted at previous committee meetings, it is important note that any costs relating to the claims for COVID-19 expenditure do not form part of the figures presented above as part of Co- Commissioning budgets. That expenditure is presented as part of the CCG Core Primary Care budgets and at month six currently totals £3.013m. The national guidance received in relation to primary Care COVID-19 claims doesn’t expect claims to continue for the second six months of the year, and funding has been reduced from the COVID-19 budgets that have been transferred to system level.
Section 96 Payments
This is a mechanism of providing discretionary payments to GP Contractors under Section 96 of the NHS Act 2006 (as amended). The approval of such payments is delegated to the Primary Care Commissioning Committee (PCCC). Funding for these types of payments comes from existing primary care contracting/ co-commissioning budgets.
To date there has been one approval of Section 96 funding in relation to patient reallocation and this totals £0.03m year to date.
Premises - Cripps Health Centre
A review has been on-going regarding rent reviews for this practice, for their previous premises on the University site, backdated to 2012. The review also identified that an additional element of reimbursable rent was due to the practice as a result of the practice’s capital contribution towards an extension that had not previously been paid to them. The netted off arrears to the CCG are £0.03m. Page 5 of 6
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The Associate Director of Estates and NHSE Contracts Manager are now supporting the practice with their business case for their new premises.
Forecast
The forecast consolidated position represents the anticipated breakeven position at month 6 and shows that an anticipated allocation is required by NHSEI, after accounting for the allocation that has been received to date. The key drivers to this position are the factors noted above.
Risks.
The key risk, which is also described in the main CCG finance report, is that the CCG does not receive sufficient funding for spend incurred. As such, an assumed breakeven position based on the additional resource allocations received to date remains as a risk.
As a result of the ‘Phase 3’ allocation, an initial forecast on this allocation suggests an additional £1.3m deficit and therefore costs will need to be reduced in order to keep within budget for M7-12.
Recommendation
The Committee is asked to NOTE and APPROVE the contents of the Primary Care Commissioning Finance Report as at September 2020
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96 of 101 09:00-10:40-21/10/20 Risk Report
Meeting Title: Primary Care Commissioning Date: 21 October 2020 Committee (Open Session)
Paper Title: Risk Report Paper PCC 20 128 Reference:
Sponsor: N/A Attachments/ Risk Register (Extract) Appendices: - Appendix A
Presenter: Eleri de Gilbert, Non-Executive Director (Chair)
Summary Approve ☐ Endorse ☐ Review ☐ Receive/Note for: ☒ Purpose: ∑ Assurance ∑ Information
Executive Summary
The purpose of this paper is to present the Primary Care Commissioning Committee with risks relating to the Committee’s responsibilities. The paper provides assurance that primary care risks are being systematically captured across the Nottingham and Nottinghamshire CCG and sufficient mitigating actions are in place and being actively progressed.
Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development (e.g. ☐ ICP, PCN development) Financial Management ☐ Cultural and/or Organisational Development ☐
Performance Management ☐ Procurement and/or Contract Management ☐
Strategic Planning ☐
Conflicts of Interest: ☒ No conflict identified
Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ None required for this paper. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ None required for this paper. Assessment (DPIA) Risk(s): Report contains all risks from the CCG’s Corporate Risk Register which fall under the remit of the Primary Care Commissioning Committee. Page 1 of 2
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Confidentiality: ☒No
Recommendation(s):
1. COMMENT on the risks shown within the paper (including the high/red risk) and those at Appendix A; and
2. HIGHLIGHT any risks identified during the course of the meeting for inclusion within the Corporate Risk Register.
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Primary Care Commissioning Committee Monthly Risk Report
1. Introduction The purpose of this paper is to present the Primary Care Commissioning Committee with risks relating to the Committee’s responsibilities. It provides assurance that primary care risks are being systematically captured across NHS Nottingham and Nottinghamshire CCG and sufficient mitigating actions are in place and being actively progressed.
2. Risk Profile There are currently five risks relating to the Committee’s responsibilities (as detailed in Appendix A). This is the same as was presented to the
last meeting. Risk Matrix Since the last meeting, risks have been 5 - Very High
reviewed by the Head of Corporate t 4 – High 2 c a
Assurance, in conjunction with the Chief p 3 – Medium 3 m Commissioning Officer and the Associate I 2 – Low Director of Primary Care. 1- Very low
e t y l l y The table to the right shows the current risk s l e b e n i o r i e k s i a a k l m s i t
profile of the five risks. There are currently no l r R n o L A e u - - P
-
- C high / red risks within the Committee’s remit. - 1
4
5 2 3 Likelihood 3. Risk Identification There have been no new risks identified since the last meeting.
4. Archiving of Risks There are no risks proposed for archiving.
5. Amendments to Risk Score/Narrative Since the last meeting, the narrative of risks RR 032 (primary care workforce) and RR 126 (impact of COVID on the safe and effective delivery of primary care services) have been updated. Risk RR 032 has been amended to reflect the challenges highlighted within the PCN ‘One Year On’ paper presented to the September meeting of the Committee and risk RR 126 had been amended to reflect concerns over prompt access to COVID tests/results.
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6. Recommendations The Committee is asked to: ∑ COMMENT on the risks shown at Appendix A; and ∑ HIGHLIGHT any risks identified during the course of the meeting for inclusion within the Corporate Risk Register.
Siân Gascoigne Head of Corporate Assurance
October 2020
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NHS Nottingham and Nottinghamshire CCG Corporate Risk Register (October 2020)
Risk Directorate Date Risk Current Risk Last Review Oversight Committee Risk Description Risk Category Initial Risk Rating Existing Controls Mitigating Actions Mitigating Actions Progress Update: Trend Ref Identified Rating Date
(Relevant committee in the (Movement (Actions required to manage / mitigate the identified risk. Actions should CCG's governance structure (Date risk (These are operational risks, which are by-products of day-to-day business delivery. in risk score (as per April 2020 support achievement of target risk score and be SMART (e.g. Specific, (To provide detailed updates on progress being made against any mitigating actions identified. Actions taken should
responsible for monitoring originally They arise from definite events or circumstances and have the potential to impact Owner Risk (The measures in place to control risks and reduce the likelihood of them occurring). since
Executive Lead Executive Score
CCG structure) Score Measurable, Assignable, Realistic and Time-bound). bring risk to level which can be tolerated by the organisation). Impact
risks relating to their delegated identified) negatively on the organisation and its objectives.) Impact previous
Likelihood Likelihood duties) month)
RR023 Primary Care Commissioning Finance and Jul-19 As practices have seen an increase in charges for non-reimbursable costs for premises Finance 3 3 9 • CCG meetings with NHS Property Services and Community Health Partnerships (quarterly). Action: To continue to work with local GP practices, the LMC and property 3 3 9 October 2020: Focus continues to be given on progressing GP Premises debt, which had been paused during the 12/10/2020 ↔ Committee Resources from Property Services and from CHP (Community Health Partnerships), there is a risk companies (NHSPS and CHP) to ensure management plans are in place. COVID pandemic. Priority areas are being focused with those Practices/Health Centres which have pressing issues that (for some practices) this may impact viability of providing primary care services • Engagement with NHS England Primary Care national and local teams linked to expansions and partner retirement. Nationally the NHSE/I Team is taking forward concerns with NHSPS. from their current location. Action: To escalate larger GP practice debts to NHSE/I for further national • LMC support to Practices support. For reimbursable debt, the CCG writes to each Practice as soon as we are aware and these are, generally, resolved This may, in turn, lead to service disruption, inability to invest and/or risks to patient fairly quickly. access to primary care services.
An update on GP Premises debt is scheduled for an upcoming meeting of the PCCC. This will enable a review of the LynneSharp
StuartPoynor risk and associated risk score.
RR032 Primary Care Commissioning Finance and Jul-19 Challenges in relation to the recruitment and retention of Primary Care workforce may Commissioning 4 4 16 • Role and remit of the Primary Care Commissioning Committee (and supporting Action: Implement and embed PCCC supporting governance and reporting 4 3 12 October 2020: An update in relation to primary care workforce was presented to the August 2020 PCCC meeting. 12/10/2020 ↔ Committee Resources present a risk that there is insufficient service provision to meet the needs of the CCG's governance structures - e.g. primary care quality / contracting teams) requirements to ensure appropriate assurance is provided regarding primary The paper provided an update in relation to current planning requirements around the recovery phase (following population. • PCCC assurance reporting requirements. care services (e.g. quality of services, delivery of contract requirements, patient COVID-19) and the approach to support future planning for the Primary Care Networks given the increased • Establishment of Primary Care Cell, as part of CCG's Covid-19 incident response experiences). responsibility in developing primary care and its delivery. This risk may be exacerbated due to lack of capacity within Primary Care to establish, • ICS Primary Care Workforce Strategy; ICS Primary Care Board and embed, recruitment processes, as well as challenges in the supply and adaptability • Establishment of Primary Care Networks (PCNs) (and/or other collaboration/federation Action: To continue to deliver requirements of Primary Care Workforce Strategy: A further update was provided at the September 2020 PCC in relation to PCNs 'One Year On'. This highlighted the of staff to transition to working within Primary Care. activities) to request further update regarding delivery of the Strategy to the CCG's PCCC. positive achievements in relation to workforce across the PCNs, as well as some of the challenges regarding the • Ensuring the best use of funding via the GP Forward View, targeting resources to areas of capacity in PCNs to set up (and run) recruitments processes, the shortages in supply of staff and the ability to
need e.g. GP Resilience Funding, Practice Manager training and development funding. transition skills to work within primary care. StuartPoynor Andrea Brown • CQC Inspection Rating(s) / Report(s).
RR126 Primary Care Commissioning Commissioning May-20 Covid-19 may present a risk to the sustainability of safe and effective delivery of Commissioning 4 4 16 • Primary Care 'Cell' within the CCG's emergency response infrastructure Action: To continue with incident response structures as described. 4 3 12 October 2020: OPEL reporting remains in place and is reported, routinely, to the IMT (x3 week) and the PCC 12/10/2020 ↔ Committee primary care services to members of the CCG's population. • Roll-out of IT infrastructure/technology to support virtual working (e.g. telephone (monthly). Digitalisation of primary care delivery is a key mechanisms to support Practices manage this risk, along appointments, etc.) Action: To produce, and share, guidance/FAQs following the Remote Working with the ability to 'step up' CMCs if required. Roving workforce support is also in place across GP Practices, alongside This may be due to Primary Care workforce having to 'shield' or self-isolate, lack of PPE • Routine OPEL reporting and escalation processes Hazard Workshop. PCN resilience and workforce planning arrangements. to ensure safe working, or challenges with GP Practice estate not meeting infection, • Establishment of CMCs and ability to step up/step down if needed prevention and control (IPC) requirements. • PCN 'buddying' processes in place • 'Roving' workforce support across Practices. 09:00-10:40-21/10/20 This risk may be exacerbated if/when there is a surge in primary care activity and/or id there are delays in primary care workforce being able to get prompt COVID
tests/results.
Joe Lunn Joe LucyDadge
RR137 Primary Care Commissioning Commissioning May-20 There is an increased risk of Covid-19 infection to clinically vulnerable (including BAME) Workforce 3 4 12 • Primary Care 'Cell' within the CCG's emergency response infrastructure Action: To continue to seek assurance regarding the completion of risk 3 3 9 October 2020: The main mitigation to this risk is the digitalisation of Primary Care service provision. The CCG has 12/10/2020 ↔ Committee primary care workforce which may impact the provision of primary care services across • Roll-out of IT infrastructure/technology to support virtual working (e.g. telephone assessments and progressing any actions identified from these (or the IPC sought assurance from all GP Practices that risk assessments have been completed and any subsequent actions the CCG's population. appointments, etc.) Estates Reviews). identified. Further actions have also been identified following review of Primary Care Estate to determine whether it • Routine OPEL reporting and escalation processes is compliant with new IPC requirements. 100% of GP Practices have now responded, providing assurance that This may particularly impact areas of Mid-Nottinghamshire and Nottingham City. • Establishment of CMCs and ability to step up/step down if needed appropriate mitigations are in place for their staff. • PCN 'buddying' processes in place
• 'Roving' workforce support across Practices. Mitigations are also via the GP Practice business continuity plans and the ability to 'step up' and 'step down' CMCs.
Joe Lunn Joe LucyDadge
RR138 Primary Care Commissioning Commissioning Jun-20 The impact of Covid-19 test, track and trace on workforce may impact primary care Workforce 3 4 12 • Primary Care 'Cell' within the CCG's emergency response infrastructure Action: To continue to seek assurance regarding the completion of risk 3 3 9 See update for risk RR 126 and RR 137 above. 12/10/2020 ↔ Committee service provision. The likelihood of this risk materialising is greater for smaller/single- • Roll-out of IT infrastructure/technology to support virtual working (e.g. telephone assessments and progressing any actions identified from these (or the IPC handed practices. appointments, etc.) Estates Reviews). • Routine OPEL reporting and escalation processes • Establishment of CMCs and ability to step up/step down if needed
• PCN 'buddying' processes in place Joe Lunn Joe LucyDadge • 'Roving' workforce support across Practices. 101 of 101 101