Meeting in Public of the Mid , North East Essex & NHS Primary Care Commissioning Committee

Wednesday 1 February 2017, 3.30 pm – 4.30 pm *

Wren House, Springfields Business Park, Road, Chelmsford CM2 5PF

Part I AGENDA

Item Title Lead/Author Action Page No. No 1. Welcome, Introductions and apologies Chair To note Verbal

2. Register of Interests Chair To note 1 – 2

3. Questions from the Public Chair To note Verbal

4. Minutes of previous meeting held on 11 Chair To note 3 - 9 January 2017 and Action Log

5. Matters Arising, including: Chair To note Verbal

• Response to representations from Mr P M Crass To note Verbal Osman on behalf of Action for Family Carers

Joint Issues 6. Period 9 Finance Report for North East M Thorpe To note 10 - 18 Essex CCG and Mid Essex CCG 7. Delegated Primary Care Commissioning – P Green / To note Verbal progress update M Crass 8, IT and Premises Update NHS To note 19 - 20 England North East Essex CCG Operational Issues None Mid Essex CCG Operational Issues None Business Issues 10. Any Other Business, including:

i) Cover sheet for reports Chair For 21 - 22 decision

11. Date, Time and Venue of next meeting Chair To note

• 3.00 pm on 1 March 2017 Aspen House, Stephenson Road, Severalls Business Park, Colchester CO4 9QR

* Please note later start time than originally advertised MID ESSEX CCG, NORTH EAST ESSEX CCG AND NHS ENGLAND PRIMARY CARE COMMISSIONING COMMITTEE REGISTER OF INTERESTS (as at 25 January 2017) A declared interest will remain on the register for at least six months after the interest has expired. Declared Interest Is the interest First Type of Interest Surname Current Position (Name of the organisation direct or Nature of Interest Date of Interest Actions taken to mitigate risk Name Declared and nature of business) indirect? From To Interest Interest Financial Non-Financial Professional Professional Non-Financial Non-Financial Personal Interest Interest Personal Non-Financial Carol Anderson Managing Director Health Education England x Direct Leadership Courses 07/12/16 Ongoing I will declare my interest if at any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented Vivienne Barnes Director of Corporate Services Nil N/A N/A

David Barter Contract Manager, NHS England Nil N/A N/A (East) Jackie Bidgood Contract Manager, NHS England Nil N/A N/A (East) Phil Cherry Finance Manager Nil N/A N/A

Alison Cowie Head of Commissioning, NHS Nil N/A N/A England (East) Melanie Crass Director of Primary Care and Nil N/A N/A Resilience Anna Davey Coggeshall Surgery - Partner Coggeshall Surgery Provider of GMS x Direct Partner in Practice providing 09/01/17 Ongoing Agreed with line manager that I will not be involved in any Services and GMS services discussion, decision making, procurement or financial authorisation involving the Coggeshall Surgery or Edgemead Medical Services Ltd GP Clinical Lead at Mid Essex CCG x Direct GP Clinical Lead 01/09/16 01/09/17 Agreed with line manager that I will not be involved in any discussion, decision making, procurement or financial authorisation involving the Coggeshall Surgery or Edgemead Medical Services Ltd Edgemead Medical Services Ltd x Direct Director 01/04/16 Ongoing Agreed with line manager that I will not be involved in any discussion, decision making, procurement or financial authorisation involving the Coggeshall Surgery or Edgemead Medical Services Ltd Caroline Dollery Chair of MECCG & Elected GP Danbury Medical Centre x Direct Salaried GP 01/09/15 Ongoing I will declare my interest if at any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented Strategic Clinical x Direct Clinical Director 01/04/12 Ongoing I will declare my interest if at any time issues relevant to the Network for Mental Health, Learning organisation are discussed so that appropriate arrangements Disability and Neurology can be implemented Eastern Region Collaborations for x Direct Non-Executive Director 01/07/15 Ongoing I will declare my interest if at any time issues relevant to the Leadership in Applied Health Research organisation are discussed so that appropriate arrangements & Care can be implemented Health Education England x Direct Leadership Courses 07/12/16 Ongoing I will declare my interest if at any time issues relevant to the organisation are discussed so that appropriate arrangements can be implemented 1 Declared Interest Is the interest First Type of Interest Surname Current Position (Name of the organisation direct or Nature of Interest Date of Interest Actions taken to mitigate risk Name Declared and nature of business) indirect?

Robert Evans Interim Primary Care RLE Health Management Solutions x Direct Owner and Director 18/04/12 Ongoing Agreed with line manager that in the extremely unlikely Commissioning Lead Limited, provider of advice and support situation that any decision-making processes and/or financial to healthcare organisations. authorisations would involved RLE Health Management Solutions Limited, I would declare my interest and withdraw from the process. Simon Evans-Evans Locality Director, NHS England Nil N/A N/A (East) Anne Marie Garrigan Lay Board Member (PPE) Latchingdon Primary School x Chair of Governors / Governor Sep-96 date School is not a provider of any health services

Pre-school Learning Alliance x Area Manager for Childrens' Jul-12 date Children Centres I manage are based in Rayleigh, Rochford Centre and Wickford White Brick Renovation Company x Direct Secretary of the Company 18/11/2013 Ongoing The company is currently not trading. In the unlikely event that Limited a conflict of interest arises, I will declare my interest and withdraw from any discussions or decision-making processes relevant to the company Pam Green Director of Transformation and Nil Strategy, NEECCG Gary Sweeney Chair, NEECCG Care UK (Health and social care x Indirect Son is IT Lead at this company Ongoing Ongoing Usual confidentiality requirements will apply provider) Mat Thorpe Head of Finance, NHS England Nil N/A N/A

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Mid Essex CCG, North East Essex CCG & NHS England Primary Care Commissioning Committee Part I Meeting

Date: 11 January 2017 Time: 3.00pm to 4.30pm Location: Aspen House, Stephenson Road, Severalls Business Park, Colchester

Members:

Name Initials Role Anne-Marie Garrigan AMG PPE Lay Member, Mid Essex CCG (Chair) Mat Thorpe MT Head of Finance, NHS England Melanie Crass MC Director of Primary Care & Resilience, Mid Essex CCG Pam Green PG Director of Transformation & Strategy, North East Essex CCG Dr Max Hickman MH Clinical Vice-Chair, North East Essex CCG (attending on behalf of Dr Gary Sweeney) Phil Cherry PC Finance Manager, NHS England Simon Evans Evans SE Locality Director, NHS England

In attendance:

Sara O’Connor SO Head of Corporate Governance (attending on behalf of Viv Barnes) Paul Osman PO Trustee, Action for Family Carers

Apologies: Dr Caroline Dollery CD Chair of Mid Essex CCG Dr Gary Sweeney GS Chair of North East Essex CCG Carol Anderson CA Managing Director, Mid Essex CCG Viv Barnes VB Director of Corporate Service, Mid Essex CCG Dr Anna Davey AD Clinical Lead, Mid Essex CCG Dr Tom Nutt TN Chief Executive, Healthwatch Essex Robert Evans RE Primary Care Commissioning Lead, Mid Essex CCG

Item No Agenda Item Actions

1 Welcome, Introductions and Apologies

Members were welcomed to the meeting and introductions provided.

AMG also welcomed Mr Paul Osman, Trustee of Action for Family Carers, to the meeting. AMG advised that Mr Osman was also a member of MECCG’s Patient Reference Group which contributed greatly to the work of the CCG.

Apologies were noted as detailed above.

2 Register of interests

Members reviewed the Register of Interests for the Committee and confirmed there were no changes to the declared interests.

Declarations declared by members of the Primary Care Commissioning Committee (PCCC) are listed in Mid and North East 3

Essex CCG’s Registers of Interests. The Register is available via the secretary to the governing body of each CCG.

Declarations of interest from sub committees

N/A.

Declarations of interest from today’s meeting

MH advised that he was a GP in Colchester and had interests in GP Provider Choice Ltd, an interest in a Pharmacy based at his GP practice and an interest in Colchester Catalyst Charity, but was of the view that none of these would create a conflict of interest in relation to the agenda items due to be discussed at the meeting.

3 Questions from the Public

Mr Paul Osman from Action for Family Carers (AfFC) read out a short statement asking when MECCG would commission GPs in its area to identify and support carers.

In particular he asked if MECCG could require all GPs in Mid Essex to adopt a Carer Identification and Support protocol putting a duty on all practice staff to identify carers at the earliest possible time by input of the correct carer code into the computer system and signposting them to support organisations, such as Social Services and AfFC.

MC advised that although there was currently no enforceable requirement on GPs to do this, Mid Essex CCG (MECCG) had already tried to implement this on an informal basis. MECCG’s proposed move to fully delegated commissioning would not change the position. However, MECCG had a Carers Strategy and had implemented social prescribing.

Mr Osman advised that AfFC had recently had its funding cut by 5% but had also been tasked to identify 5% more carers.

SE suggested that a poster should be displayed in practices asking carers to identify themselves to the GP and ask that their record be updated to reflect this. Display screens within practices could also be used for this purpose. It was also suggested that when patients register with a practice, the registration form should ask if they are a carer so that this could be logged at the earliest opportunity. MH also suggested that a drive for identification of carers could be done in conjunction with the next flu vaccination scheme.

MC asked Mr Osman to provide a copy of the full statement so that MC she could arrange for a formal response to be provided to him. The response would then be shared at the next PCCC meeting. VB

AMG thanked Mr Osman for attending the meeting and for bringing this issue to the Committee’s attention.

4 Minutes of the last meeting and Action Log

4(i) Minutes of the Meeting held on 16 November 2016

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The minutes of the previous meeting held on 16 November 2016 were agreed as an accurate record, with the exception of the following amendment:

• Item 4 – Questions from the Public – ‘Ms Maureen Hennessy’ to be amended to ‘Mrs Maureen Henes’.

Resolved: The committee approved the minutes of the meeting held on 16 November 2016.

4(ii) Action Log

It was noted that a number of the actions were completed or included on the agenda and agreed that the Finance Report action would be carried forward.

5 Matters Arising

There were no matters arising.

6 Period 8 Primary Care Medical Financial Performance Report for North East Essex and Mid Essex CCGs

MT presented the financial performance report as at the end of month 8. MT advised that the Essex GP financial performance was £785k underspent, as set out in the table at the top of page 15, predominantly due to accruals that had not yet materialised.

Mid Essex CCG was £225k overspent for the reasons set out in paragraph 2.6 of the report. MT confirmed that he would be discussing the overspend with Dee Davey, Chief Finance Officer, MECCG, later that week.

MT confirmed that North East Essex CCG was £35k underspent on a year-on-year basis and advised that additional charges for the Walk-in-Centre had been offset by a variety of underspends.

MT informed members that the budget was starting to reflect the benefit of business rates reduction appeals.

Resolved: the Committee noted the Period 8 Finance report for NECCG and MECCG.

7 IT and Premises Update

PG commented that it would be beneficial if future reports were compiled with additional input from relevant staff within the CCGs and correlated with GP activity to give members a better understanding of IT and premises issues. PG also asked that the report was made a standing agenda item. SE supported this suggestion.

Resolved: It was agreed that the IT and Premises Update would be included on the agenda of future PCCC meetings as a standing item. VB

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8 Primary Care Strategy – GP 5 Year Forward View Submissions

MC and PG confirmed that both CCGs had submitted their GP 5 Year Forward View documents. SE advised that he would provide feedback on these to CCGs very shortly. MC asked if the trajectories could be made very clear. SE confirmed that he had asked Ernst & Young to be explicit on this issue.

PG commented that appendices to the NECCG Operational Plan would be submitted to the Board very shortly.

9 Direct Enhanced Services (DES) and Local Enhanced Services (LES) Update

In response to a query from MC, SE confirmed that the latest proposals for LES and DES for 2017/18 would be issued shortly.

10 Guidance Note for GP Practices Serving Atypical Populations

PG advised that as both CCGs’ boundaries contained universities with large student populations, this placed additional demand for a number of services on relevant practices with a resulting financial impact. Recently issued NHSE guidance for GP practices serving atypical populations recognised that the demands on these practices was different and PG and MC were therefore of the view that CCGs should use the information available to them to develop an income formula appropriate to their needs to ensure standardised funding arrangements going forward. This was particularly as the University of Essex (UoE) wished to expand by 10,000 places with a high proportion of foreign students. PG explained that it was important that an evaluation of the impact on the particular practice on-site at UoE was performed as these premises only served the student population.

MT commented that there was a Local Enhanced Service agreement in place and NHSE funded affected practices in agreement with CCGs. MT also suggested that practices with an identified university demographic should be on Personal Medical Services (PMS) contracts. However, available funding was limited.

SE confirmed that NHSE could support and work with CCGs on this issue. PG suggested it would be useful to meet with affected practices to fully understand the impact of the student population.

Resolved: The Committee agreed to develop a local funding MC/PG proposal to enable relevant practices with atypical populations to and plan ahead of the Carhill Formula changes due in 2018. MT/PC

North East Essex CCG Operational Issues

11 Proposed merger of Abbey Field Medical Centre and the Hawthorn Surgery

SE advised that since the last meeting, a proposal had been received from Hawthorn Surgery to reduce surgery hours to 8.00 am to 2.00 pm with no evening surgeries. Although NHSE and the CCG were generally supportive of the proposed merger, it was important that the impact of reduced surgery hours was fully understood.

PG acknowledged that Hawthorn Surgery continued to struggle to 6

recruit staff but she was of the view that North East Essex CCG should not decide to support the reduction in surgery hours until an assessment of the impact, including equality issues, had been undertaken by the practice and NHS England. PG also explained that although Hawthorn patients would be offered appointments at one of the other two sites (Abbey Fields, Colchester and Portland Road, Elmstead), travel links were poor and would incur additional expense for patients living in an area with a high level of deprivation. In addition, the potential impact on the Walk-in-Centre and other health services needed to be taken into account. Therefore, PG would encourage the practice to first consider alternative methods of staffing Hawthorn Surgery in an attempt to avoid a reduction in surgery hours.

MH highlighted the fact that Hawthorn Surgery had 5,000 patients, as opposed to 1,400 at Portland Road, Elmstead, which was located in a more affluent area. Therefore, the adverse impact of reduced surgery hours would be disproportionately high for patients residing in the Hawthorn Surgery area.

SE agreed to ask the practices to provide further information on SE quality, equality and recruitment issues.

SO asked whether the practices had indicated if the proposed reduction in surgery hours was a permanent or temporary measure and, if approval was subsequently given, could this be on a trial basis for say 3-6 months to enable the impact to be monitored. PG advised that this had not been made clear. However, the practice had originally asked to close the Hawthorn site, but this had been refused.

Resolved: It was agreed that the practice will be requested to provide an assessment on the impact, including equality issues, on patients residing in the Hawthorn Surgery area, and that the impact on the Walk-in-Centre and wider health services would also be considered before a final decision on the practice merger and proposed reduction in surgery hours at Hawthorn Surgery was made.

12 Exercise of Emergency Powers – Special Allocation Scheme (SAS) Procurement

PG advised that the decision to commission Beacon House to deliver SAS services in North East Essex on a short-term contract from 1 January 2017 until 30 September 2017 was approved on the basis that this was a temporary arrangement to enable a more suitable longer-term solution to be implemented to meet the needs of the relevant group of patients as locally as possible.

Mid Essex CCG Operational Issues - NONE

13 Any Other Business

13(i) Frequency of Future Meetings

Members agreed that meetings of the Committee would continue to be held on a monthly basis in view of the proposed move to fully delegated commissioning.

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13(ii) Cover Sheet for Reports

The cover sheet for reports submitted to PCCC was reviewed by members. It was agreed that the level of risk and impact on wider services and the CCG should also be included. VB to amend and VB reissue the cover sheet to members.

14 Date and time of the next meeting

It was agreed that the next PCCC Part I meeting would take place on 1 February 2017 at 3.00 pm in Wren House, Hedgerows Business Park, Colchester Road, Chelmsford, Essex, CM2 5PF.

8 ME CCG & NEE CCG & NHS England Primary Care Commissioning Committee Meeting - Part I Action Log

Meeting Agenda Action Lead Deadline for Outcome/Update Date Item Completion 16/11/16 6 Finance Report: Inclusion of practice level data for CCG Local Melanie Crass 1 February 2017 Agreed that this would be carried Enhanced Services to be discussed with forward to the February meeting. NHS England `17/01/17 3 Questions from the Public: Paul Osman, Action for Family Carers, to Paul Osman ASAP Completed provide a copy of his statement.

Formal response to be provided by Primary Robert Evans 1 February 2017 12/01/17: Copy of statement provided Care Resilience Team, MECCG, to Mr to PCR Team so that a formal Osman. response can be drafted. Included as a matter arising on February PCCC agenda. 17/01/17 7 IT and Premises Update: IT and Premises Update to be included as a Viv Barnes 1 February 2017 Completed standing agenda item at all future PCCC meetings. 17/01/17 10 Guidance Note for GP Practices Serving Atypical Populations: Mel Crass 1 March 2017 Local funding proposal to be agreed for Pam Green relevant practices to enable them to plan Mat Thorpe ahead of the Carhill Formula changes due Phil Cherry 2018. 17/01/17 11 Proposed Merger of Abbey Field Medical Centre and the Hawthorn Surgery: Practices to be asked to provide further information on quality, equality and Simon Evans Evans 1 February 2017 recruitment issues to ensure that the impact of the proposals on patients and wider health services are fully understood. 11/01/17 13(ii) Report Cover sheet: VB to amend report coversheet to include V Barnes 1 February 2017 On agenda level of risk and impact on wider services and CCGs.

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Agenda Item 6

NHS England, MECCG and NEECCG Primary Care Commissioning Committee Meeting of 1 February 2017

Period 9 Primary Care Medical Financial Performance Report for Mid Essex and North East Essex CCGs

1. Background

1.1. Joint Commissioning Budget Update

1.2. In 2016/17 joint commissioning arrangements are limited to general practice services. The following report provides an overview of the budgets associated with the CCG and the context within the overall Primary Care Medical financial position. Future period reporting will focus on information around year to date and year end forecasts. All detail is dependent upon the accuracy of the coding within the financial system.

1.3. The following table summarises the Primary care medical budget allocated to the CCG. 2015-16 2016-17 2017-18 2018-19 Baseline Including Final Allocation Allocation after Allocation after adjustments and after Place Based Place Based Pace of Place Based Pace previous BCF Funding Pace of Change Change of Change Mid Essex CCG 45,106,014 46,693,014 47,543,015 48,462,015

North East Essex CCG 44,061,108 45,611,346 46,517,934 47,715,397 89,167,122 92,304,360 94,060,949 96,177,412

1.4. The majority of the GP contracting budgets within East are allocated at specific practice level therefore it is possible to reflect these accurately at a CCG level. Where this is not the case or relates to non-GP providers which are not directly linked to geographical areas apportionment methodologies have had to be adopted the majority of which is based upon contractor weighted populations.

1.5. Contractual contains General Practice GMS, PMS and other list based services relate to contract, list size driven budgets allocated to practice level. They include global sum, MPIG, contract values, PMS premium/growth and seniority budgets. These budgets, with the exception of the PMS premium treatments are driven by contractual obligations.

1.6. Premises include budgets for rent, rates and water charges. Premises budgets are also allocated on a contractual basis and have very little scope for local

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influence other than through commissioner decisions around investments in buildings or estate rationalisation.

1.7. Enhanced Services are budgeted on the basis of historic achievement for the ad- hoc smaller payments or recognising the potential full achievement for those which are list size/patient driven for the practices that have signed up to the particular SLAs, eg extended hours and avoiding unplanned admissions. Payment is based upon achievement so variances can exist from budget. Practices had a deadline of the end of June to register for 2016-17 enhanced services.

1.8. Quality outcomes Framework (QOF) aspiration payments are based upon 70% of the previous year’s achievement adjusted for year on year points and price changes. Budgets are set in line with this and pro rata to reflect final forecast achievement. As payment is based upon achievement this means that the CCG may have a financial risk or benefit depending on future practice achievement.

1.9. Material items which are not easily identifiable at a practice level because they are paid direct to other organisations are as follows. For these items assumptions have been made around apportionment methodologies: • Clinical Waste • Discretionary Payments • Other GP Related services such as Occupational Health contracts • Procurement Support • GP Suspension Budget • Translation services

1.10. Through the year budgets are reviewed and virements actioned to better reflect financial plans this will result in transfers between the budget lines not allocated at practice level and those which are.

1.11. QIPP targets associated with GP contracting are contained within the current indicative figures where appropriate and delivery will form part of future monitoring reports.

2. Period 9 Budget Monitoring

2.1. For future meetings the board can expect to receive a finical performance summary detailing year to date variances. Identifying at practice level; risks, mitigations and forecast out-turn positons. This will be taken from the most recently available budget monitoring reports.

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2.2. This report provides an update on the financial performance against Primary Care Medical budgets of member practices as at Period 8 (November 2016). The following provides a summary of the expenditure to date versus the detailed budgets associated with Mid Essex and North East Essex CCGs GP Practices.

Essex General Practice Finacial Performance at Period 9 Sum of YTD Sum of YTD Sum of YTD Previous Movement Sum of Annual Forecast (£) Forecast budget (£) Actual (£) Variance (£) Period against Previous budget (£) Variance Variance Period Variance (£) Total Mid Essex CCG 33,089,820 33,227,435 137,615 225,052 (87,437) 45,617,450 45,753,450 136,000 Total North East Essex CCG 30,913,781 30,852,522 (61,259) (35,382) (25,877) 42,596,500 42,596,500 0 Other Essex CCGs 76,972,021 76,661,798 (310,223) (295,058) (15,165) 106,113,240 106,113,240 0 Other Essex not practice specific 1,226,014 304,464 (921,550) (679,774) (241,776) 12,205,343 8,018,343 (4,187,000) 142,201,636 141,046,219 (1,155,416) (785,162) (370,254) 206,532,533 202,481,533 (4,051,000) 2.3. The CCG has been allocated shares of budgets not held at practice level, earmarked reserves and contingencies. Whilst these budgets are contained within the above table they are currently not shown within the detailed year to date position below.

2.4. There is currently no anticipated year-end over spend against practice budgets and no expected pressure against those not allocated at a practice level. The Forecast underspend within the Essex General Practice cost centre reflects the position released nationally. This is predominantly made up 2015/16 year end expenditure not materialising and the release of reserves.

2.5. Appendix 1 details further the current month and year to date position and practice level forecast out-turn, providing an explanation of the significant variations form plan. A number of the current month variances are the result of ledger adjustments which have corrected a issues accumulated over a recent months, the expectation is these will smooth in future periods. Work is underway to improve the reporting of these as a direct request from the CCG. The financial information is presented on a practice level basis and then broken down by expenditure type. A summary for the CCG is as follows.

Row Labels Sum of YTD budget (£) Sum of YTD Actual (£) Sum of YTD Variance (£) Comments Contractual 23,854,489 24,051,796 197,307 OOH settlement for 13-14 causing majority of overspend Enhanced services 1,276,605 1,248,846 (27,759) Other - GP Services 1,802,704 1,718,684 (84,020) YTD underspend the result of professional Fees payment profile Premises cost reimbursements 3,937,083 3,968,180 31,097 QOF 2,218,939 2,209,362 (9,577) TPS and Pension 0 (0) (0) Grand Total 33,089,820 33,227,435 137,615 2.6. Within Mid Essex budgets have been adjusted to reflect required APMS contract values. Within contractual a historic payment issue has been identified and a one off non-recurrent settlement payment made to correct. The position also contains some NR dual running costs following a premises move 102k and some NR Prior year enhanced Service claim payments. Some Vulnerable Practice and Improvement grant allocations are awaited from the centre totalling 36k.

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Expenditure Summary for North East Essex For period 9 - 2016 - 17

Row Labels Sum of YTD budget (£) Sum of YTD Actual (£) Sum of YTD Variance (£) Comments Contractual 23,065,652 23,050,169 (15,483) Enhanced services 1,116,241 1,077,839 (38,402) Some practices are claiming behind budget profiles Other - GP Services 1,339,162 1,317,395 (21,767) Premises cost reimbursements 3,099,988 3,068,635 (31,353) Recovery of rent overpayment QOF 2,292,738 2,338,123 45,385 Impact of 15/16 reconciliation TPS and Pension 0 361 361 Grand Total 30,913,781 30,852,522 (61,259)

2.7. Within North East Essex the month 9 underspend is mainly the result of profiling of professional fees budgets against expenditure, a reduction of business rates following appeal for some practices and a non-recurrent recovery of historic notional rent overpayments. There has been a APMS contract reconciliation carried out that has resulted in an additional one-off in year payment.

3. CCG Local Enhanced Services position

3.1. Practice level local enhanced service information has been received from Mid Essex CCG and is included within the practice level summary.

3.2. A summary of the current forecast year end position is as follows. CCG Local Enhanced Services Period 9 Forecast Annual Forecast Forecast Budget Outturn Variance Mid Essex CCG 1,190,975 1,119,585 (71,390) North East Essex CCG TBC TBC TBC

3.3. No update from North East Essex CCG has been received for period 9, the following summary is as per period 8.

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Figures reported in NEECCG Forecast month 8

16/17 16/17 Forecast Annual M8 Forecast Outturn LOCAL ENHANCED SERVICES Budget Outturn variance Minor Injury Services 23,547 38,711 15,164 LES Anti-coagulation 860,452 897,669 37,217 LES Complex Wound Care 176,160 158,348 -17,812 LES DVT 29,659 84,728 55,069 D Dimers 34,626 3,001 -31,625 LES Care of Homeless 3,178 3,270 92 LES Medicine Management 229,709 207,899 -21,810 LES Shared Care 14,799 16,057 1,258 North COLCHESTER Health Center 316 526 210 Carpaltunnel syndrome 4,182 3,611 -571 Headache clinic 54,384 64,350 9,966 LES Total (Workbook) 1,431,012 1,478,170 47,158 Medical fees 9,645 8,968 -677 Referral refinement 6,646 5,811 -835 Total All LES schemes 16,291 14,779 -1,512 YE bal 0 1,649 1,649 GRAND TOTAL LES 1,447,303 1,494,598 47,295 4. Recommendation

4.1. The Joint Committee is asked to note the Month 8 financial performance position.

Mat Thorpe NHS England – East

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Appendix 1 - Year to Date Financial Performance for Mid Essex and North East Essex CCGs

Financial Performance by Practice for Mid Essex CCG For period 9 - 2016 - 17

Actual Contractor Sum of In month Sum of In Sum of In Sum of YTD Sum of YTD Sum of YTD Sum of Annual Forecast (£) Forecast Comments Practice Weighted budget (£) month actual month variance budget (£) Actual (£) Variance (£) budget (£) Variance (£) Population Population (£) (£)

PMS 7,021 7,483.55 F81020 - THE FRESHFORD PRACTICE 90,750 206,725 115,975 853,525 981,191 127,666 1,176,300 1,176,300 0 OOH settlement for 13-14 causing majority of overspend 17,695 15,378.97 F81105 - LITTLE WALTHAM & GT NOTLEY SURGERY 241,671 159,923 (81,748) 1,630,521 1,605,441 (25,080) 2,271,400 2,271,400 0 YTD underspend the result of reduced Prof fees 9,171 9,358.13 F81126 - BURNHAM SURGERY CM0 8SJ 83,302 66,074 (17,228) 797,834 762,602 (35,232) 1,108,100 1,108,100 0 YTD underspend the result of reduced Prof fees 12,440 11,732.85 F81149 - THE LAURELS SURGERY 177,955 122,632 (55,323) 1,162,272 1,148,578 (13,694) 1,588,550 1,588,550 0 6,083 4,636.34 F81721 - BRICKFIELDS SURGERY 47,334 60,506 13,172 435,075 451,937 16,862 596,200 596,200 0 PMS Total 641,012 615,860 (25,152) 4,879,227 4,949,750 70,523 6,740,550 6,740,550 0 GMS 5,073 4,901.79 F81011 - KELVEDON & FEERING HEALTH CENTRE 42,599 42,787 188 392,868 393,223 355 536,600 536,600 0 14,616 14,273.94 F81022 - LONGFIELD MEDICAL CENTRE 140,233 135,024 (5,209) 1,220,065 1,235,671 15,606 1,691,400 1,691,400 0 5,925 5,474.00 F81024 - DICKENS PLACE 44,344 45,720 1,376 430,375 429,000 (1,375) 590,500 590,500 0 16,015 15,727.12 F81030 - FERN HOUSE SURGERY 139,725 141,302 1,577 1,289,134 1,283,671 (5,463) 1,785,500 1,785,500 0 6,971 5,993.86 F81035 - MOULSHAM LODGE SURGERY 51,267 53,921 2,654 499,106 503,393 4,287 698,600 698,600 0 4,003 4,372.00 F81040 - STOCK SURGERY 51,625 52,304 679 472,788 483,358 10,570 646,800 646,800 0 12,705 11,148.72 F81057 - WHITLEY HOUSE 101,178 105,206 4,028 1,018,087 1,012,820 (5,267) 1,384,700 1,384,700 0 16,130 15,320.77 F81068 - THE ELIZABETH COURTAULD SURGERY 134,656 138,050 3,394 1,310,057 1,306,483 (3,574) 1,806,000 1,806,000 0 12,496 10,876.88 F81071 - RIVERMEAD GATE MEDCTR 83,507 100,153 16,646 1,008,956 1,014,504 5,548 1,354,500 1,354,500 0 6,841 6,608.98 F81074 - MELBOURNE HOUSE SURGERY 73,420 46,815 (26,605) 530,968 524,431 (6,537) 736,000 736,000 0 3,885 3,810.88 F81076 - THE TOLLESBURY PRACTICE 42,850 41,432 (1,418) 338,768 347,522 8,754 468,400 468,400 0 11,795 10,644.11 F81083 - BEAUCHAMP HOUSE 93,119 95,126 2,007 894,683 890,719 (3,964) 1,229,300 1,229,300 0 13,635 13,303.74 F81087 - MOUNT CHAMBERS 112,060 123,906 11,846 1,095,605 1,140,077 44,472 1,496,700 1,530,700 34,000 Non-recurrent supprot to Premises solution 7,904 7,955.78 F81098 - THE WRITTLE SURGERY 73,797 75,220 1,423 669,756 682,234 12,478 924,200 924,200 0 14,053 13,921.55 F81099 - BLACKWATER MEDICAL CENTRE 136,965 127,554 (9,411) 1,160,385 1,158,649 (1,736) 1,603,600 1,603,600 0 18,575 17,028.61 F81100 - DANBURY MEDICAL CENTRE 274,118 179,067 (95,051) 1,731,950 1,762,614 30,664 2,366,400 2,468,400 102,000 Overspend due to invoice of 102000 for premises one off payment ytd mitigation from professional fees and enhanced services underspends 12,150 11,680.26 F81114 - BADDOW VILLAGE SURGERY 109,960 120,702 10,742 1,087,430 1,123,142 35,712 1,480,600 1,480,600 0 Overpayment of rent and larger activity than expected on dispensing causing overspend 7,708 8,013.78 F81119 - THE PUMP HOUSE SURGERY 82,024 83,969 1,945 777,267 770,944 (6,323) 1,061,700 1,061,700 0 9,127 8,292.11 F81122 - TENNYSON HOUSE SURGERY 76,601 76,743 142 720,669 721,026 357 990,800 990,800 0 10,749 9,427.93 F81127 - HUMBER ROAD SURGERY 78,976 62,080 (16,896) 750,400 749,681 (719) 1,032,000 1,032,000 0 6,141 6,348.43 F81130 - WILLIAM FISHER MEDCTR 63,311 60,591 (2,720) 536,135 531,083 (5,052) 747,700 747,700 0 17,688 15,829.11 F81132 - BLANDFORD MEDICAL CENTRE 144,121 151,476 7,355 1,416,571 1,421,154 4,583 1,938,900 1,938,900 0 3,570 3,979.30 F81138 - HILTON HOUSE 35,702 37,989 2,287 323,435 329,698 6,263 455,100 455,100 0 - - F81162 - CASTLE HEDINGHAM SURGERY 0 0 0 0 (7,978) (7,978) 0 0 0 4,549 3,677.12 F81170 - KINGSWAY SURGERY CM3 5QH 38,517 45,286 6,769 331,175 342,081 10,906 453,400 453,400 0 6,334 5,550.68 F81173 - DOUGLAS GROVE SURGERY 52,275 31,806 (20,469) 536,344 552,587 16,243 730,700 730,700 0 4,579 5,298.29 F81183 - TILLINGHAM MED CENTRE 65,519 61,886 (3,633) 564,457 559,668 (4,789) 780,400 780,400 0 5,411 5,301.08 F81193 - WITHAM HEALTH CENTRE 41,384 39,975 (1,409) 368,574 366,425 (2,149) 520,500 520,500 0 2,044 2,066.68 F81635 - COLLINGWOOD ROAD SURGERY 19,428 19,462 34 167,488 166,166 (1,322) 232,500 232,500 0 4,309 3,231.59 F81665 - CHELMER VILLAGE SURGERY 28,905 27,638 (1,267) 255,078 253,727 (1,351) 348,900 348,900 0 2,343 2,034.81 F81674 - WYNCROFT SURGERY 23,460 19,392 (4,068) 201,504 208,372 6,868 278,100 278,100 0 10,103 8,118.53 F81683 - BLYTHS MEADOW SURGERY 75,727 78,331 2,604 747,608 735,046 (12,562) 1,001,800 1,001,800 0 5,664 5,869.25 F81730 - THE COGGESHALL SURGERY 49,280 51,168 1,888 464,450 471,787 7,337 646,200 646,200 0 2,548 2,560.82 F81738 - HOUSE 21,122 22,277 1,155 216,729 215,753 (976) 290,500 290,500 0 3,538 3,487.40 F81751 - THE TRINITY MEDICAL PRACTICE 32,108 30,953 (1,155) 279,600 277,298 (2,302) 390,600 390,600 0 4,911 5,243.73 Y00293 - THE CASTLE SURGERY 48,573 50,678 2,105 454,009 460,816 6,807 637,100 637,100 0 4,428 3,619.94 Y00589 - GREENWOOD SURGERY 30,976 43,709 12,733 296,100 316,747 20,647 414,300 414,300 0 GMS Total 2,713,432 2,619,697 (93,735) 24,558,574 24,733,593 175,019 33,751,000 33,887,000 136,000 APMS 0 0 0V1096 - VIRGIN CARE PROVIDER SERVICES LTD (1,223,100) (210,850) 1,012,250 801,900 801,851 (49) 801,900 801,900 0 11,805 11,320.43 F81014 - STLAWRENCE MEDICAL PRACTICE 627,291 112,506 (514,785) 897,760 850,307 (47,453) 1,399,300 1,399,300 0 Budgets have been adjusted to reflect contract costs Ytd underspend the result of business rates charges not received, under review 11,668 10,446.12 F81117 - SUTHERLAND LODGE SURGERY 434,232 135,500 (298,732) 813,739 814,683 944 1,187,100 1,187,100 0 4,587 3,544.48 F81185 - THE PRACTICE SOUTH WOODHAM FERRERS 41,716 38,583 (3,133) 400,744 382,819 (17,925) 621,900 621,900 0 3,109 2,631.65 Y02611 - NORTH CHELMSFORD NHS HCC 56,475 56,867 392 517,024 465,797 (51,227) 754,200 754,200 0 NR Underspend due to YE accruals estimates being greater than final charge 3,550 3,419.01 Y05023 - SILVER END SURGERY 170,817 44,312 (126,505) 220,852 214,469 (6,383) 361,500 361,500 0 APMS Total 107,431 176,918 69,487 3,652,019 3,529,924 (122,095) 5,125,900 5,125,900 0

06QCCG - NHS MID ESSEX CCG 0 59,000 59,000 0 14,168 14,168 0 Other Total 0 59,000 59,000 0 14,168 14,168 0 Grand Total 3,461,875 3,471,475 9,600 33,089,820 33,227,435 137,615 45,617,450 45,753,450 136,000

15

Practice Expenditure Summary for Mid Essex CCG For period 9 - 2016 - 17

Contractual Enhanced services Other - GP Services Premises cost reimbursements QOF TPS and Pension Total Sum of YTD budget (£) CCG Local Enhanced Services Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Pro Rata Sum of Sum of YTD YTD Actual YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD Actual YTD Sum of YTD Actual YTD budget (£) (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget (£) (£) Variance YTD (£) Variance (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) budget (£) (£) APMS F81014 - STLAWRENCE MEDICAL PRA 749,629 757,505 7,876 40,348 24,614 (15,734) 11,395 391 (11,004) 53,718 37,394 (16,324) 42,670 30,403 (12,267) 0 0 0 897,760 850,307 (47,453) 8,428 7,923 (505) F81117 - SUTHERLAND LODGE SURGE 625,875 638,418 12,543 29,599 24,809 (4,790) 24,002 9,621 (14,381) 86,270 71,819 (14,451) 47,993 70,016 22,023 0 (0) (0) 813,739 814,683 944 21,134 19,867 (1,267) F81185 - THE PRACTICE SOUTH WOO359,956 349,515 (10,441) 14,100 8,529 (5,571) 0 0 0 1,945 0 (1,945) 24,743 24,775 32 0 0 0 400,744 382,819 (17,925) 9,321 8,762 (559) Y05023 - SILVER END SURGERY 176,655 176,797 142 9,700 7,107 (2,593) 0 811 811 22,500 21,750 (750) 11,997 8,003 (3,994) 220,852 214,469 (6,383) 0 Y02611 - NORTH CHELMSFORD NHS H 497,779 465,630 (32,149) 8,750 8,269 (481) 0 1,168 1,168 10,495 (9,270) (19,765) 517,024 465,797 (51,227) 5,076 4,772 (304) 0V1096 - VIRGIN CARE PROVIDER SER801,900 801,851 (49) 0 0 0 801,900 801,851 (49) 0 APMS Total 3,211,794 3,189,715 (22,079) 102,497 73,328 (29,169) 35,397 11,991 (23,406) 164,433 130,962 (33,471) 137,898 123,928 (13,970) 0 (0) (0) 3,652,019 3,529,924 (122,095) 0 GMS 0 F81193 - WITHAM HEALTH CENTRE 309,364 309,452 88 21,948 22,010 62 3,367 1,059 (2,308) 33,895 33,904 9 0 0 0 368,574 366,425 (2,149) 9,962 9,365 (597) F81099 - BLACKWATER MEDICAL CEN 860,045 860,003 (42) 53,548 54,119 571 86,545 85,758 (787) 74,072 72,625 (1,447) 86,175 86,143 (32) 0 (0) (0) 1,160,385 1,158,649 (1,736) 2,502 2,352 (150) F81100 - DANBURY MEDICAL CENTRE 1,063,051 1,068,504 5,453 72,249 82,921 10,672 150,715 124,551 (26,164) 336,811 377,487 40,676 109,124 109,151 27 0 0 0 1,731,950 1,762,614 30,664 53,915 50,683 (3,232) F81132 - BLANDFORD MEDICAL CENT 952,699 952,382 (317) 48,498 48,732 234 75,300 83,344 8,044 230,122 226,782 (3,340) 109,952 109,914 (38) 0 0 0 1,416,571 1,421,154 4,583 37,283 35,049 (2,235) F81011 - KELVEDON & FEERING HEAL 302,458 302,329 (129) 12,848 13,265 417 2,620 1,704 (916) 47,042 48,027 985 27,900 27,897 (3) 0 0 0 392,868 393,223 355 11,483 10,795 (688) F81022 - LONGFIELD MEDICAL CENTR 917,309 924,561 7,252 52,647 63,646 10,999 58,573 55,999 (2,574) 105,514 105,448 (66) 86,022 86,017 (5) 0 (0) (0) 1,220,065 1,235,671 15,606 17,734 16,671 (1,063) F81024 - DICKENS PLACE 328,812 329,046 234 20,048 20,305 257 4,275 4,347 72 47,772 45,834 (1,938) 29,468 29,468 (0) 0 0 0 430,375 429,000 (1,375) 1,998 1,878 (120) F81035 - MOULSHAM LODGE SURGER 384,678 384,529 (149) 28,349 31,715 3,366 3,150 4,598 1,448 43,025 42,619 (407) 39,904 39,933 29 0 (0) (0) 499,106 503,393 4,287 21,909 20,596 (1,313) F81040 - STOCK SURGERY 266,690 266,655 (35) 12,698 11,865 (833) 109,503 121,112 11,609 55,097 54,909 (188) 28,800 28,817 17 0 (0) (0) 472,788 483,358 10,570 7,378 6,936 (442) F81057 - WHITLEY HOUSE 712,150 710,998 (1,152) 40,148 39,700 (448) 3,897 230 (3,667) 198,297 198,285 (12) 63,595 63,606 11 0 (0) (0) 1,018,087 1,012,820 (5,267) 17,843 16,773 (1,070) F81071 - RIVERMEAD GATE MEDCTR 665,997 676,175 10,178 39,597 30,143 (9,454) 6,372 2,333 (4,039) 232,117 241,011 8,894 64,873 64,842 (31) 0 0 0 1,008,956 1,014,504 5,548 12,002 11,283 (719) F81074 - MELBOURNE HOUSE SURGER 441,380 451,118 9,738 31,000 26,425 (4,575) 3,745 4,140 395 12,100 0 (12,100) 42,743 42,749 6 0 0 0 530,968 524,431 (6,537) 8,274 7,778 (496) F81076 - THE TOLLESBURY PRACTICE 234,763 235,003 240 12,898 12,785 (113) 41,995 45,806 3,811 28,114 32,891 4,777 20,998 21,037 39 0 0 0 338,768 347,522 8,754 11,974 11,256 (718) F81083 - BEAUCHAMP HOUSE 650,444 649,786 (658) 36,698 36,176 (522) 9,145 8,472 (673) 122,797 120,712 (2,085) 75,599 75,574 (25) 0 (0) (0) 894,683 890,719 (3,964) 26,966 25,349 (1,616) F81087 - MOUNT CHAMBERS 800,562 802,544 1,982 33,797 35,961 2,164 59,930 68,178 8,248 105,850 137,912 32,062 95,466 95,482 16 0 (0) (0) 1,095,605 1,140,077 44,472 51,544 48,455 (3,090) F81098 - THE WRITTLE SURGERY 499,988 499,734 (254) 20,000 23,656 3,656 48,375 57,097 8,722 52,945 53,292 347 48,448 48,456 8 0 (0) (0) 669,756 682,234 12,478 13,630 12,813 (817) F81114 - BADDOW VILLAGE SURGERY 707,670 707,764 94 34,750 34,393 (357) 52,047 73,654 21,607 214,220 228,593 14,373 78,743 78,738 (5) 0 0 0 1,087,430 1,123,142 35,712 37,295 35,059 (2,236) F81119 - THE PUMP HOUSE SURGERY 472,620 473,017 397 20,149 13,490 (6,659) 86,400 88,361 1,961 149,425 147,383 (2,042) 48,673 48,693 20 0 0 0 777,267 770,944 (6,323) 23,686 22,266 (1,420) F81122 - TENNYSON HOUSE SURGERY 528,890 528,687 (203) 31,796 35,032 3,236 4,645 2,885 (1,760) 102,020 101,119 (901) 53,318 53,303 (15) 0 0 0 720,669 721,026 357 19,070 17,927 (1,143) F81127 - HUMBER ROAD SURGERY 585,787 585,687 (100) 34,298 34,416 118 6,300 6,248 (52) 64,695 63,999 (696) 59,320 59,330 10 0 0 0 750,400 749,681 (719) 17,535 16,484 (1,051) F81130 - WILLIAM FISHER MEDCTR 392,698 392,967 269 25,748 27,916 2,168 42,750 48,543 5,793 36,319 23,025 (13,294) 38,620 38,631 11 0 0 0 536,135 531,083 (5,052) 11,753 11,048 (704) F81170 - KINGSWAY SURGERY CM3 5Q 252,462 262,274 9,812 14,050 13,531 (519) 225 2,185 1,960 41,945 41,610 (335) 22,493 22,481 (12) 0 0 0 331,175 342,081 10,906 16,057 15,095 (963) F81173 - DOUGLAS GROVE SURGERY 354,860 354,567 (293) 16,349 14,582 (1,767) 3,295 (5,430) (8,725) 120,745 119,927 (818) 41,095 41,128 33 0 0 0 536,344 552,587 16,243 19,626 18,449 (1,176) F81183 - TILLINGHAM MED CENTRE 339,129 352,121 12,992 29,068 26,706 (2,362) 96,822 85,004 (11,818) 65,390 61,765 (3,625) 34,048 34,073 25 0 0 0 564,457 559,668 (4,789) 45,133 42,428 (2,705) F81635 - COLLINGWOOD ROAD SURG 128,200 128,276 76 6,999 5,889 (1,110) 1,125 1,190 65 18,042 17,689 (353) 13,122 13,121 (1) 0 0 0 167,488 166,166 (1,322) 1,711 1,609 (103) F81665 - CHELMER VILLAGE SURGERY 206,582 206,741 159 0 (40) (40) 1,800 455 (1,345) 27,572 27,426 (146) 19,124 19,144 20 0 0 0 255,078 253,727 (1,351) 196 185 (12) F81674 - WYNCROFT SURGERY 136,347 136,328 (19) 7,597 8,453 856 20,098 26,653 6,555 25,471 24,914 (557) 11,991 12,024 33 0 0 0 201,504 208,372 6,868 3,238 3,044 (194) F81683 - BLYTHS MEADOW SURGERY 503,496 503,495 (1) 32,800 23,007 (9,793) 2,845 2,194 (651) 166,697 164,556 (2,141) 41,770 41,794 24 0 0 0 747,608 735,046 (12,562) 7,594 7,139 (455) F81738 - BRIMPTON HOUSE 157,458 157,560 102 9,099 8,090 (1,009) 9,175 8,626 (549) 32,672 33,170 498 8,325 8,307 (18) 0 0 0 216,729 215,753 (976) 4,940 4,644 (296) F81751 - THE TRINITY MEDICAL PRAC 207,736 207,856 120 13,150 13,556 406 18,972 17,115 (1,857) 17,997 16,017 (1,980) 21,745 22,754 1,009 0 0 0 279,600 277,298 (2,302) 13,897 13,064 (833) Y00293 - THE CASTLE SURGERY 310,677 310,896 219 18,949 10,830 (8,119) 84,224 81,056 (3,168) 16,092 33,925 17,833 24,067 24,109 42 0 0 0 454,009 460,816 6,807 17,056 16,034 (1,022) Y00589 - GREENWOOD SURGERY 218,286 228,646 10,360 16,148 18,537 2,389 1,647 2,378 731 35,872 37,025 1,153 24,147 30,160 6,013 296,100 316,747 20,647 12,372 11,630 (742) F81030 - FERN HOUSE SURGERY 922,124 922,487 363 39,999 43,484 3,485 95,320 86,568 (8,752) 128,119 127,579 (540) 103,572 103,554 (18) 0 (0) (0) 1,289,134 1,283,671 (5,463) 39,211 36,861 (2,350) F81138 - HILTON HOUSE 231,789 232,881 1,092 8,599 7,812 (787) 35,702 41,266 5,564 23,197 23,573 376 24,148 24,166 18 0 0 0 323,435 329,698 6,263 10,143 9,535 (608) F81162 - CASTLE HEDINGHAM SURGE 1 0 (1) 0 (5,078) (5,078) (1) 0 1 0 (2,900) (2,900) 0 (7,978) (7,978) 0 F81730 - THE COGGESHALL SURGERY 343,911 344,062 151 20,698 26,330 5,632 16,577 18,798 2,221 44,942 44,257 (685) 38,322 38,341 19 0 0 0 464,450 471,787 7,337 22,930 21,555 (1,374) F81068 - THE ELIZABETH COURTAULD 908,839 909,063 224 68,749 68,105 (644) 6,300 6,239 (61) 234,965 231,863 (3,102) 91,204 91,214 10 0 0 0 1,310,057 1,306,483 (3,574) 43,961 41,326 (2,635) GMS Total 17,299,952 17,368,192 68,240 985,966 982,469 (3,497) 1,253,775 1,262,715 8,940 3,258,072 3,327,248 69,176 1,760,809 1,765,154 4,345 0 (0) (0) 24,558,574 24,733,593 175,019 0 PMS 0 F81105 - LITTLE WALTHAM & GT NOT1,053,154 1,051,180 (1,974) 74,248 69,504 (4,744) 224,100 206,384 (17,716) 179,345 178,695 (650) 99,674 99,678 4 0 (0) (0) 1,630,521 1,605,441 (25,080) 65,923 61,972 (3,952) F81721 - BRICKFIELDS SURGERY 338,586 357,767 19,181 19,449 16,426 (3,023) 3,375 3,997 622 43,217 43,280 63 30,448 30,468 20 0 0 0 435,075 451,937 16,862 18,099 17,014 (1,085) F81126 - BURNHAM SURGERY CM0 8S 572,222 573,230 1,008 31,449 46,728 15,279 65,025 11,407 (53,618) 63,670 62,990 (680) 65,468 65,495 27 0 0 0 797,834 762,602 (35,232) 14,985 14,087 (898) F81149 - THE LAURELS SURGERY 880,124 874,491 (5,633) 32,599 30,343 (2,256) 39,527 36,286 (3,241) 127,229 124,650 (2,579) 82,793 82,808 15 0 0 0 1,162,272 1,148,578 (13,694) 38,997 36,660 (2,338) F81020 - THE FRESHFORD PRACTICE 498,657 637,220 138,563 30,397 30,049 (348) 181,505 171,737 (9,768) 101,117 100,354 (763) 41,849 41,831 (18) 0 0 0 853,525 981,191 127,666 37,466 35,221 (2,246) PMS Total 3,342,743 3,493,889 151,146 188,142 193,050 4,908 513,532 429,810 (83,722) 514,578 509,969 (4,609) 320,232 320,279 47 0 (0) (0) 4,879,227 4,949,750 70,523 0 0 06QCCG - NHS MID ESSEX CCG 0 14,168 14,168 0 14,168 14,168 0 Other Total 0 14,168 14,168 16 0 14,168 14,168 0 Grand Total 23,854,489 24,051,796 197,307 1,276,605 1,248,846 (27,759) 1,802,704 1,718,684 (84,020) 3,937,083 3,968,180 31,097 2,218,939 2,209,362 (9,577) 0 (0) (0) 33,089,820 33,227,435 137,615 893,231 839,689 (53,543)

Practice for North East Essex For period 9 - 2016 - 17

Sum of In Sum of In Sum of In Sum of YTD Sum of YTD Sum of YTD Sum of Forecast Forecast Comments month budget month month budget (£) Actual (£) Variance Annual (£) Variance (£) (£) actual (£) variance (£) (£) budget (£)

PMS F81018 - GREAT CLACTON MEDICAL PARTNERSHIP 74,266 72,377 (1,889) 690,043 657,031 (33,012) 963,300 963,300 0 F81212 - OLD ROAD SURGERY 174,731 80,175 (94,556) 793,129 783,802 (9,327) 1,101,100 1,101,100 0 F81221 - FRONKS RD FAMILY SURGERY 23,247 40,958 17,711 367,956 353,204 (14,752) 499,800 499,800 0 F81741 - CRUSADER SURGERY 46,574 49,283 2,709 464,964 480,137 15,173 637,800 637,800 0 PMS Total 318,818 242,792 (76,026) 2,316,092 2,274,174 (41,918) 3,202,000 3,202,000 0 GMS F81091 - EAST HILL SURGERY 69,870 69,920 50 663,414 652,817 (10,597) 922,200 922,200 0 F81042 - CASTLE GARDENS MEDICAL CENTRE 199,534 199,763 229 1,864,102 1,861,070 (3,032) 2,583,400 2,583,400 0 F81067 - AMBROSE AVENUE GROUP PRACTICE 144,160 145,987 1,827 1,369,129 1,369,647 518 1,868,900 1,868,900 0 F81094 - NORTH HILL MEDICAL GROUP 116,285 133,990 17,705 1,230,880 1,180,009 (50,871) 1,713,800 1,713,800 0 YTD Underspend due to a non recurrent recovery of rent overpayment F81115 - CREFFIELD MEDICAL CENTRE 109,944 109,675 (269) 1,054,932 1,053,455 (1,477) 1,438,400 1,438,400 0 F81133 - TIPTREE MEDICAL CENTRE 97,314 100,422 3,108 930,730 936,626 5,896 1,288,100 1,288,100 0 F81012 - WEST MERSEA SURGERY 63,276 64,433 1,157 603,116 601,362 (1,754) 836,800 836,800 0 F81028 - WIVENHOE SURGERY 61,299 65,700 4,401 575,039 581,394 6,355 798,500 798,500 0 F81044 - THE ARDLEIGH SURGERY 76,160 79,949 3,789 696,430 707,855 11,425 963,500 963,500 0 F81069 - STANWAY SURGERY 55,699 68,150 12,451 651,886 619,584 (32,302) 902,800 902,800 0 YTD underspend the result of reduced Prof fees and Premises costs against last years expenditure F81079 - PARSONS HEATH MEDICAL CENTRE 80,962 90,541 9,579 847,363 846,081 (1,282) 1,173,200 1,173,200 0 F81095 - MERSEA ROAD PRACTICE 123,203 122,152 (1,051) 1,242,272 1,235,980 (6,292) 1,700,400 1,700,400 0 F81109 - LAYER ROAD SURGERY 51,265 47,277 (3,988) 443,088 443,319 231 600,800 600,800 0 F81141 - ROWHEDGE SURGERY 93,845 103,943 10,098 969,912 965,760 (4,152) 1,318,600 1,318,600 0 F81636 - MILL ROAD SURGERY CO1 5LE 98,704 102,425 3,721 971,918 981,153 9,235 1,336,000 1,336,000 0 F81746 - BLUEBELL SURGERY 31,162 30,489 (673) 297,692 295,314 (2,378) 402,900 402,900 0 Y00484 - HAWTHORN SURGERY CO4 3GW 39,604 42,186 2,582 427,169 415,510 (11,659) 571,500 571,500 0 YTD underspend for rates and baseline budget release F81116 - COLNE MEDICAL CENTRE 101,211 104,177 2,966 922,584 922,484 (100) 1,278,500 1,278,500 0 F81213 - THORPE SURGERY 67,570 51,615 (15,955) 617,664 624,899 7,235 856,000 856,000 0 F81606 - HAREWOOD SURGERY 36,676 36,372 (304) 341,753 343,590 1,837 477,000 477,000 0 F81633 - LAWFORD SURGERY 43,357 40,710 (2,647) 367,620 353,871 (13,749) 506,300 506,300 0 YTD underspend the result of reduced Prof fees against last years expenditure F81757 - THE RIVERSIDE HEALTH CTR CO11 1AA 54,253 55,589 1,336 500,513 498,673 (1,840) 690,600 690,600 0 F81017 - WALTON SURGERY CO14 8PA 111,977 88,268 (23,709) 877,630 877,723 93 1,209,000 1,209,000 0 F81021 - THE HOLLIES CO7 8PJ 80,996 85,549 4,553 764,163 766,295 2,132 1,059,000 1,059,000 0 F81037 - EAST LYNNE MEDICAL CENTRE 80,803 96,360 15,557 815,790 824,101 8,311 1,140,500 1,140,500 0 F81052 - ST.JAMES SURGERY CO15 1DA 129,708 135,160 5,452 1,232,390 1,242,676 10,286 1,726,500 1,726,500 0 F81156 - RANWORTH SURGERY 65,763 68,989 3,226 667,498 670,342 2,844 924,200 924,200 0 F81679 - HIGHWOODS SURGERY 60,640 62,779 2,139 573,161 579,352 6,191 781,700 781,700 0 F81716 - TOLLGATE HEALTH CENTRE 64,450 63,485 (965) 647,019 642,071 (4,948) 872,300 872,300 0 F81019 - MAYFLOWER MEDICAL CENTRE ALLDRICK 176,359 187,389 11,030 1,741,740 1,735,015 (6,725) 2,382,100 2,382,100 0 GMS Total 2,586,049 2,653,442 67,393 24,908,597 24,828,027 (80,570) 34,323,500 34,323,500 0 APMS F81157 - THE FRINTON ROAD MED CTR 89,983 89,818 (165) 823,395 821,427 (1,968) 1,114,600 1,114,600 0 F81026 - CARADOC SURGERY 88,549 78,384 (10,165) 817,592 806,544 (11,048) 1,119,600 1,119,600 0 F81670 - EPPING CLOSE 50,483 51,352 869 470,549 466,937 (3,612) 664,800 664,800 0 F81681 - GREEN ELMS HEALTH CENTRE 127,341 127,229 (112) 1,168,520 1,164,878 (3,642) 1,612,600 1,612,600 0 Y02646 - NORTH COLCHESTER HEALTHCARE CENTRE 0 0 0 0 0 0 0 0 0 APMS Total 356,356 346,783 (9,573) 3,280,056 3,259,786 (20,270) 4,511,600 3,397,000 0 #N/A - 0 06TCCG - NHS NE ESSEX CCG 72,115 (13,186) (85,301) 409,039 404,640 (4,399) 559,400 559,400 0 CAREUK - CARE UK CLINICAL SERVICES LTD 29,066 38,029 8,963 (3) 85,895 85,898 0 0 0 Impact of 15/16 reconciliation #N/A Total 101,181 24,843 (76,338) 409,036 490,534 81,498 559,400 559,400 0 Grand Total 3,362,404 3,267,860 (94,544) 30,913,781 30,852,522 (61,259) 42,596,500 42,596,500 0

17

Practice Expenditure Summary for North East Essex For period 9 - 2016 - 17

Contractual Enhanced services Other - GP Services Premises cost reimbursements QOF TPS and Pension Total Sum of YTD budget (£) Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of Sum of YTD YTD Actual YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD YTD Actual YTD budget (£) (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget Actual (£) Variance budget (£) (£) Variance (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) (£) APMS F81157 - THE FRINTON ROAD MED CTR 727,432 728,916 1,484 13,549 14,751 1,202 4,122 0 (4,122) 27,522 27,000 (522) 50,770 50,760 (10) 823,395 821,427 (1,968) F81026 - CARADOC SURGERY 707,102 706,769 (333) 17,948 17,318 (630) 0 29 29 39,224 29,119 (10,105) 53,318 53,310 (8) 0 0 0 817,592 806,544 (11,048) F81670 - EPPING CLOSE 407,406 406,480 (926) 16,199 12,224 (3,975) 0 1,725 1,725 25,947 25,500 (447) 20,997 21,009 12 470,549 466,937 (3,612) F81681 - GREEN ELMS HEALTH CENTRE 970,122 969,165 (957) 22,449 21,795 (654) 0 0 0 104,022 102,000 (2,022) 71,927 71,918 (9) 1,168,520 1,164,878 (3,642) Y02646 - NORTH COLCHESTER HEALTHCARE CENTRE 0 0 0 0 0 0 APMS Total 2,812,062 2,811,330 (732) 70,145 66,088 (4,057) 4,122 1,754 (2,368) 196,715 183,619 (13,096) 197,012 196,996 (16) 0 0 0 3,280,056 3,259,786 (20,270) GMS F81091 - EAST HILL SURGERY 499,455 499,579 124 29,298 23,751 (5,547) 5,770 811 (4,959) 68,142 67,573 (569) 60,749 60,742 (7) 0 361 361 663,414 652,817 (10,597) F81042 - CASTLE GARDENS MEDICAL CENTRE 1,447,588 1,438,023 (9,565) 83,097 93,016 9,919 14,400 11,233 (3,167) 165,792 165,572 (220) 153,225 153,225 0 0 0 0 1,864,102 1,861,070 (3,032) F81067 - AMBROSE AVENUE GROUP PRACTICE 899,053 900,127 1,074 51,548 52,368 820 10,495 9,506 (989) 313,235 312,843 (392) 94,798 94,803 5 0 0 0 1,369,129 1,369,647 518 F81094 - NORTH HILL MEDICAL GROUP 862,485 861,327 (1,158) 47,898 43,397 (4,501) 86,850 82,769 (4,081) 134,495 93,403 (41,092) 99,152 99,113 (39) 0 0 0 1,230,880 1,180,009 (50,871) F81115 - CREFFIELD MEDICAL CENTRE 717,073 716,358 (715) 40,098 41,967 1,869 8,920 9,001 81 214,525 211,773 (2,752) 74,316 74,356 40 0 0 0 1,054,932 1,053,455 (1,477) F81133 - TIPTREE MEDICAL CENTRE 716,114 715,835 (279) 42,999 49,020 6,021 19,750 19,700 (50) 76,122 76,291 169 75,745 75,779 34 0 0 0 930,730 936,626 5,896 F81012 - WEST MERSEA SURGERY 487,078 487,501 423 17,149 16,980 (169) 4,797 1,382 (3,415) 36,195 37,564 1,369 57,897 57,934 37 0 0 0 603,116 601,362 (1,754) F81028 - WIVENHOE SURGERY 461,170 463,296 2,126 19,848 19,236 (612) 4,870 4,715 (155) 36,575 41,590 5,015 52,576 52,557 (19) 0 (0) (0) 575,039 581,394 6,355 F81044 - THE ARDLEIGH SURGERY 471,834 473,325 1,491 18,799 18,425 (374) 107,703 117,311 9,608 53,319 54,025 706 44,775 44,769 (6) 0 0 0 696,430 707,855 11,425 F81069 - STANWAY SURGERY 427,928 427,007 (921) 25,148 20,143 (5,005) 79,947 60,929 (19,018) 76,637 69,309 (7,328) 42,226 42,197 (29) 0 0 0 651,886 619,584 (32,302) F81079 - PARSONS HEATH MEDICAL CENTRE 656,492 655,058 (1,434) 37,099 37,552 453 6,750 7,232 482 79,225 78,450 (775) 67,797 67,789 (8) 0 0 0 847,363 846,081 (1,282) F81095 - MERSEA ROAD PRACTICE 947,562 942,423 (5,139) 51,698 55,641 3,943 55,945 44,083 (11,862) 94,447 93,867 (580) 92,620 99,966 7,346 0 0 0 1,242,272 1,235,980 (6,292) F81109 - LAYER ROAD SURGERY 359,196 358,955 (241) 13,900 14,094 194 2,772 3,208 436 35,575 35,447 (128) 31,645 31,615 (30) 0 (0) (0) 443,088 443,319 231 F81141 - ROWHEDGE SURGERY 766,339 766,576 237 43,199 31,198 (12,001) 60,380 68,388 8,008 61,519 61,150 (369) 38,475 38,448 (27) 0 0 0 969,912 965,760 (4,152) F81636 - MILL ROAD SURGERY CO1 5LE 617,354 617,130 (224) 48,347 51,727 3,380 54,000 63,171 9,171 189,594 186,477 (3,117) 62,623 62,648 25 0 0 0 971,918 981,153 9,235 F81746 - BLUEBELL SURGERY 193,450 193,107 (343) 12,348 11,746 (602) 1,045 965 (80) 76,450 75,066 (1,384) 14,399 14,430 31 0 0 0 297,692 295,314 (2,378) Y00484 - HAWTHORN SURGERY CO4 3GW 331,156 324,074 (7,082) 11,699 10,618 (1,081) 2,620 1,961 (659) 58,447 55,637 (2,810) 23,247 23,220 (27) 0 0 0 427,169 415,510 (11,659) F81116 - COLNE MEDICAL CENTRE 704,572 704,530 (42) 25,748 23,451 (2,297) 36,298 39,111 2,813 74,067 73,456 (611) 81,899 81,936 37 0 (0) (0) 922,584 922,484 (100) F81213 - THORPE SURGERY 476,854 476,738 (116) 24,798 29,644 4,846 33,147 32,978 (169) 36,972 39,655 2,683 45,893 45,883 (10) 0 (0) (0) 617,664 624,899 7,235 F81606 - HAREWOOD SURGERY 237,140 236,457 (683) 10,999 10,247 (752) 50,995 54,617 3,622 19,967 19,615 (352) 22,652 22,653 1 0 0 0 341,753 343,590 1,837 F81633 - LAWFORD SURGERY 249,253 248,598 (655) 13,999 8,860 (5,139) 59,175 51,359 (7,816) 21,496 21,320 (176) 23,697 23,733 36 367,620 353,871 (13,749) F81757 - THE RIVERSIDE HEALTH CTR CO11 1AA 374,375 373,710 (665) 16,998 13,973 (3,025) 55,875 57,895 2,020 21,395 21,229 (166) 31,870 31,867 (3) 0 0 0 500,513 498,673 (1,840) F81017 - WALTON SURGERY CO14 8PA 710,270 710,981 711 22,699 22,380 (319) 6,670 6,256 (414) 53,994 54,070 76 83,997 84,036 39 0 0 0 877,630 877,723 93 F81021 - THE HOLLIES CO7 8PJ 611,122 617,114 5,992 25,699 21,671 (4,028) 5,095 5,601 506 54,297 53,944 (353) 67,950 67,965 15 0 0 0 764,163 766,295 2,132 F81037 - EAST LYNNE MEDICAL CENTRE 648,165 645,990 (2,175) 38,599 24,796 (13,803) 6,525 5,145 (1,380) 42,250 67,934 25,684 80,251 80,237 (14) 0 0 0 815,790 824,101 8,311 F81052 - ST.JAMES SURGERY CO15 1DA 960,335 960,169 (166) 49,648 60,110 10,462 11,547 12,814 1,267 71,294 70,015 (1,279) 139,566 139,567 1 0 0 0 1,232,390 1,242,676 10,286 F81156 - RANWORTH SURGERY 533,783 532,921 (862) 25,948 27,430 1,482 5,247 7,619 2,372 38,250 38,089 (161) 64,270 64,282 12 0 0 0 667,498 670,342 2,844 F81679 - HIGHWOODS SURGERY 453,596 451,591 (2,005) 20,898 18,110 (2,788) 1,647 3,262 1,615 57,797 67,172 9,375 39,223 39,216 (7) 0 0 0 573,161 579,352 6,191 F81716 - TOLLGATE HEALTH CENTRE 415,064 414,851 (213) 27,448 20,544 (6,904) 2,772 2,508 (265) 162,135 164,566 2,431 39,600 39,602 2 0 0 0 647,019 642,071 (4,948) F81019 - MAYFLOWER MEDICAL CENTRE ALLDRICK 1,164,871 1,165,067 196 63,548 55,057 (8,491) 84,400 86,458 2,058 319,870 319,395 (475) 109,051 109,038 (13) 0 (0) (0) 1,741,740 1,735,015 (6,725) GMS Total 18,400,727 18,378,421 (22,306) 961,201 927,155 (34,046) 886,407 871,988 (14,419) 2,744,078 2,726,496 (17,582) 1,916,184 1,923,607 7,423 0 361 361 24,908,597 24,828,027 (80,570) PMS F81018 - GREAT CLACTON MEDICAL PARTNERSHIP 559,300 532,832 (26,468) 24,649 24,185 (464) 10,945 5,181 (5,764) 29,820 29,530 (290) 65,329 65,304 (25) 0 0 0 690,043 657,031 (33,012) F81212 - OLD ROAD SURGERY 645,397 637,919 (7,478) 31,348 31,335 (13) 6,822 4,271 (2,551) 50,315 51,018 703 59,247 59,259 12 0 (0) (0) 793,129 783,802 (9,327) F81221 - FRONKS RD FAMILY SURGERY 300,390 293,473 (6,917) 9,800 8,054 (1,746) 17,775 12,096 (5,679) 25,220 24,823 (397) 14,771 14,758 (13) 0 0 0 367,956 353,204 (14,752) F81741 - CRUSADER SURGERY 347,781 362,326 14,545 19,098 21,022 1,924 4,050 3,469 (581) 53,840 53,150 (690) 40,195 40,170 (25) 0 (0) (0) 464,964 480,137 15,173 PMS Total 1,852,868 1,826,550 (26,318) 84,895 84,596 (299) 39,592 25,018 (14,574) 159,195 158,520 (675) 179,542 179,491 (51) 0 (0) (0) 2,316,092 2,274,174 (41,918)

06TCCG - NHS NE ESSEX CCG (2) 0 2 409,041 404,640 (4,401) 409,039 404,640 (4,399) CAREUK - CARE UK CLINICAL SERVICES LTD (3) 33,869 33,872 0 13,996 13,996 0 38,029 38,029 (3) 85,895 85,898 #N/A Total (5) 33,869 33,874 409,041 418,636 9,595 0 38,029 38,029 409,036 490,534 81,498 ( () ) Grand Total 23,065,652 23,050,169 (15,483) 1,116,241 1,077,839 (38,402) 1,339,162 1,317,395 (21,767) 3,099,988 3,068,635 (31,353) 2,292,738 2,338,123 45,385 0 361 361 30,913,781 30,852,522 (61,259) 18

Agenda Item 8

NHS England, MECCG and NEECCG Primary Care Commissioning Committee Meeting of 1 February 2017

IT and Premises Update

1. Estates and Technology Transformation Fund (“ETTF”)

A final list of schemes covering a 3 year period and split in to 2 cohorts have been supported in principle by the NHS England national team. Cohort 1 schemes must be completed by 31st March 2017. Cohort 2 Schemes must be completed to an agreed timescale between 31st March 2018 and 31st March 2019. In order to achieve full approval to enable commencement all projects are now subject to due diligence.

Bids that are supported in principle are not approved until due diligence requirements have been met and final approval is given for a scheme/project to proceed

Supported Cohort 1 schemes and their current status are shown below:

CCG Project Name Brief Description Status NE Essex Tollgate MC Extension to provide additional clinical Awaiting due diligence space – project likely to change Mid Kelvedon & Feering Reconfiguration to provide additional Awaiting due diligence Essex Health Centre clinical space - funding gap identified Mid Wyncroft Surgery Conversion of office space to clinical Awaiting due diligence Essex room NE Essex Clacton Hospital New build - Fees to work up OBC/FBC Approved NE Essex Tiptree Medical Centre New build - Fees to work up OBC/FBC Approved Mid Maldon Healthcare New build - Fees to work up OBC/FBC Approved Essex Reprovision Mid Witham Hub Surgery New build - Fees to work up OBC/FBC Approved Essex NE Essex GPIT Mobile/Remote Working Awaiting work programme Mid GPIT Mobile working Awaiting work Essex programme Mid GPIT Wifi Provision Awaiting work Essex programme Mid GPIT Video Conferencing Awaiting work Essex programme NE Essex GPIT Wifi Provision Awaiting work programme NE Essex GPIT NEE CARE IS Pilot and Rollout Awaiting work programme

In addition the following scheme originally submitted as an ETTT bid will now instead be funded as Premises Improvement Grant:

CCG Project Name Brief Description Status NE Creffield Road Reconfiguration to provide Awaiting due Essex Medical Centre additional clinical space diligence 19

Note that a number of Mid Essex CCG sponsored IT schemes now cover the whole of the Mid and South Essex STP area.

2. Other Premises Developments

The following updates on schemes within the pipeline should be noted:

Riverside, : The lease has now expired a new lease is being negotiated.

A new portacabin is required as an interim measure whilst a longer term plan is identified. Costs have now been received and a PID is to be prepared and funding sought.

Wivenhoe Health Centre: A full business case has been approved. Currently awaiting a revised construction programme and finalised IT costs.

West Mersea: Currently on hold

Harewood Surgery - currently on hold, awaiting revised proposal

Beaulieu Park - awaiting commissioning decision before estates proposal can progress. A meeting with the developer is being arranged to progress with the build whilst details are finalised.

South Woodham Ferrers- PID approved, Outline Business case to be prepared

Kennedy Way, Clacton: - Architect has been commissioned by NHSPS to draw up initial plans for review

St Lawrence, Braintree- Work on the new premises are underway. Completion expected March 2017

Abbeyfield, Colchester - Expression of Interest for premises improvements has been approved – awaiting Project Initiation Document – Currently on hold at the request of the CCG.

20

Agenda Item 10 i)

REPORT TO THE MID ESSEX, NORTH EAST ESSEX & NHS ENGLAND PRIMARY CARE COMMISSIONING COMMITTEE

Meeting Date:

Agenda No:

FOR DECISION / INFORMATION

Report Title: Executive Sponsor:

Presented by: ______

1. Summary

2. Key Points to Note

3. Risks Identified

4. Accountability

5. Resource Implications

6. Strategic Objectives

7. Impact on Commissioners (NHS England and CCGs), Providers and wider health services

8. Finance Impact

Q1 Is investment required?

Non- In-year £ Full year £ Yes No Recurrent recurrent requirement requirement

Q2 What is the net impact of the proposal? (after any investments)

Negative - Neutral - Positive - Cost pressure No budget impact QIPP available £

21

Q3 What is the impact of the proposal?

Non- In-year £ Full year £ Recurrent recurrent requirement requirement

Negative - Neutral - Positive - Cost pressure No budget impact QIPP available £

Q4 What is the current budget position?

Existing annual budget available: Current year-end forecast expenditure on this budget Budget code: Management account lead name:

9. Implications for Engagement and Communication

10. Equality and Diversity

11. Recommendation

22