Agenda

Chair: Eleri de Gilbert Enquiries to: [email protected]

Meeting Agenda (Public Session)

Primary Care Commissioning Committee Wednesday 16 December 2020 9:00-09:50 Zoom Meeting

Time Item Presenter Reference 09:00 Introductory Items 1. Welcome, introductions and apologies Eleri de Gilbert PCC/20/148 2. Confirmation of quoracy Eleri de Gilbert PCC/20/149 3. Declarations of interest for any item on the agenda Eleri de Gilbert PCC/20/150 4. Management of any real or perceived conflicts of Eleri de Gilbert PCC/20/151 interest 5. Questions from the public Eleri de Gilbert PCC/20/152 6. Minutes from the meeting held on 18 November 2020 Eleri de Gilbert PCC/20/153 7. Action log and matters arising from the meeting held on Eleri de Gilbert PCC/20/154 18 November 2020 8. Actions arising from the Governing Body meeting held Eleri de Gilbert PCC/20/155 on 2 December 2020 09:10 Covid-19 Recovery and Planning 9. Overview of GP Practice Additional Expenses in Joe Lunn PCC/20/156 Relation to COVID-19 10. General Practice Covid Capacity Expansion Fund Joe Lunn PCC/20/157

11. Covid-19 Vaccination Enhanced Service Joe Lunn PCC/20/158 09:20 Strategy, Planning and Service Transformation 12. Final response letter to Nottingham City Health Scrutiny Joe Lunn PCC/20/159 Committee 13. Update on the Learning Disability Annual Health Theodore PCC/20/160 Checks Phillips/Adele Smith 09:35 Financial Management 14. Finance Report Michael Cawley PCC/20/161 09:40 Risk Management 15. Risk Report Siân Gascoigne PCC/20/162 09:45 Closing Items 16. Any other business Eleri de Gilbert PCC/20/163 17. Key messages to escalate to the Governing Body Eleri de Gilbert PCC/20/164

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09:00 - 09:50-16/12/20 1 of 136 Agenda

18. Date of next meeting: Eleri de Gilbert PCC/20/165 20/01/2021 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 136 09:00 - 09:50-16/12/20 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 17 November 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 - 09:50-16/12/20 09:00 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 discussions relating to this practice but be excluded from decision-making.

AINSWORTH, David Locality Director Mid-Notts Merco Agency (nursing agency) Ad hoc clinical work in a variety  01/07/2020 Present Involvement in commissioning work of settings relevant to this interest will be kept under review and specific actions determined as required. AUDIS, Adrian NHS England/NHS No relevant interests declared Not applicable Not applicable 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. 3 of 136 3 of 4 of 136 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 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. 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

09:00 - 09:50-16/12/20 09:00 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 - 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 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 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. DADGE, Lucy Chief Commissioning Officer Valley Road 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 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.

09:00 - 09:50-16/12/20 09:00 DADGE, Lucy Chief Commissioning Officer Primary Integrated Community Daughter has a temporary  01/09/2020 02/11/2020 Interest expired - no action required Services (PICS) Ltd working contract with PICS (as a Band 2 administrator) for the period 1st September to 2nd November 2020. DAWS, Lynette Head of Primary Care Rivergreen Medical Centre Family members are registered  01/04/2020 Present This interest will be kept under review 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.

DAWS, Lynette Head of Primary Care Sherwood Medical Partnership – Registered Patient  Present This interest will be kept under review Farnsfield Surgery 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 - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making. 5 of 136 5 of 6 of 136 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 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 grandchildren registered 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.

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 09:00 - 09:50-16/12/20 09:00 required.

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 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 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 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. LUNN, Joe Associate Director of Primary Kirkby Community Primary Care Registered Patient  Present This interest will be kept under review

09:00 - 09:50-16/12/20 09:00 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 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.

STRATTON, Dr Richard GP Representative Fosse Medicare Ltd: a property Director/Shareholder  01/11/2018 Present This interest will be kept under review company which owns the Cotgrave and specific actions determined as Surgery which Belvoir Health Group required. have a lease to occupy.

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. 7 of 136 7 of 8 of 136 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 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 Unity Surgery, Mapperley Registered Patient  - 30/09/2020 Interest expired - no action required TRIMBLE, Dr Ian Independent GP Advisor Victoria and Mapperley Practice, Registered Patient  01/10/2020 Present This interest will be kept under review Nottingham 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.

09:00 - 09:50-16/12/20 09:00 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. 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 - 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 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. 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 WRIGHT, Michael LMC Representative, CEO Radcliffe-on-Trent Practice Parents are registered patients  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. 09:00 - 09:50-16/12/20 09:00 9 of 136 9 of 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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09:00 - 09:50-16/12/20 11 of 136 Minutes from the meeting held on 18 November 2020

NHS Nottingham and Nottinghamshire Clinical Commissioning Group Public Session of the Primary Care Commissioning Committee Unratified minutes of the meeting held on 18/11/2020, 09.00 – 10:12 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 Associate Director of Primary Care Sue Sunderland Non-Executive Director Dr Ian Trimble Independent GP Advisor In attendance: Adrian Audis Commissioning Manager, NHS England/Improvement GP Hub Helen Brocklebank-Clark Corporate Governance Officer (minutes) Daisy May Coster-Hollis Interim Head of Corporate Governance Lynette Daws Head of Primary Care Siân Gascoigne Head of Corporate Assurance Esther Gaskill Head of Quality – Primary Care Michael Wright Chief Executive, Nottinghamshire Local Medical Committee Apologies: Fiona Callaghan Locality Director, South Nottinghamshire Dr Richard Stratton GP Representative Michelle Tilling Locality Director, Nottingham City

Cumulative Record of Members’ Attendance (2020/21) Name Possible Actual Name Possible Actual Shaun Beebe 8 8 Joe Lunn 8 7 Michael Cawley 8 7 Dr Richard Stratton 8 6 Lucy Dadge 8 8 Sue Sunderland 8 8 Eleri de Gilbert 8 8 Dr Ian Trimble 8 8 Helen Griffiths 8 7 Danielle Burnett 8 4

Introductory Items PCC 20 132 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.

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Apologies were noted as above. PCC 20 133 Confirmation of Quoracy The meeting was declared quorate PCC 20 134 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 20 135 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 20 136 Questions from the public No questions had been received from members of the public.

PCC 20 137 Minutes from the meeting held on 21 October 2020 It was agreed that the minutes were an accurate record of the meeting.

PCC 20 138 Action log and matters arising from the meeting held on 21 October 2020 There were no actions outstanding.

During item PCC 20 124 Giltbrook Surgery Boundary Reduction members observed that feedback received from Jacksdale Medical Centre indicated concerns around the sustainability of their practice list, as such it was requested that an update be brought back to the November 2020 meeting. Joe Lunn provided a verbal update confirming that the concerns highlighted as part of item PCC 20 124 were raised a number of months ago, in the early stages of the Covid-19 pandemic and had been confirmed by the practice as no longer representative of their current situation.

COVID-19 Recovery and Planning PCC 20 139 COVID-19 GP Practice Additional Expenses’ Joe Lunn presented the item and highlighted the following points: a) This paper provides an overview of the COVID-19 additional expense claims for September 2020. b) In September 46 practices submitted claims at a cost of £97,363.63 which is a significant reduction on the amount for previous months. The total amount approved so far for September 2020 is £60,428.21 and was paid to practices in October 2020. c) The review of outstanding claims continues and it is anticipated that these will either be substantiated or rejected by the end of November 2020. d) For claims dated 1 October 2020 onwards, only items with CCG prior approval for exceptional support will be accepted, these requests are reviewed on a daily basis. The following points were made in discussion: e) Members were keen to understand whether there was any indication that the change in eligibility criteria for making COVID-19 claims from 1 October onwards was putting additional financial pressure on practices. It was explained that daily meetings take place between primary care and finance team colleagues to review the exceptional claims that are being received. As part of this process

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consideration is given to the impact of COVID-19 outbreaks and isolation requirements on the wider practice workforce, and the resource availability across the practice as a whole. This has resulted in some requests being rejected as it has been possible for practices to redistribute their workload. f) An update was received in relation to the national announcement from NHS England and NHS Improvement (NHSEI) of a £150 million General Practice Covid Capacity Expansion Fund. Nottingham and Nottinghamshire is entitled to a £2.73 million share of this fund, the purpose of which is to support the expanding general practice capacity up until the end of March 2021. The fund is ringfenced exclusively for use in general practice and it is anticipated that a return will need to be submitted to NHSEI before the end of November detailing what the fund will be used for. Members welcomed the fund and a further update on its deployment and utilisation across Nottingham and Nottinghamshire at the December 2020 meeting.

Michael Wright right joined the meeting at this point.

The Primary Care Commissioning Committee:  NOTED the information for assurance purposes.

Items for Approval PCC 20 140 Additional PCN Pharmacy Technicians; Nottingham and Nottinghamshire PCNs Helen Griffiths presented the item and highlighted the following points: a) Under the Primary Care Network (PCN) Contract Directed Enhanced Service (DES), funding is made available to PCNs through the Additional Roles Reimbursement Scheme (ARRS) to recruit additional workforce across a range of specific roles. One of these roles is the Pharmacy Technician. b) The PCN DES places a limitation on the number of Whole Time Equivalent (WTE) Pharmacy Technicians a PCN is eligible to be reimbursed for within the year 2020/21. PCNs with a patient number of 99,999 or less are limited to one Pharmacy Technician, whilst PCNs with a patient number of 100,000 or more are limited to two Pharmacy Technicians. c) However the document also states that “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) Following discussion at the October meeting regarding the ARRS underspend the localities at Integrated Care Partnership (ICP) level have considered how best to use this underspend and six have identified that they would like to recruit additional Pharmacy Technicians for the latter part of the year. As this would be funded through the national ARRS there is no financial implication for the CCG. e) The Committee is asked to waive the limits detailed in the PCN DES to enable: i. Rushcliffe PCN to increase the number of Whole Time Equivalent (WTE) Pharmacy Technicians from 2.0 WTE to 6.0 WTE. ii. Nottingham West PCN to increase the number of WTE Pharmacy Technicians from 2.0 WTE to 3.0 WTE. iii. BACHS PCN to increase the number of WTE Pharmacy Technicians from 1.0 WTE to 2.0 WTE. iv. City South PCN to increase the number of WTE Pharmacy Technicians

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from 1.0 WTE to 2.0 WTE. v. Ashfield South PCN to increase the number of WTE Pharmacy Technicians 1.0 WTE to 2.0 WTE. vi. Mansfield North PCN to increase the number of WTE Pharmacy Technicians from 1.0 WTE to 2.0 WTE. The following points were made in discussion: f) Assurance was provided that although this is a part year effect, increasing the number of Pharmacy Technicians remains in line with the workforce budget undertaken by the PCNs and continues to be affordable through 2021/22. g) Confirmation was sought that Rushcliffe PCN had assessed whether they would be constrained in future years by their decision to increase the number of WTE Pharmacy Technicians to 6.0. It was confirmed that due to the population size the Rushcliffe PCN had a sizeable ARRS budget and they were keen to build on the additional benefits of the Pharmacy Technician role which had been incorporated into their revised workforce plan through to 2023/24. h) Members observed that in the current climate planning over three to four years is challenging and sought clarification as to how the effectiveness of ARRS roles would be measured. It was confirmed that it was appropriate for PCNs to use the ARRS to appoint to roles that would have the greatest benefit for their local demographic. The value for money impact and effect of these roles will be measured through the PCN dashboard once it was made available over the coming months. i) Members welcomed the PCN dashboard and were supportive of PCNs appointing the roles that they felt would benefit their local populations.

The Primary Care Commissioning Committee:  APPROVED the increase in number of WTE Pharmacy Technicians eligible to be reimbursed to the Rushcliffe PCN under the Additional Roles Reimbursement Scheme for 2020/21 from 2.0 WTE to 6.0 WTE.  APPROVED the increase in number of WTE Pharmacy Technicians eligible to be reimbursed to the Nottingham West PCN under the Additional Roles Reimbursement Scheme for 2020/21 from 2.0 WTE to 3.0 WTE.  APPROVED the increase in number of WTE Pharmacy Technicians 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.  APPROVED the increase in number of WTE Pharmacy Technicians eligible to be reimbursed to the City South 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 Pharmacy Technicians eligible to be reimbursed to the Ashfield South 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 Pharmacy Technicians eligible to be reimbursed to the Mansfield North PCN under the Additional Roles Reimbursement Scheme for 2020/21 from 1.0 WTE to 2.0 WTE. Items for Assurance PCC 20 141 National 2019/20 Primary Care Patient Survey Summary Esther Gaskill presented the item and highlighted the following: a) The purpose of this item is to provide an overview of the 2019/20 national

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Primary Care Patient Survey results for Nottingham and Nottinghamshire practices. b) The data analysis was completed by Andrew Edwards, Data Analyst for the CCG. c) Across Nottingham and Nottinghamshire 43,960 questionnaires were sent out, and 14,160 were returned completed. d) In terms of the overall experience of GP practices, rates ranged from between 72% to 99%, with Mid-Nottinghamshire and City in the third quintile and South Nottinghamshire in the first quintile. e) Although the overall experience of patients in Mid-Nottinghamshire was in line with the national average, the experience of getting through on the phone was 8% below the national average. f) In Nottingham City the experience of getting through on the phone was 1% above the national average, however online awareness and usage were below the respective national averages. g) In South Nottinghamshire the overall experience of patients is 5% above the national average and getting through on the phone is 12% above the national average. h) Bilborough Medical Centre, St Alban’s Medical Centre, Bridgeway Practice, Sherwood Medical Group and Highcroft Surgery flagged up as outliers several times in the results. i) Online services, such as bookings or repeat prescriptions need to continue to be promoted within Nottingham City particularly as awareness of these options appear to be less known than elsewhere. This remains the same conclusion as in 2017, 2018, 2019 although the numbers are improving. j) Further work is needed in Mid-Nottinghamshire to improve the experience of patients contacting the practice via phone. k) The survey results will be shared with the Primary Care Quality Groups and relevant CCG teams to determine how to promote awareness amongst practices and formulate an action plan to improve results where required.

The following points were made in discussion: l) Members noted that the pattern of the patient survey remains consistent with previous years, which was perhaps an indicator that previous improvement plans had not fully had the anticipated impact. m) It would be helpful to review the performance of the outlying practices alongside indicators on the quality dashboard as this might highlight areas of pressure. Confirmation was received that the outlying practices were being supported and alternative improvement plans would be explored. n) Disappointment was expressed that Nottingham City was below the national average in terms of online access and usage; with confirmation received that an exercise was being planned to remind GPs of their contractual obligations to provide patients with online access to their records. o) The Local Medical Committee (LMC) highlighted that if the results were considered in conjunction with the Care Quality Commission (CQC) ratings then the overall performance for Nottingham and Nottinghamshire practices was positive and something to be celebrated and were keen for this to be communicated to practices. Members noted that there were some very positive

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results relating to patient experience, for which practices should be commended. p) It was noted that the survey took place between January and March 2020 in advance of the COVID-19 pandemic. As such, caution was urged in applying actions in response to areas requiring improvement as this was an atypical year and it was expected that next year’s results would be significantly different, particularly in response to advances in online access to services. q) Members were keen for patients across Nottingham and Nottinghamshire to have equitable access to services online and by phone and welcomed the sharing of good practice and innovation via the LMC Practice Managers Forum. r) Consideration was given to potential barriers in place to accessing online services, and it was noted that an Equality and Quality Impact Assessment was completed when establishing the online system which could be set up in 20 different languages to enable access for patients who did not speak English as their first language. However, it was unclear how options for accessing services were communicated to this patient cohort, which was being progressed with the Patient and Public Engagement Committee and Healthwatch. s) The LMC suggested revitalising their ‘See How Others Practice’ scheme as an option for sharing best practice which was welcomed by members. t) It was noted that the results needed to be interpreted appropriately and consistently. It was confirmed this would be done via the Primary Care Quality. Groups, who would work with outlier practices to ensure robust improvement plans were in place.

The Primary Care Commissioning Committee:  NOTED the National 2019/20 Primary Care Patient Survey Summary.

Quality Improvement PCC 20 142 Quality Report Esther Gaskill presented the item and highlighted the following points: a) The item provides an overview of Primary Care Quality for the Nottingham and Nottinghamshire CCG during quarter two. b) During quarter two no practice received a red rating. c) The overall ratings may not yet reflect the true impact that COVID-19 has had on service provision as some of the available data is from before the start of the pandemic. d) As at quarter two, 88 practices (an increase of six) were struggling to achieve the 80% cervical screening target. This indicator is likely to be further impacted by the second wave of COVID-19 and second lockdown. e) Within the Patient Experience domain, the number of practices achieving the ‘% of list size recorded as a carer’ indicator continued to increase. As such, the threshold will be increased from 0.5 to 0.75. This increase will adversely impact some practices, all of which have been contacted regarding preparatory work they can undertake in advance of this change. f) Performance against both the Learning Disability and Mental Health Condition health checks had deteriorated as practices postponed all routine work due to COVID-19. g) The number of enquiries and complaints received by the Patient Experience

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Team during quarter two remains consistent with the quarter one figures, with 101 enquiries and four complaints, which at the request of the complainants, were passed to NHSEI to investigate. h) During quarter two, 37 patient safety incidents were received by the CCG relating to primary care, none of which met the national Serious Incident framework threshold. i) In terms of CQC ratings of practices in Nottingham and Nottinghamshire, as of 1 November 2020 19 are rated ‘Outstanding’, 99 are ‘Good’, one ‘Requires Improvement’, two are ‘Inadequate’ and six are ‘Not yet rated’ due to recent changes in provider. Of the two practices rated as ‘inadequate’, Hounsfield Surgery in Mid-Nottinghamshire was inspected last week, with the outcome pending, and Queens Bower Surgery in Nottingham City will be inspected in December. j) The Operations Pressures Escalation Levels report continues to be reviewed and triangulated with other intelligence to identify practices under pressure that require additional support. The following points were made in discussion: k) Discussion took place regarding the CQC ratings and the process followed to seek assurance that there were no patient safety implications associated with the practices that were rated as inadequate. It was confirmed that the Quality Team links closely with colleagues at the LMC and Health and Safety Executive to identify if they are aware of any concerns, regular meetings take place with the practice to seek a contractual and quality assurance update, and the dashboard is reviewed to identify any areas of deteriorating performance. l) Concern was raised regarding the deteriorating number of Learning Disability and Mental Health Condition health checks being undertaken given the vulnerability of the respective patient cohorts, and assurance was sought regarding the scale of the issue. Assurance was provided that a focused exercise was taking place to review the dashboard data to understand the scale of the problem and provide targeted support where required. In terms of the Learning Disability health checks, clarification was received that a significant amount of work has taken place across Nottingham and Nottinghamshire to improve the lived experience of patients, and it was anticipated that the 69% target threshold would be achieved and surpassed. Further detail on this programme of work would be provided to the Committee at the December 2020 meeting. m) Eleri highlighted that the Quality and Performance Committee had also expressed concern regarding the deteriorating number of Learning Disability and Mental Health Condition health checks, along with the increasing number of practices struggling to achieve of the Cervical Screening target and hoped that the General Practice Covid Capacity Expansion Fund would help to address these issues. n) Furthermore, it was noted that Learning Disability health checks are incorporated into the Investment and Impact Fund that PCNs are working to and is very much an area of focus. o) Members thanked Esther for the comprehensive report.

The Primary Care Commissioning Committee:

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 NOTED the Primary Care Quality Report November 2020. Financial Management PCC 20 143 Finance Report Michael Cawley presented the item and highlighted the following points: a) The overall reported position remains consistent with previous months; the year to date financial position for Primary Care Commissioning (PCC) an overspend position of £0.36 million. b) At month seven the main drivers of the remaining overspend are Alternative Provider Medical Services Caretaking costs, anticipated Locum cover and Quality and Outcomes Framework delivery. c) If the spend continues at the current run rate and remains un-checked then it could lead to a financial risk arising of £2 million when compared against the 2020/21 delegated budgets; and would be a movement in the CCG’s forecast deficit position from £17 million to £19 million. Therefore it is imperative that a more detailed review of the position is undertaken and specifically to include a review of mitigations available that would offset the £2 million risk if it were to materialise. This would be done in partnership with the Primary Care Team.

The following points were made in discussion: d) Members recognised the risk of a £2.0 million PCC overspend by the end of the financial year and sought to understand the implications of this. It was explained that there would be an increased level of scrutiny from the regulators, with an expectation that the CCG would get back on track by identifying mitigating actions. e) Members recognised that although some overspend was due to sound and appropriate decisions taken by the Committee it was now crucial to develop mitigation plans. f) Discussion took place regarding whether the General Practice Covid Capacity Expansion Fund could be used to offset this risk and it was confirmed that the CCG is committed to ensuring that the fund is used to support General Practice, and utilisation will need to be clearly evidenced. g) Assurance was provided that work was ongoing to ensure the ledgers accurately reflected the spending and captured definitive, rather than anticipated, activity levels. h) Members agreed to consider solutions and management actions to mitigate the current financial position in the confidential session of the December meeting, following review of the financial position by the Finance and Resources Committee, and Governing Body.

The Primary Care Commissioning Committee:  NOTED and APPROVED the contents of the Primary Care Commissioning Finance Report as at October 2020 for onward submission to the Governing Body.  AGREED to consider solutions and management actions to mitigate the current financial position in the confidential session of the December 2020 meeting. Risk Management PCC 20 144 Risk Report Siân Gascoigne presented this paper and highlighted the following points:

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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) Further to discussion at the October meeting, the narrative of risk RR 126 has been expanded to reference the potential impact on primary care capacity due to requirements to deliver flu and COVID-19 vaccinations. c) The concerns relating to the financial position are captured within the overarching finance risks that fall within the responsibility of the Finance and Resources Committee. d) No further points were raised in discussion.

The Committee:  COMMENTED on the risks shown at Appendix A. Closing Items PCC 20 145 Any other business Lucy Dadge made the Committee aware that an extraordinary meeting of the Nottingham City Health Scrutiny Committee (HSC) would be taking place on Thursday 19 November 2020 to scrutinise the decisions taken by the CCG in relation to the recommissioning of the Platform One practice. The following key points were highlighted: a) The meeting will be attended by Lucy Dadge, Joe Lunn, and Dr Ian Trimble who have received a number of questions in advance of the meeting for consideration. b) It is understood that the HSC is concerned that the CCG has not given due account to patient need as part of the process for partial dispersal of the Platform One patient list and identification of a new provider and location for the remaining patient cohort. c) Confidence was expressed that the CCG has ample evidence to demonstrate that patient need has been considered, however it is recognised that it would have been helpful to share the Equality Quality Impact Assessment with Healthwatch and other interested partners when requested. This will be shared moving forward and should assuage some of the HSC’s concerns. d) Questions had been asked around the patient consultation process. At a macro level the PCCC had considered three options and agreed to a partial list dispersal which has been communicated to patients. e) The existing provider of the Platform One practice was unwilling to continue to deliver the service. f) The HSC has further concerns around the location of the new practice, although continuing to deliver services from the current location was not an option. Specific requirements for the practice to be located within the geographical location have been incorporated into the process of seeking a new provider. g) CCG colleagues were happy to be scrutinised, had completed a significant amount of preparatory work, would be open with the Committee about the process followed to date and share requested information where it is appropriate to do so. h) There is a significant amount of comment in the media about the process at the moment. i) Dependent on the outcome of the meeting there might be a need to hold an

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extraordinary confidential meeting of the PCCC.

PCC 20 146 Key messages to escalate to the Governing Body The Committee:  NOTED the COVID-19 GP Practice Additional Expenses’ report information for assurance purposes and welcomed the announcement from NHSEI of a £150 million General Practice Covid Capacity Expansion Fund. Nottingham and Nottinghamshire is entitled to a £2.73 million share of this fund, the deployment and utilisation of which will be confirmed at the December 2020 meeting.  APPROVED the increase in number of WTE Pharmacy Technicians eligible to be reimbursed to the Rushcliffe PCN under the Additional Roles Reimbursement Scheme for 2020/21 from 2.0 WTE to 6.0 WTE.  APPROVED the increase in number of WTE Pharmacy Technicians eligible to be reimbursed to the Nottingham West PCN under the Additional Roles Reimbursement Scheme for 2020/21 from 2.0 WTE to 3.0 WTE.  APPROVED the increase in number of WTE Pharmacy Technicians 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.  APPROVED the increase in number of WTE Pharmacy Technicians eligible to be reimbursed to the City South 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 Pharmacy Technicians eligible to be reimbursed to the Ashfield South 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 Pharmacy Technicians eligible to be reimbursed to the Mansfield North PCN under the Additional Roles Reimbursement Scheme for 2020/21 from 1.0 WTE to 2.0 WTE.  NOTED the National 2019/20 Primary Care Patient Survey Summary and discussed options for the effective sharing best practice and innovation in relation to improving access to online services and appointments via phone.  NOTED and APPROVED the contents of the Primary Care Commissioning Finance Report as at October 2020 for onward submission to the Governing Body. Members recognised the challenging financial position and agreed to explore possible mitigations during the confidential session of the December meeting.

PCC 20 147 Date of next meeting: 16/12/2020 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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09:00 - 09:50-16/12/20 21 of 136 22 of 136 22 Action log and matters arising from the meeting held on 18 November 2020

Primary Care Commissioning Committee Action Log from the public Committee meeting held on 18 November 2020

MEETING AGENDA AGENDA ITEM ACTION LEAD DATE TO BE COMMENT DATE REFERENCE COMPLETED

ACTIONS OUTSTANDING

No actions outstanding

09:00 - 09:50-16/12/20 09:00 ACTIONS ONGOING/NOT YET DUE

No actions ongoing/not yet due

Page 1 of 1

Actions arising from the Governing Body meeting held on 2 December 2020

Primary Care Commissioning Committee OPEN ACTION LOG from the Governing Body on 2 December 2020

MEETING CCG AGENDA AGENDA ITEM ACTION LEAD DATE TO BE COMMENT DATE REFERENCE COMPLETED

ACTIONS OUTSTANDING

No actions outstanding 09:00 - 09:50-16/12/20 09:00 ACTIONS ONGOING/NOT DUE

No actions ongoing/not due

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23 of 136 23 Overview of GP Practice Additional Expenses in relation to Covid-19

Meeting Title: Primary Care Commissioning Committee Date: 16 December 2020 (Open Session)

Paper Title: Overview of GP Practice Additional Expenses Paper PCC 20 156

in Relation to COVID-19 Reference:

Sponsor: Joe Lunn, Associate Director of Primary Care Attachments/ Appendices: Joe Lunn, Associate Director of Primary Care Presenter:

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 October 2020, including a summary of the requests for exceptional COVID support funds. This is a further update to the previous papers presented to the committee between April and November.

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 applicable to this item Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not applicable to this item Assessment (DPIA) Risk(s): There are no risks identified with this paper. Confidentiality: ☒No

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Recommendation(s): 1. 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 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.

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. A full summary of these changes was presented to the committee in September 2020.

The guidance letter dated 4th August was published on TeamNet on 19th October 2020 and detailed the CCG Executive Teams decision to continue to support practices in need of additional support for COVID exceptional requests, as of 1st October 2020.

Practices are required to seek prior approval before any claim submission; requests are reviewed daily on a practice-by-practice basis by a virtual panel involving Primary Care Commissioning and Finance Team representatives. Decisions are shared with clinicians for agreement prior to any communication of outcome to the practice.

1.1 Overview of Claims Processed in October Only claims dated between 1st March and 30th September would be accepted for this submission and practices were required to submit backing rationale and evidence of spend with their claim, by the 30th November 2020, along with the declaration form issued by NHS England and NHS Improvement.

Summary of Claims Processed in October:  27 practices submitted claims  The total cost of the claims submitted was £55,690.62; this is a significant reduction on the amount for previous months.  From this total, £11,902 has been approved for payment. The monthly breakdown is as follows:

o £0 relates to March claims. The total sum of paid March claims now stands at £196,329.20 o £303.84 relates to April claims. The total sum of paid April claims now stands at £793,863.33 o £344.90 relates to May claims. The total sum of paid May claims now stands at £440,890.06 o £602.02 relates to June claims. The total sum of paid June claims now stands at £311,188.95 o £419.04 relates to July claims. The total sum of paid July claims now stands at £339,999.70 o £2, 580.50 relates to August claims. The total sum of paid August claims now stands at £210,654.29 o £4,051.70 relates to September claims. The total sum of paid September claims now stands at £64,479.91 o £3,600 relates to October claims approved for payment as exceptional COVID support.

Across all claims dated 1st March to 30th September a total of £147,615.19 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 Page 3 of 5

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 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 needed and whether the costs can be paid or rejected.

1.2 Total Spend Breakdown of claims paid in October

A breakdown of the spend in each claim category is listed below: Area of Spend Cost for October Cleaning Resources £0 Equipment Costs £725.45 Estates Costs £0 Laundry Costs £0 PPE £417.85 Postage Costs £0 Printing/Stationary £0 Scrubs £55.87 Telephony Charges £138.06 Admin Staffing (Including Practice Manager Time) £3,115.34 GP Partner and Salaried Staffing £0 Nursing Staff Costs £957.00 GP Locum Costs £3,600.00 Cleaning Staff (Additional Expense) £0 COVID Expenses - Other £2,892.43 (N.B this table is based on the categorisation of items by individual practices).

1.3 Overview of Exceptional COVID Claim Requests in October Claims received from 1st October 2020 are considered for exceptional COVID support.

Practice submits their request for exceptional COVID support; requests are reviewed by the group either on the same day or the following working day.

Summary of Exceptional COVID Support Claims:  13 practices submitted claims, 4 were approved and 9 were rejected  4 approved (3 in Nottingham City ICP and 1 in South Nottinghamshire ICP)  9 rejected (5 in Nottingham City ICP and 4 in Mid- Nottinghamshire ICP)  The total cost of approved claims is £10,854.18 with £3,600 processed for payment in the October claiming month.

A brief summary of approved claims:  Small practice GP partner/s isolating therefore only able to work remotely, support provided for GP Locum to provide Face to Face and Home Visits  GPs with a Risk Assessment of High; only GP covering session in practice and only able to work remotely, support provided for GP Locum to provide Face to Face and Home Visits  Support for staffing where outbreaks have impacted on workforce capacity.

Brief summary of rejected claims:  Cover for isolation where practice rota demonstrates capacity to allow adjustment with individuals to able to work remotely  Additional support for flu – not primary care cost, referred to flu group Page 4 of 5

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 Cleaning costs  PPE  GP Sickness claims – referred to the Statement of Financial Entitlements for claiming.

Future correspondences will be cascaded to practices via TeamNet.

2. Summary The total amount approved so far in October 2020 is £19,156.18; of which, £11,902 has been paid to practices in October 2020 and the remaining £7,254.18, approved for exceptional COVID support, is pending as the practices are yet to submit the claim form and supporting evidence.

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 £147,615.19.

A notification was cascaded to practices via TeamNet that requested practices to submit outstanding backing documentation for claims submitted to September 2020, by close of play on Monday 30th November 2020. As of 1st December 2020, all claims dated between 1st March to 30th September 2020 are closed.

3. Recommendation The Primary Care Commissioning Committee is asked to NOTE the information for assurance purposes.

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28 of 136 09:00 - 09:50-16/12/20 General Practice Covid Capacity Expansion Fund

Meeting Title: Primary Care Commissioning Committee Date: 16 December 2020 (Open Session)

Paper Title: General Practice COVID Capacity Paper Reference: PCC 20 157 Expansion Fund

Sponsor: Joe Lunn, Associate Director of Primary Attachments/ Appendix One: Letter Care Appendices: from NHS England 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 3 – Management of the delegated funds

NHS England wrote to General Practice on 9 November 2020 outlining an Additional £150 million of Funding – General Practice COVID Capacity Expansion Fund.

This letter is included as part of this paper and includes clear expectations for utilisation.

The CCG is required to confirm how this funding will be used to support the achievement of goals and to confirm they have spent the money fully within general practice.

Assurance will be provided to NHS England by Thursday 17 December in relation to the practice utilisation plans.

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 applicable to this item Assessment (EQIA) Page 1 of 4

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Data Protection Impact Yes ☐ No ☐ N/A ☒ Not applicable to this item Assessment (DPIA) Risk(s): There are no risks identified with this paper. Confidentiality: ☒No Recommendation(s): 1. 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

NHS England wrote to General Practice on 9 November 2020 outlining an Additional £150 million of Funding – General Practice COVID Capacity Expansion Fund.

The funding has clear expectations which are aimed at supporting general practice over the period to March 2021, these are detailed below:-

1. Increasing GP numbers and capacity 2. Supporting the establishment of the simple COVID oximetry@home model, arrangements for which will be set out in a parallel letter shortly 3. First steps in identifying and supporting patients with Long COVID 4. Continuing to support clinically extremely vulnerable patients and maintain the shielding list 5. Continuing to make inroads into the backlog of appointments including for chronic disease management and routine vaccinations and immunisations 6. On inequalities, making significant progress on learning disability health checks, with an expectation that all CCGs will without exception reach the target of 67% by March 2021 set out in the inequalities annex to the third system letter. This will require additional focus given current achievement is one fifth lower than the equivalent position last year; and actions to improve ethnicity data recording in GP records 7. Potentially offering backfill for staff absences where this is agreed by the CCG, required to meet demand, and the individual is not able to work remotely.

Practices have been asked to complete a brief plan template detailing how they will utilise their share of the funding in line with the above requirements.

The CCG allocation of the £150m is £2.73m, this funding will be apportioned across practices using the Carhill formula with an adjustment to reflect the demography, deprivation and ethnicity of the population across the CCG.

A small top-slice has been agreed to support backfill for COVID Staff Sickness in general practice as part of the support under expectation 7 above. COVID sickness absence for staff other than GPs will be covered by this funding for the period December 2020 to March 2021

A further top-slice has been agreed to support Oximetry@Home, this has been organised by the CCG on behalf of member practice at a Locality level, funding to support this is shown below:-

Mid Notts £16,570 City £30,634 South Notts £16,570 111/NEMS - whole CCG £44,635 coverage

The balance of £2.4m will be paid to general practice to support delivery of plans against the above expectation.

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2. Summary NHS England wrote to General Practice on 9 November 2020 outlining an Additional £150 Million of Funding – General Practice COVID Capacity Expansion Fund.

The CCG is required to confirm how this funding will be used to support the achievement of goals and to confirm they have spent the money fully within general practice.

Assurance will be provided to NHS England by Thursday 17 December in relation to the practice utilisation plans.

3. Recommendation The Primary Care Commissioning Committee is asked to NOTE the information for assurance purposes.

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Classification: Official

Publications approval reference: 001559

Copy: ICS leaders

An electronic copy of this letter, and all other relevant guidance from NHS England and NHS Improvement can be found here: https://www.england.nhs.uk/coronavirus/primary-care

9 November 2020

Dear CCGs, GPs and general practice teams,

SUPPORTING GENERAL PRACTICE – ADDITIONAL £150 MILLION OF FUNDING FROM NHS ENGLAND

Thank you for the work you have done and continue to do. It is recognised, valued and appreciated.

Across England, patients are now accessing general practice as much as they were before the pandemic, with overall national activity levels above 6 million appointments a week. This is an important achievement reflecting the work of everyone in general practice.

Patients and the public are now hearing and responding to the message that general practice everywhere is and will continue to remain fully open for them safely during this second wave of COVID-19 and second national lockdown. Every possible measure should be taken by practices, PCNs and CCGs to maintain and expand general practice capacity, to address the continued needs of patients as practices respond to COVID-19, deal with the backlog of care, and improve services.

Progress is being made. Nearly 6,000 full-time equivalent (FTE) staff have been employed on the Additional Roles Reimbursement Scheme (ARRS). CCGs should continue to prioritise maximum support to PCNs, to ensure that PCN recruiting intentions are fully delivered. This could mean that over 9,000 PCN staff are in place nationally by spring. The funding entitlement for the PCN workforce has already been guaranteed now and it will continue to remain protected for the future.

Full use should also be made of the GP recruitment and retention initiatives and dedicated funding, including the new to partnership payment, returners scheme, mentorship scheme and fellowship scheme, with ICS and CCG support.

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Classification: Official

General Practice Covid Capacity Expansion Fund

NHS England is today establishing a new General Practice Covid Capacity Expansion Fund. £150 million of revenue is being immediately allocated through ICS to CCGs for general practice, for the purpose of supporting the expanding general practice capacity up until the end of March 2021. Allocations by ICS are attached in Appendix 1.

The fund is ringfenced exclusively for use in general practice. It will be for ICSs and CCGs to determine how best it is spent within general practice, with a focus on simplicity and speed of deployment, within the following parameters. CCGs should not introduce overly burdensome administrative processes for PCNs and practices to secure support.

Expanding capacity

Accessing the fund will be conditional on practices and PCNs continuing to complete national appointment and workforce data in line with existing contractual requirements. Where an individual practice is not yet accurately recording activity that is broadly back at its own pre-COVID levels, it is expected to do so as part of accessing the fund. CCGs should seek to understand and support the relatively small number of practices that are finding restoration of their activity most difficult.

Systems are encouraged to use the fund to stimulate the creation of additional salaried GP roles that are attractive to practices and locums alike. The fund could also be used for the employment of staff returning to help with COVID, or to increase the time commitment of existing salaried staff. And in line with commitments already made in the GP contract, support will be available to establish flexible pools of employed GPs (including returners) and other staff to deploy across local communities.

The following will also be made available to support systems to increase GP capacity:

• financial support (up to £120k) in addition to the £150m to each STP/ICS to support the process of recruiting and deploying employed GPs on the basis above • an optional flexible GP employment contract template; • a digital suppliers framework to assist GP workforce deployment by matching sessional capacity to local demand.

Expectations

Subject to the above requirement about returning activity to at least prior levels, the £150 million funding will be expected to support seven priority goals:

2

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Classification: Official

1. Increasing GP numbers and capacity 2. Supporting the establishment of the simple COVID oximetry@home model, arrangements for which will be set out in a parallel letter shortly 3. First steps in identifying and supporting patients with Long COVID 4. Continuing to support clinically extremely vulnerable patients and maintain the shielding list 5. Continuing to make inroads into the backlog of appointments including for chronic disease management and routine vaccinations and immunisations 6. On inequalities, making significant progress on learning disability health checks, with an expectation that all CCGs will without exception reach the target of 67% by March 2021 set out in the inequalities annex to the third system letter. This will require additional focus given current achievement is one fifth lower than the equivalent position last year; and actions to improve ethnicity data recording in GP records 7. Potentially offering backfill for staff absences where this is agreed by the CCG, required to meet demand, and the individual is not able to work remotely. ICSs and CCGs will be expected to achieve these goals, and confirm they have spent the money fully within general practice. The funding is non-recurrent and should not be used to fund commitments running beyond this financial year. The £150m fund represents the total available additional COVID funding for general practice until March 2021, except for arrangements for potential COVID vaccine delivery which would be in addition. With our appreciation and thanks for everything you are doing.

Ian Nikki Ed

National Director of Medical Director for Director of Primary Care Primary Care Primary Care Community Services & Strategy

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Classification: Official

Appendix 1: Fair shares allocation at STP level weighted by primary care 20/21 allocation

Fair shares allocation of the CSF H2 (£150m) weighted STP by 20/21 primary care allocation Bath and North East Somerset, Swindon and Wiltshire STP 2.26m Bedfordshire, Luton and Milton Keynes STP 2.78m Birmingham and Solihull STP 3.40m Bristol, North Somerset and South Gloucestershire STP 2.40m Buckinghamshire, Oxfordshire and Berkshire West STP 4.43m Cambridgeshire and Peterborough STP 2.40m Cheshire and Merseyside STP 7.02m Cornwall and the Isles of Scilly Health and Social Care Partnership (STP) 1.53m Coventry and Warwickshire STP 2.71m Cumbria and North East STP 9.35m Devon STP 2.62m Dorset STP 2.03m East London Health & Care Partnership (STP) 4.49m Frimley Health & Care ICS (STP) 2.40m Gloucestershire STP 1.58m Greater Manchester Health and Social Care Partnership (STP) 8.00m Hampshire and the Isle of Wight STP 4.26m Healthier Lancashire and South Cumbria STP 4.61m Herefordshire and Worcestershire STP 2.17m Hertfordshire and West Essex STP 3.69m Humber, Coast and Vale STP 5.40m Joined Up Care Derbyshire STP 1.33m Kent and Medway STP 4.71m Leicester, Leicestershire and Rutland STP 2.54m Lincolnshire STP 2.16m Mid and South Essex STP 2.95m Norfolk and Waveney Health & Care Partnership (STP) 2.94m North London Partners in Health & Care (STP) 4.11m North West London Health & Care Partnership (STP) 7.19m Northamptonshire STP 1.87m Nottingham and Nottinghamshire Health and Care STP 2.73m Our Healthier South East London STP 4.98m Shropshire and Telford and Wrekin STP 2.43m Somerset STP 1.43m South West London Health & Care Partnership (STP) 3.99m South Yorkshire and Bassetlaw STP 2.94m Staffordshire and Stoke on Trent STP 3.31m Suffolk and North East Essex STP 2.64m Surrey Heartlands Health & Care Partnership (STP) 2.54m Sussex Health and Care Partnership STP 4.60m The Black Country and West Birmingham STP 2.67m West Yorkshire and Harrogate Health & Care Partnership (STP) 6.41m Grand Total 150m

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Classification: Official

5

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Meeting Title: Primary Care Commissioning Committee Date: 16 December 2020 (Open Session)

Paper Title: Enhanced Service Specification – COVID- Paper Reference: PCC 20 158 19 Vaccination Programme 2020/21

Sponsor: Joe Lunn, Associate Director of Primary Attachments/ NHS Enhanced Presenter: Care Appendices: Service Specification 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 3 – Management of the delegated funds Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts

This paper provides an update on the Enhanced Service Specification – COVID-19 Vaccination Programme 2020/21. A copy of the document is attached to this paper.

Across Nottingham and Nottinghamshire CCG 119 out of 126 practices have signed up - 94%.

The Nottingham and Nottinghamshire approach is a collaborative model with the Local Resilience Forum.

Currently tied to vaccine characteristics and delivery timescales, clinical quality and safety remain priorities.

Practices receiving enquiries about the COVID-19 vaccination programme overall, have been asked to reiterate the following messages

∑ When it is the right time people will receive an invitation to come forward; ∑ For most people this will be a letter, either from the local or national NHS ; ∑ This letter will include all the information you will need to book appointments, including your NHS number; ∑ Please do not contact the NHS to get an appointment until you get this letter; ∑ Information on the vaccine is available on the The NHS website - NHS (www.nhs.uk)

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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 applicable to this item. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not applicable to this item. Assessment (DPIA)

Risk(s): Vaccine characteristics and delivery timescales, clinical quality and safety remain priorities; Equipment & consumables delivery; Links to national roll-out programme. Confidentiality: ☒No

Recommendation(s): 1. To NOTE the Enhanced Service Specification – COVID-19 Vaccination Programme 2020/21

Page 2 of 2

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Enhanced Service Specification

COVID-19 vaccination programme 2020/21

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Enhanced Service (ES) Specification

COVID-19 vaccination programme

Publishing approval number: 001559

Version number: 1.0

First published: 1 December 2020

Prepared by NHS England and NHS Improvement

Equalities and health inequalities statement

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

 given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it;

 given regard to the need to reduce inequalities between patients in access to, and outcomes from, healthcare services and in securing that services are provided in an integrated way where this might reduce health inequalities."

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Contents

1 Introduction ...... 1

2 Commonly Used Terms ...... 2

3 Background and Duration ...... 3

4 Process ...... 4

5 Collaboration Requirements: General ...... 5

6 Collaboration Requirements: PCN Groupings ...... 6

7 Site Designation ...... 8

8 Sub-contracting Arrangements ...... 10

9 Service Delivery Specification ...... 10

10 Monitoring and Reporting ...... 18

11 Payment and Validation ...... 18

12 Withdrawal from this ES ...... 22

13 Variations To and Subsequent Withdrawal From this ES ...... 23 Annex A: Provisions relating to GP practices that terminate or withdraw from this ES (subject to the provisions below for termination attributable to a GP practice formation or merger) and New GP practices ...... 24

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As of November 2020, several potential vaccines for COVID-19 are in the later stages of phase III trials. If one or more are authorised for use, the NHS needs to be ready to start immediate vaccination.

The NHS is a global leader in achieving high levels of vaccination coverage. The UK has one of the world’s highest levels of public support for making a safe COVID-19 vaccine available. Through their place in local neighbourhoods, GP practices are well placed to reach out to our diverse communities and avoid inequalities in access. This means general practice will have an important role in a potential COVID-19 vaccination programme, alongside other providers.

Our plans for deployment of a COVID-19 vaccine build on the tried-and-tested rollout plans for influenza vaccine, which we deploy every autumn. Given the uncertainty over whether, and when, a vaccine may be approved, we are planning to be ready from any date from December, with mass vaccination more likely in the new year.

The BMA General Practitioners Committee in England has now agreed with NHS England that the general practice COVID-19 vaccination service will be commissioned in line with agreed national terms and conditions as an enhanced service directed by NHS England (ES). The ES will be offered to all GP practices and will not be capable of amendment by CCGs. This specification provides GP practices with sufficient information to commence planning whilst also noting that requirements and timescales will be subject to change.

This ES relates to COVID-19 vaccinations only.

Other formats of this ES specification are available on request. Please send your request to: [email protected]

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1 Introduction

1.1 This ES1 is subject to amendments from time to time as the COVID-19 vaccination programme develops.

1.2 This ES has been agreed between NHS England and the British Medical Association (BMA) General Practitioners Committee (GPC) in England. It is a national specification that cannot be varied locally. NHS England will agree any future amendments to the terms of this ES specification with the GPC unless it is necessary to amend it in line with recommendations or decisions of the JCVI, MHRA, vaccine manufacturers or Ministers, where NHS England will discuss the required changes with the GPC.

1.3 This ES is offered by the Commissioner (NHSE) to all General Medical Services, Personal Medical Services and Alternative Provider Medical Services contract holders.

1.4 An ES is designed to cover enhanced aspects of clinical care, all of which are beyond the scope of essential and additional services. No part of this ES specification by commission, omission or implication defines or redefines essential or additional services.

1.5 All GP practices are offered the opportunity to sign up to this ES provided they meet the requirements of this specification. By signing up to deliver this ES, a GP practice agrees to a variation of its primary medical services contract to incorporate the provisions of this ES. The provisions of this ES are therefore deemed a part of the GP practice’s primary medical services contract.

1.6 On agreement to participate in this ES, a GP practice will work together with others in a collaborative manner and in accordance with the collaboration requirements at paragraphs 5 and 6 of this ES to deliver all aspects of this specification. The GP practice, in collaboration with other GP practices in the PCN Grouping, must have the ability to deliver this ES during the hours of 8am to 8pm, 7 days per week and including on bank holidays. The Commissioner (NHSE) will inform practices where this is required, based on the need to

1 Section 7A functions are arrangements under which the Secretary of State delegates to NHS England responsibility for certain elements of the Secretary of State’s public health functions, which add to the functions exercised by NHS England under the National Health Service Act 2006 (“the 2006 Act”). They are made under section 7A of the 2006 Act. They are described as 'reserved functions' which are not covered by the 'enhanced services delegated to CCG' category in the delegation agreement. NHS England remains responsible and accountable for the discharge of all the Section 7A functions. As this vaccination is defined as a Section 7A function, this agreement cannot be changed or varied locally.

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maximise vaccinations when the supply of vaccine is available to reduce waste and in support of the mass vaccination of the population.

1.7 A GP practice need not be a member of an established Primary Care Network to participate in this ES. GP practices are expected to collaborate with neighbouring practices and established Primary Care Networks in a ‘PCN Grouping’ to deliver all aspects of this ES. All collaborating GP practices, whether they are members of an established Primary Care Network or not, will be expected to sign up to a COVID-19 ES Vaccination Collaboration Agreement as described in this ES. Practices should refer to the definition of PCN Grouping in paragraph 2.2.10 to see exactly how the term is used in this ES.

1.8 Where this ES sets out a requirement or obligation of a PCN Grouping, each GP practice of a Primary Care Network together with neighbouring GP practices as described above, is responsible for ensuring the requirement or obligation is carried out on behalf of that PCN Grouping.

2 Commonly Used Terms

2.1 This specification is referred to as this “ES”.

2.2 In this ES:

2.2.1 the “Commissioner (NHSE)” refers to the organisation with responsibility for contract managing these ES arrangements and this is NHS England;

2.2.2 "COVID-19 ES Vaccination Collaboration Agreement" refers to the agreement entered into by GP practices, including those that are members of an established Primary Care Network, and which incorporates the provisions that are required to be included in a COVID-19 ES Vaccination Collaboration Agreement in accordance with paragraph 6.4;

2.2.3 a “Designated Site” refers to premises nominated by the PCN Grouping and approved by the Commissioner (NHSE) in accordance with the Designation Process as the premises from which the vaccination will be administered to Patients;

2.2.4 the “Designation Process” refers to the General Practice Site Designation Process (which includes the site designation criteria) which is undertaken to ensure that any site delivering vaccinations

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under this ES meets the specified site criteria and which may be updated and amended as required from time to time and is an integral part of this ES. A copy of Designation Process (as may be amended from time to time) is published on https://www.england.nhs.uk/coronavirus/publication/preparedness- letters-for-general-practice/;

2.2.5 a “GP practice” refers to a provider of essential primary medical services to a registered list of Patients under a General Medical Services contract, Personal Medical Services agreement or Alternative Provider Medical Services contract who has agreed with the Commissioner (NHSE) to deliver this ES;

2.2.6 “JCVI” means the Joint Committee on Vaccination and Immunisation;

2.2.7 “MHRA” means the Medicines and Healthcare products Regulatory Agency;

2.2.8 "Ministerial Decision" means a decision issued by the Secretary of State for Health and Social Care;

2.2.9 “Patient” means those patients eligible to receive the vaccination in general practice and who fall under the cohorts listed at paragraph 9.2; and

2.2.10 "PCN Grouping" refers to the group of GP practices which collaborate to deliver the services under this ES, which may include established Primary Care Networks, and additional neighbouring GP practices and/or other groups of GP practices working together.

2.3 In this ES words importing the singular include the plural and vice versa.

3 Background and Duration

3.1 This ES is for the Commissioner (NHSE) to commission the provision of COVID-19 vaccinations to Patients. This ES begins on 8 December 2020 and shall continue until 31 August 2021 unless it is terminated in accordance with paragraph 3.2.

3.2 This ES may be terminated on any of the following events:

3.2.1 automatically when the COVID-19 vaccination programme comes to an end;

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3.2.2 the Commissioner (NHSE) is entitled to require that the GP practice withdraws from this ES as set out in this ES;

3.2.3 the Commissioner (NHSE) terminates this ES by giving not less than 42 days’ notice to the GP practice;

3.2.4 the Commissioner (NHSE) is entitled to terminate this ES by giving not less than 42 days’ notice where the GP practice has failed to comply with any reasonable request for information from the Commissioner (NHSE) relating to the provision of the services pursuant to this ES; or

3.2.5 the GP practice terminates this ES in accordance with paragraph 13.4.

3.3 GP practices should note that delivery of the vaccines and the administration of the vaccinations will not begin until the date notified under paragraph 9.1.

3.4 The Patients eligible for vaccination under this ES are set out in paragraph 9.2. Vaccinations must only be administered to Patients.

3.5 GP Practices will be provided with vaccines to deliver this ES. The GP practice, together with the other GP practices in the PCN grouping shall be considered joint and several owners of the vaccine. GP practices should understand that the vaccine availability and supply is challenging and may be constrained and is subject to change over time. The Commissioner (NHSE) is likely to need to make allocation decisions regarding the vaccine during the term of this ES. Allocation decisions could include prioritising GP practices’ PCN Groupings or the use of a particular type of vaccine. GP practices support in relation to stock forecasting, use and ordering is important to this ES.

3.6 Please note that this ES will be updated from time to time as the vaccination programme develops and is subject to Ministerial Decision. This may include amendments to eligible cohorts and prioritisation of cohorts of Patients, and on-going adaptation of the requirements within this ES.

3.7 Details of this ES and the wider COVID-19 vaccination programme can be found at https://www.england.nhs.uk/coronavirus/covid-19-vaccination- programme/.

4 Process

4.1 GP practices must sign up to participate in this ES before 23:59 on 7 December 2020 unless the Commisisoner (NHSE) agrees otherwise in certain circumstances. GP practices must record their agreement to participate in this

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ES in writing to the Commissioner (NHSE). Local CCGs will collate the written agreement of each GP practice to participate in this ES on behalf of the Commissioner (NHSE).

4.2 All GP practices participating in this ES must have nominated and have access to a Designated Site from which vaccinations must be administered unless there is a specific reason not to (for example, the medical condition of a Patient is such that, in the reasonable opinion of the GP practice attendance on the Patient is required and it would be inappropriate for the Patient to attend at the Designated Site, in which case the GP practice must provide the vaccination to the Patient at another location). The Commissioner (NHSE) may be able to support GP practices to work with community partners and other local providers as appropriate to identify pragmatic local solutions to vaccinating these Patients. GP practices must make arrangements to vaccinate Patients resident in care homes at their care home of residence.

4.3 Payment under this ES is conditional on GP practices:

4.3.1 entering into this ES, including any variations and updates;

4.3.2 complying with the requirements of this ES; and

4.3.3 completing the course of vaccinations to Patients (unless exceptional circumstances apply as set out at paragraph 11.3).

4.4 A GP practice's participation in this ES shall only continue for so long as it is in compliance with its terms.

5 Collaboration Requirements: General

5.1 Each GP practice participating in this ES will:

5.1.1 co-operate with others in so far as is reasonable, including any other person responsible for the provision of services pursuant to this ES, in a timely and effective way and give to each GP practice in its PCN Grouping and outside of its PCN Grouping (where appropriate) such assistance as may reasonably be required to deliver the services under this ES;

5.1.2 openly, honestly and efficiently share information with relevant other parties including the GP practices in its PCN Grouping and outside of its PCN Grouping (where appropriate) that is relevant to the services, aims and objectives of this ES;

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5.1.3 comply with any reasonable request for information from the Commissioner (NHSE) relating to the provision of the services pursuant to this ES;

5.1.4 have regard to all relevant guidance published by the Commissioner (NHSE) or referenced within this ES;

5.1.5 comply with all clinical protocols giving explicit consideration to contra- indications and any guidance around concurrent adminstration of vaccinations (e.g influenza vaccinations);

5.1.6 take reasonable steps to provide information (supplementary to national communications) to Patients about the services pursuant to this ES, including information on how to access the services and any changes to them; and

5.1.7 ensure that it has in place suitable arrangements to enable the lawful sharing of data to support the delivery of the services, business administration and analysis activities.

6 Collaboration Requirements: PCN Groupings

6.1 GP practices are expected to work in their PCN Grouping to co-ordinate and deliver the vaccinations at scale and in line with the requirements set out in this ES.

6.2 GP practices are expected to participate in relevant PCN Grouping meetings relating to the COVID-19 vaccination programme, in so far as is reasonable.

6.3 All GP practices participating in this ES must ensure that they collaborate with other GP practices in the PCN Grouping in accordance with the Designation Process and agree (prior to participating in the ES) the site to be nominated as the Designated Site for delivering vaccinations under this ES.

6.4 All GP practices must have in place a COVID-19 ES Vaccination Collaboration Agreement signed by all collaborating GP practices in its PCN Grouping by no later than the day before the date of the first adminstration of the vaccinations that sets out the clinical delivery model (i.e. how clinics are delivered and responsibility is shared between the GP practices within the PCN Grouping) deployed by the PCN Grouping and as a minimum contains additional provisions in relation to the following:

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6.4.1 appropriate arrangements for Patient record sharing in line with data protection legislation;

6.4.2 appropriate arrangements for reporting of activity data, vaccine stock (to include stock use and stock forecasting which must include the brand of vaccine delivered and required by the PCN grouping), available capacity and submission of required data to the Commissioner (NHSE). Where appropriate access to mandatory national systems is required, these will be made available free of charge;

6.4.3 appropriate arrangements for communicating with Patients, including but not limited to call/re-call;

6.4.4 arrangements for any sharing and deployment of staff as agreed by the PCN Grouping in relation to the efficient delivery of the services pursuant to this ES;

6.4.5 financial arrangements between the collaborating GP practices and, if relevant, financial arrangements relating to other healthcare providers (such as community pharmacies) outside of its PCN Grouping involved in local delivery of this ES;

6.4.6 arrangements in relation to use of the Designated Site and any other relevant premises (as required);

6.4.7 sub-contracting arrangements (as required);

6.4.8 a lead contact email address for the PCN Grouping which shall be supplied to the Commissioner (NHSE) for use in disseminating information urgently; and

6.4.9 appropriate indemnity arrangements. The Clinical Negligence Scheme for General Practice (CNSGP) provides clinical negligence indemnity cover for all staff engaged by a GP practice under the CNSGP Regulations. It covers NHS activities delivered by a Part 4 contractor under a Primary Medical Services contract (including an NHS standard contract with Schedule 2L), a Primary Medical Services sub- contractor, or the provision of ‘Ancillary Health Services’ for a Part 4 contractor or Primary Medical Services sub-contractor such as an Enhanced Service. Cover under CNSGP is not restricted to a GP practice’s registered patients so would apply to the provision of an

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Enhanced Service (ES) by a GP practice to a person such as practice staff who are not on the registered list of that GP practice.

6.5 The Commissioner (NHSE) will publish a template COVID-19 ES Vaccination Collaboration Agreement on https://www.england.nhs.uk/gp/investment/gp- contract/, which the PCN Grouping may wish to use and adapt for the purpose of delivering this ES.

6.6 PCN Groupings will be expected to collaborate with any national and regional Sustainability and Transformation Partnership operations centre in relation to vaccine stock forecasting and ordering arrangements that are put in place, which will include complying with the processes and requirements set out in any relevant Standard Operating Procedures. This may include, for example, providing daily updates on actual stock use, vaccines delivered (including the brand of vaccine used) and forecasted requirements. PCN Groupings may need to submit information using the national Foundry system.

6.7 PCN Groupings will need to plan service delivery arrangements in line with stock forecasting and ordering arrangements including:

6.7.1 planning clinics according to expected vaccine supply;

6.7.2 coordinating required trained staff;

6.7.3 ordering required vaccine and consumables supply within required timeframes;

6.7.4 receiving and safely storing supply; and

6.7.5 amending clinic schedules if there is a disruption to supply and undertaking timely communication of any changes to Patients.

7 Site Designation

7.1 All GP practices must collaborate to identify at least one suitable premises from which their PCN Grouping is capable of delivering the requirements of this ES, and on approval of those premises as a Designated Site, from which vaccinations must be administered (unless exceptions apply in this ES).

7.2 PCN Groupings must complete the Designation Process so that they can include the name of the Designated Site in their sign-up confirmation in accordance with paragraph 4.1.

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7.3 The Commissioner (NHSE) shall determine whether any proposed premises meets (and is likely to continue to meet) the requirements of the Designation Process while having regard to issues of Patient access, the geographical distribution of sites and the total number of Designated Sites that can be accommodated within vaccine supply arrangements. The Commissioner (NHSE) shall have regard to the PCN Groupings’ preferences. The Commissioner (NHSE) shall have the right to choose between multiple premises put forward by a PCN Grouping.

7.4 The Commissioner may invite PCN Groupings to nominate additional sites for designation as Designated Sites. Such sites will also need to comply with the Designation Process and become a Designated Site prior to vaccinations being administered from them.

7.5 If it is necessary to amend a Designated Site, the application in accordance with the Designated Process must be undertaken as soon as possible to minimise the impact on the delivery of this ES to Patients.

7.6 As the COVID-19 vaccination programme develops, there may be the requirement for additional Designated Sites.

7.7 It may be necessary to periodically update the Designated Site designation criteria to reflect changes to the COVID-19 vaccination programme. Where a change occurs, the amended criteria will be published on https://www.england.nhs.uk/gp/investment/gp-contract/ and GP practices will be notified in writing and through the Primary Care Bulletin (as referred to in paragraph 10). Designated Sites must continue to (at least) meet the Designated Site designation criteria in place at the time of their application and approval by the Commissioner.

7.8 GP practices are responsible for ensuring that the quality and connectivity of internet broadband at the Designated Site is sufficient to support access to the point of care system 7 days a week between the hours of 8am and 8pm.

7.9 Where the Commissioner (NHSE) requires the GP practices to put into place any reasonable security requirements regarding the vaccine and the Designated Site, the GP practice shall make all reasonable efforts to ensure that these requirements are put into place as soon as possible.

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8 Sub-contracting Arrangements

8.1 The Commissioner (NHSE) acknowledges that to deliver the services pursuant to this ES, a GP practice may require the ability to sub-contract the delivery of the required clinical services to another GP practice in the PCN Grouping or another party. Where a GP practice is considering sub-contracting arrangements related to the provision of services under the ES, the GP practice must comply with the requirements set out in the statutory regulations or directions that underpin its primary medical services contracts in relation to sub-contracting, which will also apply to any arrangements to sub-contract services under the ES.

8.2 GP practices and their PCN Grouping must make available, on request from the Commissioner (NHSE), any reasonable information relating to the sub- contracting arrangements and reporting information relating to the delivery of ES.

8.3 Insofar as the sub-contracting of the clinical services pursuant to this ES is necessary to deliver these services and is compliant with the primary medical services legal and contractual requirements, the Commissioner (NHSE) will not object to the sub-contracting.

9 Service Delivery Specification2

9.1 The requirement to provide vaccinations under this ES will begin on the date to be notified to GP practices in writing by the Commissioner (NHSE). The commencement date for vaccine delivery will not be less than 10 calendar days following notification from the Commissioner (NHSE).

9.2 Patients eligible to receive the vaccination in general practice are those Patients who are on the GP practice’s registered patient list; are unregistered patients; or are care home workers or primary medical services workers which are registered on another primary medical services practice’s list of patients, but who have been advised by the Commissioner (NHSE) that they may elect to receive the vaccination from the GP practice for convenience; and fall under the cohorts listed below. GP practices must deliver the vaccinations to Patients within the cohorts, in the order of the cohorts listed below. The Commissioner (NHSE) will announce the authorisation of cohorts for vaccination. Vaccination will be permitted to Patients outside of the announced cohort where the GP

2 GP practices must ensure they have read and understood all sections of this document as part of the implementation of this programme and to ensure understanding of the payment regime.

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practice can demonstrate exceptional circumstances, that it is clinically appropriate and where resources would otherwise have been wasted. Patients eligible to receive the vaccination in general practice and the cohorts set out below are as currently defined in published interim guidance and are subject to change (which may include consolidation, expansion and reprioritisation). This paragraph 9.2 is therefore a snapshot in time and accurate as at the date of publication of this ES. Patients eligible to receive the vaccination in general practice and the cohorts will change in line with the JCVI authorised announced eligible Patients and cohorts, which will be available at https://www.gov.uk/government/groups/joint-committee-on-vaccination-and- immunisation. GP practices are required to keep up to date with these criteria which will change from time to time and will be notified by NHS England of amendments through the Primary Care Bulletin (as referred to in paragraph 10). The cohorts of Patients referred to above are as follows:

i. Older adults’ resident in a care home and care home workers;

ii. All those 80 years of age (and over) and Health and Social Care Workers3;

iii. All those 75 years of age and over;

iv. All those 70 years of age and over;

v. All those 65 years of age and over;

vi. High-risk4 adults under 65 years of age;

vii. Moderate-risk5 adults under 65 years of age;

viii. All those 60 years of age and over;

ix. All those 55 years of age and over; and

x. All those 50 years of age and over.

9.3 GP practices must liaise with Primary Care Networks which are responsible for delivery of the Enhanced Health in Care Homes provisions in the Network

3 JCVI will publish guidance describing Health and Social Care Workers for this cohort 4 Criteria for "High-risk adults under 65 years of age" to be provided by JCVI prior to authorisation of delivery of vaccines to cohort. 5 Criteria for "Moderate-risk adults under 65 years of age" to be provided by JCVI prior to authorisation of delivery of vaccines to cohort.

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Contract Directed Enhanced Service to ensure that a joined up service is delivered to all PCN-linked Care Homes to be served by the relevant PCN.

9.4 GP practices will not be eligible for payment for the administration of vaccinations outside the announced authorised cohorts unless they are able to evidence exceptional circumstances at the request of the Commissioner (NHSE).

9.5 GP practices must ensure they offer vaccinations to Patients in accordance with paragraph 9.2 and:

9.5.1 GP practices are required to ensure:

(a) that, in addition to any national call/re-call service, they write, text or call Patients (as appropriate) using standard nationally determined text;

(b) that they actively co-operate with any national call/re-call service requirements; and

(c) that they maintain clear records of how they have contacted (including ‘called’ and recalled) Patients; and

(d) to support high uptake of vaccinations and minimise vaccine wastage, that they proactively contact Patients for vaccinations. This may include additional contacts over and above the call/re-call requirements set out in paragraph 9.5.1(a)where appropriate to do so. GP practices are not required under this ES to offer call/re-call to care home residents, and Health and Social Care workers. Where these Patients are easily identifiable, GP practices may wish to offer call/re-call;

9.5.2 that vaccinations are not administered where contra-indicated as per JCVI published guidance;

9.5.3 that vaccinations must be administered during the period of this ES;

9.5.4 that all Patients who receive vaccinations are eligible under the cohorts and suitable clinically in accordance with law and guidance;

(a) Informed Patient consent is obtained by a registered healthcare professional and the Patient’s consent to the vaccination (or the name of the person who gave consent to

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the vaccination and that person’s relationship to the Patient) must be recorded in the point of care system and in accordance with law and guidance;

9.5.5 Patient consent obtained in accordance with paragraph 9.5.4(a) is recorded (as appropriate) for any necessary information sharing with the Commissioner (NHSE) in accordance with data protection law and guidance;

9.5.6 that they comply with the Standard Operating Procedures relating to delivery of local vaccination services and continue to meet the designation criteria as set out in the Designation Process;

9.5.7 that Patients receive a complete course of the same vaccine, unless in exceptional circumstances in which, for a patient attending for a second vaccination, that first vaccine type is not available, or the vaccine type received is not known. In such circumstances GP practices should offer a single dose of the locally available product in line with available guidance.6

9.5.8 that the correct dosage of the vaccine is administered, as clinically appropriate;

9.5.9 that they comply with relevant guidance issued by JCVI on:

(a) which vaccine is the most suitable for each cohort of Patients;

(b) the relevant maximum and minimum timescales (as applicable) for administration of each vaccination;

(c) the number of doses of each vaccine required to achieved the desired immune response; and

(d) any other relevant guidance relating to the administration of the different types of vaccine and the different cohorts from time to time; and

9.5.10 that they provide to each Patient being administered a vaccine the vaccination information as directed by the Commissioner (NHSE), which may include a printed copy of the manufacturer’s patient

6 https://www.gov.uk/government/publications/covid-19-vaccination-programme-guidance-for- healthcare-practitioners

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information leaflet about the vaccine (which would be provided to GP practices) and any other relevant information.

9.5.11 Although no data for co-administration of COVID-19 vaccine with other vaccines exists, in the absence of such data, first principles would suggest that interference between inactivated vaccines with different antigenic content is likely to be limited. Based on experience with other vaccines, any potential interference is most likely to result in a slightly attenuated (weaker) immune response to one of the vaccines. There is no evidence of any safety concerns, although it may make the attribution of any adverse events more difficult. Because of the absence of data on co-administration with COVID-19 vaccines, COVID19 vaccine should not be routinely offered at the same time as other vaccines. Based on current information about the first COVID-19 vaccines which may be used, scheduling of COVID-19 vaccine and other vaccines should ideally be separated by an interval of at least 7 days to avoid incorrect attribution of potential adverse events. As both of the COVID-19 vaccines which may be authorised for use first are considered inactivated, where individuals in an eligible cohort present having received another inactivated or live vaccine, COVID-19 vaccination should still be considered. The same applies for other live and inactivated vaccines where COVID-19 vaccination has been received first. In many cases, vaccination should proceed to avoid any further delay in protection and to avoid the risk of the patient not returning for a later appointment. In such circumstances, patients should be informed about the likely timing of potential adverse events relating to each vaccine. In the circumstances described in this paragraph, GP practices should refer to the available guidance7.

9.6 GP practices must adhere to defined standards of record keeping ensuring that the vaccination event is recorded the same day that it is administered within the specified point of care system in line with guidance published on https://www.england.nhs.uk/coronavirus/covid-19-vaccination-programme. GP practices must ensure that all staff recording the vaccination have received the relevant training.

7 https://www.gov.uk/government/publications/covid-19-vaccination-programme-guidance-for- healthcare-practitioners

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9.7 The GP practice must ensure the Patient has understood that failure to receive all recommended doses of the vaccine may render the vaccination ineffective and should ensure that a follow up appointment to receive the subsequent dose has been booked, acknowledging that in exceptional circumstances appointments may need to be moved, before administering the first dose of the vaccine. The Patient should receive all doses in the regimen from the same provider unless, in the exceptional circumstances as per paragraph 11.3, the GP practice is unable to complete the regimen.

9.8 Persons involved in administering the vaccine:

9.8.1 all healthcare professionals administering the vaccine, must have:

(a) read and understood the clinical guidance available and to be published on https://www.england.nhs.uk/coronavirus/covid- 19-vaccination-programme/;

(b) completed the additional online COVID-19 specific training modules available on the e-learning for health website when available. GP practices will be expected to oversee and keep a record to confirm that all staff have undertaken the training prior to participating in vaccinations;

(c) the necessary experience, skills and training to administer vaccines in general, including completion of the general immunisation training available on e-learning for health and face-to-face administration training, where relevant;

(d) the necessary experience, skills and training, including training with regard to the recognition and initial treatment of anaphylaxis; and

(e) understood and be familiar with the Patient Group Direction for the COVID-19 vaccines, made available by Public Health England and authorised by the Commissioner (NHSE) including guidance on who can use them https://www.gov.uk/government/publications/patient-group- directions-pgds/patient-group-directions-who-can-use-them; and

(f) ensured that registered healthcare professionals were involved in the preparation (in accordance with the

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manufacturer’s instructions) of the vaccine(s) unless unregistered staff have been trained to do this.

9.8.2 all other persons administering the vaccine, must:

(a) be authorised, listed, referred to or otherwise indentified by reference to The Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2020;

(b) while preparing and/or administering vaccinations be supervised by a healthcare professional fulfilling the requirements of paragraph 9.8.1 above;

(c) have completed the additional online COVID-19 specific training modules available on the e-learning for health website when available. GP practices must oversee and keep a record to confirm that all staff have undertaken the training prior to participating in administration of the vaccination. This includes any additional training associated with new vaccines that become available during the period of this ES;

(d) have the necessary skills and training to administer vaccines in general, including completion of the general immunisation training available on e-learning for health and face-to-face administration training, where relevant;

(e) the necessary skills and training, including training with regard to the recognition and initial treatment of anaphylaxis; and

(f) be familiar with, understand and act within the scope of the national protocol for the COVID-19 vaccines, made available by Public Health England and approved by the Secretary of State for Health and Social Care.

9.9 GP practices should ensure that all vaccines are received, stored, prepared and subsequently transported (where appropriate) in accordance with the relevant manufacturer's8, Public Health England’s9 and NHS England’s instructions and all associated Standard Operating Procedures, including that all refrigerators in which vaccines are stored have a maximum/minimum

8 Information from the manufacturer suggests that there will be very specific handling requirements to preserve stability. Vaccines will require 2-8c storage on-site 9 PHE's ordering, storing and handling protocol https://www.gov.uk/government/publications/protocol-for-ordering-storing-and-handling-vaccines

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thermometer and that the readings are taken and recorded from that thermometer on all working days and that appropriate action is taken when readings are outside the recommended temperature. Where vaccinations are administered away from a Designated Site (for example, at a care home), the GP practice must ensure that appropriate measures are taken to ensure the integrity of the cold chain, following any guidance issued by JCVI or Public Health England. Appropriate procedures must be in place to ensure stock rotation, monitoring of expiry dates and appropriate use of multi-dose vials to ensure that wastage is minimised and certainly does not exceed 5% of the total number of vaccines supplied. Wastage levels will be reviewed by the Commissioner (NHSE) on an ongoing basis. Where wastage exceeds 5% of the vaccines supplied and that wastage is as a result of supply chain or Commissioner (NHSE) fault, those vaccines shall be removed from any wastage calculations when reviewed by the Commissioner (NHSE) on an ongoing basis.

9.10 GP practices should ensure that services are accessible, appropriate and sensitive to the needs of all Patients. No eligible Patient shall be excluded or experience particular difficulty in accessing and effectively using this ES due to a protected characteristic, as outlined in the Equality Act (2010) – this includes Age, Disability, Gender Reassignment, Marriage and Civil Partnership, Pregnancy and Maternity, Race, Religion or Belief, Sex or Sexual Orientation.

9.11 GP practices and the PCN Groupings they each work within must ensure that Designated Sites and the vaccination clinics are operated in accordance with the Designation Process and any other criteria published alongside this ES specification. GP practices should inform the Commissioner (NHSE) immediately if for any reason a Designated Site ceases to meet the criteria set out in this ES and the Commissioner (NHSE) reserves the right to require a GP practice to withdraw from this ES in these circumstances, in accordance with the withdrawal criteria at paragraph 13.4.

9.12 The Commissioner (NHSE) may be able to provide support to PCN Groupings by way of equipment loan. Where such support is made available, all equipment will be maintained by the GP practices and shall be returned to the Commissioner (NHSE) at the end of the delivery of service sunder this ES.

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Monitoring and Reporting

10 GP practices delivering this ES must (if they have not already done so) sign up to receive the Primary Care Bulletin published by the Commissioner (NHSE) so key information in relation to the delivery of this ES can be communicated in a timely manner. GP practices can sign up to the Primary Care Bulletin at: https://www.england.nhs.uk/email-bulletins/primary-care-bulletin/.

10.1 GP practices and PCN Groupings must monitor and report all activity information in accordance with the monitoring and reporting standards as published by the Commissioner (NHSE).

10.2 GP practices will be responsible for recording adverse events and providing the Patient with information on the process to follow if they experience an adverse event in the future after leaving the vaccination site, including signposting the Yellow Card service. GP practices will be expected to follow MHRA incident management processes in the case of a severe reaction.

11 Payment and Validation

11.1 A payment of £25.16 shall be payable to the GP practice on completion of the second adminstration of the vaccination to each Patient. This £25.16 is made up of two items of service payments of £12.58 each and is intended to reflect the two vaccinations per Patient which make up the course of treatment. The Commissioner (NHSE) does not intend to make payment for the administration of a single vaccination, to encourage GP practices to ensure that Patients are called/re-called to second vaccination appointments and to reduce bureaucracy for practices. Payment will however be available for single adminstration of the vaccination in exceptional circumstances as set out at paragraph 11.3.

11.2 GP practices will only be eligible for the payment of £25.16 in accordance with this ES where all of the following requirements have been met:

11.2.1 the Patient which received the vaccinations was a Patient at the time the vaccine was administered, and all of the following apply (except where the claim for reimbursement is for a qualifying exception):

(a) the GP practice has used the specified vaccines recommended in the JCVI guidance10;

10 https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation

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(b) the Patient in respect of whom payment is being claimed was within an announced and authorised cohort at the time the vaccine was administered, unless the exceptional circumstances set out in this ES apply;

(c) the vaccination has been recorded on the point of care system; and

(d) the GP practice has not received and does not expect to receive any payment from any other source (other than any discretionary funding made available by the Commissioner (NHSE) relating to the delivery of the COVID-19 vaccination programme and/or under their COVID-19 ES Vaccination Collaboration Agreement) in respect of the vaccine or vaccination.

11.2.2 the Patient’s vaccinations have been administered by the GP practice’s PCN Grouping. GP practices must make arrangements within their PCN Grouping for payments in respect of unregistered patients; and care home workers and primary medical services workers which are registered on another primary medical services practice’s list of patients, but who have elected to receive the vaccination from the GP practice for convenience; and who fall within the definition of Patient and who are vaccinated at the PCN Grouping’s Designated Site. GP practices must nominate a single GP practice within the PCN Grouping to claim and receive (on their own behalf) payment for these unregistered patients, care home workers and primary medical services workers which shall be set out in the COVID- 19 ES Vaccination Collaboration Agreement.

11.2.3 GP practices must make arrangements within their PCN Grouping for the nomination of a host GP practice for the PCN Grouping which will receive payments due under this ES for and on behalf of the GP practice. This is necessary as existing systems are unable to support payment in a timely manner and to facilitate the payment system for this novel and complex situation where vaccination of the population across multiple locations and settings is required. The PCN Grouping should ensure that arrangements are in place so that the correct ODS code is entered to enable payment to the host GP practice. The host GP practice will then receive data which enables it to identify how many Patients on the GP practice’s list of registered patients have been vaccinated, for verification and the transfer of funds to the GP practice.

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Payment arrangements may be reviewed in line with subsequent developments to I.T. systems.

Exceptional circumstances criteria and process:

11.3 There may be exceptional circumstances where a GP practice should be paid for the administration of a single dose of the vaccine which are:

11.3.1 unsuitability of the Patient:

(a) because of medicine intolerance or allergy discovered during administration of the first dose of the vaccine;

(b) if the Patient has commenced end of life care before a second dose of the vaccine could be provided; or

(c) if the Patient has died before a second dose of the vaccine could be provided;

11.3.2 changed circumstances in relation to the Patient:

(a) Patient choice: the Patient has definitively chosen not to receive the second dose of the vaccine following a discussion with a clinician;

(b) no response: the Patient did not attend a booked appointment to receive the second dose of the vaccine and the GP practice has made at least two separate attempts to contact the Patient and a period of 60 days has elapsed following theadministration of the first dose of the vaccine;

(c) the Patient’s name has been removed from the GP practice’s list of registered patients between the first and second doses of the vaccine and their name is on the list of registered patients of another primary medical services practice outside of the PCN Grouping;

(d) the GP practice is unable to access the Patient to administer a vaccination within the recommended time period: the Patient is in hospital or has moved to a new form of residence such as the detained estate, a residential care home or other long-stay care facility since receiving the first dose of the vaccine and the GP practice is unable to access or it is not appropriate for

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the GP practice to access the location to administer the second dose of the vaccine; or

(e) the GP practice has not been provided with the vaccine in order for the GP practice to administer the vaccination within the recommended time frame.

11.4 GP practices must keep a record of the relevant exceptional circumstances to support a payment claim in accordance with the reporting requirements and payment processes which will be published. Where the exceptional circumstances criteria have been satisfied, the relevant Patient will be a "qualifying exception" for payment purposes.

11.5 Payment under this ES, or any part thereof, will be made only if the GP practice satisfies the following conditions:

11.5.1 they have in place a COVID-19 ES Vaccination Collaboration Agreement that complies with the requirements of paragraph 6.4;

11.5.2 they comply (and maintain compliance) with the requirements of this ES;

11.5.3 they make available to the Commissioner (NHSE) any information under this ES which the Commissioner (NHSE) needs and the GP practice either has or could be reasonably expected to obtain;

11.5.4 they make any returns or provide any information reasonably required by the Commissioner (NHSE) (or on the Commissioner’s behalf) (whether computerised or otherwise) to support payment and do so promptly and fully; and

11.5.5 all information supplied pursuant to or in accordance with this paragraph 11.5 must be accurate.

11.6 If the GP practice does not satisfy any of the above conditions, the Commissioner (NHSE) may withhold payment of any, or any part of, an amount due under this ES that is otherwise payable.

11.7 Practices may not claim payment for Patients vaccinated outside of the PCN grouping (for example, at a vaccination centre).

11.8 If the Commissioner (NHSE) makes a payment to a GP practice under this ES and:

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11.8.1 the GP practice was not entitled to receive all or part thereof, whether because it did not meet the entitlement conditions for the payment or because the payment was calculated incorrectly (including where a payment on account overestimates the amount that is to fall due);

11.8.2 the Commissioner (NHSE) was entitled to withhold all or part of the payment because of a breach of a condition attached to the payment, but is unable to do so because the money has already been paid; or

11.8.3 the Commissioner (NHSE) is entitled to repayment of all or part of the money paid,

the Commissioner (NHSE) may recover the money paid by deducting an equivalent amount from any payment payable to the GP practice, and where no such deduction can be made, it is a condition of the payments made under this ES that the contractor under its General Medical Services contract, Personal Medical Services agreement or Alternative Provider Medical Services contract (as relevant) must pay to the Commissioner (NHSE) that equivalent amount.

11.9 Where the Commissioner (NHSE) is entitled under this ES to withhold all or part of a payment because of a breach of a payment condition, and the Commissioner (NHSE) does so or recovers the money by deducting an equivalent amount from another payment in accordance with this ES, it may, where it sees fit to do so, reimburse the GP practice the amount withheld or recovered, if the breach is cured.

11.10 The Commissioner (NHSE) is responsible for post payment verification. This may include auditing claims of practices to ensure that they meet the requirements of this ES.

12 Withdrawal from this ES

12.1 Where a practice wishes to withdraw from this ES it must provide the Commissioner (NHSE) with no less than 42 days’ notice of its intention to withdraw to enable the recommissioning of services for Patients unless otherwise agreed with the Commssioner (NHSE).

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13 Variations To and Subsequent Withdrawal From this ES

13.1 Due to the continually changing nature of the COVID-19 pandemic and the resources and vaccines that the NHS is able to deploy, this ES will need to be responsive and may be frequently updated. GP practices are expected to be alive to this issue and committed to providing the best possible COVID-19 vaccination service to Patients.

13.2 Variations to this ES will be published on https://www.england.nhs.uk/gp/investment/gp-contract/ and will take effect immediately on publication. GP practices will also be notified of any changes via the Primary Care Bulletin (as referred to in paragraph 10).

13.3 In order to simplify the participation process, where there are any in-year variations to this ES specification after 8 December 2020, the GP practice participating in this ES will automatically be enrolled.

13.4 If a GP practice cannot meet the requirements of this ES it must withdraw from this ES by serving written notice on the Commissioner (NHSE) to that effect with supporting reasons as to why it cannot meet the revised requirements, such notice must be received by the Commissioner (NHSE) no later than 42 days after publication of the relevant variation and providing no less than 42 days’ notice of the GP practice’s withdrawal. The GP practice will also need to make the necessary amendments to the COVID-19 ES Vaccination Collaboration Agreement.

13.5 Following notice of their intention to withdraw from the ES, but prior to the actual withdrawal date, GP practices must comply with their COVID-19 ES Vaccination Collaboration Agreement and co-operate with their PCN Grouping during and following their withdrawal from this ES.

13.6 The provisons of Annex A will apply to practices that withdraw from this ES.

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Annex A: Provisions relating to GP practices that terminate or withdraw from this ES (subject to the provisions below for termination attributable to a GP practice formation or merger) and New GP practices

1 Where a GP practice has entered into this ES but its primary medical services contract subsequently terminates or the GP practice withdraws from this ES prior to the end of this ES, the GP practice is entitled to a payment in respect of its participation if such a payment has not already been made, in accordance with the provisions set out below. Any payment will fall due on the last day of the month following the month during which the GP practice provides the information required.

2 In order to qualify for payment in respect of participation under this ES, the GP practice must comply with and provide the Commissioner (NHSE) with the information in this ES specification or as agreed with the Commissioner (NHSE) before payment will be made. This information should be provided in writing within 28 days following the termination of the contract or the GP practice’s withdrawal from this ES.

3 The payment due to a GP practice whose primary medical services contract subsequently terminates or that withdraws from this ES prior to the end of this ES will be based on the number of completed vaccination courses provided to Patients or single doses where a qualifying exception applies (as set out at paragraph 11.3), prior to the termination of the primary medical services contract or withdrawal from this ES.

Provisions relating to GP practices who merge or are formed

4 Where two or more GP practices merge or a new primary medical services contract is awarded and as a result two or more lists of registered patients are combined, transferred (for example from a terminated practice) or a new list of registered patients is developed, the new GP practice(s) may enter into a new or varied arrangement with the Commissioner (NHSE) to provide this ES.

5 In the event of a practice merger, the ES arrangements of the merged GP practices will be treated as having terminated (unless otherwise agreed with the Commissioner (NHSE)) and the entitlement of those GP practice(s) to any payment will be assessed on the basis of the provisions of paragraph 11 of this ES.

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6 The entitlement to any payment(s) of the GP practice(s), formed following a practice merger, entering into the new or varied arrangement for this ES will be assessed and any new or varied arrangements that may be agreed in writing with the Commissioner (NHSE) will begin at the time the GP practice(s) starts to provide this ES under such arrangements.

7 Where that new or varied arrangement is entered into and begins within 28 days of the new GP practice(s) being formed, the new or varied arrangements are deemed to have begun on the date of the new GP practice(s) being formed and payment will be assessed in line with this ES specification as of that date.

8 Where the GP practice participating in the ES is subject to a practice merger and:

8.1 the application of the provisions set out above in respect of practice mergers would, in the reasonable opinion of the Commissioner (NHSE), lead to an inequitable result; or,

8.2 the circumstances of the split or merger are such that the provisions set out above in respect of practice mergers cannot be applied,

the Commissioner (NHSE) may, in consultation with the GP practice or GP practices concerned, agree to such payments as in the Commissioner’s (NHSE) opinion are reasonable in all of the circumstances.

New contract awards

9 Where a new primary medical services contract is awarded by the Commissioner (NHSE) after the commencement of this ES, the GP practice will be offered the ability to opt-in to the delivery of this ES where it is able to join a PCN Grouping.

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Meeting Title: Primary Care Commissioning Committee Date: 16 December 2020 (Open Session)

Paper Title: Nottingham City HSC Platform One Paper Reference: PCC 20 159 Practice

Sponsor: Lucy Dadge, Chief Commissioning Officer Attachments/ Attachment 1: HSC Appendices: letter Presenter: Joe Lunn, Associate Director of Primary Care Attachment 2: CCG response to HSC letter Appendix 1: Boundary Map Appendix 2: EQIA Appendix 3: Strategic Needs Review Appendix 4: Patient Contacts

Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for: ☒ ∑ Assurance ∑ Information

Executive Summary Arrangements for Discharging Delegated Functions: Delegated function 2 – Planning the provider landscape: The procurement of new Primary Medical Services Contracts Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services

On 19 November 2020, the Nottingham City Health Scrutiny Committee (HSC) considered the forthcoming changes to the Platform One Practice. Subsequent to this, on 20 November, the CCG received a letter from the Chair of the HSC setting out a number of requests and recommendations and requesting a response by close of play on Friday 11 December 2020. Please see Attachment 1 for a copy of the letter.

On the 10 December 2020 the Primary Care Commissioning Committee reviewed the CCG’s draft response to the HSC and endorsed the response being sent in line with the stated deadline, subject to members’ feedback.

The Committee is asked to RECEIVE the CCG’s response to the HSC letter submitted on the 11 December 2020, see Attachment 2.

Page 1 of 2

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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 ☐ Included as part of CCG response letter Assessment (EQIA) (Appendix 2) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this item. Assessment (DPIA) Risk(s): Potential reputational risk. Confidentiality: ☒No Recommendation(s): The Primary Care Commissioning Committee is asked to RECEIVE the CCG’s response to the HSC letter submitted on 11 December 2020.

Page 2 of 2

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Georgia Power Labour

Councillor for Bestwood LH Box 28 Loxley House, Station Street, Nottingham. NG2 3NG 07730685330 [email protected] www.nottinghamcity.gov.uk

20 November 2020

Dear Lucy Dadge, Chief Commissioning Officer, Nottingham and Nottinghamshire Clinical Commissioning Group

Health Scrutiny Committee 19 November 2020 – Platform One Practice

On behalf of the Committee I would like to thank you and your colleagues for coming to the Health Scrutiny Committee meeting on 19 November to discuss changes relating to the Platform One Practice. I’d also like to again thank the Clinical Commissioning Group and all colleagues working in the NHS for the dedication you have shown to Nottingham throughout these unprecedented times in dealing with the Covid-19 pandemic.

The minutes of the meeting, containing the Committee’s comments and recommendations will be published on the Council’s website in due course, but in advance of that the details of the Committee’s comments and recommendations are set out for you below.

Having considered the information available to it, including from the Clinical Commissioning Group (CCG) and submissions from other stakeholders at the Health Scrutiny Committee meeting on Thursday 19 November, the Committee has significant concerns about the decision.

As you know, the Committee raised concerns as to whether the CCG’s current trajectory is based on adequate evidence and understanding of patient need of a particularly complex cohort of service users, and how best to meet those needs. Naturally, the Committee expressed particular concern around the potential impact

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this may have for service users - present and future - and their outcomes. But the Committee was also concerned about the knock on effect the potential absence of a comprehensive, and long term wrap around support package may have on other NHS and partner services should the proposed changes go ahead.

The Committee is also concerned that the approach seems out of line with the Integrated Care Partnership’s focus on patients who experience disadvantage. The absence of provision of the Equality Impact Assessment and Strategic Needs Review to inform members’ consideration at the meeting has made it harder for the Committee to get assurance about this. Therefore, the Committee:

1) requests that the Equality Impact Assessment, Strategic Needs Review and any other relevant documents are made available to the Committee and key partners, and made publicly available as soon as possible;

2) requests additional information relating to:  anonymised feedback received from the 15 patients who contacted the Patient Experience Team in response to the letter sent about the changes;  proportion of the patients being dispersed to other practices with severe multiple disadvantage and disadvantage;  details of consultation carried out with current patients in January 2020 and feedback received from that consultation;  numbers of patients currently registered with the City South Local Mental Health Team who may be dispersed to other practices covered by a different Local Mental Health Team;

3) recommends that the CCG work with NEMS to agree a short extension to its current contract enabling the CCG to pause its procurement process and review the approach being taken based on the issues that have been raised at the Health Scrutiny Committee meeting on 19 November, also allowing the CCG to carry out meaningful engagement and consultation with service users and other relevant stakeholders. The Committee also asks that you report back to the Committee on the outcomes of this review to provide assurance that the option being progressed is in the best interests of service users - current and future, and local health services and other supporting agencies, and if not, your proposals to amend the approach. The review should include a) the process carried out, approach to engagement and consultation and understanding of patient need; b) the financial aspects in the context of the wider health system;

4) recommends that the CCG works with organisations who are already engaged with service users potentially affected, and who have experience of supporting service users on how best to consult and engage with service users as part of the consultation process. The Committee notes the need for particular consideration to be given to the barriers that this group of service

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users may face as part of a standard consultation process given the additional and complex needs represented. The necessity of a pro-active approach to support and encourage service users to be able to fully participate in a meaningful consultation cannot be understated;

5) recommends that the CCG works proactively to engage with non-health commissioners and providers to understand any knock on effect and potential impacts any changes may have, and how they may be mitigated to ensure the best possible outcome both for service users and for health and other public services; and

6) requests that the CCG keep the Committee and key partners regularly updated on the progress of commissioning and mobilisation processes; including provision of the mobilisation plans at the earliest opportunity.

I look forward to receiving your response to these recommendations and the Committee’s requests for further information, engagement and consideration to be given to this vital service. As ever, I look forward to continuing to work together to ensure the best possible outcomes for service users and local health services.

Yours sincerely,

Councillor Georgia Power Chair of the Nottingham City Health Scrutiny Committee

Jane Garrard, Senior Governance Officer Email: [email protected] Tel: 0115 8764315

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1 Standard Court Park Row Nottingham NG1 6GN

Telephone: 01623 673140 Email: [email protected]

Date: 11 December 2020

To: Councillor Georgia Power Chair, Nottingham City Health Scrutiny Committee

Sent via email to: [email protected]

Dear Councillor Power

Health Scrutiny Committee 19 November 2020 – Platform One Practice

Firstly, I would like to thank the Committee for inviting Clinical Commissioning Group (CCG) colleagues to attend the Health Scrutiny Committee (HSC) on 19 November 2020 to discuss the CCG’s plans for commissioning services for the patients currently served by NEMS at the Platform One Practice. We welcome the discussion, ongoing dialogue and your thorough scrutiny and we trust that the contents of this briefing address the issues raised in your letter dated 20 November 2020.

Executive Summary

This full letter addresses all of the matters raised by the Committee in writing on 20 November 2020, but for the convenience of the Committee I summarise the key points here:

Background 1. Due to historical national policy decisions, the contract that NEMS hold for Platform One pays a high rate per patients when compared to the nationally mandated rate. 2. In addition to this, national policy has also allowed NEMS to register patients from outside the set boundary area, thus further growing the list size. 3. Following the natural end of the existing contract with NEMS, national policy required the CCG to run an open competitive procurement process to secure a succession provider. 4. The Nottingham and Nottinghamshire CCGs, and its predecessor (Nottingham City CCG) have run such processes, but not been able to identify a new provider to date.

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Procurement 5. Following two open market procurements in 2016 and 2018, which failed to produce a successful bidder (due to there being no suitable premises in the city centre), the CCG agreed with NHS England to award a further two year contract to NEMS to ensure that patients continued to have a primary care service available to them. 6. In early 2020 a further open market procurement exercise was conducted. This again was not successful due to a lack of premises, although a number of providers indicated that the requirements and commercial terms were otherwise acceptable. 7. Following this, and given the previous indications from the Committee and Elected Members (Councillors and MPs) that a local general practice provider would be preferred, a local solution was sought. The CCG gave due thought to the most effective process by which to do this, given the views expressed by local stakeholders and the prevailing legislative framework. 8. In order to facilitate a local provider being able to take up the contract, and given the lack of available premises for such a large list, the decision was taken to partially disperse the list to create a more manageable list size for a new provider. 9. Two local providers have been identified through a local Expression of Interest and the CCG will be considering the contract award on 16 December 2020. Transition and Mobilisation 10. A short extension of the existing NEMS contract will be considered to facilitate the transition to this new local provider. 11. We will work with Healthwatch and other local stakeholders to ensure that this transition is smooth and does not disrupt care for patients. EQIA and Current Provider Performance 12. We have shared the Equality and Quality Impact Assessment with the Committee and again apologise for the delay in supplying this. Detailed consideration of the issues captured within the EQIA has underpinned all of the decision making for the process of securing a new provider for the patients currently served by NEMS at Platform One. Wider Health System Impact 13. Analysis of the impact of the service currently provided at Platform One indicates a significantly higher than anticipated utilisation of emergency secondary care for both physical and mental health needs. 14. There is no evidence that the higher level of investment in this practice is correlated with reduced secondary care utilisation or with a stronger CQC rating. Supporting Patients with SMD 15. The CCG recognises the specific needs of patients with Severe Multiple Deprivation (SMD) and commits to developing a Local Enhanced Service to support this group of patients, ensuring that this additional support is available to all practices across Nottingham and Nottinghamshire. We are grateful for the Committee’s steer in that regard, and we are cognisant of the views of local stakeholders. Mental Health Support 16. Detailed analysis has been undertaken on the prevalence of mental health (MH) conditions within the Platform One list. This indicates a level of MH needs broadly in line with neighbouring practices. 17. Of the c. 3000 patients who have a mental health diagnosis code, 67% will remain on the list for the new provider.

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18. Any patient currently supported by City South Local Mental Health Team (LMHT) that are due to be dispersed to another practice will remain with their current team until they can be safely and holistically transitioned to a new team related to their new practice. The level of care provided will be the same in all LMHTs, regardless of geographical location. Engagement and Involvement with Patients 19. The CCG involved patients in the procurement exercise in January 2020 and details of this engagement can be seen below. 20. When this procurement was unsuccessful, there was limited time for further patient involvement without risking the future provision of services for this patient list. Engagement and Involvement of Service Providers 21. The CCG is committed to ongoing dialogue and involvement with providers of support services to these patients, as well as with the commissioners of those services. Again, we are very grateful to the Committee and key stakeholders for their commitment to work with us in this regard. Next Steps and Conclusion 22. The CCG is grateful for the detailed scrutiny and input from the Committee and wishes to continue this dialogue over the coming months.

Background

At the Committee meeting on 19 November 2020, we outlined the process the CCG has been through over recent years to secure primary medical services for patients of Platform One Practice. We set out how determining the needs of the population served is at the centre of this process.

Platform One Practice was initially procured and established in 2008/9 and was part of the first mainstream roll-out of the APMS (Alternative Provider Medical Services) contracts. The APMS contract value at set-up stage was designed to support the establishment of a new practice. It should be noted that establishing a new patient list from a zero patient list incurs significant overhead costs that are not reflective of usual patient activity. The terms of this initial procurement and the rapid growth in the size of the list meant that the contract with NEMS was paying circa £170.85 per patient by 1 April 2015. This was significantly higher than the ‘Global Sum’ payment made to other practices in Nottingham, many of whom provide services to populations with high levels of need. Global sum payments are based on an estimate of a practice’s patient workload and costs. The Global Sum stood at £63.21 in 2009 and subsequently rose to £88.96 (2018/19) and £93.46 (2020/21).

As part of the original procurement in 2008, the Nottingham City PCT specified that the premises the brand new practice should be sourced by the successful bidder. In this case, a building on Station Street was secured and fully refurbished by NEMS. The practice formally opened in February 2010 for an initial term of 5 years.

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Practice Area

The original contract with NEMS for Platform One Practice had a boundary for registered patients that reflected the procurement undertaken by Nottingham City PCT. The map from the original APMS contract dated 24 December 2008 is shown in Appendix 1. Also included as part of Appendix 1 is the new Inner City boundary, which reflects the smaller list size practice that is currently being sought as part of the Expressions of Interest process locally. While not unconstrained, the new practice area is larger than the 2008 original.

NHS England implemented a new policy from January 2015 which gave all GP practices the option to register new patients who live outside their practice boundary area without any obligation on the practice to provide home visits for such patients when the patient is at home, and unable to attend their registered practice. This policy enabled the practice to register patients from outside of their practice boundary and, unlike other Nottingham practices, has led to a substantial list of patients registered that live outside the practice boundary.

The detailed guidance for this change can be seen here: https://www.england.nhs.uk/wp- content/uploads/2017/02/gp-con-enhanced-service-out-area-reg.pdf

Procurement Timeline

The nature of APMS contracts for primary medical services is that they are time limited. The original Platform One contract was for a term of 5 years, with an option to extend for 1 year. In 2016 the CCG requested permission from NHS England (NHSE) for the term of future contracts to be extended to ensure that services for this cohort of patients were stable for a longer period. NHSE approved our proposal for the replacement APMS contract to be for a 10 year term with an option to extend by a further 5 years (15 years in total). NHSE guidance requires that when contracts expire, the CCG must work with the regional NHSE team to secure a succession provider through an open market procurement process, under the OJEU (Official Journal of the European Union) regime. The commissioning and procurement processes for Platform One Practice were led by the former Nottingham City CCG, with the newly formed Nottingham and Nottinghamshire CCG becoming the lead organisation from 1 April 2020 onwards.

A procurement process was undertaken by Nottingham City CCG in 2016 and again in 2018. Neither of these exercises identified a preferred provider due to premises constraints, specifically that the site that NEMS currently use for the practice from was not available for transfer to a new provider. Alternate options for premises with easy conversion to a general practice in the city centre were not available at the time. Therefore, to secure an interim solution and maintain continuity of services, approval was given by NHSE in 2018 for a short term “direct award” contract with NEMS for a 2 year term, at £143.35 per patient. This was still significantly higher than the prevailing Global Sum, in acknowledgement of the short term nature of the contract.

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A further procurement process was initiated in January 2020 by the new Nottingham and Nottinghamshire CCG (acting in shadow form) and is described in detail later in this briefing. Due to the complex needs of the patients using the practice and the history of unsuccessful procurements, the CCG was able to secure agreement with NHSE/I for a contract offer of £110 per patient, which was 17% higher than the prevailing Global Sum, for this APMS contract. The incumbent provider (NEMS) did not submit a bid. However, a number of providers did submit bids as part of this process, demonstrating an ability to deliver services within the financial envelope and a good understanding of the needs of the population. The procurement process was, again, unsuccessful. It should be noted however that this was solely due to the unavailability of suitable premises within the inner city area to support delivery of services.

While this is a complex process involving local and national stakeholders, and working within national guidance for commissioning and procurement, we would like to reassure the Committee that we have prioritised the needs of our most vulnerable patients. We do however acknowledge that we could have been more proactive in engaging with the Health Scrutiny Committee to ensure that the context and background was more fully understood.

Identification of a Local Provider

In discussion with Council representatives over the summer of 2020, a desire was expressed to see a local provider for the Platform One Practice, if the capacity and expertise could be identified; and through working within the prevailing guidance and legislative framework for commissioning and procurement. It was recognised that the most recent procurement had failed due to the inability to identify and secure premises of sufficient capacity to accommodate a practice list of circa 11,000 patients. For this reason, the option of dispersing patients living outside the practice list area was examined. This would reduce the list size, and therefore the premises requirements, and was considered to make a bid from local providers more likely.

We have undertaken a local Expressions of Interest process, based on demonstrable evidence of having tested the broader market through previous procurement exercises over a number of years. The opportunity to provide services to the population has therefore been offered to all Nottingham City practices. On the grounds that NEMS have been clear that they need to retain the current practice premises, but in recognition of the particular needs of the new practice population (boundaries as described above) a key pre-condition for consideration of any bid is that the preferred provider must be able to operate from premises within a half mile radius of Nottingham city centre.

We are pleased to be able to update Committee members that the local Expressions of Interest process has been successful in attracting bids from local providers with experience of delivering services for the complex cohort of patients currently registered at Platform One Practice. The bidders have also identified suitable premises within the stipulated 0.5 miles radius of Market Square to deliver services from and these would be available for immediate use. A decision with regard to awarding the contract will be made on 16 December at the CCG’s Primary Care Commissioning Committee, as required by our governance arrangements. Once the decision is

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made we will convey the outcome to the bidders, and commence appropriate transition and mobilisation discussions with the incumbent and successor providers.

The CCG recognises the importance of a smooth mobilisation and transition period for transfer of services from the current provider to the new one. We have therefore planned an extended transition period from contract award (subject to ratification through CCG governance processes in December 2020). Our current planning therefore assumes an extended mobilisation period from January 2021, to enable us to undertake wider engagement with patients in relation to the changes. We will work with Healthwatch and other local organisations on the most effective methods of communication for this practice population to ensure that patients are fully informed of the changes impacting them and the support they can access to make the transition as smooth as possible for them. The current contract with NEMS concludes at the end of March 2021.

We would again acknowledge that, despite the complexity of the process and the national legislative restrictions, we could and should have engaged the Committee earlier and we are committed to doing so for future exercises that affect our patients in a similar way.

Extending Contract with NEMS

Subject to the CCG’s decision to award the contract to a new local provider, we shall offer an extension to the current APMS contract held by NEMS for Platform One Practice, in line with the options previously explored to support an extended mobilisation period. We have previously discussed this proposal with NEMS and are extremely grateful for their co-operation in this matter, which clearly reflects their commitment to the practice’s registered patients. The exact duration of the extension will be subject to negotiation with NEMS, and we will work with NEMS and the future provider to ensure that transition is seamless and the new provider is able to commit fully to a longer term and sustainable provision arrangement for the new practice at the earliest possible opportunity.

Equality and Quality Impact Assessment (EQIA) and Strategic Needs Review

An EQIA has been developed as part of the local Expressions of Interest process. The EQIA is a “live” document, updated as new information becomes available, and was shared following the Nottingham City HSC on 19 November 2020 as requested during the committee meeting. A copy of the current version of the EQIA is also included at Appendix 2. Please accept my apologies once again for this document not being shared ahead of the HSC meeting.

As the procurement process undertaken in early 2020 did not secure a new provider with all of the required capacity and capabilities to meet our requirements for APMS contract award, the CCG considered options in relation to future services for the patients of Platform One Practice at our Primary Care Commissioning Committees (PCCC) in June and July 2020. The Strategic Needs Review of the practice population formed part of the papers for these meetings and were considered as part of the discussions. The points outlined in Appendix 3 were presented to the PCCC meetings for consideration.

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The PCCC has also considered the impact that a full or partial list dispersal would have had on neighbouring practices. In particular, the PCCC was concerned about the potential for some local practices to receive very high numbers of new patients were the full list to be dispersed, which might even lead to practice failures. The partial dispersal option reflects the new practice boundary (Appendix 1), reduces the impact on other practices receiving dispersed patients, and spreads the impact across practices in Nottingham and Nottinghamshire, with 96 practices receiving between 1 and 70 patients.

I hope that the sharing of the detailed EQIA last month, and as an attachment to this letter, provides reassurance to the Committee that we have undertaken detailed analysis of the impact of our decision. I can assure you that we are doing all we can to mitigate any negative impact we have identified.

Wider Health System Impact

The CCG has considered the potential impact of the Platform One contract on system wide health costs.

The practice has a relatively young population and a high proportion of patients with mental health problems and drug and alcohol problems. Attendance rates of Platform One patients at the Emergency Department have consistently been amongst the highest in the city (and county) for the past 5 years. They are currently the highest in the CCG at 543 per 1000 patients and were even higher just prior to Covid-19 at 674 per 1000. Emergency medical admission rates have also been consistently high over the past 5 years. They are currently the third highest in the city at 171 admissions per 1000 patients. The same pattern is observed with mental health admissions, which are currently the highest in the city at 19.2 admissions per 1000 patients.

As the practice was established from a zero baseline there were no previous providers for the practice population, meaning a direct comparative provider analysis is not possible. It is therefore not possible to predict whether a change in service provider would have a positive or negative effect on the wider system impacts. There is no clear evidence however, that the current level of investment in the existing provider's service model has supported patients in avoiding emergency treatment, given that the secondary care utilisation rates are the highest in the city and county by a significant margin.

The CCG has also considered points made by Committee members in relation to Platform One having an “Outstanding” rating with the CQC. It is difficult to make a direct correlation between the level of funding received by a practice and CQC ratings. The majority of practices across Nottingham and Nottinghamshire are funded in line with national equitable funding requirements, with the rate linked to the Global Sum (£93.46 for 2020/21).

Across 126 practices the CQC ratings for the CCG are detailed below, demonstrating 93% of practices have ratings of either “Outstanding” or “Good”.

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% of Rating Practices Outstanding 15% Good 78% Requires Improvement 1% Inadequate 2% Not Rated 4%

Patients with Severe Multiple Disadvantage (SMD)

The CCG is currently mapping the postcodes for patients currently receiving support for the four SMD conditions of Homelessness, Substance Misuse, Offending, and Mental Health. This baseline of those accessing support services provided to the patients of Platform One Practice will be used to ensure that all handover care plans contain the required information about the vulnerability and complexity of some patients. Patients accessing the services below are currently being reviewed to establish an SMD list for the practice for both cohorts of patients – those being dispersed and those transferring to the new inner city provider;

 Willoughby House – Substance Misuse  Platform One Postcode – Homeless patients  Information Redacted – Homeless patients  Information Redacted – Homeless patients  Nottingham and Notts Refugee Forum  Trent House (Offenders)  Nottingham Probation (Offenders)  Clean Slate  NRN  Shared Care Clinic.

We have carefully considered the issues raised by the Committee in relation to this particularly vulnerable population group. As part of our annual review of local enhanced services (LESs) we are currently reviewing the support provided by general practices to homeless patients across the whole of Nottingham city and county.

Whilst Platform One Practice does provide support to a large number of homeless patients, the CCG currently has patients registered as homeless across 122 of the 126 practices in our area. Based on available data, circa 18 % of homeless patients across Nottinghamshire are registered with Platform One.

In consideration of the Committee’s feedback we also intend to widen the scope of the current Local Enhanced Service (LES) review to give further consideration to the Homelessness LES currently provided in Nottingham City. This will mean a broader view will be taken on the complex needs of vulnerable SMD patients within the specification for services. It will also open the LES to

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all practices across Nottingham and Nottinghamshire who have patients registered with them that are part of the SMD cohort. This will mean that our most vulnerable patients are supported wherever they live. This will require additional investment from the CCG, which will be discussed at the December meeting of the Primary Care Commissioning Committee. Once more, we are grateful for stakeholder input in shaping our commissioning perspectives in this regard.

A working group will be established to ensure the CCG has a LES in place during 2021/22 to provide additional support to vulnerable patients most in need covering the four conditions – Homelessness, Substance Misuse, Offending, and Mental Health, with patients falling into this cohort if they fulfil two or more of these. Consideration will be given to the LES specification with clinical input from both the city and county and likely to include flexible registration and access, links with other services providers and an annual review of both physical and mental health. We also recognise the importance on working with partners on this work as links with mental health services, drug and alcohol treatment services, and issues relating to debt, housing and probation issues are all vital.

We are pleased that our dialogue with the Committee has prompted a reconsideration of the support available for patients who might be homeless or be otherwise disadvantaged. We are confident that, with your support, we can make the revised approach to our LES for this year and for 2021/22 unlock the appropriate support for patients in this cohort across the whole of Nottingham and Nottinghamshire.

Local Mental Health Teams (LMHTs)

The January 2020 EQIA refers to the reported higher number of patients with mental health conditions. Diagnosis information by NEMS, as the current provider of services, at Platform One practice is given below. This is information relating to patients with a diagnosed mental health condition. This may include past or inactive mental health conditions; mild mental health conditions (e.g. phobias) and does not include patients who do not engage with secondary care and therefore have no diagnosis code. This information has been updated on 7 December 2020 following further review of the mental health data and removal of duplicate patient information.

Of the circa 11,000 patients registered at NEMS, 2,955 patients have at least one mental health diagnosis code. We do not currently have this level of data for other city practices. However, 2019/20 QOF prevalence for the following disease areas demonstrates that prevalence is above CCG average but is broadly in line with neighbouring practices.

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NHS Digital: 2019/20 QOF Schizophrenia, bipolar affective Depression Results Clinical Prevalence disorder & other psychoses NEMS Platform One 15.67% 1.67% Family 14.14% 1.69% Victoria 14.11% 1.68% Windmill 12.32% 1.65% Wellspring 11.05% 1.53% CCG Average 10.84% 0.81% Bakersfield 9.90% 0.59% Greendale 9.72% 1.14%

Of this 2,955 total who have a mental health diagnosis code:  1,937 will remain on the Platform One list (1,664 have a mild MH diagnosis, 273 have a major MH diagnosis) 961 will be allocated to another GP practice in Nottinghamshire (847 have a mild MH code, 114 have a major MH code); and  57 reside outside of Nottinghamshire and will therefore be asked to register at another practice closer to their home residence (35 have a mild MH code, 22 have a major MH code).

LMHTs (run by Nottinghamshire Healthcare Trust) are linked to specific GP practice registered list. The City South LMHT covers NEMS Platform One GP Practice. They have 160 patients ‘open’ from the Practice. City South LMHT covers the following practices in Nottingham City:

City South Deer Park Family Medical Practice Derby Road Health Centre PCN 7 Grange Farm Medical Centre Wollaton Park Medical Centre

Bridgeway Practice Clifton Medical Practice John Ryle Medical Practice PCN 8 Meadows Health Centre Rivergreen Medical Centre Cripps NEMS Platform 1

The University of Nottingham Health Service PCN U Sunrise Medical Practice

Services commissioned for Mental Health (MH) patients are consistent across the whole of Nottingham and Nottinghamshire. Following liaison with Nottinghamshire Healthcare NHS Foundation Trust (NHT), the CCG has confirmed that any patient currently supported by City South LMHT that is due to be dispersed to another practice will remain with their current team until they

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can be transitioned to a new team related to their new practice in a safe way, depending on each patient’s needs and only when the receiving LMHT has the capacity to support them. This process is followed across all LMHTs and the speed of transition to a new team when a patient moves area is dictated by the patient’s condition, with some able to move quickly whilst others may take a number of months to ensure that the patient is stable and has an individualised care plan.

There are currently 114 patients with a major MH code that live outside of the city and a further 22 patients that live outside of Nottingham and Nottinghamshire. Should these patients need intervention from their LMHT, the team would have to provide support to patients living some distance outside the LMHT's geographical service area. Currently the LMHT staff have to make home visits to patients, which can mean travelling outside of the city to support registered at Platform One Practice. Discussions with Nottinghamshire Healthcare Trust have confirmed that this change will help their service provision as once patients have been fully transitioned to the LMHT closer to their home it will improve the support provided for patients in crisis.

Patient Engagement in January 2020

Under Section 14Z2(2) of the NHS Act 2006, as amended by the Health and Social Care Act 2012, CCGs have a duty to ‘make arrangements’ to involve the public in the planning, development and decisions on commissioning arrangements. For primary medical services, the CCG discharges this duty in a number of ways. These include, but are not exclusive to, using information published in CQC reports, the NHS ‘Friends and Family’ Test results, the GP Patient Survey and other local intelligence as well as direct discussions with patients and service users.

In line with the CCG’s statutory duties and our approach to patient involvement for primary medical services, the CCG held an engagement event with patients registered with Platform One on 7th January 2020. This event was hosted by CCG representatives and supported by Platform One staff. It included a presentation followed by a discussion and Q&A. Patients attending the event were recruited by the existing provider of services at Platform One (NEMS) and were intended to be a good cross-section of the practice list. This meant that the group included both working age patients, those from complex families, representatives from supported accommodation and patients with more complex mental health needs.

The feedback from this event included the following points;

 Strong indication of support for the services provided at Platform One  Particular interest in ensuring continuity of the MH provision at Platform One  Some concerns regarding ability to access timely appointments  Some concerns about administration of letters and handoffs to other services  Discussion around the tendering and procurement process and potential future provider  Concern around ensuring that the existing clinical staff were retained by any new provider.

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Patient Experience Team – Patient Feedback

The CCG confirmed to the Committee at the November 2020 meeting that, following the distribution of letters to the 3,000 patients that are due to be dispersed, our Patient Experience Team had received contact from 15 patients in relation to the changes. As requested, Appendix 4 contains the information relating to the contacts made and the information provided to support patients regarding the changes that are due from 1st April 2021.

Process and Approach to Engagement

Under the previous procurement undertaken in January 2020 engagement was carried out with services users in relation to the NEMS contract being time limited and coming to an end as outlined above. The procurement process was explained including that those services may transfer to a new provider and alternative premises within the city centre.

At the time of the January 2020 engagement event, it was anticipated that the contract for the service at Platform One would be let in its current form, i.e. based on the complete patient list for an APMS contract for the provision of primary medical services. When it became apparent that a different approach would be needed due to not being able to award an APMS contract, there was limited time available before the expiry of the existing contract in March 2021. Therefore, as set out in this briefing, a decision was taken to proceed in securing a local provider through an Expressions of Interest process. This was seen as the right approach to avoid the situation of there being no provider in place after March 2021 and the resulting requirement to fully disperse the list to other practices. Unfortunately, due to the compressed timetable and the impact of the Covid-19 Pandemic, it was not possible to involve patients and other stakeholders as fully as we might have liked in this revised process. The CCG recognises that this was not ideal and acknowledges that if more time had been available and the prevailing environment been different, then other approaches would have been taken.

It should be noted however, that the CCG has been in dialogue with City Councillors and the Health Scrutiny Committee for a number of months regarding the providers for General Practice services in the city. The most recent conversation on this topic was on 14th May 2020 and culminated in a specific request from Councillors to prioritise wherever possible a local (Nottingham based) provider for future General Practice contracts awarded in the city. This was the impetus for pursuing a local provider Expression of Interest approach.

The CCG has a clear and strong appreciation of the needs of the practice population, through our close work with the existing provider, our interrogation of the JSNA and our general understanding of the needs of our population through our wider commissioning work. We trust that the depth and breadth of the understanding of the patient is evidenced in the EQIA we have now shared with the Committee.

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Ongoing Engagement with Service Users

We are extremely respectful of the unique insights that Healthwatch provide in support of our overall commissioning activities; and the CCG will actively liaise with Healthwatch and other local organisations to ensure that engagement with services users during the mobilisation period from now until 30 June 2020, for this particular programme of work, is appropriate. We will endeavour to ensure we explore all options available to us to communicate with patients.

Engagement with Non-Health Commissioners and Providers

The CCG will work with our partner commissioners within the Integrated Care System (ICS), and jointly with the providers they commission, to understand the impact the changes for the patients at Platform One Practice. We will ensure the outcomes are as positive as possible as they transfer to their new provider, especially where we identify services that support our most vulnerable patients.

Early discussions have taken place with the Lead Commissioner for Nottingham Crime and Drugs Partnership relating to their services that support the patients of Platform One Practice.

Services discussed include;

 Shared Care Clinics  Framework – Drug and Alcohol Services o Nottingham Recovery Network o CleanSlate  Wellbeing Hub at Houndsgate  Harm Reduction Service including Needle Exchange

The CCG will continue to liaise with commissioners at the Local Authority in relation to services accessed by the patients of Platform One Practice. During mobilisation we will work with the providers of the services detailed above that support our most vulnerable patients. As we disperse patients to practices closer to home consideration will be given to the support needed if a transfer of service is required. We have already compiled a comparison of city and county services as part of the planning process.

Ongoing Dialogue and Updates

The CCG will consider at the 16 December meeting of the CCG’s Primary Care Commissioning Committee the decision to make the APMS contract award for the new inner city practice to deliver services to the population of Platform One Practice that live within the new practice boundary. The outcome of this contract award will be notified to all stakeholders following the standstill period once all bidders in the local process are informed of the outcome.

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We shall ensure that the Committee are regularly updated on progress throughout the mobilisation period to 30 June 2021 and will of course share our mobilisation plans with you at the earliest opportunity.

We have hugely valued the input of the Health Scrutiny Committee over the last few weeks and wish to continue this useful dialogue over the coming months, in the same spirit of helpful scrutiny and challenge.

Conclusion

I trust the additional information provided will assure Nottingham City Health Scrutiny Committee members that the CCG has given detailed consideration to the patient population of Platform One Practice during the period of trying to secure a replacement provider and that patients will remain at the centre of the process as we move towards developing mobilisation plans with the newly identified and incumbent providers.

I would like to record my personal thanks for the detailed scrutiny and due diligence undertaken by the Committee on this matter, and sincerely hope that we are able to move towards identifying the best possible commissioning solution for this vulnerable patient group based on our joint discussions and through working together constructively in the best interests of our local population.

Yours sincerely

Lucy Dadge Chief Commissioning Officer NHS Nottingham and Nottinghamshire CCG

cc. Jane Laughton, Chief Executive, Healthwatch Nottingham and Nottinghamshire

Encs.

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Appendix 1

Boundary Map for registered patients from the original APMS contract for Platform One Practice dated 24 December 2008

The revised Inner City boundary for the local Expressions of Interest process shown below is wider than the 2008 original (patients outside of this boundary will be dispersed/allocated back to practices more geographically aligned to patients home residence):-

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Nottingham and Nottinghamshire CCG’s Equality and Quality Impact Assessment

When public sector organisations undertake any work involving changes that will impact service users there is a duty to consider the impacts of that change / project. The aim of such an impact assessment is not to eliminate risk, but for both project leads and organisations to be fully informed of any risks and impacts before deciding to proceed with a change / project. This Equality and Quality Impact Assessment (EQIA) template has been developed to bring together equality and quality impact considerations into a single assessment process. It should be completed whenever there is a change to a service / pathway that is directly commissioned by the CCG, a CCG Quality Innovation Productivity and Prevention (QIPP) scheme and any new CCG business or project where it is appropriate to assess the impact of the proposed piece of work.

To support understanding and completion of the EQIA, please refer to the glossary at EQIA Glossary July 2020.docx, the CCG’s EQIA Standard Operating Procedure (see below) and EQIA Process Flowchart (see below).

The EQIA is designed to:

 Assess the impact of proposed changes in line with the CCG’s duty to reduce health inequalities in access to health services and in health outcomes  Assess the impact of proposed changes to services in line with the CCG’s 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 direct or indirect discrimination or negative effect on equality for 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 to enable the escalation of any risks and prevent equality and quality risks from being considered in isolation  Support in determining whether a project 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 project development and implementation, particularly following the conclusion of any engagement and consultation activities to inform decision-making.

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Section 1: Project Overview Proposal / Project Title: Platform One Practice – next steps (Confidential) Project / Commissioning Lead: Primary Care Commissioning Team EQIA Completed By: Primary Care Commissioning Manager Senior Responsible Lead: Associate Director of Primary Care Date EQIA Completed: September 2020

Description of Project: Following three failed procurements, the most recent one being in April 2020, the Primary Care Commissioning Committee (PCCC) decided to look at alternative options. In July 2020, the PCCC supported the option to reduce the current list size of Platform One Practice by way of a partial patient dispersal and the remaining patient list be secured under a new APMS contract via a local expression of interest process. It is anticipated that by reducing the list size (and subsequently redrawing the practice boundary) there may be more available premises options for the new contract from 1st April 2021. Note - the reason for the most recent unsuccessful procurement was due to lack of suitable premises. Legal advice has been sought on this approach which confirms that the CCG can proceed with risk mitigating actions in place. This EQIA covers both phases of the project; A) Partial dispersal and allocation and B) Procurement. At the time of preparing this, the current list size of platform one is circa 10,800. They have a large practice boundary which covers the whole of Nottingham City and have patients from outside of City, see below for breakdown. Within City ICP South Nottinghamshire ICP Mid-Notts ICP Outside Nottinghamshire No. of patients resident 9,900 660 50 218 Part of the outer City population is likely to be commuter patients who work in the City (example at Loxley House, Capital One etc.) or use the train station for commuting and the city centre location of Platform One was more convenient. However, as a result of COVID and greater working from home it may be that some of these patients are already considering registering at a practice closer to their home to avoid travel into the City centre.

A) Partial dispersal & allocation The primary care team have reviewed the boundary, individual patient postcodes and impacts on surrounding practices and determined that it may be possible to move circa 3,000 patients from the Platform One Practice list and allocate these patients to another practice closer to where the patient lives. The primary care team are to explore allocating patients to practices, rather than writing to patients and asking them to re-register themselves. The allocation approach has been adopted recently for the closure of Radford Health Centre and Bilborough Surgery as it does not require patient action (as their registration will be physically transferred to another practice by the CCG) and reduces public movement which is preferred during the current COVID situation. However patients continue to have the right to choose to register at another GP practice. There are 96 practices that have been identified as potentially receiving patients (41 City, 37 South Nottinghamshire, 18 Mid-Nottinghamshire). This project is confidential at this stage and is dependent upon discussions with the 96 practices around their capacity and appetite to accept additional patients, this will be undertaken at a PCN level. At this stage it is not anticipated that practices will be allocated more than 70 patients; the breakdown of allocation at present is:  21 practices receiving between 60 & 70 patients  17 practices receiving between 40 and 59 patients  58 practices receiving less than 40 patients Should the allocation proceed as planned it is anticipated that all patients will be written to during Q4 2020/21 to advise them that their registration has been transferred to a named practice closer to their registered address. Discussions are being held with the CCG Communications and Engagement Team regarding stakeholder and patient engagement and communication. Note - Platform One Practice does not have a formed PPG group therefore alternative patient engagement approaches will be explored with the CCG engagement team.

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B) Procurement To support this phase B, please also see EQIA completed in January 2020 for the most recent procurement of Platform One Practice. This has been attached as it provides further background information on the practice and because the impacts stated in that EQIA in response to the procurement exercise will remain the same here albeit the impacts will now be on a slightly smaller list size than those quoted in the January 2020 EQIA. The CCG has to re-procure the Platform One Practice APMS contract for core primary care services. This decision was reviewed in 2015/16 when all APMS contracts were reviewed, concluding they should be re-procured in line with the National Direction to align practice income (APMS contracts regionally and centrally were offered out at global sum and our offer is reducing down to global sum over 5 years). The APMS contract will be to provide core primary care services, any additional services to be provided should / will be commissioned as enhanced services and should be available to all GP practices at either an ICP or ICS level. This reduces inequality amongst the GP practice offer. For the remaining circa 7,800 patients that will stay on the Platform One Practice list a local expression of interest process will be run to identify a new provider, this will involve a mini competitive Expression of Interest process. The new provider will be required to identify new premises within 0.5miles of the City centre (Old Market Square) for the contract start date of 1st April 2021. The current premises are owned by the incumbent provider NEMS and they have indicated that they would not be willing to rent these out to another provider. It is standard practice within procurements to also assess the bidders knowledge and understanding of the patient population and how they will tailor their services to meet these needs. Identify Area Affected (CCG wide / Locality / Primary Care Network (PCN)): Platform One Practice is located in Nottingham City East PCN. The 96 receiving practices are located across all ICP areas and across the majority of the 20 Nottingham and Nottinghamshire PCNs. 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 from your evidence search and how they have informed this scheme) If you have been unable to find evidence, please describe what you have based this project on instead (e.g. activity data, population data, patient experience or public engagement intelligence, clinical opinion etc.): The practice profile used for the January 2020 EQIA provides an overview of the total practice population. Additional information gathered in recent weeks is included in the impact assessment below. A list of the postcode dispersal areas has been provided to NEMS who are reviewing the patients’ resident in those areas and will flag patients that may require a care plan and detailed handover to a new GP practice and/or support services (if not already accessing them). The latest GP Patient Survey results for the practice are available here https://www.gp-patient.co.uk/.

Section 2: Health Inequalities Assessment Identify the impact of the project on health inequalities in terms of both outcomes and access for service users? The WHO describes health inequalities as differences in health status or in the distribution of health determinants between different population groups.

Positive impact ☐ Negative impact ☐ No impact ☒ N/A ☐

Comments/rationale: When completing this section include:  Details of the specific under-served people/groups that will benefit from the project (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  Details of any differential impact between CCG populations.

No impact is anticipated at this stage for either Part A (dispersal) or Part B (procurement) because: Access  Core opening hours (8am – 6:30pm) will remain the same at all practices for the A) dispersed patients, and for the B) newly procured practice as these are based on national standard contract hours.  Extended hours – at this stage anticipate minimal changes. Any change in extended hours for the new procured practice would need to be agreed within their PCN during the mobilisation period of the new APMS contract. For those patients being dispersed to another GP practice (and PCN) there may be different arrangements in place for extended hours, but all PCNs have to offer extended hours for their practice population. This may mean that extended hours are provided on a different day/time and location to what the patient is currently used to.  The minimum number of clinical hours provided (quoted in the specification) remains the same. If a bidder fails to meet this minimum threshold then they will be rejected during the procurement process.

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 Discussions are underway re: the TUPE implications however at this stage it is anticipated that some staff will transfer over if the contract is awarded to a new provider. It is assumed that this will happen therefore access to male and female clinicians should remain the same. TUPE will not apply for phase A of the project therefore patients who are allocated to another practice will see different staff members however access to male and female clinicians should be in place across the other 96 practices.  If a mini competitive expression of interest process is run then patient feedback on access (from survey results, NHS choices etc.) will be provided with the tender documentation and bidders will be expected to include a response in their submission on how they plan to maintain and improve (where necessary) the access results. For the dispersed patients GP access results vary between practices but all practices are expected to review and continually try and improve on patient experience of access.  For phase B the physical location of the practice is likely to change which could result in some of the circa 7,800 patients having to travel a further or lesser distance (depending upon where they live / work). Patients can continue to exercise their choice and choose to register at another practice. As previously stated a maximum radius of 0.5miles of the City Centre has been set for the re-location. At this pre-procurement stage we do not know what the proposed premises will be however they will be expected to be compliant with NHS premises requirements and reviewed during the expression of interest and tender.  Where patients are allocated to another GP practice they will continue to be able to access CCG wide commissioned primary, community and secondary care services. One of the aims of standardising the APMS contracts is to reduce inequity between primary care GP services, ensuring that patients receive a consistent level of service regardless of which GP practice they are registered at. If they require enhanced levels of care then this should be available to be delivered by all GP practices by way of commissioned enhanced services at an ICP or ICS level. For example, enhanced homeless support should be offered by way of the enhanced homeless service to all GP practices, for enhanced mental health support this should be provided by community, secondary or PCN wide services that are available to all local practices. Further reference is made to this in the assessments below for vulnerable and protected groups. Outcomes  QOF performance – it is expected that the new provider will achieve similar or improved results. This has a direct impact on outcomes as many of the QOF indicators are linked to better outcomes for a range of health conditions e.g. blood pressure reading for diabetes patients and CKD patients with readings within NICE recommended range which is linked to better management of the condition, annual CHD health checks etc. QOF performance for other practices (including the 96 practices) does vary but all practices are expected to aspire to the same QOF performance targets.  The specification for the procured practice states that the provider is expected to achieve a CQC rating of ‘Good’ or above, this includes an assessment on service outcomes which is expected to be consistent or an improvement on the current CQC rating of the practice. The Platform One Practice is currently rated as “Outstanding”.  For the patient dispersal and allocation, the vast majority of the circa 3,000 patients are being allocated to either a Good or Outstanding GP practice. There are however approximately 37 patients due to be allocated to Beechdale Surgery which is currently a Requires Improvement practice and 2 patients allocated to Queens Bower which is Inadequate rated. The primary care commissioning and quality teams are working closely with Beechdale Surgery regarding the improvements to be made there. The 2 patients allocated to Queens Bower are being reviewed and will be allocated to another practice.

Section 3: Protected Characteristics and Inclusion Health Groups Assessment:

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. Nottingham and Nottinghamshire CCG EQIA Template V1 July 2020

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 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.  Try to put yourself in patients’ or carers’ 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

i) Impact on the protected characteristic of Age: Positive impact ☐ Negative impact ☒ No impact ☐ N/A ☐ Comments/rationale The practice has a predominantly young working age population. Patients aged 60 and over make up a small proportion of the list (see age breakdown in January 2020 EQIA). The January 2020 EQIA also highlighted CQC report references to the practice having a high number of vulnerable children (280). Phase A impact (partial list dispersal and allocation) At the time of preparing this EQIA the age breakdown of the patients who are to be dispersed to another Nottinghamshire practice is: Age 0 – 17 years 18 – 30 years 31 – 49 years 50 – 65 years 66+ years No. of pts. 456 802 1,214 300 61 There is a small number of patients aged 66+ who are on the dispersed list, these patients are being re-allocated to either another City practice or a South Nottinghamshire practice – mostly within the West Bridgford area. These patients are being re-allocated to a practice closer to where they live however depending on how they travelled to NEMS (car, public transport etc.) there may be a negative impact as public transport routes may not be as direct to their new practice. Due to the small numbers there is limited impact on the whole population in relation to age as a result of this dispersal, acknowledging that the impact for a small number of people may be significant we would recommend that this is mitigated through a robust transition plan. The majority of the dispersed patients are student / working age 18 – 49 who may have chosen to register at NEMS because they work/study in the City and this provided more convenient access for them around their working hours. Allocating them to a practice closer to their home could have a potentially negative impact; however, this is in part mitigated as there are extended hours available within locality PCN areas for all patients to access. Also, with the increased remote working from home following COVID it should be acknowledged that it may no longer be as convenient for a patient to be registered at a practice close to where they work / study. Phase B impact (re-procurement) The impact of the re-procurement on Age is the same as that quoted in the January 2020 EQIA i.e. no impact is anticipated overall. The location change of the new service may have both positive and negative impact on age, particularly the elderly dependent upon how far they have to travel to the new practice. The impact is reduced slightly as the new practice is required to be within 0.5 miles from the City centre (Old Market Square) and that is well served by public transport. As previously recommended acknowledging that the impact for a small number of people may be significant we would recommend that this is mitigated through a robust transition plan ii) Impact on the protected characteristic of Disability:

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Positive impact ☐ Negative impact ☒ No impact ☐ N/A ☐

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Comments/rationale: Phase A impact (partial list dispersal and allocation) For the patients who are being allocated to a practice closer to home there may be a positive impact on disability in terms of a lesser travel distance to the practice however depending on how they travelled to NEMS (car, public transport etc.) there may be a negative impact as public transport routes may not be as direct to their new practice. There may be some negative impacts on continuity of care as patients will be receiving care from a different practice team. Phase B impact (re-procurement) The impact of the re-procurement on Disability is the same as that quoted in the January 2020 EQIA. The location change of the new service may have both positive and negative impact on disability, particularly the disabled population depending upon how far they have to travel to the new practice. The impact is reduced slightly as the new practice is required to be within 0.5 miles from the City centre (Old Market Square). The premises will need to be compliant with NHS premises rules and regulations including accessibility standards for premises. There may be some negative impacts on continuity of care as it is likely that not all staff will TUPE over to a new provider and provide services for the smaller list size. Mental Health The January 2020 EQIA refers to the reported higher numbers of patients with mental health conditions. NEMS diagnosis information is provided below – this is information on patients with a diagnosed mental health condition. These may include past or inactive mental health conditions; mild mental health conditions e.g. phobias and does not include patients who do not engage with secondary care and therefore have no diagnosis code. A full list of the mental health coded conditions is included at appendix B.  Of the circa 11,000 patients registered at NEMS 7,163 patients have a mental health diagnosis code (note caveats above). We do not currently have this level of data for other City practices, however, 2019/20 QOF prevalence for the following disease areas demonstrates that prevalence is above CCG average but is broadly in line with some of their neighbouring PCN practices in that PCN Schizophrenia, bipolar affective NHS Digital: 2019/20 QOF Results Clinical Prevalence Depression disorder & other psychoses NEMS Platform One 15.67% 1.67% Family 14.14% 1.69% Victoria 14.11% 1.68% Windmill 12.32% 1.65% Wellspring 11.05% 1.53% CCG Average 10.84% 0.81% Bakersfield 9.9% 0.59% Greendale 9.72% 1.14%  Of this 7,163 total who have a mental health diagnosis code 2,389 appear on the dispersal list  294 of the 2,389 dispersed patients have either a major or severe MH diagnosis code e.g. psychosis, severe depression, schizophrenia, personality disorder etc. See appendix B for a list of codes. Local Mental Health Teams (Notts Healthcare Trust) are linked to specific GP practices; the City South Local Mental Health Team covers NEMS Platform One GP Practice. They have 160 patients ‘open’ from Platform One Practice and they anticipate that due to NEMS working model (i.e. large practice boundary area) there could be approximately 100 patients that will be allocated to another GP practice and therefore may need re-allocating to another Local Mental Health Team. However, we have not yet validated this information; this team is unlikely to know what the new practice boundary is therefore this number could change. We will work with the team and NEMS to understand which patients are affected. There may be a negative impact on this patient group for both Phase A and Phase B as these patients may not receive the same service that they have been receiving to date from NEMS e.g. the new provider and other practices may not have dedicated Mental Health Nurses (further information below). However as a result of this project those patients will continue to be able to access mental health services on the same basis as other mental health patients across the City and County i.e. via the CCG commissioned mental health services where they meet the necessary service criteria. A list of these services is available at https://www.asklion.co.uk/kb5/nottingham/directory/advice.page?id=fvGQCJXp_WY and includes IAPT, Turning phone MH telephone line, 24/7 crisis line and Community Mental Health Team support. The CCG Mental Health commissioners also advise that as part of the transformation of community MH services in the next 3 years there is expected to be additional staff provided for community mental health and in a more integrated primary and community care model. There are also discussions at PCN level regarding the additional roles with some PCNs exploring whether

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to employ Mental Health Nurses to work across their PCN and work at an ICP level for additional Link Workers. Mental Health Nurses – In January 2020, NEMS employed 1 Mental Health Nurse who worked 9 hours a week, equivalent to 2 clinics per week. Platform One Practice APMS contract is currently paid at a very higher £ per patient compared to other practices and higher than available under the new contract. It is understood that NEMS have been able to use this increased funding to offer their patients an above core GMS service e.g. they can provide more mental health support whilst the patient waits for secondary care mental health services. Other practices may not currently be able to do this within their core GMS funding and therefore patients at other practices may access to mainstream mental health services only. NEMS have confirmed that the Mental Health Nurse does not have a specific case load or offer specific mental health programs to patients. They support the GPs by seeing these patients in place of a GP. The Mental Health Nurse would be eligible to TUPE over to a new provider if that new provider included this role in their service model. iii) Impact on the protected characteristic of Gender re-assignment: Positive impact ☐ Negative impact ☒ No impact ☐ N/A ☐ Comments/rationale: The core services for this group that are commissioned and provided at other GP practices and under the new APMS contract will not change i.e. they should be the same as those currently available at Platform One Practice. The main impacts may be observed around continuity of care. Phase A impact (partial list dispersal and allocation) There may be some negative impacts on continuity of care as patients will be receiving care from a different practice team who may not be familiar with their history. Patient records will transfer and be available to the new practice and all practice staff are expected to receive training in relation to confidentiality, privacy and dignity. Phase B impact (re-procurement) There may be some negative impacts on continuity of care as it is likely that not all staff will TUPE over to a new provider therefore patients may be receiving care from a different member of staff who may not be familiar with their history. However patient records will be available at the new practice and all practice staff are expected to receive training in relation to confidentiality, privacy and dignity iv) Impact on the protected characteristic of Pregnancy and maternity: Positive impact ☐ Negative impact ☒ No impact ☐ N/A ☐

Comments/rationale: The core primary care services for this group that are offered at other GP practices and under the new APMS contract will not change i.e. they should be the same as those currently available at Platform One Practice. The main impacts may be observed around continuity of care and location of baby and health visitor clinics. Phase A impact (partial list dispersal and allocation) The CQC report indicated that Platform One run a weekly baby clinic. This is common practice amongst other GP practices. If NUH (as the provider of the baby clinics) does not run a clinic from the new GP practice then patients may have to travel to another location. However it is the location rather than the service availability that will change and NUH will continue to provide access to this service for all eligible patients. There may be some short term negative impacts on continuity of care for women who are currently pregnant patients will be receiving care from a different practice team who may not be familiar with their history. However patient records will be available at the new practice and all practice staff are expected to receive training in relation to confidentiality, privacy and dignity. Phase B impact (re-procurement) At this stage of the procurement we do not know what the potential bidders will propose in terms of meeting the needs of this population however we anticipate no impact on this group. There may be some negative impacts on continuity of care as patients may be receiving care from a different practice team who may not be familiar with their history. However patient records will be available at the new procured practice and all practice staff are expected to receive training in relation to confidentiality, privacy and dignity v) Impact on the protected characteristic of Race (Includes Gypsies, Roma and Travellers): Positive impact ☐ Negative impact ☒ No impact ☐ N/A ☐

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Comments/rationale: The practice serves a diverse inner City population which includes patients seeking asylum. We are not aware of particularly high numbers of patients from a specific ethnicity group, the population is diverse. The practice boundary (appendix 1) still covers the inner city therefore we anticipate that a large proportion of the diverse patients will remain with the practice and not be dispersed to other practices. Nottingham and Nottinghamshire Refugee Forum have contacted the CCG to advise that due to some issues they experience with registering clients at GP practices their current procedure is to ask for clients to be registered at Platform One Practice using their Refugee Forum address as a care of address. We have checked this address against the patient list, there are 26 patients registered at this address and this address remains within the new practice boundary therefore these patients will remain on the Platform One Practice list i.e. they will not be dispersed. Phase A impact (partial list dispersal and allocation) We do not hold demographic information on the patients that are being dispersed and allocated to another GP practice. Where patients are being allocated to another City practice we anticipate a lesser impact because those practices may serve similar populations and the access to GP interpreting services will be the same i.e. it includes face to face GP interpreting. Where patients are being allocated to an out of City practice, closer to their home, there may be some negative impact if the practice does not have the same level of cultural or language expertise / knowledge. Similarly, a different level of service is available for GP interpreting in the County areas. It does not include face to face language interpreting. However, with COVID there may be a greater reliance on telephone based GP interpreting. Phase B impact (re-procurement) Some staff are expected to TUPE over to a new provider therefore staff with cultural or language expertise / knowledge for the local patient population may continue to provide services under the new APMS contract. There will be no change to the way in which the practice accesses GP interpreting services (spoken language or sign language) under the new contract as this is a separately commissioned service. vi) Impact on the protected characteristic of Religion or belief: Positive impact ☐ Negative impact ☒ No impact ☐ N/A ☐ Comments/rationale: The core services for this group that are offered at other GP practices and under the new APMS contract will not change i.e. they should be the same as those currently available at Platform One Practice. The main impacts may be observed around continuity of staff with knowledge and experience of local cultures. However this may be mitigated if staff have received cultural awareness training. Phase A impact (partial list dispersal and allocation) We do not hold demographic information on the patients that are being dispersed and allocated to another GP practice. Where patients are being allocated to another City practice we anticipate a lesser impact because those practices may serve similar populations and have some understanding of local cultures. Where patients are being allocated to an out of City practice, closer to their home, there may be some negative impact if the practice does not have the same level of cultural or language expertise / knowledge. However this may be mitigated if staff have received cultural awareness training. Phase B impact (re-procurement) Some staff are expected to TUPE over to a new provider therefore staff with cultural or language expertise / knowledge for the local patient population may continue to provide services under the new APMS contract. vii) Impact on the protected characteristic of Sex: Positive impact ☐ Negative impact ☐ No impact ☒ N/A ☐

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Comments/rationale: The core services for this group that are offered at other GP practices and under the new APMS contract will not change i.e. they should be the same as those currently available at Platform One Practice. Phase A impact (partial list dispersal and allocation) It is expected that all of the 96 practices will be able to offer appointments with both male and female clinicians. Phase B impact (re-procurement) Some staff are expected to TUPE over to a new provider therefore the population should continue to have access to male and female clinicians. viii) Impact on the protected characteristic of Sexual orientation: Positive impact ☐ Negative impact ☒ No impact ☐ N/A ☐ Comments/rationale: The core services for this group that are offered at other GP practices and under the new APMS contract will not change i.e. they should be the same as those currently available at Platform One Practice. The main impacts may be observed around continuity of care. Phase A impact (partial list dispersal and allocation) There may be some negative impacts on continuity of care as patients will be receiving care from a different practice team who may not be familiar with their history. Patient records will transfer and be available to the new practice and all practice staff are expected to receive training in relation to confidentiality, privacy and dignity. Phase B impact (re-procurement) There may be some negative impacts on continuity of care as patients may be receiving care from a different practice team who may not be familiar with their history. However patient records will be available at the new practice and all practice staff are expected to receive training in relation to confidentiality, privacy and dignity ix) 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) Positive impact ☐ Negative impact ☒ No impact ☐ N/A ☐

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Comments/rationale: (with an indication of which of the above groups have specifically influenced your impact conclusion)  Carers The practice has a young population. In their CQC report the practice identified 68 patients as carers and a similar number of patients who had a carer. These are low numbers; this is to be expected with the nature of their patient population. The CQC report noted this as an area for improvement – ‘the provider should … identify further patients who are carers and direct them to available support to enable them to carry out their role’. The practice also recognised the need to appoint a carer’s lead to support with this, have a carer’s strategy/policy and develop links with the local carers association. Phase A impact (partial list dispersal and allocation) Carer’s may be impacted by having to travel further if the person they are caring for is allocated to another GP practice. The carer and the cared for may have chosen to register at the same practice for ease of access to services. However this could also have a positive impact for carers if the practice is closer to their home. Phase B impact (re-procurement) Carer’s may be impacted by having to travel further to a new practice location, however, this is mitigated by the requirement for the new location to remain central to the City and be within 0.5miles of the City centre. This could also have a positive impact for carers if the practice is closer to their home.

 Homeless people The inner city location of this practice and close proximity to homeless hostels means that the practice does have a number of patients who are from this disadvantaged group. The CQC report indicated that 350 people were registered as homeless. The current practice has recently chosen to end the support (a weekly drop in clinic) that they were providing alongside Nottingham CityCare to the Emmanuel House (this was not specifically commissioned by the CCG) and whilst this will have an impact on the homeless population it is not linked to the Platform One Practice dispersal and expression of interest exercise being considered. It is impossible at this stage to predict the level of engagement that any new provider may have with Emmanuel House. Phase A impact (partial list dispersal and allocation) It is anticipated that the homeless population will remain with the new GP practice as it is understood that they may use the practice’s address as their home address and so they will remain within the boundary of the new practice. Using the patient list there are 346 patients registered at Platform One Practice who have the Platform One Practice address as their main home address. Phase B impact (re-procurement) Due to the potential location change of this practice there could be a negative impact on this group as they may need to travel further to access services; however, this is mitigated by limiting the distance to 0.5miles of the City centre. Staff that are experienced with this population may be eligible to TUPE over to a new provider and offer continuity of care and knowledge/expertise. However they may be some disruption to continuity of care if not all staff TUPE over. At an ICS and ICP level there is progress being made to pool resources for complex patient populations, including homeless, and the additional needs of this population group should be addressed by this approach. It was expected that a new approach will be in place by the time that this new APMS contract commences in April 2021 however this may have now been delayed due to COVID. As a result of the re-procurement of this APMS contract the provider will still be expected to register homeless patients and provide core primary care services. The Homeless Local Enhanced Service continues to be available for the practice to participate in. During the mobilisation of the new service a new bidder will be expected to clearly communicate any service changes to this population group and build relationships with organisations that support this group. The support groups for these patients will be key in communicating this change to the cohort. The homeless patients temporarily housed in the INFORMATION REDACTED remain within the practice boundary. We are aware of 17 individuals who are being temporarily housed during COVID in the INFORMATION REDACTED. This location falls just outside of the new practice boundary and these individuals did receive a letter notifying them of the dispersal. However, we should review this as part of a robust transition plan and if these individuals are still living at this hotel in January 2021 will consider keeping them on the Platform One Practice list.

 People who misuse drugs The impacts described above for the homeless population also apply here (requirement to travel further, access to specialist staff etc.). The CQC report from 2017 noted that 8% of the patient list (800) had a substance misuse diagnosis. NEMS have provided a list of their substance misuse patients; there are a total of 49 patients. 21 of these live outside of the new Nottingham and Nottinghamshire CCG EQIA Template V1 July 2020

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practice boundary and will therefore be dispersed. Based on resident address 1 patient lives outside of Nottinghamshire, the remaining 20 patients will be allocated across 16 GP practices – 14 GP practices in the City, 2 GP practices in the County. The 2017 CQC report indicated that the practice run a weekly shared care clinic with the specialist drug worker from the central recovery team. The Nottingham City Local Authority commissions this via their enhanced service. There are 5 practices in the City signed up to provide this Shared Care Service for patients who are primary or secondary opiate users (excludes alcohol only users who are referred to Nottingham Recovery Network (NRN) which is run by Framework from The Wellbeing Hub, Hounds Gate). Practices work in close partnership with specialist substance misuse workers currently provided by NRN to provide prescribing-based drug treatment within a primary care setting. Practices are paid £410 per patient per annum. There are around 300 patients in total on the scheme, 50 of which are registered at Platform One Practice (with 21 of being to be dispersed in this project). The enhanced service / shared care service means that participating practices can see patients from any GP practice i.e. the patient does not have to be registered at that practice in order to receive this enhanced support. Framework also runs ‘Clean Slate’ from The Wellbeing Hub, a service to reduce reoffending through engagement and treatment of people who are addicted to drugs and alcohol. NRN Harm Reduction Service at Broad Street provides needle exchange. NRN holds joint clinics as part of the Shared Care Service. Patients generally attend NRN via signposting by GP / self-referral therefore the service is unable to provide practice level activity data. These services will continue to be available to patients.

In the County there is no similar enhanced shared care service, however Change Grow Live have been commissioned to provide Drug & Alcohol support. They prescribe methadone and work with the patient’s registered GP practice.

We will continue to work with both Local Authority’s over the coming months to ensure a safe and appropriate patient allocation and handover of the 20 patients. We are also informed that some Pharmacies provide substance misuse support in the form of “supervised consumption”. Concerns have been raised by the Nottingham City East PCN (which Platform One Practice is in) about the ability of practices to manage substance misuse patients and a possible influx of patients to the Nottingham Recovery Network in the City. This will be discussed with the Local Authority as the lead commissioners of this service. It is expected that following the expression of interest process a new provider for the 7,800 patients will continue to deliver this substance misuse enhanced service for the 28 patients remaining on the list. Staff that are experienced with this population may be eligible to TUPE over to a new provider and offer continuity of care and knowledge/expertise. This continuity of care will not be available for patients on the dispersed list; however, there may be clinical staff within the new practice that have an interest of specialism in this area. During the mobilisation of the new service a new provider will be expected to clearly communicate any service changes to this population group and build relationships with organisations that support this group.

Platform One Practice also provide primary medical services to approximately 70 male patients who reside at Willoughby House in Upper Broughton on the Nottinghamshire / Leicestershire border. This arrangement was made between Platform One Practice and Teen Challenge UK, who is a registered charity helping young people with drug and alcohol additions. It is a not an arrangement which is commissioned separately by the CCG. Willoughby House is outside of the new Platform One Practice boundary and therefore all of these patients will be allocated to their closest practice which is the Village Health Group (Keyworth Surgery). There will be an impact on continuity of carer as their core primary care services will be provided by this different GP practice however these patients will continue to receive the specialist support and treatment from Willoughby House for the time period that they are resident at the rehabilitation centre. Willoughby House does not receive support from Change Grow Live (referred to above), they manage this in house. Willoughby House have confirmed the following:  They have a private GP who deals with all of their medical detoxification programmes, therefore they do not require detox medical intervention from a GP practice  They look to only register their residents for general medical health purposes  They have a very good relationship with Mr Singh from Keyworth Pharmacy who has worked with them for over 7 years. The CCG plans around dispersal should not affect this  Current arrangements with Platform One Practice = patients are triaged and primarily receive telephone / skype consultations as necessary. Should they need a face to face appointment this is then arranged  There are some medications that Teen Challenge do not accept, they do not accept patients on antipsychotic medications as they are not equipped to deal with the acute mental health needs. They also do not allow any Benzodiazepine, Opiod or SRRI based medications, and do not accept sleeping tablets or Pregablin. They are happy to work with GP's to discuss the needs of the resident and look for alternatives as appropriate and GP led.

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Prior to COVID, NEMS also confirmed that patients either arrive by mini bus as a group or attend individually with their support workers to receive primary care services and advised that the average contact for these patients is 5 times per year for physical health check only (as their addiction support is provided at the rehabilitation centre).  New and emerging communities, including refugees and asylum seekers The CQC report noted that the practice had a high number of families from overseas and their patient population had 100 different ethnic groups recorded with 5% of the patient list recorded as non-English speaking. This is to be expected and is not dissimilar to other neighbouring practices in the inner City locations. We are not aware of the practice providing any specific services to this patient population over and above core primary care services. Phase A impact (partial list dispersal and allocation) It is likely that many of these patients reside within the inner city and so will remain on the list of the new practice. If there are patients who are to be dispersed there may be some impact depending upon which practice they are allocated to. If the patient is allocated to another GP practice in the City then this practice may have experience of managing patients from this protected group and also signed up to the Asylum Seekers enhanced service. The enhanced asylum seekers service is also available to the County practices. Practice staff may also have received cultural awareness training. Phase B impact (re-procurement) The re-procurement of the new APMS contract should not change the level of service provided to this patient group. The practice is expected to continue to be signed-up to the Asylum Seekers enhanced service and access to translation service will continue as these are commissioned separately. The change in location of the service could have an impact as some patients may have to travel further and this could cause some confusion if not communicated and managed appropriately. Some patients may have to travel a shorter distance therefore having a positive impact. Staff with experience and understanding of these patients will be eligible to TUPE over to a new provider.  People experiencing economic or social deprivation, including those who are long-term unemployed, have limited family or social networks Due to its inner city location the practice does serve populations from this group. Under the new APMS contract these patients may be expected to travel further for services or travel a shorter distance (depending upon where they live and how they access the services). The new premises are required to be within 0.5miles from Market Square and is central to the City with easy access to public transport. Due to its central location patients from this group may not incur additional financial costs if they access services via public transport e.g. bus or tram, as the cost of ‘all day tickets’ for example are fixed are likely to cover the city centre radius. The APMS contract does not stipulate how services are to be provided (providers are required to meet the health needs of their population) therefore at this stage we do not anticipate an impact on this patient population. It is unlikely that patients from this group will be on the dispersed list, if they are there may be positive impacts as they have to travel a lesser distance from their home to access primary care services at their new allocated practice. However it is acknowledged that public transport routes may not be as direct as they are to the City Centre.  Gypsies, Roma and Travellers It is not anticipated that there will be any changes to the services received by this group at this stage of the procurement process. Patients may have to travel further however this is mitigated by restricting the location of the new premises to be within 0.5 miles of the Market Square. Similarly, it is unlikely that these patients will be on the dispersed list. If they are there may be positive impacts as they have to travel a lesser distance from their home to access primary care services at their new allocated practice. Probation Hostels NEMS register patients from 2 probation hostels in the City and we have confirmed that they are within the new practice boundary and will therefore remain on the Platform One Practice list (they will not be dispersed / allocated to another GP practice). - Trent House Probation Hostel, 392 Woodborough Road, NG3 4JF – the patient list indicates that 23 patients were resident here at the end of September - Nottingham Probation Service, 106-108 Raleigh Street, NG7 4DJ – the patient list indicates that 44 patients were resident here at the end of September. NEMS advised that when patients leave the hostels they tend to remain registered with Platform One Practice unless they move completely out of area. These patients should then be treated in the same way as other registered patients and supported to access primary care services within the appropriate practice boundaries of long term addresses.

Section 4: Assessment of Likely Impact of Controversy

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a) Is the proposal likely to result in controversy due to:  The nature of the service  The patients or carers affected Highly Likely ☐ Likely ☒ Unlikely ☐ N/A ☐ Comments/rationale: Phase A impact (partial list dispersal and allocation) Phase A could be considered controversial as we are allocating patients to another practice and the legal advice received highlighted two risks here (see below) in relation to challenge from patients who may not be amenable to the proposed plans. 1) Patients who are identified as being on the list for dispersal but wish to remain on the list for the new APMS contract. This is considered to be a higher risk and the CCG needs to demonstrate the objective basis on which the decision to allocate patients to the dispersal list has been made. 2) Risk of challenge from dispersed patients who are unhappy with the new practice that they have been allocated to. This is considered a lower risk if the CCG follows an engagement process to make patients aware of this forthcoming change and if there remains a number of other practices from which patients can choose to re- register with then. There may also be controversy from Nottingham and Nottinghamshire practices who are being allocated patients as there is a perception that Platform One Practice has a complex difficult patient population. There could also be some controversy from Willoughby House (male residential rehabilitation unit) around being allocated to another GP practice. Similarly there is likely to be some local councillor interest. We are working with the CCG Communications and Engagement Team to prepare communications and engagement plans to support this project. Phase B impact (re-procurement) The services are expected to remain the same however the location and provider organisation that will be running those services will change. The level of controversy for this element of the project is expected to be low so long as we are able to clearly communicate why this is happening i.e. the practice has to be reprocurred via the local expression of interest process as we are at the end of a time limited contract and NEMS own the current building and have indicated that they would not be willing to rent this out to another provider. Although the decision to reprocure and/or disperse has being made following three failed procurement attempts, and the decision by NEMS not to bid to continue to provide core GMS services at Platform One Practice, there may be impact or controversy surrounding this procurement and change of location and provider . To mitigate this the CCG and PC teams should ensure that the rationale plans and decisions made are shared

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

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Comments/rationale: GP practices in Nottingham have in the past attracted media attention for a variety of reasons; there have been a small number of practice closures in the past few months which may mean that there could be greater media attention on local primary care, especially given the current COVID situation. Following a patient engagement exercise earlier in the year around the procurement one patient did contact NHS England about why the practice has to be re-procured. We have recently allocated patients following another City practice closure. This process did attract some patient feedback and confusion, however, that was mainly around confusion caused by NHS England sending out the wrong letters to the wrong patient groups. Further controls are in place to prevent this from happening in future. A comprehensive transition plan including a clear communication strategy will help mitigate against these risks.

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: As noted above, re-procuring an APMS practice is standard practice across primary care commissioning. The CCG has recently completed a round of 4 APMS procurements and has just started another round. Media attention was received for bundle 2 whereby the local Nottingham Post just reported the facts that these contracts are being procured. As noted above, there was patient contact following a recent patient dispersal and allocation and this is planned to be mitigated through an appropriate transition plan.

d) What engagement activity has been undertaken or planned to gain the views of patients and carers?

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Comments/rationale: The communication and engagement plan is as follows: GP practice engagement (for 96 practices receiving patients)  Meeting held with LMC to share dispersal methodology and engagement approach (10th September)  Meeting with Locality Directors and CCG Clinical leads on Thursday 17th September  Meeting with Clinical Directors on an ICP foot print (24th Sept City, 29th Sept Mid-Notts, 2nd October Nottinghamshire South)  7th October presentation to all GP practices about the project (presentation was also recorded and available on Team Net)  GP FAQ’s produced based on questions raised at all engagement events – being finalised and will be circulated w/c 12th October  NEMS – CCG have kept NEMS informed throughout and the CCG comms and engagement team are linking with NEMS re: staff communication.  Meetings at PCN level with all affected GP practices to answer questions and “agree” their patient allocation numbers Patient Engagement & Stakeholder  Letter posted 7th October to all 3,000 patients who are on the dispersal list. Letter advises patients of upcoming change (that boundary is being reduced, they will be written to in the new year allocating them to another practice) letter points to FAQs on CCG website and Patient Experience Team and advises patients that they do not need to take any action now and also highlights that patient still have a choice (can register at any practice where they are within the boundary).  Associate Director of Primary Care and Head of Primary Care are responding to enquires from stakeholders including the Health Scrutiny Committee around this procurement process.  Meeting with the Health Scrutiny Committee scheduled for 19th November.  In January 2021 the allocation list will be reviewed and updated with the latest list size, the 3000 dispersed patients will be written to advising them of their new GP practice. Vulnerable patients will be highlighted to ensure a safe transfer between providers. Letters will also be sent to the 7,800 patients who are remaining on the list to advise them of arrangements from 1st April i.e. the outcome of the expression of interest process and their GP practice and location PCCC

 Decision to disperse was made in July 2020 by the PCCC  Update papers taken to September and October meeting  Final decision on the outcome of the expression of interest for a provider from 1st April is expected to be made at the December PCCC meeting

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). DPIA completed and sent to IG Team 25/9/2020 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: This is a complicated project which has identified that there are likely to be impacts on a number of protected groups for both phases of the project. The communication and engagement with these groups and local stakeholders will be key to managing the impacts.

Action/s to be taken to minimise adverse impacts / risks:

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Recommendation from project lead:

Proceed with project but with constant consideration and review of risks.

Submit completed EQIA to: [email protected]

Section 7: EQIA Meeting Outcome

Date of EQIA Meeting: 15/09/20

Summary of EQIA Meeting Considerations Considered and recommended to undergo appropriate and Outcome: Quality Team Review.

Data Protection Impact Assessment Yes Required:

Engagement Plan Required: Yes

Quality & Equality Link Identified: Head of Quality Primary Care Quality Health Inequalities Lead Date of Feedback to Project Lead: 15/09/20

Section 8: Quality & Equality Link Review

Date of Review: 15/09/20

Review Undertaken By: Head of Quality Primary Care Health Inequalities Lead Review Summary: To consider below comments and amend EQIA where appropriate prior to submission to EQIA Panel (30/09/20)

Page 5  Age: Further explore impact on working age (access pre and post working hours)  Age & Disability: Acknowledge public transports routes for dispersed patients may be less convenient despite being closer  Disability: Identify mitigations for accessing alterative mental health services Page 6  Gender reassignment: Confirm that all staff will undergo training in relation to confidentiality, privacy and dignity” in respect of continuity of carer (phase A and B)  Pregnancy / Maternity: Acknowledge there may be some negative impacts re continuity of carer and that patient records will transfer and be available to new practice  Race: Requested demographic information to support identification of disadvantaged groups  Race: To identify what interpreting provision is available in the County to mitigate against impact identified Page7

 Religion: Confirm that all staff will undergo cultural awareness training

 Sexual Orientation: Acknowledge that phase B may result in some negative

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impact and confirm that all staff will undergo training in relation to confidentiality, privacy and dignity” in respect of continuity of carer (phase A and B) Page 8  Carers: Consider that this may have a positive impact on carers also  Homelessness: acknowledge this may have a negative impact re continuity of carer Page 9  Substance misuse: further assurance required re review of patients currently accessing specialist support and contingency / care plan for patients that are identified to be dispersed. To further consider whether any patients from this group should be dispersed if there is no contingency in place  Substance misuse: further assurance required re Willoughby House patients and request for further information re outcome of review referenced (have Teen Challenge been engaged)  Substance misuse: adverse impact on continuity of carer to be considered  New and emerging communities: To confirm if an enhanced asylum seeker service exist in the County and to address mitigations if not

Head of Quality Primary Care Quality Health Inequalities Lead

The above comments have been addressed within the EQIA. Some additional concerns were discussed in relation to the patients with mental health needs and those who are homeless / have substance misuse issues. These have also been subsequently addressed within the EQIA and the project team have agreed to undertake work to identify these cohorts of patients and review whether they fall within the cohort that will stay at the practice or not. Where it is identified that they do not, the individual patient case will be assessed as to the suitability to be allocated to a different practice or not. Although some other negative impacts have been referenced throughout the EQIA, the majority have been mitigated, including access to alterative mental Further review with health services, interpreting provision and assurance required re Willoughby project manager: House patients. 12.10.2020 It is noted that there have been 3 recent failed procurements have already taken place and that failure to procure on this occasion could result in a lack of safe and effective primary care services for several thousand patients. The model proposed supports the longer term resilience of primary care and the allocation of patients ensures access to primary care services during the middle of a pandemic.

Section 9: EQIA Panel Outcome Date of EQIA Panel: 18 November 2020 Virtual Review

Summary of EQIA The comments in Section 8. largely acknowledge the potential impacts of the Panel Considerations options described. and Outcome: Continuity of Care is a key theme across all identified groups with particularly

focus on pregnancy / homeless / and mental health.

It is recommended that further engagement is conducted with maternity and mental health services to ensure safe and effective transition to new caseloads. Concerns are flagged about the potential action to transfer circa 100 to another Local Mental Health Team, can plans be built in to ensure this cohort maintain

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their teams / leads. It is also recommended to ensure there is a robust handover where gender reassignment cases are identified

Access is another key theme and the location to the Homeless Hub and placements around the current location. If plan b was to be mobilised it is recommended that rather than ‘clearly communicating’ that this is strengthened as part of the procurement process.

The nature of patient engagement is a fairly standard approach via a letter however it is recommended that further work is undertaken as part of the planning to continue to engage with the patient group through alternative routes and methods in order. The current patient population suggests 100 different ethnic groups recorded with 5% of the patient list recorded as non-English speaking – what additional plans are in place to engage and update.

It is recommended that a comprehensive transition plan be used to manage the impacts identified, incorporating all of the considerations identified above.

It is acknowledged that the impact for a small number of people may be significant especially in cases where people may transect a number of the groups affected. This should be considered in the planning and handover of complex cases and for people who are in the ‘dispersal group’ with exceptional circumstances to be considered on a case by case basis by the new practice,

Date of Feedback to 18 November 2020 Danni Burnett Project Lead:

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Appendix B – list of major or severe diagnostic codes used to identify the 294 patients on the dispersal list Column A – Minor/ Low MH Diagnosed Patients Column B – Major/ Severe MH Diagnosed Patients 294 patients on the dispersal list Other mixed anxiety disorders Psychotic disorder due to use of cocaine/ drug induced Anxiety State NOS psychosis Mixed Anxiety and depressive disorders Severe depression Moderate depression Psychotic disorder Feeling Anxious Manic-depression psychosis, depressed, no psychotic Depression symptoms Depressive Disorder Other schizophrenia Anxiety Disorder/ anxiety disorder unspecified Paranoid schizophrenia Depression NOS Schizophrenia/ schizophrenia disorder Emotionally unstable personality disorder Unspecified schizophrenia Personality disorder Non-organic psychosis NOS Endogenous depression – recurrent Single major depressive episode, severe with psychosis Generalised anxiety disorder Personality disorder (& neurotic) Post-traumatic stress disorder Brief reactive psychosis Other post-traumatic stress disorder Bipolar affect disorder, now depressed, severe with psychosis Mild depression Unspecified nonorganic psychosis Agoraphobia Schizotypal personality disorder Recurrent depressive disorder Acute transient psychotic disorder Chronic depression Schizoaffective disorder Major depressive disorder Panic Attack Narcissistic personality disorder Borderline personality disorder Severe major depression with psychotic features Maternal concern Emotionally unstable personality disorder Obsessive compulsive disorder Parental anxiety Psychotic episode NOS Reactive Depression Catatonic schizophrenia in remission Single major depressive episode Non-organic psychosis NOS Non- organic psychosis in remission Dysthymia Schizoaffective disorder Anankastic personality disorder Bulimia nervosa Eating disorder

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Strategic Needs Review – Platform One Practice – June / July 2020

Objectives for strategic review Rationale 1. Understand the population health The practice has a diverse population ranging from extremely vulnerable inner city patients to the “working well” population that needs of the registered patients commute into the city from outer suburb areas.

The health needs and demands on services of the distinct groups of patients needs to be further understood. The ICS Population Health Management Team has been approached for support in this area and there are plans to work with the incumbent provider. 2. Identify the additional services This is partly documented within the latest CQC inspection report (published in October 2017) and based on information gathered from provided by the practice above and a discussion with NEMS in November 2017. beyond core general medical This area will require clinical support as well as LMC involvement. services (GMS)

3. For services above core (GMS) To identify whether the higher current contract value is supporting the provider to deliver a primary care service that is not comparable with identify whether alternative other practices also serving these populations. Identifying whether commissioned services are in place this has led to inequity amongst the population groups and could be filling unknown commissioning gaps. or whether commissioning gaps exist 4. Understand the strategic direction of To understand how the PCN proposes to design and deliver services to its local patient population and to understand how the ICP complex the Primary Care Network and ICP patient approach will impact upon the commissioning of primary care including commissioning intentions services for this practice. for complex patients.

5. Identify whether there are suitable The CCG’s Associate Director of Estates will be leading this area of work. A fee proposal for an initial premises search is referenced premises available in the City for a above in section 3.5. As previously noted two prospective bidders new GP practice (list size to be had identified potential premises but neither had progressed in any real depth to understand impact on mobilisation. The premises determined by this review) and search commissioned will further explore the work and time required timescales to make ready for clinical to make potential premises suitable for a GP practice.

use This objective has interdependencies with objective 6 below. This objective can be started immediately but will need to be revisited as the review progresses and the future commissioning options in objective 6 are determined. 6. Determine the options for future This objective has interdependencies with objective 6 above.

commissioning arrangements based 6.1 Will include consideration of impact on patients, capacity and on need and the factors identified resilience of other practices, political and reputational impact, and alignment with strategic directions of ICS, ICP and PCN. above. Options may include:

6.1 Full dispersal of the list with 1.2 Will include determining the practice list size, population separate commissioning of the characteristics and specialisms, boundary, delivery model e.g. more online remote working. It will also include consideration of Special Allocation Scheme procurement routes for this contract including; full competitive 6.2 Commission a new APMS process, use of national frameworks, competitive negotiation or direct aware. practice

6.2.1 With the Special Allocation

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Scheme 6.2.2 Without the Special Allocation Scheme

Services to be considered as delivered by Platform One Practice under the APMS Contract

Specialty / Services Commissioned Service CQC reported high coding of MH however this Primary Care Mental Health Offer is not necessarily supported by QOF prevalence Primary Care Mental Health Service, funded by BCF ended Jan which is line with their PCN peers. 19 modelled on the NEMS Platform 1 MH Nurse role to bridge Employ(ed)Primary Care Mental Health Nurse the gap between primary, community and secondary care  Complete mental health assessments services. The service was not evaluated.  Bridge gaps and support patients that do The MH Commissioning Team is considering a business case to not meet the criteria for commissioned provide an Adult ADHD Service to commence 2020/21. LES mental health services – caught in the gap would fund primary care monitoring. between general community MH services, Children’s ADHD Shared Care Protocol approved by APC, IAPT and specialised secondary MH funds practice monitoring via a LES services Need to discuss impact of service change with ante-natal  Supports ante-natal clinic discharge to services should the current level of primary care support reduce NEMS who can provide the required mental health support thereby reducing impact on secondary care Aligned to two Probation Hostels in Nottingham Need to confirm if this is through a contract / sub- contracting City providing primary care services to c43 arrangement with NHS England as commissioners of Offender patients, visits conducted in secure Health services. Tudor House Medical Practice contracted to environments, managing difficult prescribing support HMP Nottingham as sub-contract to CityCare. May protocols require similar procurement Homeless Homeless LES available to practices across the CCG to sign up  Around 350 pts. / 40% of Nottingham City and support this cohort of patients. Focus on transition from homeless are registered with Platform 1 specialist support to accessing mainstream services.  Established weekly GP drop in clinic at Due to the practice location and additional resources they are Emmanuel House in partnership with the willing & able to take on large proportion of the most complex homeless team rough sleepers and individuals experiencing severe multiple disadvantages Review of Homeless services is on-going, Nottm City ICP considering service model options, may be delayed due to COVID. Asylum seekers The needs of asylum seekers go beyond “ordinary” primary care  Agreed to register around 200pts currently services. The need for an interpreter means each patient residing in a Nottingham City centre hotel contact takes longer. Asylum Seeker and Interpreter Assisted  Platform 1 Practice not signed up to IAA, Appointments LESs developed to support practices registering may reflect lack of longer appts this patient group. NEMS not signed up to Interpreter LES.

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Special Allocation Scheme Provided by NEMS Platform One, accessible to Greater NEMS provide a ‘step down’ service in order to Nottingham registered patients, separate service in Mid-Notts keep patients in mainstream services and not commissioned by NHSE. Need to confirm commissioner and on the scheme. contract end date. As a consequence of holding the SAS contract they advise they provide a step down service. Teen Challenge UK (Willoughby House, Arrangement set up by NHS England but not documented in Leicester) – according to postcode mapping = contract. Need to understand the commissioning of this service. approx., 91 patients Believe NEMS took it on because no Rushcliffe or Leicester GP Pts. arrive individually or in a group with support practices would accept responsibility these patients at this worker(s). NEMS liaise with Drug and Alcohol private rehabilitation centre. residential rehabilitation centre to offer Work with Capital One and Loxley House to Not believed to be formally commissioned. An additional service provide convenient appointment times for staff provided by NEMS tailored to their population. and link with the Workplace Chaplaincy GP Clinical Lead for Substance Misuse holds / Need to understand the commissioning of this service held weekly shared clinic with specialist drug Potential loss of skilled staff providing targeted support. Could worker from central recovery team this be a PCN scheme? Pharmacist mentored to set up prescription medicine misuse clinics with support of GP lead

112 of 136 09:00 - 09:50-16/12/20 Final response letter to Nottingham City Health Scrutiny Committee

Reference Enquiry Current Organisation Date Category Sub Provider Practitioner Contact Enquiry Description Date Closed Outcome Outcome Reason Number Type Stage Received Category Organisation Source GP/20/276 Enquiry Closed South 08/10/20 Primary GP practice GP NEMS Telephone Unhappy that GP practice is closing, even though lives out side of 08/10/20 Enquiry resolved Nottinghamshire Care closed Platform One the area. Does not think his local surgeries are clean and is not Locality happy about having to be moved to one. He was advised that Platform 1 will be closing 31.3.21 and that could contact NHSE if not happy with this. GP/20/277 Enquiry Closed City Locality 08/10/20 Primary GP practice GP NEMS Telephone Patient was confused by the letter. We confirmed that it was to 08/10/20 Enquiry resolved Patient reassured they do not have to do anything. Letter Care closed Platform One notify them of the changes happening next March, he will be for information only. automatically found a new GP and that he wont have to do anything. GP/20/278 Enquiry Closed City Locality 08/10/20 Primary GP practice GP NEMS Telephone Very distressed patient shouting down the phone that 'you can't 08/10/20 Enquiry not resolved - No contact details left. Care closed Platform One send me a letter saying you're taking my GP away. You can't do unable to contact this to me. No contact details left. enquirer GP/20/279 Enquiry Closed City Locality 09/10/20 Primary GP practice GP NEMS Telephone Enquirer advises is devastated that Platform 1 is closing. Patient 14/10/20 Enquiry resolved Patient devastated surgery is closing down as needed to Care closed Platform One advised they are disabled and has to be accompanied by their be accompanied due to disability. partner to the surgery because their partner works close to the practice . Since receiving the letter the partners personal circumstances has changed and will now be available to take patient to a closer practice. Would prefer to be moved to Netherfield which they say is closest to them but will wait for second letter to advise on the new practice. GP/20/280 Enquiry Closed City Locality 09/10/20 Primary GP practice GP NEMS Telephone Patient is distressed in having to move surgeries. Suffers from 14/10/20 Enquiry resolved Patient felt better for having spoken to someone who Care closed Platform One anxiety and depression and has got to know all staff and has confirm what was going to happen and was re-assured. formed a comfortable relationship with the clinical staff. I confirm the process and that the surgery was closing. Patient assured having spoken to someone, confirming the what was happening.

09:00 - 09:50-16/12/20 09:00 GP/20/281 Enquiry Closed City Locality 09/10/20 Primary GP practice GP NEMS Telephone Patient said was worried about Platform 1 closing, was previously 09/10/20 Enquiry resolved Patient felt assured having spoken to someone. Care closed Platform One homeless and has been registered there since then. I explained the process and the patient said they reassured having spoken to someone. I explained that the practice would still be seeing patients as normal up until the end of March. GP/20/282 Enquiry Closed City Locality 09/10/20 Primary GP practice GP NEMS Telephone Is really concerned that has received letter about Platform 1. Is 14/10/20 Enquiry not resolved - Felt unsettled as is currently undergoing investigations Care closed Platform One currently undergoing investigations for condition and is concerned enquirer not satisfied and will have to start from the beginning with the new will have to build a relationship with a new GP and go through all practice. health issues with them. I confirmed that medical records should be automatically transferred to new practice at the end of March. I gave assurances practice was not opening else where. Finished call patient still unsettled.

GP/20/283 Enquiry Open City Locality 09/10/20 Primary GP practice GP NEMS Telephone Left voicemail wanting to speak about the closure of Platform 1. Care closed Platform One Unable to contact patient.

GP/20/284 Enquiry Closed City Locality 13/10/20 Primary GP practice GP NEMS Telephone Has received letter advising about the closure of Platform 1, is ok 14/10/20 Enquiry resolved Left message for patient call back end of January if not Care closed Platform One with this but the letter was sent to their previous address. Is received letter. concerned that will not get the second letter advising of the new surgery being allocated to. I was unable to speak with patient but left a message apologising for this situation and to contact us at the end of January 2021 if has received their second letter.

GP/20/286 Enquiry Closed City Locality 13/10/20 Primary GP practice GP NEMS Telephone Enquirer is the carer of the patient registered at Platform 1 and 14/10/20 Enquiry resolved Explained surgery was closing and all patients are being Care closed Platform One suffers from mental health and physical disabilities. Enquirer says transferred to alternative practices. I apologised for any that this change will cause a drama and additional stress for this distress this process would cause. patient, is the first time they have got settled at surgery, he is taking GP advice, has a really good relationship with Dr Courcha and feels comfortable with them and would like to stay at the surgery. I advised that the surgery was closing and that all patients would be transferred to an alternative practices. I apologised for any distress this would cause. 113 of 136 113 114 of 136 114 Final response letter to Nottingham City Health Scrutiny Committee

GP/20/275 Enquiry Closed South 14/10/20 Primary GP practice GP NEMS Email Enquiry from patient following receipt of letter saying that 12/10/20 Enquiry resolved Enquirer advised to contact Platform 1 and ask where Dr Nottinghamshire Care closed Platform One Platform 1 will close in March 2021. Patient says that's Dr Graham Graham will be transferring to when the surgery closes. Locality has kept him alive during the last 10 years as he suffers from Patient also advised that he can register at any practice as chronic depression and is the only GP he has come across who long as he is in the catchment area. understands him. The letter has set the patient back and now needs further therapy in order to be able to deal with the effect of the letter. Patient says that he needs to be wherever Dr Graham is as he is a crucial part of the patient's wellbeing.

GP/20/114 Enquiry Closed City Locality 14/10/20 Primary GP practice GP NEMS Telephone Anxious Platform 1 is closing. Is concerned as is being well 21/10/20 Enquiry resolved Care closed Platform One supported at the Stonebridge Centre and doesn't want to have to be referred elsewhere if they have to register at a GP practice closer to their home address. GP/20/290 Enquiry Closed City Locality 15/10/20 Primary GP practice GP NEMS Email Patient is furious about the changes being made, has previously 15/10/20 Care closed Platform One had some poor experiences with local practices and is feeling very anxious about having to go back. would like the family to be continue to be registered with the practice.

GP/20/296 Enquiry Closed City Locality 19/10/20 Primary GP practice GP NEMS Telephone Enquirer wanting to speak with some regarding the changes at 27/10/20 Enquiry not resolved - Unable to get through and speak to patient. Care closed Platform One Platform 1 Practice. unable to contact enquirer GP/20/300 Complaint Closed South 23/10/20 Primary GP practice GP NEMS Email Complaint about complainant and family being moved from NEMS 10/11/20 Complaint not upheld The current provider does not wish to tender for services Nottinghamshire Care closed Platform One Platform One next year as they do not live within the new practice once the contract ends so the practice will close. The CCG Locality boundary. Complainant says this is not a person centred decision has to look at alternative options. The complainant is not as he has 2 adult sons with autism and LD and wants to be able to able to stay with the practice as it will not exist. stay with Platform One. Complainant says patients should be consulted about this decision and is raising the issue with the local 09:00 - 09:50-16/12/20 09:00 authority and his MP. Update on the Learning Disability Annual Health Checks

Meeting Title: Primary Care Commissioning Committee Date: 16 December 2020 (Open Session)

Paper Title: System Update on Learning Disability Annual Paper PCC 20 160 Health Checks Reference:

Sponsor: Danni Burnett –Deputy Chief Nurse, Attachments/ Presenter: Nottingham and Nottinghamshire CCG Appendices: Adele Smith, Commissioning Manager – Learning Disabilities, Theodore Phillips, Head of Transforming Care for LD and Autism.

Purpose: Approve ☐ Endorse ☒ Review ☒ Receive/Note for: ☐ ∑ Assurance ∑ Information

Executive Summary The purpose of the paper is to update the Committee regarding the national expectations regarding completion of learning disability (LD) annual health checks (AHCs), review the performance achieved recently in Nottingham and Nottinghamshire, consider the impact to delivery and risks to performance posed by the Covid-19 pandemic, and endorse the proposed system actions and approach to address the risks involved.

There is no award of contract recommended within the update

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 ☒ Local proposals to improve delivery of AHCs are Assessment (EQIA) being taken forward within the existing primary care offer of AHCs by existing system partners.

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Data Protection Impact Yes ☐ No ☐ N/A ☒ Local proposals to improve delivery of AHCs are Assessment (DPIA) being taken forward within the existing primary care offer of AHCs by existing system partners. Risk(s): There is a risk to the Nottinghamshire System that the performance target of 67% achievement of LD Annual Health Checks (per registered population) will not be achieved for a variety of factors. Factors relating to system capacity and service user choice/lack of awareness predate the current position, but challenges to delivery are now further impacted by the restrictions and pressures of delivery within the Covid-19 climate. Confidentiality: ☒No

Recommendation(s): 1. NOTE the national expectation regarding delivery of AHCs and the associated system pressures/risks. 2. NOTE the barriers to delivery faced locally and the action that has been taken to achieve stepped progression in this area. 3. ENDORSE the proposed actions and system approach to mitigate the risks and to improve delivery and performance.

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System Update December 2020 117 of 136 117 118 of 136 118 Update on the Learning Disability Annual Health Checks

Learning Disability Annual Health Checks (LD AHC) Learning Disability Annual Health Checks (LD AHC) is led by the ‘Living and Aging Well’ work-stream one of 4 work streams within the LD/A transformation programme which includes a collaborative partnership approach from the CCG, local authorities as well as primary and secondary care clinicians.

• WS3 Living and Aging well Theme – focuses on 3 key themes that address health inequality, morbidity and mortality, and improving quality: ÿ Annual Health Check ÿ LeDeR (Learning Disabilities Mortality Reviews) ÿ STOMP/STAMP (Stop the over medication of children and young people with a learning disability, autism or both prescribing and Support Treatment and Appropriate Medication in Paediatrics) Governance Structure 09:00 - 09:50-16/12/20 09:00

LD Annual Health Checks Update on the Learning Disability Annual Health Checks

Learning Disability Annual Health Checks (LD AHC) The NHS Long Term Plan gave a commitment that at least 75% of people with a Learning Disability (LD) aged 14 years and over would receive an Annual Health Check from their GP practice by 2023/24. • The target in 2019/20 for Nottingham & Nottinghamshire CCG was 70% and we achieved 69% against the verified GP LD registers. • The target for 2020/21 was 75%, however this was revised to 67% by NHSE/I in recognition of the impact of COVID-19. • The percentage of patients on the LD register (aged over 14years) who receive an annual learning disability health check, is contained as an indicator within the Network DES - Investment and Impact Fund (Sept 2020).

2020/21 Current Performance & Developments • As detailed above the Nottingham and Nottinghamshire delivery of AHCs and progression towards percentage compliance improved

09:00 - 09:50-16/12/20 09:00 throughout 2019/20. Compliance however is not consistent across the demographic groups with younger people in the 14-25 years age range being significantly under represented as well as people from BME groups

• Delivery was also inconsistent both between PCN areas and within individual PCNs with some practices performance being stronger then others

• A commitment was made in Q4 2019/20 by LD and Autism system partners to incorporate the governance and oversight of the AHC improvement plan within the wider LD/A transformation programme, to involve subject matter and provider expertise to drive change and improvement, manage internal and external reporting within robust partnership governance arrangements and provide oversight by the LD/A Exec Board.

• Monitoring of performance and partnership agreement on action to improve performance is led by the ‘Living and Aging Well’ work- stream one 4 work streams within the LD/A transformation programme which includes partner representation from the CCG, local authorities as well as primary and secondary care clinicians.

LD Annual Health Checks 119 of 136 119 120 of 136 120 Update on the Learning Disability Annual Health Checks

2020/21 Current Performance & Developments As at 9th December, 30% of LD Annual Health Checks (AHC) have been completed across Nottingham and Nottinghamshire and the system is largely on track to achieve trajectories.

1,500 LD Annual Health Checks - 20/21 Trajectory Nottingham & Nottinghamshire

1,300

C H A

n a 1170 g n i v i e

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299

300

100

Month

Trajectory Actual

LD Annual Health Checks Update on the Learning Disability Annual Health Checks

The challenge of COVID has affected performance, especially when compared to last years performance. In comparison 47% of AHCs were completed by the end of Q3 2019/20

LD Annual Health Check Q3 ICP Performance Comparison 60%

50% 50% 46% 44% 09:00 - 09:50-16/12/20 09:00 40% 40%

30% Q3 19/20 % completed 26% 25% Q3 20/21 % completed (as at 9 Dec 20)

20%

10%

0% Mid Notts Nottingham City South Notts

LD Annual Health Checks 121 of 136 121 122 of 136 122 Update on the Learning Disability Annual Health Checks

LD Annual Health Check Q3 PCN Performance Comparison 100% 100%

90%

80%

70% 65% 65% 63%

60% 58% 54% 54% 52%

09:00 - 09:50-16/12/20 09:00 50% 50% 50% 49% 49% 47% 46% 46% 47% 45% 45% 41% Q3 19/20 % completed 39% 40% Q3 20/21 % completed (as at 9 Dec 20) 36% 35% 34% 31% 31% 29% 28% 30% 27% 25% 24% 23% 19% 19% 20% 20% 19% 20% 18% 17% 14% 10% 10%

0%

LD Annual Health Checks Update on the Learning Disability Annual Health Checks

Challenges Completion of AHCs have been impacted by COVID-19 and as priorities continue to increase (winter pressures, flu vaccinations etc.) capacity in primary care is limited. Patients continue to choose not to attend GP practice due to self-shielding/anxieties surrounding COVID-19, or other factors e.g. the practice is an unfamiliar environment. National messages regarding people with LD being classed as extremely vulnerable and not making non essential visits/appointments are potentially conflicting for patients, parents/carers as well as for practitioners.

Data is reviewed both from NHS digital and from e Healthscope, which is then compared against the Learning Disabilities Annual Health Check Improvement Plan and added to the monthly Situation Report (SitRep). This provides a snapshot on the current performance against the following: The number of Health checks carried out ÿ The number of partial health checks carried out (if available) ÿ The number of health checks declined and number of DNAs. 09:00 - 09:50-16/12/20 09:00 Focus of work to increase AHC’s To help support the delivery of LD AHCs this year, the Nottinghamshire LD and Autism Programme has allocated some non-recurrent funding to implement the following initiatives which have been developed with key partners:

ÿ Offer additional locum support to our underperforming practices within all ICP locations (who achieved under 50% last year) to provide the AHCs at the patient’s preferred community location. ÿ Increase capacity within the Primary Care Liaison Nurses to provide focused and targeted training to GP practice staff, so each practice has their own expert in LD AHCs who supports the practice in a train the trainer capacity. Training will also be delivered to the 54 Social Prescribing Link Workers across the system by March 21 and currently exploring Social Care Teams too. ÿ The Nottinghamshire Training Alliance are working with PCLN to develop LDA training for GPs and PCN colleagues – this will include AHCs ÿ MLC – Strategic Coproduction group now have AHC as a standard agenda and a member representative on the AHC steering group. ÿ Trevor Clower – Carers Champion and MLC member runs The Carers Road Show, has recently adapted this due to the currently social distancing rules to a digital format and includes a video on AHC’s https://bit.ly/2K6AsBZ (AHC’s Video 26)

LD Annual Health Checks 123 of 136 123 124 of 136 124 Update on the Learning Disability Annual Health Checks

Risks

• Without targeted support to identified demographic groups there remains a risk that certain groups remains under-represented and at greater risk of developing or having worsening long term conditions. Practices will need support of LD expertise including LD Primary care Liaison Nurses and secondary care specialisms to ensure that environmental and access issues are overcome and tailored to the needs of the cohort • National and local communications regarding CV19 and shielding may be a barrier to uptake of AHCs and needs to be consistent with messages regarding safe access to primary care services • Capacity for primary care to deliver AHCs may be limited when considered as a priority within the CV19 climate such as rollout of vaccination programmes

09:00 - 09:50-16/12/20 09:00 Support required from Committee

• GP and primary care leads to flag local barriers to delivery faced at PCN level in order to assist with development of target support. • GP champions required in all three ICP areas to assist with disseminating good practice and training for example at Protected Learning Time (PLT) sessions. • Develop strong interface between PCCC and secondary care commissioning/LD/A exec groups to aid cross system working to address identified risks and shortfalls.

LD Annual Health Checks Financial Management

Meeting Title: Primary Care Commissioning Committee Date: 16 December 2020 (Open Session)

Paper Title: Finance Report Month Eight Paper Reference: PCC 20 161

Sponsor: Michael Cawley – Operational Director of Attachments/ Appendix 1: Month Presenter: Finance Appendices: one to six PCCC Financial Position

Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for: ☒  Assurance  Information

Executive Summary This paper represents the financial position for Primary Care Commissioning Committee (PCCC) spend for month eight 2020/21. This report has been prepared in the context of the revised financial regime implemented by NHSEI in response to the current COVID-19 pandemic.

The months one to six financial regime has effectively closed, and a new planning and reporting period – months 7 to 12 – has commenced. NHS England and Improvement (NHSEI) have termed this period Phase 3 (P3). The Integrated Care System (ICS) has been given a system-wide allocation for P3, with a constituent allocation for the CCG; that includes delegated allocations over-seen by PCCC. As part of the transition to the new planning period, months 7-12 budgets have been revised. That revision has been based on a re- assessment of how spend lines are expected to perform during this period.

For the month eight, the year to date (month seven and eight) position is £0.1 million overspent when compared to delegated budgets. The forecast of PCCC spend for the rest of the year is that it will stay within the PCCC delegated allocations.

Since month seven, work has been underway to assess level of financial mitigations available to offset financial risk if it were to materialise. That review has confirmed that the primary care position would be able to mitigate that risk.

To conclude, the CCG is expecting to remain within the delegated budgets that have been set for the rest of the year. In addition the CCG is in a position to absorb additional unplanned costs if they were to arise in future months. 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 ☐

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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 detailed within the paper. 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 November 2020. This includes approval of revised PCCC budgets for the months 7-12 period of the temporary financial regime.

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Primary Care Commissioning – Finance Report – NOVEMBER 2020

NHS Nottingham & Nottinghamshire CCG

Introduction

This Primary Care Commissioning Committee (PCCC) finance report is written in the context of the revised financial regime implemented by NHSEI in response to the current COVID-19 pandemic.

As reported last month, the CCG is reporting months one to six and Phase 3 as two separate accounting periods, with months one to six being accounted and reported as ‘breakeven’ against delegated (PCCC) allocations received in that period. The previously reported £1.241 million “overspend” against months one to six PCCC budgets has been funded with top-up allocations from NHS England and Improvement (NHSEI) to close out months one to six as breakeven. (See Appendix 1 of this report).

As part of transition to months 7-12, budgets for that period have been revised. Revisions made reflect a more accurate position on how spend lines are expected to perform. The revised budgets are set out below and reconcile to the allocation received by NHSEI. The allocation represents the full value (part year effect) of the original Delegated Primary Care allocation for 2020/21:

Month 7-12 Revised Plan

Variance - under / (over) M7 - 12 Plan Changes

M7 - 12 Plan M7 - 12 Plan M7 - 12 Plan Allocations M7 - 12 Plan Co-Commissioning Category (Original) (Changes) (Revised) Received M8 (Revised at (£m) (£m) (£m) (£m) M8) (£m)

Dispensing/Prescribing Drs 0.74 0.00 0.74 0.74 Enhanced Services 2.04 0.00 2.04 2.04 General Practice – APMS 4.38 (1.07) 3.31 3.31 General Practice – GMS 35.44 0.00 35.44 35.44 General Practice – PMS 11.33 0.00 11.33 11.33 Other GP Services 1.82 (0.13) 1.70 1.70 Other Premises costs 1.65 0.00 1.65 1.65 Premises Cost Reimbursement 7.60 0.00 7.60 7.60 Primary Care Networks 5.88 0.00 5.88 0.88 6.76 QOF 6.70 0.00 6.70 6.70 Subtotal 77.59 (1.19) 76.40 0.88 77.28

General Reserves (1.19) 1.19 0.00 0.18 0.18 Grand Total 76.40 0.00 76.40 0.18 77.46

Main changes to the original budgets are in relation to the Alternative Provider Medical Services (APMS) contract and ‘Other GP Services’. In month eight, the CCG received £1.06 million of additional allocations; details of which being:

Allocations Received

Funding Received Allocation Detail (£m) Increase in Practice Funding 0.183 Enhanced Health in Care Homes 0.435 Impact & Investment Fund 0.442

1.060

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Month Eight PCCC Financial Position

As previously reported, the months one to six period closed out and reported a break-even position (Appendix 1). This leaves the M7-12 period on which to focus. The position is summarised in the table below:

Month 8 Position

Variance - under / (over)

M7-8 M7-12 Plan M7-8 YTD M7-8 Actual Co-Commissioning Category Variance (£m) Budget (£m) (£m) (£m) Dispensing/Prescribing Drs 0.74 0.25 0.37 (0.12) Enhanced Services 2.04 0.68 0.59 0.09 General Practice – APMS 3.31 1.10 1.29 (0.19) General Practice – GMS 35.44 11.81 11.95 (0.14) General Practice – PMS 11.33 3.78 3.61 0.17 Other GP Services 1.70 0.50 0.43 0.07 Other Premises costs 1.65 0.55 0.58 (0.03) Premises Cost Reimbursement 7.60 2.53 2.62 (0.09) Primary Care Networks 6.76 2.25 2.31 (0.05) QOF 6.70 2.23 2.18 0.05 Reserves 0.18 0.13 0.00 0.13 Total Initial PCCC Financial Position 77.46 25.82 25.92 (0.10)

Year to Date (YTD)

There is a year to date overspend position of £0.10 million. The main drivers of spend are:

 Dispensing / Prescribing Drs (£0.12m) –Spend is based mainly on prescribing profiles that sees spend increase in the winter months in line with the flu season.

 General Practice – APMS (£0.19m) – The rate of overspend is driven by the number of caretaking arrangements across current APMS contracts. However the rate of spend is starting to fall in line with the reduction in overall care taking contracts. [Three of the caretaking contracts were re-procured; new contracts commenced w.e.f. 1st October 2020 at a lower value compared to the previous period].

The YTD overspend is offset by underspends across several spend lines plus a balance on reserves to leave a net £0.1 million overspend on the YTD position.

Forecast Position/ Risks

Last month’s finance report to PCCC highlighted a year to date overspend position along with a commentary that if trends remained un-checked this could lead to a financial risk arising of £2 million; with no mitigations available. It was agreed that a more detailed review of the position would be undertaken.

A detailed financial review of forecast delegated spend has taken place with primary care officers. That review has highlighted that if the £2 million risk were to crystallise the primary care position would be able to mitigate that risk.

As a result the CCG is expecting spend will remain within the delegated budgets that have been set for the rest of the year. In addition the CCG is in a position to absorb additional unplanned costs if they were to arise in future months.

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The results of the financial review will be incorporated, where relevant, into the spend lines of next month’s forecast outturn position.

Other

Section 96 Payments

This is the 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 PCCC. Funding for these types of payments comes from existing primary care contracting/ co- commissioning budgets. There has been one approved Section 96 payment; relating to a patient reallocation (Total £0.03m).There have been four other s.96 approvals relating to ‘exceptional’ COVID-19 related cost claims (Total £0.01m).

COVID-19 Expenditure

As previously reported, any costs relating to the primary care claims for Covid-19 expenditure does not form part of the reported position to PCCC. At month eight the primary care element currently totals £3.097 million. National guidance in relation to Primary Care COVID-19 claims does not envisage claims to continue into the second part of the year. In effect funding has reduced compared to the first part of the year for COVID-19 spend in primary care.

In respect of any exceptional claims that practices make in relation to Covid-19; there is a daily meeting to ensure that these are reviewed and only claims that are deemed ‘exceptional’ are agreed. This is because the financing for those claims comes from existing Core PC budgets and payment is made via the Section 96 approval route.

Primary Care Spend (Non-Delegated Budgets)

[FOR INFORMATION AND COMPLETENESS ONLY] The financial position for other areas within the remit Primary Care (but not the PCCC) is set out below. These budgets are considered and overseen by the CCG’s Governing Body.

Variance - under / (over) M1- 6 Financial Position M7-8 Position M1-6 M1-6 M7-8 M1-6 Actual M7-8 Budget M7-8 Actual Primary Care Area Budget Variance Variance (£m) (£m) (£m) (£m) (£m) (£m) GP Forward View 2.46 2.99 (0.53) 1.03 0.92 0.11 Local Enhanced Services 5.05 5.53 (0.48) 1.56 1.30 0.25 Primary Care Development 0.00 0.00 (0.00) 0.05 0.05 0.00 Primary Care Covid 3.01 3.01 0.00 0.08 0.08 0.00 GP IT 2.29 0.48 1.81 0.10 0.04 0.05 Out of Hours 5.29 5.62 (0.33) 1.86 1.87 (0.01) Meds Management Clinical 1.86 1.66 0.20 0.54 0.49 0.06 Primary Care Corporate Team 0.46 0.47 (0.02) 0.10 0.09 0.01 NHSEI Funding (0.80) 0.00 (0.80) 0.00 0.00 0.00 Total 19.62 19.77 (0.15) 5.33 4.85 0.48

Prescribing 77.12 79.78 (2.66) 27.22 27.38 (0.16) NHSEI Funding 2.66 0.00 2.66 0.00 0.00 0.00 Total 79.78 79.78 0.00 27.22 27.38 (0.16)

Other Primary Care Position 99.40 99.55 (0.15) 32.55 32.23 0.32

For the months one to six position the CCG received additional funding of £1.86 million to arrive at a net overspend of £0.15 million. The £0.15 million adverse variance is a reflection that half of the commitment made last year in relation to PCN Development has been funded. In respect of the GP Page 5 of 7

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Information Technology (IT) spend, most of that is incurred with the CCG’s IT service provider, which is hosted by Sherwood Forest Hospitals NHS Foundation Trust (SFHT). The budget for this spend is ordinarily shown in Primary Care. For this year, under the temporary financial regime, actual spend has formed part of the NHS block payments made to SFHT; and is therefore coded separately. The “benefit” on this line is recovered by NHSEI via a block contract reconciliation process. The months seven to eight position is showing overall £0.32 million underspent with a £0.16 million overspend position in relation to Prescribing. The main underspend position being attributed to Local Enhanced Services, where a clearer position has been derived due to receipt of claims from practices.

Recommendation

The Committee is asked to NOTE and APPROVE the contents of the Primary Care Commissioning Finance Report as at November 2020. This includes the revision of PCCC budgets for the months 7 to 12 period of the temporary financial regime.

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APPENDIX 1 – Month one to six PCCC Financial Position

The M1-6 position shows breakeven as the ‘top-up’ allocation for M1-6 has been received (in M8) for £1.241m.

Variance - under / (over) M1- 6 Financial Position M1-6 M1-6 M1-6 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) Reserves (0.19) 0.00 (0.19) Total Initial PCCC Financial 76.11 77.35 (1.24) Position

NHSEI Funding Received 1.24 0.00 1.24 Total PCCC Position M1-6 77.35 77.35 0.00

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Meeting Title: Primary Care Commissioning Date: 16 December 2020 Committee (Open Session)

Paper Title: Risk Report Paper PCC 20 162 Reference:

Sponsor: N/A Attachments/ Risk Register (Extract) Appendices: - Appendix A

Presenter: Siân Gascoigne, Head of Corporate Assurance

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 NHS 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

132 of 136 09:00 - 09:50-16/12/20 Risk Report

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 4 – High 2 Assurance, in conjunction with the Chief 3 – Medium 3

Commissioning Officer and the Associate Impact 2 – Low

Director of Primary Care. 1- Very low

The table to the right shows the current risk

profile of the five risks. There are currently no

Rare

Likely

Almost Almost

unlikely

-

Possible -

-

-

high / red risks within the Committee’s remit. Certain

-

1 1

4 4

5 5 2 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 There have been no amendments to risk narrative or score since the last meeting.

1

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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

December 2020

2

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NHS Nottingham and Nottinghamshire CCG Corporate Risk Register (December 2020)

Risk Oversight Directorate Date Risk Current Risk Last Review Risk Description Risk Category Initial Risk Rating Existing Controls Mitigating Actions Mitigating Actions Progress Update: Trend Ref Committee Identified Rating Date (Relevant committee in the (Movement (Actions required to manage / mitigate the identified risk. Actions should support CCG's governance (Date risk (These are operational risks, which are by-products of day-to-day business delivery. They in risk score (as per April 2020 achievement of target risk score and be SMART (e.g. Specific, Measurable, Assignable, (To provide detailed updates on progress being made against any mitigating actions identified. Actions taken should bring risk to level which can be

structure originally arise from definite events or circumstances and have the potential to impact negatively Risk Owner (The measures in place to control risks and reduce the likelihood of them occurring). since

Executive Lead Score

CCG structure) Score Realistic and Time-bound). tolerated by the organisation). Impact

responsible for identified) on the organisation and its objectives.) Impact previous

Likelihood Likelihood monitoring risks month) relating to their RR023 Primary Care 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 companies 3 3 9 December 2020: Focus continues to be given on progressing GP Premises debt, however, the Estates Team is having to prioritise focus on the roll-out 03/12/2020 ↔ Commissioning Resources from Property Services and from CHP (Community Health Partnerships), there is a risk (NHSPS and CHP) to ensure management plans are in place. of COVID vaccinations during December/January. The Team is continuing to work with those Practices/Health Centres which have pressing issues Committee that (for some practices) this may impact viability of providing primary care services • Engagement with NHS England/Improvement 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 support. • LMC support to Practices For reimbursable debt (pass through), the CCG writes to each Practice as soon as we are aware and these are, generally, resolved fairly quickly. This may, in turn, lead to service disruption, inability to invest and/or risks to patient

access to primary care services.

Lynne Sharp Stuart Poynor

RR032 Primary Care 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 governance Action: To ensure that routine Primary Care workforce updates are provided to PCCC. 4 3 12 December 2020: An update in relation to primary care workforce was presented to the August 2020 PCCC meeting. The paper provided an update in 03/12/2020 ↔ Commissioning Resources present a risk that there is insufficient service provision to meet the needs of the CCG's structures - e.g. primary care quality / contracting teams). relation to current planning requirements around the recovery phase (following COVID-19) and the approach to support future planning for the Committee population. Action: To continue to deliver requirements of ICS Primary Care Workforce Strategy: to Primary Care Networks given the increased responsibility in developing primary care and its delivery. • Routine Primary Care workforce updates in PCCC's committee work programme for August request further update regarding delivery of the Strategy to the CCG's PCCC. This risk may be exacerbated due to lack of capacity within Primary Care to establish, 2020 and January 2021. A further update was provided at the September 2020 PCCC in relation to PCNs 'One Year On'. This highlighted the positive achievements in relation and embed, recruitment processes, as well as challenges in the supply and adaptability of to workforce across the PCNs, as well as some of the challenges regarding the capacity in PCNs to set up (and run) recruitment processes, the staff to transition to working within Primary Care. • Establishment of Primary Care Cell, as part of CCG's COVID-19 incident response. shortages in supply of staff and the ability to transition skills to work within primary care.

• ICS Primary Care Workforce Strategy, ICS Primary Care Board and ICS Primary Care The next Primary Care Workforce Update is scheduled to be presented to the January 2021 PCCC meeting (this has been deferred from the December

Workforce Group. meeting due to COVID priorities/capacity). At that time, a review of the risk and its score will be undertaken. Stuart Poynor • Establishment of Primary Care Networks (PCNs) (and/or other collaboration/federation

activities) and PCN workforce plans. Andrea Brown Griffiths / Helen

• System Planning approach to primary care development and transformation ensuring the best use of System Transformation funding via NHSE/I and System Workforce Development/CPD funding via HEE. RR126 Primary Care 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 December 2020: OPEL reporting remains in place and is reported, routinely, to the IMT (x3 week) and the PCCC (monthly). PCCC reporting has been 03/12/2020 ↔ Commissioning primary care services to members of the CCG's population. • Roll-out of IT infrastructure/technology to support virtual working (e.g. telephone strengthened to enable trend analysis to be undertaken. IMT requested the Primary Care Cell to revisit the metrics/triggers for OPEL reporting to Committee appointments, etc.); ensure these are being clearly and consistently applied across all our GP Practices; this has been undertaken. 09:00 - 09:50-16/12/20 09:00 More specifically, this may be due to: • Routine OPEL reporting and escalation processes; • increased likelihood of Primary Care workforce having to 'shield' or self-isolate due to • Establishment of CMCs and ability to step up/step down if needed; Digitalisation of primary care delivery is a key mechanism to support Practices to manage this risk, along with the ability to 'step up' CMCs if required. being at risk and/or due to delays in COVID tests/results; • PCN 'buddying' processes in place; CMC utilisation has increased during the second lockdown. Roving workforce support is also in place across GP Practices, alongside PCN resilience and • challenges with GP Practice estate not meeting infection, prevention and control (IPC) • 'Roving' workforce support across Practices; workforce planning arrangements.

requirements; LunnJoe • Clinical vulnerable COVID risk assessment for all primary care workforce. • lack of national funding to support the reimbursement of GP Practices (for months 7 to Lucy Dadge It was advised that further pressures to primary care capacity is likely to arise given the unprecedented requirements of the flu and COVID vaccination 12 of 2020/21) for COVID related expenditure; programme. The COVID Enhanced Services specification was published on 1 December 2020. • pressures on primary care capacity due to requirements to deliver flu and COVID vaccinations.

RR137 Primary Care 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 assessments 3 3 9 December 2020: The main mitigation to this risk continues to be the digitalisation of the Primary Care service provision. The CCG has sought 03/12/2020 ↔ Commissioning 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 and progressing any actions identified from these (or the IPC Estates Reviews). assurance from all GP Practices that risk assessments have been completed and any subsequent actions identified. Further actions have also been Committee the CCG's population. appointments, etc.); identified following review of Primary Care Estate to determine whether it is compliant with new IPC requirements. 100% of GP Practices have now • Routine OPEL reporting and escalation processes; responded, providing assurance that appropriate mitigations are in place for their staff. This may particularly impact areas of Mid-Nottinghamshire and Nottingham City. • Establishment of CMCs and ability to step up/step down if needed; • PCN 'buddying' processes in place; Mitigations are also via the GP Practice business continuity plans and the ability to 'step up' and 'step down' CMCs.

• 'Roving' workforce support across Practices; Joe LunnJoe

Lucy Dadge • Clinical vulnerable COVID risk assessment for all primary care workforce.

RR138 Primary Care 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 assessments 3 3 9 See update for risks RR 126 and RR 137 above. 03/12/2020 ↔ Commissioning 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 and progressing any actions identified from these (or the IPC Estates Reviews). Committee handed practices. appointments, etc.); • Routine OPEL reporting and escalation processes; • Establishment of CMCs and ability to step up/step down if needed;

• PCN 'buddying' processes in place; Joe LunnJoe Lucy Dadge • 'Roving' workforce support across Practices; • Clinical vulnerable COVID risk assessment for all primary care workforce.