Public Agenda – Meeting in Common

Primary Care Commissioning Committees of Redditch and Bromsgrove CCG South Worcestershire CCG Wyre Forest CCG ‘Meetings in common’ Wednesday, 31 October 2018 at 10:30am Bewdley Medical Centre, Dog Lane, Bewdley, DY12 2EF

Public Agenda – meeting in common

Times Subject Purpose Lead Enclosure

1. 10:30 Welcome and introductions TH

2. Apologies for absence TH

3. Declarations of interest TH Report 4. Approval of minutes & action log: TH/SK Report 11 July 2018 Any items not covered on the 5. ALL agenda Strategy & decision

6. 10:40 Financial Update Information & note MD/NM Report

7. 11:00 Woodrow Medical Centre Approval LD Report

8. 11:25 Improving Access Approval DG Report General Practice Forward View 9. 11:40 Information & note LD/SC Report highlight report Information, Approval & Note

10. 11:50 IQSP – update Information & note LD Report

11. 11:55 Contract Variations Approval & note DG Report

12. Integrated Risk Report 12:00 Board Assurance Framework & Risk Approval & note TC Report Register 13. 12:10 Open Forum/Public TH/Public Verbal

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 1 |

14. 12:15 Report Planner 2018 Note & amend TH/LD Report Next meeting: 12 December at 15. ALL 10:30am (St John’s Medical Centre) 16. Proposed 2018/19 meeting dates: 30 Jan 2019 at 10:30am (WF) 13 Mar 2019 at 10:30am (BHI Parkside) 17. 12:15 STP – feedback items. Discussion LD/ALL Verbal

12:20 CLOSE

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 2 |

Which CCG Name Current positions Declared Interest: (name and Interest Type: Interest Actions taken to mitigate does the nature of the organisations) (Financial / Non- Dates risk: conflict relate Financial Professional / Non- to? Financial Personal/ Indirect Interest) All 3 CCGs Dr Carl Ellson Strategic Clinical Lead Employed as salaried GP at Corbett Financial 1992- Will not take part in decisions Voting Medical Practice Present which Corbett Medical practice NON-VOTING could directly benefit from Voting member of SWCCG, RBCCG and Non-Financial April 2018 Will ensure due consideration of WFCCG Governing Bodies Professional – present any CCG specific matters

All 3 CCGs Trish Haines GB Member - Lay Chair of H&W Age UK Non-Financial September Will not take part in decisions Member for Primary Personal 2015 – which Age UK could directly VOTING Care Present benefit from

Independent Complaints Reviewer of Non-Financial September Will not take part in decisions Independent Press Standards Personal 2016 – which IPSO could directly benefit Organisation (IPSO) Present from

Voting member of SWCCG, RBCCG and Non- Financial April 2018 Will ensure due consideration of WFCCG Governing Bodies Professional – Present any CCG specific matters

Which CCG Name Current positions Declared Interest: (name and Interest Type: Interest Actions taken to mitigate does the nature of the organisations) (Financial / Non- Dates risk: conflict relate Financial Professional / Non- to? Financial Personal/ Indirect Interest) All 3 CCGs Sarah Harvey GB Member - Lay Independent Governor and Chair of Non-Financial 2013 – Will not take part in decisions Speck member for Patient Finance and Development, University Personal Present which University of Worcester and Public of Worcester could directly benefit from VOTING Involvement (PPI) and Quality Vice Chair of Governors, University of Worcester Independent Director of Mercian Non- Financial 2012 – Will not take part in decisions Educational Trust Personal Present which Mercian Educational Trust could directly benefit from

Director of Sarah Harvey-Speck Financial 2005- Will not take part in decisions Consulting – Ltd (Dormant Company) Present which Sarah Harvey-Speck Consulting Ltd could directly benefit from Voting member of SWCCG, RBCCG and Non- Financial April 2018 Will ensure due consideration of WFCCG Governing Bodies Professional – Present any CCG specific matters

All 3 CCGs Simon Trickett Accountable Officer Voting member of SWCCG, RBCCG and Non-Financial April 2018 Will ensure due consideration of WFCCG Governing Bodies Professional – Present any CCG specific matters VOTING

Accountable Officer of Herefordshire Non-Financial 8th May Provide appropriate consideration CCG Professional 2018 – of any Herefordshire CCG matters, Present which would have an impact on the Worcestershire CCGs

All 3 CCGs Mark Dutton Chief Finance Officer Voting member of SWCCG, RBCCG and Non-Financial April 2018 Will ensure due consideration of WFCCG Governing Bodies Professional – Present any CCG specific matters VOTING

All 3 CCGs Nicola Malyon Deputy Chief Finance Voting member of SWCCG, RBCCG and Non-Financial April 2018 Will ensure due consideration of Proxy vote in Officer WFCCG Governing Bodies Professional – Present any CCG specific matters absence of Chief Finance Officer

All 3 CCGs Tricia Lowe Supporting NHS Warwickshire North CCG Financial July 2018 Will not take part in discussions Independent Lay Senior Independent Advisor, Non- – Present that NHS Warwickshire North CCG VOTING Member voting Governing Body member 2.5 will directly benefit from days per month.

All 3 CCGs Hana Taylor Head of Governance Voting member of SWCCG, RBCCG and Non-Financial April 2018 Will ensure due consideration of and Corporate Affairs WFCCG Governing Bodies Professional – Present any CCG specific matters NON-VOTING

All 3 CCGs Lynda Dando Associate Director of Voting member of SWCCG, RBCCG and Non-Financial April 2018 Will ensure due consideration of Primary Care WFCCG Governing Bodies Professional – Present any CCG specific matters NON-VOTING

Which CCG Name Current positions Declared Interest: (name and Interest Type: Interest Actions taken to mitigate does the nature of the organisations) (Financial / Non- Dates risk: conflict relate Financial Professional / Non- to? Financial Personal/ Indirect Interest) WFCCG Dr Louise GB GP member Partner in GP Surgery - Chaddesley Financial April 2015 Will not take part in decisions Bramble Corbett – Present which Chaddesley Corbett could directly benefit from NON-VOTING Spouse – GP Partner at Riverside Indirect October Will not take part in decisions Surgery, Evesham 2015 - which Riverside Surgery could Present directly benefit from

RBCCG Dr Jonathan Governing Body GP Salaried doctor at Davenal House Financial January Will not take part in decisions Leach Surgery, Bromsgrove 2010 – which Davenal House Surgery Present could directly benefit from NON-VOTING Chair of Armed Forces & Their Families Non-Financial October Declare any conflicts that may Clinical Reference Group Professional 2015 – arise as appropriate Present

Joint Honorary Secretary and Trustee Non-Financial September Would not take part in any of Royal College of General Professional 2017 – decisions where RCGP was a Practitioners Present beneficiary

Primary Care Commissioning Trustee Non-Financial August Would not take part in any Professional 2013 - decisions where PCCC was a Present beneficiary

Periodic medico-legal work Financial August Will not take part in decisions predominantly involving military cases 2013 - which I could benefit from Present financially or professionally

Which CCG Name Current positions Declared Interest: (name and Interest Type: Interest Actions taken to mitigate does the nature of the organisations) (Financial / Non- Dates risk: conflict relate Financial Professional / Non- to? Financial Personal/ Indirect Interest) N/A Dr Matthew PCCC member LMC Partner at Wyre Forest Health Financial December Will not take part in decisions Davis representative Partnership 2015 – which Wyre Forest Health Present Partnership could directly benefit NON-VOTING from LMC member representative Financial 2008 - Will not take part in decisions Present which the Worcestershire LMC could directly benefit from

RBCCG Nigel Practice Manager Income from a provider as Practice Financial February Will not take part in decisions Higgenbottam Representative Manager of St Johns House Surgery in 2014 – which St Johns House Surgery Bromsgrove Present could directly benefit from NON-VOTING

N/A Jo Ringshall Non-voting member of Nil declaration PCCC representing NON-VOTING Health Watch Worcestershire N/A Jane Stanley Non-voting member of Nil declaration PCCC representing NON-VOTING Health Watch Worcestershire N/A Matthew Fung Consultant in public Wife is a salaried GP working in Dudley Indirect Present Will not take part in decisions health at WCC; (Eve Hill Medical practice). which the Eve Hill Medical Practice NON-VOTING Honorary CPH at could directly benefit from Worcestershire CCGs

Which CCG Name Current positions Declared Interest: (name and Interest Type: Interest Actions taken to mitigate does the nature of the organisations) (Financial / Non- Dates risk: conflict relate Financial Professional / Non- to? Financial Personal/ Indirect Interest) N/A Dr Dominic Independent Out of GP Partner, Much Birch Surgery, Financial May 2018- Will not take part in decisions Horne Area GP Herefordshire Present which Much Birch Surgery could directly benefit from NON-VOTING Clinical Vice Chair, Herefordshire CCG Financial May 2018- Will not take part in decisions Present which Herefordshire CCG could directly benefit from

Honorary Senior Lecturer, University of Non-Financial May 2018 Will not take part in decisions Worcester Professional – Present which University of Worcester could directly benefit from

Member of NICE Indicators Advisory Non-Financial May 2018 Declare as appropriate Committee Professional - Present

Agenda item 4 County-Wide Primary Care Commissioning Committee Wednesday, 11 July 2018

LD Dashboard WFHP dashboard is proving difficult Proposal for a new dashboard, based broadly on the concept used at WFHP. to roll out to other members of the Worcestershire CCGs due to Discussions have commenced with Wyre Forest Health Partnership and a further update will capacity issues and is fraught with be provided when financial and logistical information is available. Item deferred until May complications. It has been agreed 2018. to reconsider how the CCGs might automate their systems whilst also Update for 16 May 2018 enabling key reporting functions. No progress has been made to date, WFHP members will be considering their Development Members agreed the fundamental 16.05.18 Plan shortly and will consider the impact of the Countywide dashboard on WFHP work plans. principles behind the system are The Partnership need to ensure they can produce with confidence a dashboard which the worthwhile and we should find a County can rely on and feel assured of how the data is created. way of making this work. Further work will be undertaken with the Business Information Team and further proposals would be presented at a later date. ITEM CLOSED

St Saviours Surgery opened their St Saviours Surgery – SW CCG practice list at the end of the 4 14.03.18 Members of the SW PC Commissioning Committee agreed the closure of St Saviours patient JH month list closure period. list for a temporary period of 4 months. This would be reviewed after that time. ITEM CLOSED Still in progress, Project Initiation ETTF Documents (PIDs) are being Update on approval to practice proposals from NHSE would be provided in due course. JH submitted by practices to NHSE for

approval. 16.05.18 Update 11 July 2018: Kerry Biggs has been visiting all the practices whose proposals are agreed and ensuring criteria is being met, updating them on process to be followed and once final approval is received, funding is released.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Practice Boundary Changes – criteria Work in progress. Members agreed it would be useful to have a set criteria and standard template for practices December meeting update. to complete in respect of boundary changes to enable conclusions to be decided upon in a 16.05.18 fair and consistent manner. Members of the committees needed to be assured patients will JH continue to receive good quality care and patient safety is assured.

Internal Audit Plan MD & LD will discuss outside the Members discussed options for items to include in the Internal Audit Plan. Consideration was meeting to reach conclusion. given to GPFV implementation and contract around funding or the PCE 17/18 contract which 16.05.18 TH/LD differed in parts across the CCGs but might reap valuable learning. MD emphasised the need to understand the Terms of Reference and consider what the Committee would like to learn from the outcome. Members agreed to consider and decide on one item for inclusion. Workforce and retention On-going. NM reported a multitude of problems: young doctors and nurses are needed and mentorship needs much development plus there is a whole tranche of aspects between recruitment and 16.05.18 retention which require work. Part of the problem is a lack of infrastructure and funds. MD MD/NM highlighted Health Education England huge resources and the potential for exploring ways of unlocking funds. MD will consider through his finance contacts and will raise the issue to the STP Finance Board.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Public Primary Care Commissioning Committees of Redditch & Bromsgrove CCG South Worcestershire CCG Wyre Forest CCG ‘Meetings in common’ Notes of the meeting held on Wednesday, 11 July 2018 at 10:30am The Hive, Sawmill Walk, The Butts, Worcester, WR1 3PD

Present (voting members) Trish Haines (Chair) TH Lay Member for Primary Care, R&B/SW/WF CCGs Mari Gay MG Chief Operating Officer, R&B/SW/WF CCGs Lynda Dando LD Director of Primary Care Worcestershire, R&B/SW/WF CCGs Nicola Malyon NM Deputy Chief Finance Officer, R&B/SW/WF CCGs Sarah Harvey-Speck SHS Lay Member for Patient & Public Involvement, R&B/SW/WF CCGs In Attendance (non-voting) Dr Jonathan Leach JL Redditch & Bromsgrove CCG Governing Body GP and countywide Primary Care Lead Dr Louise Bramble LB Wyre Forest CCG Governing Body GP and countywide Maternity and Paediatrics Lead; GP Partner, Chaddesley Corbett Surgery Dr David Herold DH LMC representative, GP Partner, Wyre Forest HP Dr Dominic Horne AP Independent GP, Herefordshire CCG Jo Ringshall JR Director – Healthwatch (SW) Matthew Fung MF Consultant, Directorate of Public Health, Worcester CC Head of Governance & Corporate Affairs R&B/SW/WF CCGs Hana Taylor HT Nigel Higenbottam NH Practice Manager representative, St John’s Surgery

Apologies Dr Matthew Davis MD LMC representative, GP Partner, Wyre Forest HP Simon Trickett ST Accountable Officer, R&B/SW/WF CCGs Mark Dutton MD Chief Finance Officer, R&B/SW/WF CCGs Dr Carl Ellson CE SW GP & Strategic Clinical Lead, R&B/SW/WF CCGs Jane Stanley JS Director – Healthwatch (R&B, WF)

In Attendance Peter Quinn PQ Senior Contract Manager – NHSE, West Midlands Jo Hall JH PC Commissioning Manager Robert Connor RC Consultant, Improved Access Sharon Kendrick SK Business Support Officer, Primary Care, R&B/SW/WF CCGs

For & on behalf of Redditch & Bromsgrove, South Worcestershire & Wyre Forest Clinical Commissioning Groups 1

Subject ACTION

1. Welcome and introductions TH welcomed Primary Care Commissioning Committees members and officers to the meeting with particular welcome to Dr David Herold who is attending for Dr Matthew Davis as the LMC representative and Tricia Lowe, who is joining the CCGs as a Supporting Lay Member and will be attending all future PCCC meetings.

2. Apologies for absence Apologies for absence have been received from members noted above. Members in attendance of the ‘committees in common’ meeting today ensured a quorate meeting.

3. Declarations of interest

The Declarations of Interest (DoI) has been distributed to members in advance of the meeting with an invitation to members to highlight any items in advance of the meeting where a conflict may arise. Nigel Higenbottam declared for transparency his position as Practice Manager at St John’s Surgery which is discussed at agenda item 7, Improving Access. Dr George Henry declared his interest as a partner at Malvern Health Centre and Dr David Herold declared his partner role at Riverside Surgery and the LMC. Both doctors are also members of the GP Federation.

4. Minutes of the meeting held on 18 May 2018

The 3 Primary Care Commissioning Committees of South Worcestershire, Redditch & Bromsgrove & Wyre Forest Clinical Commissioning Groups approved the minutes of their ‘meetings in common’ held on 18 May 2018 as an accurate record of the meeting with the SK exception of a typing error at agenda item 7 “the aim is to release GP capacity” and not “reduce GP capacity”. Action Log ETTF – Peter Quinn reported Kerry Biggs only had a few practices left to visit and the outcome for final approval and funding should be concluded very shortly. Internal Audit Plan – MD/LD are to meet to conclude the item(s) which will be incorporated into the Internal Audit plan. Workforce and retention is discussed in the agenda.

5. Any items not covered on the agenda

Governance – HT confirmed voting membership of the Primary Care Commissioning committees was purely executive and lay membership. All other members of the committees are non-voting. 6. Financial Update

At Month 2 all 3 CCGs are reporting delivery against their agreed control totals – a balanced position for both South Worcestershire and Wyre Forest and a deficit of £2.3m for Redditch & Bromsgrove.

The Committee is to note that Redditch & Bromsgrove will have access to £2.3m of Commissioner Sustainability Funds (CSF) (off-setting the agreed control total deficit position of £2.3m for 2018/19) subject to the production of a financial recovery plan that will demonstrate recovery of the CCG’s underlying position in 2019/20 (to an in-year

For & on behalf of Redditch & Bromsgrove, South Worcestershire & Wyre Forest Clinical Commissioning Groups 2

balanced position) without receipt of CSF monies in future years. The deadline for this was 30th June 2018 and we await confirmation that our plans have been approved.

Referral performance in Wyre Forest is causing some concern with the level of activity being referred out of County, favouring Dudley to Worcester. Cap and collar contracts are in place with Worcester Acute Trust to provide stability, however, patient choice favours Dudley with shorter waiting times.

The QIPP target for 18/19 across all 3 CCGs at month 2 shows an anticipated negative variance of £8m. The greatest loss is shown in Elective Care and plans are in place to explore the reasons and put in place recovery actions.

NM updated members on the second year of a two year cap and collar contract with the Worcester Acute Trust reporting an over performance of £430k. Conversations are taking place to improve this position and report a clear improvement towards the national targets.

JL acknowledged the reduction in referrals last year, which data clearly shows, but was concerned this may not be realistic to mirror in the current year with an ever increasing ageing/growing population. The Executive recognised this but felt it prudent to explore why referrals had in fact increased in the current year. Savings had been made in some pathways for example ophthalmology. MG acknowledged the challenge for General Practice but also highlighted the importance of seeing a return on the investment made through the Promoting Clinical Excellence contract to help financial sustainability.

LB agreed highlighting the need to focus on pathway redesign and making Worcester a more attractive option. The Chair agreed with LB’s comment and concerns recognising GP’s challenge to deliver patient choice and the ethical balance.

In Herefordshire DN confirmed practices have done their best to reduce referrals and are encouraging locality working to achieve greater support.

2018/19 plans at Appendix 1 show an overall CCG wide deficit potentially of £800k in Primary Care which will be managed through the year and committees will be kept up to date on the position.

Members agreed at the next meeting to focus on a less technical financial discussion and more strategic plan.

The Primary Care Commissioning committees of Redditch & Bromsgrove, South Worcestershire and Wyre Forest noted the contents of this report. 7. Update on General Practice Improved Access NH declared a direct conflict of interest as the Practice Manager at St John’s Surgery in Bromsgrove and leading on R&B’s improved access delivery model. This was noted by the Chairperson and members who agreed NH’s input would be useful in understanding the current position in respect of R&B’s proposal for improved access. Robert Connor (RC) updated members on significant changes to the general practice improved access requirements namely achievement of 100% by 1 October 2018 rather than the previously stated 1 April 2019. South Worcestershire revised proposals SW Healthcare Limited have been providing improved access since 2015 under the Prime Minister’s Challenge Fund. A revised proposal has been considered by the Improved Access Steering Group to update the current service to meet the new national 7 core criteria. The Steering Group agreed to recommend the SW proposal to the South Worcestershire PC Commissioning Committee subject to increasing utilisation rates. For & on behalf of Redditch & Bromsgrove, South Worcestershire & Wyre Forest Clinical Commissioning Groups 3

Redditch & Bromsgrove proposal St John’s Surgery is the lead provider for improved access in R&B. The R&B proposal included 50% capacity until 1st September, after which time they propose to deliver 75% with 100% from 1st October 2018. Plans also include utilising £1.50 per head transformational funding to provide additional capacity. Ultimately, delivery will be provided from 5 hubs (2 of which will alternate), however, the 75% September provision would be provided from two hubs. The Improved Access Steering group agreed to recommend this proposal to the R&B PC Commissioning Committee. NHSE have expressed concerns that only 50% capacity is being provided in August. For practices to provide extra capacity in August has proved extremely difficult due to the holiday season and workforce already reduced. NHSE had been considering a red RAG rating, however, considerable work has been undertaken presently to assure NHSE that the model presented is a credible one and a green rating is currently in place. NHSE are monitoring closely and are empowered to remove funding if any aspect of the MOU in place including trajectories aren’t delivered. The Steering Group’s recommendation is to approve the R&B proposal Wyre Forest – revised proposal

Wyre Forest Health Partnership (as lead provider) and the Wyre Forest Network of Independent Practices (NIPS) propose to deliver improved access services from two hubs but continue to discuss alternatives which could offer more economies of scale.

The provider lead for Wyre Forest was unable to present their revised delivery model to the Steering Group on June 13th. Following a meeting between the CCGs and the provider lead on June 27th, the provider lead will now present their revised model to the Steering Group by mid-July. It was noted that, as a result of a combination of delays associated with the proposed service’s IT software solution provider and constraints relating to workforce recruitment, the lead provider proposes to remain at 50% capacity provision until September 1st, after which they will increase provision to 75% and then 100% from October 1st.

Subject to Steering Group acceptance of the revised proposal, the Committee will be asked to approve the recommendation at the next meeting. Similar concerns are expressed by NHSE as discussed above with the R&B proposal in respect of the delivered trajectories.

Members debated the issues of delivering services and how pre-bookable appointments would be linked into the 111 services. Clinical members expressed their concerns at providing improved access with an already stretched and limited workforce which will impact on day to day appointments; a thorough analysis would be undertaken which would be monitored alongside A&E attendance and other services to show the impact; LD informed members that at least 30% in hours appointments could be used to meet the trajectories which fits with local flexibility and needs.

Recommendations 1. The Redditch & Bromsgrove PC Commissioning Committee agreed the R&B improved access proposal. 2. The South Worcestershire PC Commissioning Committee agreed the SW proposal subject to improved utilisation. 3. The Wyre Forest PC Commissioning Committee accepted the current position confirming their agreement to the current direction of travel and will consider the final proposal at the next meeting.

For & on behalf of Redditch & Bromsgrove, South Worcestershire & Wyre Forest Clinical Commissioning Groups 4

8. Quality & Performance Presentation

Dr George Henry provided the committees with a thorough update providing members

with assurance as to the quality of patient safety and the monitoring of general practice

within Worcestershire.

Workforce continues to be a major concern for general practice in Worcestershire. The CCG is bidding for more funding for resilience and Estates Transformation and Technology Funding (ETTF).

The Chair was assured information is being received and used critically to inform future

decisions and investment. The IQSP (Improving Quality Supporting Practices) process

has been fundamental for best practice, both clinically and to encourage practices to

receive greater funding through QoF. JL confirmed that had shown real positive results

with 65 less strokes in Worcestershire. GH also highlighted the improved communication

with practices providing them with an opportunity to share their views and concerns.

SHS considered how IQSP could link in with the patient participation providing patients with ways of supporting practices, for example, highlighting choice, guidelines which would impact on the PPG survey, MORI results, etc. SHS to promote. GH requested the minutes included a note of thanks to the Primary Care Team for the SHS work undertaken in the IQSP process, especially to Sally Everton and Jayne Hinkins. 9. GPFV Highlights Report

An updated reported is presented to members on year 2 of the 5 year Forward View plan. 2 specific areas of work are highlighted below:

• Workforce – LD confirmed a bid had been submitted to NHSE to support our workforce plan and GP retention. The outcome of the bid, submitted for Herefordshire & Worcestershire in the sum of £450k, will be known at the end of July. • Investment has been made into a new telephony system which is being rolled out across Worcestershire and should support releasing GP capacity.

The Chair and members of the South Worcestershire, Redditch & Bromsgrove and Wyre Forest commissioning committees agreed this was a huge work programme and noted the updated report. 10. Contract Variation – R&B and SW CCGs

Members of the Redditch & Bromsgrove and South Worcestershire commissioning committees noted the contractual changes noted in the report. 11. Board Assurance Framework & Risk Register reports

Members recognised the continued work being undertaken in respect of workforce retention discussed previously in the agenda and noted the reduction from 9 to 6 on the register, the reduced risk for improved access with targets due to be met with 100% coverage in all three localities. Wyre Forest are still experiencing some IT difficulties but these are being addressed presently.

Risk Register shows one risk area in respect of Woodrow Medical Centre which will be discussed in the confidential agenda.

Members of the Redditch & Bromsgrove, South Worcestershire and Wyre Forest commissioning committees agreed and noted the reports presented.

For & on behalf of Redditch & Bromsgrove, South Worcestershire & Wyre Forest Clinical Commissioning Groups 5

12. NHSE Board Report: Developing the NHS long term plan for Primary Care reform

The Director of Primary Care circulated for information the NHSE Board report which signals changes to QoF and GMS contracts; when more details is known the committees will need to make decisions on local flexibilities and outcomes of negotiations.

JL confirmed the direction of travel is clearly to reduce the number of indicators and incentivise member practices to put building blocks in place and move towards improved transformational pathways. towards on new initiatives and transformational pathways.

A report will be presented to Redditch & Bromsgrove, South Worcestershire and Wyre Forest commissioning committees at a future time; members noted the contents of the report. 13. Open Forum – no members of public attended the meeting.

14. AOB Workforce & General Practice JL updated members on the recent partnership review by Dr Nigel Watson, LMC (Wessex) which looked primarily at GP workforce and workload (particularly in relation to liability). There is concern within General Practice if doctors do not become ‘business partners’ this could affect surgeries as limited liability partnerships. As the regulations stand this is not law but the Secretary of State could make changes which raises risks to surgery management structures. This could see a reduction is productivity. The review is due to publish its initial findings in September 2018 with final recommendations at the year end. The current liability structure does require change to ensure the protection of future business partners. Local Development At the recent Health Overview and Scrutiny Committee members discussed the impact of increased housing on the health infrastructure. JH confirmed the regular conversations taking place with local councils across Worcestershire to identify gaps and joint funding solutions. This would also be raised as an area of concern and requiring greater discussion at a STP level. Clinical members confirmed the smaller developments and redevelopments for retirement homes had caused issues for practices. MF informed members Public Health had undertaken some work on ‘Health Assessments’, a process completed for ‘new developments’ which included the impact of new developments on health services and small developments showed the greater risk. MF also highlighted a new levy for developers linked to community infrastructures, which is a proposal to link new sources of funding for capital development. 15. STP Key Messages

1. Workforce 2. Increasing number of new housing developments 16. Report Planner – agreed.

17. Future meeting dates 31 October 10:30am 12 December 10:30am 30 January 10:30am 13 March 2019 10:30am

For & on behalf of Redditch & Bromsgrove, South Worcestershire & Wyre Forest Clinical Commissioning Groups 6

Agenda item 6

Finance update

Report author Nicola Malyon, Deputy Chief Finance Officer, 3 CCGs

Presented by Mark Dutton, Chief Finance Officer, 3 CCGs

Target CCG RBCCG ☐ SWCCG ☐ WFCCG ☐ All CCGs ☒

The Committee is asked to note:

Recommendation • The overall financial context of the 3 CCGs; and • The current level of risk within the ring-fenced Primary Care budgets.

Purpose Assurance ☒ Decision ☐ Approval ☐ Discussion ☐ Information/noting ☒

Overall Financial Context

2018/19

The Committee is asked to note that the CCGs continue to report achievement of their agreed control total as at Month 6. However, current levels of over-performance within the Acute SLAs and Non-Commissioned providers are of significant concern. This combined over-performance in Continuing Healthcare and S75 expenditure has reduced the CCGs financial flexibility to cover the remaining six months of the financial years. The County's QIPP Schemes are anticipated to deliver £26.15m - 84% of the £31m target. Further mitigations will need to be identified to manage the CCGs performance in the coming months, in order to ensure the continued expected delivery of our control totals given the diminishing level of reserves available to mitigate the pressures being seen to date.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

The main areas across the CCGs portfolio to draw to the Committee’s attention at Month 6 are:

Acute – currently forecasting an over-spend of £4.1m across the 3 CCGs based on the Provider’s monitoring as at August 2018 – £1.6m for R&B, £1.7m for WF and £0.8m for SW. Generated by over-performance at Dudley Group of Hospitals, Birmingham Women & Children’s, Wye Valley NHS Trust and Spires Hospitals resulting from increases in referrals out-of-county and emergency pressures.

Mental Health – currently forecasting an over spend of £1.2m - reflecting an increase in the funding requirements for S117 Placements (healthcare for patients sectioned under the Mental Health Act). The CCGs are working closely with their Council colleagues to understand and review this unexpected cost pressure.

Continuing Healthcare – forecasted to over spend by £2.8m – reflecting additional expenditure on a number of complex mental health patients discharged from WAT to support patient flow challenges at the Trust and large increases in the number of jointly-funded packages with the Council.

Prescribing – a forecast over-spend of £0.3m across the 3 CCGs. The Committee is asked to note that our expenditure continues to show an impact from the ‘No Cheaper Stock Obtainable’ issue that was discussed at length during 2017/18 by the Committee. The CCGs have raised this with NHSE with the expectation that the cost neutrality agreement remains in place for 2018/19.

QIPP 2018/19

At Month 5, the CCGs are reporting delivery against the £31m target of £26.01m as detailed below.

Programme Plan Forecast Variance £m £m £m Primary Care 1.20 1.00 (0.20) Prescribing 8.71 7.30 (1.41) Elective Care 6.47 4.68 (1.79) Urgent Care 3.01 2.38 (0.63) Neighbourhood Teams 2.85 1.74 (1.11) CHC 4.98 5.28 0.30 S75 – Mental Health 1.48 1.02 (0.46) S75 – Children’s and Other 0.39 0.70 0.31 Contracting 4.40 4.40 0.00 Other 0.75 0.74 (0.01) Other adjustments (3.23) (3.23) 0.00 Total 31.01 26.01 (5.0) Forecast achievement 84% A number of actions and mitigations are being explored to understand what recovery actions can be accelerated.

2018/19 WAT Update

2018/19 is year 2 of a two year Cap & Collar Contract – with a capped contract value of £277.3m (+£4.5m) and collar of £269.8m ( -£3m) on a baseline of £272.8m. This includes a QIPP value of £7.5m.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

At Month 5 the Trust is showing a £0.4m over-performance – which when extrapolated up and reflective of contractual challenges would indicate that the CCGs Year End position will be close to the plan value of £272.8m. However, the Trust maintains their position that they will increase current through-put during the winter months to deliver activity up to the £4.5m cap

Outside of this the CCGs have invested an additional £3.5m to support the impact of FoASH and Winter Planning (in line with national guidance) – subject to a jointly signed Winter Plan with key deliverables on improving the County’s A&E performance.

Primary Care Co Commissioning – Month 6 Reporting 2018/19

Appendices 1 & 2 show an analysis of expenditure against plan for both the ring-fenced Co- Commissioning Budgets and primary care expenditure funded from CCGs Programme Budgets.

In line with national business rules the Co-Commissioning budgets are required to show a break- even position.

At Month 6 the Co-Commissioning budget is showing over-performance of £132k against the GMS plan, reflective of the additional 1% for pay-award over and above the planning requirement for CCGs of 1%; £457k for QOF achievement, and the agreed management of the £450k gap off-set by under-performance against enhanced services and premises costs.

Expenditure against Other Primary Care spend is showing a small underperformance of £77k.

The overall position is showing a balanced forecast due to the CCG managing in 2018/19 from within the CCGs resources overall to protect Primary Care expenditure as there was a large financial gap as previously reported to the Primary Care Committee.

As we head towards 2019/20 the CCGs are refreshing its financial planning for 2019/20. CCGs will receive new funding formula allocations for the next 5 years, 2 years allocation and 3 years indicative, this may result in the perceived over-funding of Primary Care predominantly within South Worcestershire remaining. This will result in lower growth uplift and require savings to be made from within the overall primary care allocation to deal with this.

We are also aware of pre-commitments by the NHS namely the pay uplift for Primary Care which will need to be modelled in to the 2019/20 planning numbers.

A draft Co-Commissioning financial plan will be brought to the January 2019 Committee.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Appendix 1 – 2018/19 Co Commissioning Plans & Forecast @ Month 6

Worcestershire CCG's GMS/PMS/APMS

DESCRIPTION / PROVIDER Redditch & Bromsgrove CCG South Worcestershire CCG Wyre Forest CCG Total CCG

ANNUAL FOT POSTED SURPLUS / ANNUAL FOT POSTED SURPLUS / ANNUAL FOT POSTED SURPLUS / ANNUAL FOT POSTED SURPLUS / BUDGET TO LEDGER (DEFICIT) BUDGET TO LEDGER (DEFICIT) BUDGET TO LEDGER (DEFICIT) BUDGET TO LEDGER (DEFICIT)

C&M-GMS Global Sum 14,396,988 14,267,928 129,060 25,467,572 25,911,542 (443,970) 8,480,685 8,612,343 (131,658) 48,345,245 48,791,813 (446,568) C&M-GMS MPIG Correction Factor 321,501 209,925 111,576 236,333 153,803 82,530 118,116 77,193 40,923 675,950 440,921 235,029 C&M- GMS Transitional Payments 264,045 227,200 36,845 1,023,505 983,504 40,001 320,270 310,899 9,371 1,607,820 1,521,603 86,217 C&M-APMS List Size Growth 0 0 0 1,566 1,566 0 0 0 0 1,566 1,566 0 C&M-APMS Contract Value 0 0 0 331,910 360,248 (28,338) 0 0 0 331,910 360,248 (28,338) C&M-APMS Contract KPIs 0 0 0 28,023 27,356 667 0 0 0 28,023 27,356 667 C&M-PMS Contract Value 0 0 0 0 0 0 1,408,700 1,387,476 21,224 1,408,700 1,387,476 21,224 C&M-PMS Out of Hours Opt Outs 0 0 0 0 0 0 0 0 0 0 0 0 General Practice (GMS) 14,982,534 14,705,053 277,481 27,088,909 27,438,019 (349,110) 10,327,771 10,387,911 (60,140) 52,399,214 52,530,983 (131,769)

C&M-GMS QOF Aspiration 1,701,692 1,713,290 (11,598) 3,098,435 3,255,880 (157,445) 1,136,057 1,206,310 (70,253) 5,936,184 6,175,480 (239,296) C&M-GMS QOF Achievement 633,953 648,240 (14,287) 1,043,319 1,231,894 (188,575) 448,132 456,419 (8,287) 2,125,404 2,336,553 (211,149) C&M-APMS QOF Achievement 0 0 0 8,942 8,913 29 0 0 0 8,942 8,913 29 C&M-APMS QOF Aspiration 0 0 0 21,626 23,557 (1,931) 0 0 0 21,626 23,557 (1,931) C&M-PMS QOF Aspiration 0 0 0 0 0 207,128 216,393 (9,265) 207,128 216,393 (9,265) C&M-PMS QOF Achievement 0 0 0 0 0 85,648 81,874 3,774 85,648 81,874 3,774 QOF 2,335,645 2,361,530 (25,885) 4,172,322 4,520,244 (347,922) 1,876,965 1,960,996 (84,031) 8,384,932 8,842,770 (457,838)

C&M-GMS DES Minor Surgery 301,489 309,642 (8,153) 497,131 466,739 30,392 264,936 259,977 4,959 1,063,556 1,036,358 27,198 C&M-GMS DES Violent Patients 20,420 19,845 575 37,698 38,287 (589) 14,960 16,532 (1,572) 73,078 74,664 (1,586) C&M-GMS DES Extended Hours Access 324,012 284,597 39,415 393,675 438,951 (45,276) 223,601 191,585 32,016 941,288 915,133 26,155 C&M-GMS DES Learn Dsblty Hlth Chk 64,895 61,952 2,943 97,338 60,800 36,538 53,698 18,340 35,358 215,931 141,092 74,839 C&M-GMS DES Unplanned Admissions 0 0 0 0 0 0 0 0 0 0 0 0 C&M-GMS Dispensing Quality Sch 25,609 23,819 1,790 173,567 162,855 10,712 19,065 17,423 1,642 218,241 204,097 14,144 C&M-GMS DES TPP QRISK 53 0 53 150 150 0 13 13 0 216 163 53 Translation Fees 1,128 4,960 (3,832) 0 8,706 (8,706) 0 3,249 (3,249) 1,128 16,915 (15,787) C&M-APMS DES Extended Hours Access 0 0 0 9,903 9,903 0 0 0 0 9,903 9,903 0 C&M-APMS DES Learn Dsblty Hlth Chk 0 0 0 430 420 10 0 0 0 430 420 10 C&M-PMS DES Minor Surgery 0 0 0 0 1,611 (1,611) 54,275 41,232 13,043 54,275 42,843 11,432 C&M-PMS DES Extended Hours Access 0 0 0 0 0 0 29,788 29,357 431 29,788 29,357 431 C&M-PMS DES Learn Dsblty Hlth Chk 0 0 0 0 0 0 2,999 2,940 59 2,999 2,940 59 Enhanced Services 737,606 704,815 32,791 1,209,892 1,188,422 21,470 663,335 580,648 82,687 2,610,833 2,473,885 136,948

C&M-GMS Prem Actual Rent 1,116,741 1,100,507 16,234 5,416,955 5,306,769 110,186 924,134 915,503 8,631 7,457,830 7,322,779 135,051 C&M-GMS Prem Notional Rent 870,109 791,622 78,487 723,555 686,410 37,145 350,951 337,525 13,426 1,944,615 1,815,557 129,058 C&M-GMS Prem Cost Rent 69,318 67,892 1,426 133,567 133,567 0 0 0 0 202,885 201,459 1,426 C&M-GMS Prem Rates 308,257 321,193 (12,936) 705,659 735,897 (30,238) 262,542 199,497 63,045 1,276,458 1,256,587 19,871 C&M-GMS Prem Water Rates 28,098 26,112 1,986 60,294 65,913 (5,619) 9,223 5,252 3,971 97,615 97,277 338 C&M-GMS Prem Clinical Waste 6,126 18,041 (11,915) 17,030 34,422 (17,392) 4,080 11,810 (7,730) 27,236 64,273 (37,037) C&M-APMS Prem Actual Rent 0 0 0 57,883 56,658 1,225 0 0 0 57,883 56,658 1,225 C&M-APMS Prem Rates 0 0 0 4,074 15,909 (11,835) 0 0 0 4,074 15,909 (11,835) C&M-APMS Prem Water Rates 0 0 0 537 2,094 (1,557) 0 0 0 537 2,094 (1,557) C&M-PMS Prem Actual Rent 0 0 0 0 0 0 334,294 327,707 6,587 334,294 327,707 6,587 C&M-PMS Prem Rates 0 0 0 0 0 0 54,726 55,216 (490) 54,726 55,216 (490) C&M-PMS Prem Water Rates 0 0 0 0 0 0 2,336 2,336 0 2,336 2,336 0 Abbottswood 18/19 Rent increase 0 0 0 52,000 52,000 0 0 0 0 52,000 52,000 0 Premises Cost Reimbursement 2,398,649 2,325,367 73,282 7,171,554 7,089,639 81,915 1,942,286 1,854,846 87,440 11,512,489 11,269,852 242,637

C&M-GMS Prem Other 29,372 18,778 10,594 46,652 144,660 (98,008) 15,990 21,085 (5,095) 92,014 184,523 (92,509) Prem Improvement Grant 0 0 0 0 0 0 373,000 373,000 0 373,000 373,000 0 C&M-APMS Prem Other 0 0 0 6,146 0 6,146 0 0 0 6,146 0 6,146 Other Premises Costs 29,372 18,778 10,594 52,798 144,660 (91,862) 388,990 394,085 (5,095) 471,160 557,523 (86,363)

C&M-GMS Prof Fees Dispensing 382,198 333,695 48,503 3,201,296 3,254,969 (53,673) 425,667 432,268 (6,601) 4,009,161 4,020,932 (11,771) C&M-GMS Prof Fees Prescribing 127,761 161,603 (33,842) 147,897 139,135 8,762 79,992 74,587 5,405 355,650 375,325 (19,675) C&M-GMS PrscChrgsCll&RmttdbyGPCntra (68,271) (64,370) (3,901) (370,506) (699,981) 329,475 (52,171) (60,927) 8,756 (490,948) (825,278) 334,330 C&M-APMS Prof Fees Prescribing 0 0 0 1,359 1,359 0 0 0 0 1,359 1,359 0 C&M-PMS Prof fees Prescribing 0 0 0 0 0 0 17,279 15,441 1,838 17,279 15,441 1,838 Dispensing/Prescribing Fees 441,688 430,928 10,760 2,980,046 2,695,482 284,564 470,767 461,369 9,398 3,892,501 3,587,779 304,722

C&M-GMS PCO Seniority 271,283 206,019 65,264 422,087 336,840 85,247 148,258 117,373 30,885 841,628 660,232 181,396 C&M-PMS PCO Seniority 0 0 0 0 0 0 36,406 17,463 18,943 36,406 17,463 18,943 C&M-GMS PCO Locum Adop/Pat/Mat 118,335 73,902 44,433 139,010 168,449 (29,439) 127,013 39,974 87,039 384,358 282,325 102,033 C&M-GMS CQC Fees 100,154 127,713 (27,559) 174,872 224,505 (49,633) 50,832 70,479 (19,647) 325,858 422,697 (96,839) C&M-PMS CQC Fees 0 0 0 0 0 0 0 0 0 0 0 0 C&M-APMS CQC Fees 18/19 0 0 0 0 10,045 (10,045) 0 0 0 0 10,045 (10,045) C&M-PMS PCO Locum Adop/Pat/Mat 0 0 0 0 0 0 8,850 33,779 (24,929) 8,850 33,779 (24,929) C&M-GMS PCO Doctors Ret Scheme 0 0 0 28,376 29,700 (1,324) 3,190 3,627 (437) 31,566 33,327 (1,761) C&M-GMS PCO Locum Sickness 193,989 186,301 7,688 246,179 218,801 27,378 94,274 108,949 (14,675) 534,442 514,051 20,391 Choice of GP - Home Visits 2,808 2,808 0 18,679 18,679 0 1,530 1,530 0 23,017 23,017 0 Meeting Expenses/Room Hire 261 261 0 0 0 0 0 0 0 261 261 0 Indemnity Payments 0 0 0 152,492 0 152,492 0 0 0 152,492 0 152,492 Homeless and Vulnerable serv 0 0 0 46,098 46,098 0 0 0 0 46,098 46,098 0 Needles & Syringes 19,387 19,387 0 30,732 30,732 0 7,330 7,330 0 57,449 57,449 0 Meeting room Expenses /Other 0 0 0 0 0 0 510 510 0 510 510 0 C&M-GMS Voluntary Levy 0 0 0 0 (19,546) 19,546 0 0 0 0 (19,546) 19,546 C&M-GMS GP Statutory Levy 0 0 0 0 (95,431) 95,431 0 0 0 0 (95,431) 95,431 C&M-APMS Voluntary Levy 0 0 0 0 (55) 55 0 0 0 0 (55) 55

Reserves 0.5% Contingency (Frozen) 115,340 115,340 0 232,240 232,240 0 83,420 83,420 0 431,000 431,000 0 Cost Pressures Flexibility/Pressure Baseline (223,381) 245,468 (468,849) (309,880) (421,117) 111,237 (393,462) (286,024) (107,438) (926,723) (461,673) (465,050) GP Forward View/Transformation Monies 1% Reserve Bal (£1.50/head) 265,160 265,160 0 464,480 464,480 0 173,049 173,049 0 902,689 902,689 0 PCE (£11 per Head ) PCE 18/19 £11 per head balance required 1,015,950 1,015,950 0 723,303 723,303 0 413,507 413,507 0 2,152,760 2,152,760 0 PMS Premium 511,908 511,908 0 1,950,695 1,950,695 0 622,630 622,630 0 3,085,233 3,085,233 0 CCG Support 368,000 368,000 0 728,000 728,000 0 271,000 271,000 0 1,367,000 1,367,000 0 Sub total PCE 1,895,858 1,895,858 0 3,401,998 3,401,998 0 1,307,137 1,307,137 0 6,604,993 6,604,993 0 Less Meds optimisation (387,789) (387,789) 0 (695,863) (695,863) 0 (267,369) (267,369) 0 (1,351,021) (1,351,021) 0 Less Meds Waste (258,527) (258,527) 0 (463,909) (463,909) 0 (178,246) (178,246) 0 (900,682) (900,682) 0 Less Sustainability contribution (141,000) (141,000) 0 0 0 0 0 0 0 (141,000) (141,000) 0 Total PCE 1,108,542 1,108,542 0 2,242,226 2,242,226 0 861,522 861,522 0 4,212,290 4,212,290 0 Minor Surgery 0 0 0 0 0 0 0 0 0 0 0 0 Care Home Pharmacists 0 0 0 0 0 0 0 0 0 0 0 0 Treatment Room 37,000 37,000 0 58,000 58,000 0 56,000 56,000 0 151,000 151,000 0 EOL (88,000) (88,000) 0 0 0 0 (52,000) (52,000) 0 (140,000) (140,000) 0 Improving access surplus 0 0 0 (290,000) (290,000) 0 0 0 0 (290,000) (290,000) 0 IQSP Practice Payments 0 0 0 0 0 0 0 0 0 0 0 0 LIS 0 0 0 5,378 5,378 0 28,054 28,054 0 33,432 33,432 0 EZ Document Workshop 0 0 0 0 0 0 0 0 0 0 0 0 Stroke/ AF 0 0 0 0 0 0 0 0 0 0 0 0 Hypertension 0 0 0 0 0 0 0 0 0 0 0 0 COPD 0 0 0 0 0 0 0 0 0 0 0 0 Asthma 0 0 0 0 0 0 0 0 0 0 0 0 Compression Bandaging Uplift 15,000 15,000 0 0 0 0 24,000 24,000 0 39,000 39,000 0 External Data Contracts 26,000 26,000 0 0 0 0 10,000 10,000 0 36,000 36,000 0

Other GP Services 1,961,878 2,340,901 (379,023) 3,660,969 3,260,024 400,945 1,268,776 1,299,035 (30,259) 6,891,623 6,899,960 (8,337)

Grand Total Primary Care/GMs_PMs 22,887,372 22,887,372 (0) 46,336,490 46,336,490 0 16,938,890 16,938,890 0 86,162,752 86,162,752 (0)

Allocation 22,887,372 22,887,372 0 46,336,490 46,336,490 0 16,938,890 16,938,890 0 86,162,752 86,162,752 0 Variance 0 (0) 0 0 0 0 0 0 0 0 (0) 0

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Appendix 2 – 2018/19 - Other Primary Care Expenditure @ Month 6 DESCRIPTION / PROVIDER Redditch & Bromsgrove CCG South Worcestershire CCG Wyre Forest CCG Total CCG

Resilliance LMC 0 0 0 0 0 0 0 0 0 0 0 0 Resilliance Mentoring 0 0 0 0 0 0 0 0 0 0 0 0 Reception & Clerical Training 0 0 0 0 0 0 0 0 0 0 0 0 GPFV On-Line Consultation 0 0 0 0 0 0 0 0 0 0 0 0 Improving Access SW Healthcare 740,561 740,561 0 1,762,465 1,762,465 0 497,805 497,805 0 3,000,831 3,000,831 0 Improving Access Contingency 0 0 0 0 0 0 0 0 0 0 0 0 Improving Access Balance 17/19 allocation 0 0 0 0 0 0 0 0 0 0 0 0 GP Forward View 740,561 740,561 0 1,762,465 1,762,465 0 497,805 497,805 0 3,000,831 3,000,831 0

Diabetes/Insulin Intiation 274,441 262,978 11,463 513,648 518,078 (4,430) 234,216 227,588 6,628 1,022,305 1,008,644 13,661 Nursing Home 302,775 349,185 (46,410) 271,890 271,890 0 144,651 129,780 14,871 719,316 750,855 (31,539) UP's Beds 0 0 0 0 0 0 30,227 19,955 10,272 30,227 19,955 10,272 DVT/Clexane 44,875 52,377 (7,502) 45,196 47,983 (2,787) 35,499 21,691 13,808 125,570 122,051 3,519 Inter Practice Minor Surgery 21,106 16,785 4,321 0 0 0 0 39,937 (39,937) 21,106 56,722 (35,616) End of Life 0 (488) 488 0 0 0 0 0 0 0 (488) 488 PSA 21,058 25,680 (4,622) 0 0 0 44,296 66,550 (22,254) 65,354 92,230 (26,876) Anticoagulation 315,759 275,108 40,651 678,147 608,610 69,537 373,438 373,438 0 1,367,344 1,257,156 110,188 Near Patient Testing 131,600 129,565 2,035 175,172 168,593 6,579 129,630 129,630 0 436,402 427,788 8,614 Compression Bandaging 29,744 28,088 1,656 0 0 0 54,389 49,360 5,029 84,133 77,448 6,685 Treatment Room LES 188,295 183,082 5,213 395,714 395,714 0 123,262 123,262 0 707,271 702,058 5,213 Menorrhagia 18,298 22,023 (3,725) 16,179 16,810 (631) 12,661 14,058 (1,397) 47,138 52,891 (5,753) Ear Canal Clearance 36,433 36,114 319 0 0 0 13,241 14,339 (1,098) 49,674 50,453 (779) Engagement scheme 0 0 0 0 0 0 0 0 0 0 0 0 IQSP Practice Payment 0 0 0 0 0 0 0 0 0 0 0 0 IQSP Visits 0 0 0 0 0 0 0 0 0 0 0 0 Management Fee Sw Healthcare 0 0 0 0 20,288 (20,288) 0 0 0 0 20,288 (20,288) Minor injuries 0 0 0 0 0 0 0 0 0 0 0 0 Phlebotomy 0 0 0 38,527 34,920 3,607 0 0 0 38,527 34,920 3,607 Urethral Stricture 0 0 0 0 0 0 0 0 0 0 0 0 24 Hr ECG 0 0 0 47,030 45,920 1,110 0 0 0 47,030 45,920 1,110 Epley 0 0 0 17,810 0 17,810 0 0 0 17,810 0 17,810 Laryngoscopies 0 0 0 0 0 0 11,500 3,718 7,782 11,500 3,718 7,782 Long Term Conditions 0 0 0 0 0 0 0 0 0 0 0 0 Safeguarding 0 0 0 0 0 0 33,944 24,777 9,167 33,944 24,777 9,167 Postage 0 (65) 65 0 0 0 0 (136) 136 0 (201) 201 Local Enhanced Services 1,384,384 1,380,432 3,952 2,199,313 2,128,806 70,507 1,240,954 1,237,947 3,007 4,824,651 4,747,185 77,466

Grand Total Other Primary Care Budgets 2,124,945 2,120,993 3,952 3,961,778 3,891,271 70,507 1,738,759 1,735,752 3,007 7,825,482 7,748,016 77,466

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Agenda item: 7

Woodrow Medical Centre Inequalities Assessment

Report author Denise Goddard, Primary Care Commissioning Manager

Presented by Denise Goddard, Primary Care Commissioning Manager

Target CCG RBCCG ☒ SWCCG ☐ WFCCG ☐ All CCGs ☐

Recommendation To approve the Equality Impact Assessment.

Purpose Assurance ☐ Decision ☐ Approval ☒ Discussion ☐ Information/noting ☐

Executive Summary

The decision to close Woodrow Medical Centre following a CQC Inspection and option appraisal considered by the Primary Care Commissioning Committee will result in the permanent closure of Woodrow Medical Centre from 1 January 2019. Therefore, the practice list (currently 3293 – as of 22.10.18) is being dispersed to other nearby practices.

The CCG is aware of the diversity and potential needs to the practice population and therefore an Equality Assessment has been undertaken to ensure there is patient groups are not disadvantaged as a result of dispersal and/or support can be given as appropriate.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 1 of 2

Assessment

An equality impact analysis and risk assessment was completed and signed off by the Equality and Inclusion Lead at Midlands and Lancashire CSU. This is a standard form and process for any new project or activity that may affect patients. See Appendix A.

The Assessment has been supported by further analysis due to the impact on the patients at Woodrow. See Appendix B.

The analysis identified a young population in a deprived area. There are also a number of vulnerable groups and a large ethnic population. The information has been used to inform the dispersal communication plan for Woodrow Medical Centre. The plan is fluid, in that a number of patients have already moved to alternative practices, however, work continues to liaise with community groups. Vulnerable patient numbers are monitored on a weekly basis with additional support to be considered for patients who have yet to re-register. Other teams are also aware and will be supporting patients, for example the local mental health team. Practices taking on the majority of patients have informed us about specific languages their staff speak, which may influence patient choice.

The process is being supported by Healthwatch and Communications and Frequently Asked Questions are regularly updated.

Recommendation

• To approve the Equality Impact Assessments.

Appendices

A – EIA Screening Tool. B – Equality Impact Analysis.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 2 of 2 EQUALITY IMPACT & RISK ASSESSMENT STAGE 1 SCREENING TOOL

Organisation: Service: Redditch and Bromsgrove CCG Woodrow Medical Centre Closure Project Lead: Service Area: Lynda Dando/Denise Goddard Primary Care GP Practice

Person responsible for this Assessment: Date of Review:

Denise Goddard 1.10.18

Brief explanation of what is happening / being assessed (MAX 1000 CHARACTERS) Due to the practice being closed on 23 March 2018, following a CQC visit, and the caretaker practice ceasing service provision 31 December 2018 alternative arrangements had to be found for primary care services for patients. No practice was willing to take on the contract and as a result the list is being dispersed. 3868 patients will need to register with another local practice; most Redditch practices cover some of the boundary areas, although 3 practices are willing to take the majority of patients. A communications plan has been put in place, and each patient has been written to. Key stakeholders have been informed an a series of drop in events are being held.

QUESTION type EQUALITY IMPACT Comments (provide example) No. y or n

Does this issue plan to withdraw a service, activity or 1 y A number of separate plans are either working documents or have been completed to document the presence? issues. See documented plan for various protected characteristics. Does this issue plan to reduce a service, activity or 2 y presence? Does this issue plan to introduce or increase a charge for 3 n Service?

4 Does this issue plan to change to a commissioned service? n

Does this issue plan to introduce, review or change a policy, 5 n strategy or procedure?

6 Does this issue plan to introduce a new service or activity? n

Is this primarily about improving access to, or delivery of a 7 y service? Does this affect employees or levels of training for those 8 y who will be delivering the service?

9 Does this issue affect Service users? y

Can you foresee a negative impact on any Protected 10 Characteristic Group(s)? If YES please state what these could y be.

EQUALITY RISK Comments (provide example)

Numbers of vulnerable groups. Maps of location of patients. Age profiles. Have you got any general intelligence (research, 11 y consultation, etc.)? If YES please list any related documents.

As above. Have you got any specific intelligence (research, 12 y consultation, etc.)? If YES please list any related documents.

Have you taken specialist advice? (Legal, E&I Team, etc). If 13 YES please state. Y

Have you considered your Public Sector Equality Duty? Yes we are considering the implications in line with the Equality Act 2010. See separate document. 14 Please provide a rationale. Y Decisions are via CCG Primary Care Commissioning Committee and published on public websites. FAQs Do you plan to publish your information? Include any 15 are published on the CCG website and healthwatch. "Decision Reports" Y A number of patients will be effected by the change in terms of travel distance or being able to find another 16 Can you minimise any negative effect? Please state how. Y GP. Bus information is available for patients. Vulnerable groups have been identified and will be supported. Do you have any supporting evidence? If YES please list the Separate document. 17 documents. y

Have you/will you engage with affected staff and users on A staff meeting has been held. An assessments of vacancies elswehere has taken place and the current 18 Y provider is aware of this information, so will be able to support staff with re-deployment. Users have been these proposals? contacted and drop in sessions arranged. IMPACT 600 There will be some impact. You should undertake a Stage 2 assessment

RISK 0 There should be little risk involved HUMAN RIGHTS IMPACT Comments (provide example)

Will the policy/decision or refusal to treat result in the death 19 n of a person?

Will the policy/decision lead to degrading or inhuman 20 n treatment?

21 Will the policy/decision limit a person’s liberty? n

Will the policy/decision interfere with a person’s right to 22 n respect for private and family life?

23 Will the policy/decision result in unlawful discrimination? n

24 Will the policy/decision limit a person’s right to security? n

Will the policy/decision breach the positive obligation to 25 n protect human rights?

Will the policy/decision limit a person's right to a fair trial 26 n (assessment, interview or investigation)?

Will the policy/decision interfere with a persons right to 27 n participate in life?

RISK 0 There is little chance of Human Rights breach. There is no requirement to carry out a Stage 2 assessment

PRIVACY IMPACT Comments (provide example)

Will the project involve the collection of new information This will be standard information passed onto the new practice, as would be in the patients notes, and 28 n transferred with the records as per any routine transfer. about individuals? Some vulnerable patients may need further support and as such relevant information may be discussed Will the project compel individuals to provide information with the new practice to support their registration, or to ensure safety. 29 y Patients will need to provide their own patient details to the new practice registering them. about themselves? Will information about individuals be disclosed to 30 organisations or people who have not previously had y routine access to the information? Are you using information about individuals for a new 31 purpose or in a new way that is different from any existing n use?

Does the project involve you using new technology which 32 might be perceived as being privacy intrusive? For example, n the use of biometrics or facial recognition.

Will the project result in you making decisions about individuals in ways which may have a significant impact on 33 y them? e.g. service planning, commissioning of new services.

Is the information to be used about individuals’ health 34 y and/or social wellbeing?

Will the project require you to contact individuals in ways 35 n which they may find intrusive?

RISK 400 There is some chance of a Privacy breach. You should contact your IG Support Officer PLEASE SEND YOUR COMPLETED STAGE 1 SCREENING TOOL TO THE EQUALITY & INCLUSION TEAM EMAIL: [email protected] GENERAL GUIDANCE Please use the comments section to explain any 'RED' scores or to further elaborate what is being assessed is necessary

All 'RED' scores will require further action in future planning regardless of the requirement to carry out Stage 2 approaches.

Signature of person completing the screening tool: Denise Goddard

Comments (MAX 250 CHARACTERS) The EIA has identified that dispersal process will need equality considerations included so service is accessible to all groups

Signature of Equality & Inclusion Business Partner & Date Mohammed Ramzan 18.10.18 in conjunction with plan

Comments (MAX 250 CHARACTERS)

Equality Impact Analysis – Woodrow Medical Centre – List Dispersal v 2 APPENDIX B

Summary of Issues and Actions

1. Background Equality Analysis to support the decommissioning of Woodrow Medical EA Title Centre Denise Goddard/ EA Author Team Primary Care Steve Connelly Date Started 1.10.18 Date Completed What are the intended outcomes of this work? Include outline of objectives and function aims To help inform the supporting of patients during the dispersal phase, and work with staff for a smooth and stable transfer. Who will be affected by this work? eg staff, patients, service users, partner organisations etc. Practice Staff and around 3868 Patients will be impacted by the proposals. Nearby practices and the LMC are aware of the issues and current status.

Woodrow Medical centre in located in Woodrow, Redditch in a deprived part of the CCG. The practice has a younger age population. See graphs over the page. 75% of patients are under 50, 46% are aged between 20 and 49.

The percentage of ethnic minority residents is above the CCG city average – 44% are from BME groups.

A list of vulnerable patients is as follows: Child safeguarding 42 Adult Safeguarding 53 LD Register 17 Mental Health Register 47 >65 years 390 Carer register 39 Care Homes 0

Woodrow Age distribution July 2018

2 1 90-94 5 5 11 7 80-84 20 17 25 25 70-74 53 46 90 84 60-64 95 98 121 114 50-54 116 89 132 124 40-44 147 108 196 166 30-34 173 147 175 163 20-24 135 119 128 118 10-14 162 136 155 147 0-4 157 126

Male 1

Woodrow Age distribution July 2018

0.1% 0.1% 90-94 0.2% 0.3% 0.5% 0.4% 80-84 1.0% 0.9% 1.2% 1.4% 70-74 2.5% 2.5% 4.3% 4.6% 60-64 4.5% 5.3% 5.8% 6.2% 50-54 5.5% 4.8% 6.3% 6.7% 40-44 7.0% 5.9% 9.3% 9.0% 30-34 8.2% 8.0% 8.3% 8.9% 20-24 6.4% 6.5% 6.1% 6.4% 10-14 7.7% 7.4% 7.4% 8.0% 0-4 7.5% 6.8%

Woodrow Male Woodrow Female

2. Impact and Evidence: In the following boxes detail the findings and impact identified (positive or negative) within the research detailed above; this should also include any identified health inequalities which exist in relation to this work. Age: Describe age related impact and evidence. This can include safeguarding, consent and welfare issues:

There is a young patient population. So there is relatively little impact regarding frail or elderly patients.

Any known child safeguarding issues or concerns will need to be identified and appropriately recorded as part of the patient record, so the patient’s new practice is fully informed and aware, as part of the planned dispersal. Disability: Describe disability related impact and evidence. This can include attitudinal, physical, communication and social barriers as well as mental health/ learning disabilities, cognitive impairments: Any patients with disabilities or learning disabilities have been identified. The practice must ensure all patients on its Disability and LD registers are contacted and offered support to discuss the changes and options for re-registering with another local practice. Reasonable adjustments will need to be put in place to ensure patients with communication or information support needs receive the information regarding the closure of the practice along with options to transfer to alternative providers in accessible formats.

Patients with serious mental illness may need to be provided with additional support to ensure smooth transition between services. Other agencies supporting these patients including Mental Health support services, Mental Health Trust with whom the patients is under the care of would also need to be informed of the new GP practice in line with the communications strategy.

2. Impact and Evidence: Gender reassignment (including transgender): Describe any impact and evidence on transgender people. This can include issues such as privacy of data and harassment:

There is no known impact on this particular group. Marriage and civil partnership: Describe any impact and evidence in relation to marriage and civil partnership. This can include working arrangements, part-time working, and caring responsibilities:

There is no known impact on this particular group. Pregnancy and maternity: Describe any impact and evidence on pregnancy and maternity. This can include working arrangements, part-time working, and caring responsibilities:

The midwives and maternity services will be informed about patients in line with the communications strategy. Where appropriate, arrangements will be made in line with the detailed exit plan being worked on during the closure phase.

Any known risk of child safeguarding will need to be identified and appropriately recorded as part of the patient record, so the patient’s new practice is fully informed and aware, as part of the planned dispersal. The safeguarding team have been contacted. Race: Describe race related impact and evidence. This can include information on different ethnic groups, travellers, nationalities, cultures, and language barriers:

Patients who have English language needs will need to be communicated with in their preferred language to ensure they receive the information regarding the closure of the practice along with options to transfer to alternative providers in an accessible formats. This may require the use of language line and telephone calls. The first patient letter has included information regarding translation. Various non-English languages spoken are as follows:

26 languages, plus NOS polish 179 urdu 138 not specified 88 punjabi 57 romanian 38 other 84 total 584

Information from the current provider shows very little translation services are used as part of routine measures and most patients bring a person to appointments to translate for them. This would indicate that despite ethnic origin many of these patients can speak/read English and/or have access to members of family or friends who can translate.

Patients who are classed as migrants or newly arrived to the UK may require additional support and information on how to register with a new practice. Factors such as a lack of identity information must not be a factor for not being able to register at a new practice. NHSE have produced leaflets that can be used for newly arrived patients accessible at these links: These leaflets should be used to support patients to re-register 4

2. Impact and Evidence: Registering with a DR – Asylum Seekers and Refugees

Other nearby practices have female GPs, which may be the preference of certain cultures. Religion or belief: Describe any religion, belief or no belief impact and evidence. This can include dietary needs, consent and end of life issues:

There is no known impact on this particular group. Other nearby practices provide services for patients with various religions or beliefs. Sex: Describe any impact and evidence on men and women. This could include access to services and employment:

There is no known impact on this particular group. The surrounding surgeries have both male and female GPs, where patients can choose to register. Sexual orientation: Describe any impact and evidence on heterosexual people as well as lesbian, gay and bisexual people. This could include access to services and employment, attitudinal and social barriers:

There is no known impact on this particular group. Carers: Describe any impact and evidence on part-time working, shift-patterns, general caring responsibilities:

This may impact particularly on carers who accompany patients to their surgery who may have further to travel than they do now.

Carers that are known to the practice (listed on the Carer’s Register) could also be written to about the changes and options, and engaged in supporting patients to make decisions about their choice of practice.

Other disadvantaged groups: Describe any impact and evidence on groups experiencing disadvantage and barriers to access and outcomes. This can include lower socio-economic status, resident status (migrants, asylum seekers), homeless, looked after children, single parent households, victims of domestic abuse, victims of drugs / alcohol abuse: (This list is not exhaustive)

Many of the patients are of lower socio-economic status. Information regarding transport will be provided. However, the standard of care by the new GPs will be of equal quality to the current provider in line with their GMS contracts.

Many of the patients will be part of single parent households. See above. In addition, Healthwatch have been actively involved in the process and will be able to support and signpost patients. Any transfer of sensitive patient information such as those at risk of domestic violence or safeguarding issues will need to be flagged in the event of patient transfer or re-registration to a new practice. A number of patients struggle with drug and alcohol abuse. The transfer will include the transfer of notes which will outline their current treatment, support and where necessary medication. Shared care arrangements will continue as far as possible with the new practice. Many of the larger practices are equipped to manage these patients and therefore may be a safer option for some of these patients.

2. Impact and Evidence:

Gypsy Roma Traveller (GRT) patients registered at the practice may experience concern at having to re-register with a new GP due to wider distrust of the health care system and difficulties in registering due to a lack of postcode. These patients should be offered additional support and the following NHS leaflet: Register with a GP – Gypsy Roma Traveller Communities

3. Health Inequalities Yes/No Evidence

Could health inequalities be created or persist by the No proposals? Is there any impact for groups or communities living in Yes particular geographical areas? Is there any impact for groups or communities affected by Yes unemployment, lower educational attainment, low income, or poor access to green spaces? How will you ensure the proposals reduce health inequalities?

As a consequence of dispersal then the patients may or may not have further to travel to their new practice.

Bus timetables have been obtained and will be available for patients at the drop in sessions.

The nearby practices are willing to take patients and having the stability of long-term registration could only benefit patients. The aim of registering with another local practice will enable this rather than short-term caretaker arrangements.

4. FREDA Principles/ Question Response Human Rights Fairness – Fair and How will this respect a All patients will still have equal access to services person’s entitlement to access to a local GP access this service? Respect – right to have How will the person’s right to All contractual and legal private and family life respect for private and family obligations to patients would respected life, confidentiality and continue, but at a different consent be upheld? surgery

Equality – right not to be How will this process ensure Patients will be engaged with discriminated against that people are not in the appropriate way, based on your protected discriminated against and dependant on their identified characteristics have their needs met and needs identified? How will this affect a person’s NA right to freedom of thought, conscience and religion? Dignity – the right not to How will you ensure that Patients will be fully informed be treated in a degrading individuals are not being and have contacts to ask way treated in an inhuman or questions or request help. degrading way? There will be options available

to them to access support should they wish with registering at a new surgery Autonomy – right to How will individuals have the Selection of a GP surgery is a respect for private & opportunity to be involved in patient’s choice. Patients have family life; being able to discussions and decisions been given a list of local make informed decisions about their own healthcare? surgeries and choices Right to Life Will or could it affect No someone’s right to life? How? Right to Liberty Will or could someone be No deprived of their liberty? How?

5. Engagement, Involvement and Consultation If relevant, please state what engagement activity has been undertaken and the date and with which protected groups: Engagement Activity Protected Characteristic/ Date Group/ Community There are patient All patients invited 8 October engagement meetings 11 October arranged All patients will receive All patients contacted 28 September 2018 letters Staff brief Staff have had a briefing 26 September 2018 session

For each engagement activity, please state the key feedback and how this will shape policy/service decisions (eg patient told us …. So we will …..): All patients will have ample opportunity to engage with the CCG and practice regarding any questions and concerns.

Patients have individually been informed by a patient letter.

Staff will be provided with frequently asked questions so that a consistent message is shared with patients whatever the outcome.

Key stakeholders, such as Healthwatch are available for support, as required.

Letters can be made available in accessible formats for patients with disabilities including easy read, large print, braille if required.

Patient movements to other practices will be monitored on a weekly basis. At an agreed point in time, vulnerable patients or patients with community language needs will need to be contacted by the practice to ensure they receive the information.

6. Summary of Analysis Considering the evidence and engagement activity you listed above, please summarise the impact of your work: In summary, the decision to disperse patients will not have major, significant adverse impacts for patients as long as the process is implemented in a manner that is inclusive supports the identified needs of patients:

• Information and options for disabled patients will need to be available to patients in accessible formats, including all correspondence informing patients of the closure and forthcoming options.

• Patients with non-English language needs are communicated with via telephone and language line, if necessary, to ensure they receive and understand the information and options available to them.

• Carers should be informed about the changes and engaged with regarding decisions about patients.

• Vulnerable patients and those with safeguarding risks are supported through the process and appropriate information is made available to the receiving practice.

• Disabled patients including vulnerable patients with serious mental illness are offered reasonable adjustments to register with an alternative practice including a face to face appointment.

• Migrant patients and travelling patients are given additional information supporting them to register with a GP practice in the form of the following NHSE leaflets

Registering with a DR – Asylum Seekers and Refugees

7. Mitigations and Changes :

Please give an outline of what you are going to do, based on the gaps, challenges and opportunities you have identified in the summary of analysis section. This might include action(s) to mitigate against any actual or potential adverse impacts, reduce health inequalities, or promote social value. Identify the recommendations and any changes to the proposal arising from the equality analysis. 1. Ensure the dispersal process supports the needs of patients that are disabled or vulnerable, carers, and those who have English language needs to ensure all patients are well informed of the process and options available to them. This may include correspondence in easy read, telephone contact with use of Language Line, face-to- face with the GP. e. standard letters in English will not meet the needs of all patients 2. Ensure all patient records and information is comprehensive and fully covers information regarding any safeguarding issues, for the purposes of patients re- registering with a new practice. 3. Ensure the practice uses Patients registers to identify Carers, Disabled Patients, Mental Health Patients, and other vulnerable groups to put in place appropriate support. 4. Practices taking in patients will be required to utilise the Accessible Information Standard. A briefing on the standard will be sent to all practices.

8. Contract Monitoring and Key Performance Indicators

Detail how and when the service will be monitored and what key equality performance indicators or reporting requirements will be included within the contract (refer to NHS Standard Contract SC12 and 13): A team within the CCG has been set up to manage the process. Daily updates are undertaken. Fortnightly meetings continue with the provider and will encorporate the engagement and communication strategy, and relevant aspects of the exit plan. The provider has a detailed exit plan and where appropriate, EIA elements will be included in the plan.

9. Publication How will you share the findings of the Equality Analysis? This can include: reports into committee or Governing Body, feedback to stakeholders including patients and the public, publication on the web pages. It will be included In the Primary Care Committee Board Papers which will be available on the CCG website

10. Sign Off The Equality Analysis will need to go through a process of quality assurance by the Senior Manager for Equality and Diversity, Senior Manager for Assurance and Compliance or Equality and Human Rights Manager and signed-off by a delegated committee Name Date Mohammed Ramzan Quality Assured By: (Equality Lead, CSU)

Comments from MR: Accessible information standard dispersed to all practices. In view of the fact that the changes are taking place in an area of significant BAME populations, is that local BAME organisations and faith groups need to be contacted to cascade the change that is taking place so that there is a maximum awareness. For example someone briefing the local mosque imam before the Friday congregation prayer so he can inform the attendees of the changes. Similarly for other BAME groups, contacting the head of the organisation/writing to them around the changes. Similar approach that would utilise age concern and similar bodies for the elderly and frail of the community. Also involvement of disability organisations so as to plan more effectively of how the changes will be managed for patients disabilities.

Agenda item: 8

Improving Access in Primary Care

Report author Denise Goddard, Primary Care Commissioning Manager

Presented by Denise Goddard, Primary Care Commissioning Manager

Target CCG RBCCG ☐ SWCCG ☐ WFCCG ☐ All CCGs ☒

Recommendation To note the progress made on the Improved Access Agenda

Purpose Assurance ☐ Decision ☐ Approval ☒ Discussion ☐ Information/noting ☐

Executive Summary

All 3 CCGs now have in place Improving Access schemes based at a number of hubs, in line with NHSE requirements. This report outlines the current status.

Introduction

Improving Access is part of the GP Forward View agenda and all CCGs have been required to set up Primary Care additional appointments in line with Nationally specified, 7 core criteria. The core criteria are outlined in Appendix A. The appointments offered are at scale, in hubs, and are to be provided in addition to any other primary care appointments provided at individual surgeries or any appointments offered under the Extended Access Directed Enhanced Services (DES).

A lead provider in each CCG has been procured/appointed to offer a specified number of additional appointment hours.

Improved Access services enable patients with routine needs to see a clinician outside of core business hours and they can access these services via their own General Practice – when a patient contacts their Practice to make a routine appointment, they can be offered either an appointment at Practice during core working hours or they can be offered an Improved Access appointment at one of the hubs, usually the hub closest to that patient’s Practice. Patients are encouraged to ask about Improved Access appointments when contacting their Practice.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 1 of 7

1. Progress in all 3 CCGs.

A summary of provision is given in Appendix B.

South Worcestershire

A version of this service has been in place since 2015, and has continued to be amended to reflect either NHS England (NHSE) criteria or current need and capacity during this time. GP improved Access services are being offered from four hubs in South Worcestershire – Droitwich Medical Centre, Riverside Surgery, Malvern Health Centre and Farrier Surgery. In addition, patients can access telephone consultations via their ‘virtual hub’. South Worcestershire’s Improved Access Services offer routine face-to-face and telephone appointments to patients between 8:30 and 20:00 on weekdays and between 08:00 and 12:00 on Saturdays and Sundays. Appointments during the week will be a mix of pre-bookable and, where available, same-day. There are currently 488 Improved Access appointments available each week in South Worcestershire.

Wyre Forest

From the last week of September, GP improved Access services are being offered from two hubs in Wyre Forest – Kidderminster Medical Centre and Northumberland House Surgery. Wyre Forest’s Improved Access Services offer routine face-to-face and telephone appointments to patients between 18:30 and 20:00 on weekdays, between 08:00 and 11:45 on Saturdays and 09:00 and 10:00 on Sundays. Appointments during the week will be a mix of pre-bookable and, where available, same-day. There are 228 Improved Access appointments available each week in Wyre Forest.

Redditch and Bromsgrove

GP improved Access services are being offered from four hubs in Redditch and Bromsgrove – St Stephen’s Surgery (Redditch), Winyates Health Centre (Redditch), St John’s Surgery (Bromsgrove) and Hollywood Medical Practice, alternating with Cornhill Surgery in Rubery. Redditch and Bromsgrove’s Improved Access services offer routine face-to-face and telephone appointments to patients between 18:30 and 20:00 on weekdays, between 08:00 and 12:00 on Saturdays and 08:00 and 10:00 on Sundays. Appointments during the week will be a mix of pre-bookable and, where available, same-day. There are 336 Improved Access appointments available each week in Redditch and Bromsgrove.

In addition, Redditch and Bromsgrove have agreed to use £44,000 from their Transformation Fund budget to fund an underpayment in their Improved Access service. The group are also looking at setting up a blood collection service from November, which will collect bloods from the hubs in the weekday evenings and once on a Saturday morning and deliver them to the laboratory. At the time of writing the CCG is waiting on confirmation as to how much that will cost for an 18 month service. There will be further discussions with Wyre Forest Health Partnership as to whether this is something they might also be interested in doing.

2. Monitoring

NHS England

NHSE have been extensively monitoring delivery plans, particularly in the North of the County. This has been as a result of the requirement to be delivering at 100% required capacity from October 2018, the National Target, which was brought forward to September 2018 as a NHSE West Midlands local target. The providers have had to reactively amend their mobilisation plans in order to work towards achieving this new target. Currently there is 100% coverage, and the CCG has therefore met the National target.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 2 of 7

NHSE continue to monitor against the core criteria. This includes monthly data returns, including activity, plus specific returns requested against particular criterion, such as website advertising. This is likely to continue for the duration of the service.

In November 2017 NHSE carried out a one-day assurance visit for the South provider. This involved a series of interviews with the provider and CCG during the day and was backed up by pre-submission of data information. A similar visit will now be carried out on 11 December 2018 and 12 December 2018 for the two North CCGs. Plans are in place for the visit and collection of the pre-submission data.

CCG

The CCG has a sub-group of the Primary Care Commissioning Committee to oversee and monitor progress. The Improving Access Steering Group has met on several occasions to access Providers’ plans and Service Specifications, and also to review Access Transformation plans. On occasion, where timescales have not allowed Steering Group meetings to be convened, the Executive Leadership Team has agreed plans.

Contracts have all been signed and the monitoring phase now begins. As the full service has only been provided in the North of the County since the end of September, contract monitoring meetings will commence from November 2018, in line with detailed templates outlined in the contract. In the South of the County regular contract monitoring meetings continue. All contract monitoring is undertaken using a structured template against the 7 core criteria and locally agreed standards as per each contract.

The CCG is also assessing bids for transformation funding linked to access. For two of these bids further information is awaited pending decision. There are further discussions with Wyre Forest following unsuccessful bids. For the Redditch and Bromsgrove practices, in addition to the phlebotomy courier service, mentioned in section 1, a number of practices in R&B have submitted a request to continue with Emis Anywhere Laptops so that GPs can continue to access the patient records on Laptops offsite and the same exercise is happening within South Worcestershire. Ongoing engagement is happening with practices regarding how the fund can support ‘Improved access’ as well as the ‘releasing time for care: 10 high impact actions’ which should further facilitate the implementation of Improving Access.

3. Communications

A communications plan is in place and activity commenced – see Appendix D

A patient survey was undertaken in summer, ending in June 2018. This was to ascertain patients’ knowledge of Improving Access, and how patients may be able to access these services. There were 631 responses overall, but skewed numbers have meant that further analysis at CCG level is not that helpful. A high level summary is given in Appendix E.

4. Summary of Current Status

The Providers have worked extremely hard, in a very dynamic environment, in order to implement Improving Access in line with NHSE’s national requirements. There is now 100% coverage across Worcestershire. The hub models are still in their infancy, and it will be interesting to see how and if these models are re-worked during the duration of the contract. The CQC have already asked us how the hub models are working, despite only being in full operation for 2 weeks.

Some developments are still to be finalised, and active work continues to ensure continued delivery, for example setting up of a phlebotomy delivery service for Redditch and Bromsgrove.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 3 of 7

Recommendation

• To note the current status of the Improving Access Services in Worcestershire.

Appendices

A - National 7 Core Criteria. B – Summary of Improving Access in Worcestershire. C – Hub Locations Across Worcestershire. D – Communications Plan E – Access Survey.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 4 of 7

Appendix A

Improving Access 7 Core Criteria

Timing of appointments: • commission weekday provision of access to pre-bookable and same day appointments to general practice services in evenings (after 6:30pm) – to provide an additional 1.5 hours a day; • commission weekend provision of access to pre-bookable and same day appointments on both Saturdays and Sundays to meet local population needs, including bank holidays; • provide robust evidence, based on utilisation rates, for the proposed disposition of services throughout the week; and • appointments can be provided on a hub basis with practices working at scale.

Capacity: • commission a minimum additional 30 minutes consultation capacity per 1000 population, rising to 45 minutes per 1000 population.

Measurement: • ensure usage of a nationally commissioned new tool to be introduced during 2017/18 to automatically measure appointment activity by all participating practices, both in-hours and in extended hours. This will enable improvements in matching capacity to times of high demand.

Advertising and ease of access: • ensure services are advertised to patients, including notification on practice websites, notices in local urgent care services and publicity into the community, so that it is clear to patients how they can access these appointments and associated service; • ensure ease of access for patients including: • all practice receptionists able to direct patients to the service and offer appointments to extended hours service on the same basis as appointments to non-extended hours services • patients should be offered a choice of evening or weekend appointments on an equal footing to core hours appointments.

Digital: • use of digital approaches to support new models of care in general practice.

Inequalities: • issues of inequalities in patients’ experience of accessing general practice identified by local evidence and actions to resolve in place.

Effective access to wider whole system services: • effective connection to other system services enabling patients to receive the right care from the right professional, including access from and to other primary care and general practice services such as urgent care services.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 5 of 7

Appendix B

Summary of Improving Access Services in Worcestershire 2018

South R&B WF Wyre Forest Health Contractor Staywell Healthcare Ltd St John's Surgery - M81064 Partnership Standard NHS Contract - Standard NHS Contract - Contract APMS Shorter Shorter Termination date 31.3.2020 31.3.2020 31.3.2020 Annual Full Contract Value at £6 £1,762,464 £1,004,922 £682,146 Weekly hours at 30 mins/1000 147 84 57 Populations NHSE 2015 projected 293,744 167,487 113,691

Appointment structure Mon 7-8 am (HCA) am or in hours Tuesday 7-8 am (HCA) Mon 6.30-8 pm - (GPs,Pharm) Mon 5-8 (ANP, HCA) WFHP, Tues 6.30-8 pm (GPs, 6.30-8 (GP) WFNIPS Tues 5-8.30 (GPs, HCA) WFHP, Pharm) 6.15 - 8 (GPs) WFNIPS Wed 6.30-8 pm (GPs, Mon 6.30-8 pm (GPs) 2 hubs Wed 5-8.30 (GPs, HCAs, ANPs) Pharm, ANP) Tues 6.30-8 pm (GPs) 2 hubs WFHP, 6.15 - 8 (GPs) WFNIPS Thurs 6.30-8pm (GPs, Wed 6.30-8 pm (GPs) 2 hubs Thurs 5-8.30 (GPs, ANPs, HCAs) Appointment structure ANP, Pharm) Thurs 6.30-8 pm (GPs) 2 hubs WFHP, 6.15 - 8 (GPs) WFNIPS IA weekday core Fri 6.30-8pm (GPs,HCA) Friday 6.30-8 pm (GPs) 1 hub Fri 6.15- 8 (GPs) WFNIPS Sat 8-12 (HCAs, GPs, PNs, Pharm) Sun 8-12 pm (GPs, HCA) Sat 8-12 1 hub (GPs) Sat 8-11.45 (GPs) Appointment structure BH - mirror Saturday Sun 8-10 1 hub (GPs) Sun 9-10 (GPs) weekends and BHs offering BH - 4 hours BH - 3.75 hours ANPs, HCAs Family planning Other types Pharmacists Long-term conditions appointments ANP, PNs, HCA Phlebotomy Minor Ops Appointment numbers (approximately per week) 488 336 228 Utilisation rates - month % - from April 49, 55, 64, 68, 66, 71% 63, 66, 64, 57, 64, 67% 83, 87, 89, 85, 89, 91% DNA numbers month 141, 105, 127, 129, 104, from April 2018 150 30, 36, 41, 33, 44, 38 10, 9, 12, 15, 13, 29

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 6 of 7

South R&B WF EMIS Web Clinical Services Telephony through Microllab software IT EMIS Anywhere Laptops EMIS Web Clinical Services EMIS Remote Droitwich Medical Centre Hub 1a - Hollywood Medical Kidderminster Medical Riverside Surgery Practice Centre Malvern Health Centre Hub 1b - Cornhill Surgery Northumberland House Farrier Surgery Hub 2 - Wynates Health Centre Surgery Remote - virtual hub Hub 3 - St Johns Surgery Hubs Hub 4 - St Stephens Surgery Droitwich MC - Corbett Medical Hub 1a - Hollywood MP and Hub Kidderminster Medical Practice, Ombersley Medical 1b - Cornhill - Hollywood Medical Centre - Kidderminster Centre, Salters Medical Practice, Practice, Hollyoaks Medical Medical Centre, Bewdley Spa Medical Practice Centre, Cornhill Surgery, New Medical Centre, Church Riverside - Riverside Surgery, Street Practice, Hagley Road Surgery (Rubery) Demontfort Medical Centre, Surgery, Stourport Health Abbey Medical Practice, Grey Hub 2 - Wynates H - Wynates Centre, York House Medical Gable Surgery, Merstow Green Health Centre, Ridgeway Surgery, Centre Medical Practice Woodrow Medical Centre, Crabbs Northumberland House Malvern HC - Malvern Health Cross Medical Centre, Crabbs Surgery - Northumberland Centre, Knightwick Surgery, Cross Surgery House Surgery, Aylmer Upton Surgery, Pershore Medical Hub 3 - St Johns - St Johns Lodge, Chaddesley Surgery. Practice, New Court Surgery, St Surgery, Churchfields Surgery, Stanmore House, Wolverley Saviours Surgery Catshill Village Surgery, Barnt Surgery, Northumberland Farrier - Farrier Surgery, Severn Green Surgery, The Glebeland House Surgery Valley Medical Practice - 2 sites, Surgery, New Road Surgery St Johns House Surgery, Barbourne Health Centre, Elbury (Bromsgrove) Davenal House Moor Medical Centre, Haresfield Surgery House Surgery Hub 4 - St Stephens Surgery - Maple View Medical Practice, St Stephens Surgery, The Dow Surgery, Elgar House Surgery, Hillview Medical Centre, The Attached surgeries Bridge Surgery PIA agreed November 2018 PIA agreed November 2018 PIA agreed November Data Protection Replaced DPIA - 1.8.18 Replaced DPIA - 1.8.18 2018 Equality Impact Assessment Agreed 19.9.17 Agreed 19.9.17 Agreed 19.9.17 14.8.18 - CQC confirmed that providing the service under the registration and governance you do not need to register each hub as a location. They would only need to be registered separately if it was a completely independent Notification - ENQ1-5679820293 - Notification - DPL-416990 CQC registration service. sent 29.8.18 - sent 22.8.18

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 7 of 7 Worcestershire CCG Extended Access Hubs APPENDIX C Key

• R&B Practice Locations

R&B Hub 1b R&B Hub 1a • R&B Extended Access Hub

R & B Hub details - (Location) and member practices {Preferred}

• 1a (Hollywood MP) / 1b (New Road Rubery) o Hollywood MP o New Road Rubery o Hollyoaks R&B Hub 3 o New Road o Cornhill • 2 (Winyates HC) o Winyates HC R&B Hub 4 o Ridgeway o Woodrow o Crabbs Cross Surgery R&B Hub 2 o Crabbs Cross MC • 3 (St Johns Surgery) o St Johns Surgery o Barnt Green o Glebeland o Catshill o Churchfields o Davenal House o New Road Bromsgrove • 4 (Maple View MP) o Maple View MP o Elgar House Surgery o The Dow Surgery o St Stephens Surgery o Hillview Key

• SW Practice Locations

• SW Extended Access SW Hub 1 Virtual Hub Hub • Virtual Hub

SW Hub details - (Location) and member practices {Preferred}

SW Hub 4 • 1 (SWHC Droitwich MC) o Spa o Salters o Corbett o Ombersley o Great Witley SW Hub 3 o Tenbury • 2 (Riverside Surgery ) o Riverside SW Hub 2 o Abbey MP o Barn Close Surgery o Bredon Hill Surgery o DeMontford MC o Grey Gable Surgery Merstow Green MP o o Pershore o Abbottswood • 3 (Malvern HC) o Malvern HC o New Court o St Saviours o Whiteacres o Upton • 4 (Farrier House) o All Worc City Practices o Knightwick • Virtual Hub (based anywhere) o Any / All Practices

Key

• WF Practice Locations(Various colours)

• WF Extended Access Hub WF Hub details - (Location) and member practices {Preferred}

WF Hub 2 Hub 1 (Northumberland House WF Hub 1 Surgery) • WF Network of Independent Practices (NIPs) o Northumberland House o Aylmer Lodge o Chaddesley Corbett o Stanmore House o Wolverley Hub 2 (Kidderminster MC) • WF Health partnership Practices o Kidderminster MC o Bewdley MP o Church Street Surgery o Hagley Surgery o Stourport HC o York House MC

Appendix D

Worcestershire Improved Access Communications Plan

Background

National Context

The General Practice Forward View published in April 2016 set out plans to enable CCGs to commission and fund additional capacity across England to ensure that, by 2020 everyone has improved access to GP services including sufficient routine appointments at evenings and weekends to meet locally determined demand, alongside effective access to out of hours and urgent care services.

Improving access – what have we got to deliver?

National Answer:

- ‘Ensure everyone has easier and more convenient access to GP services including appointments at evenings and weekends’

Local Context

Currently, South Worcestershire operates some extended GP access; from April 2018 the whole county will provide this service.

It is a National requirement for all areas to offer extended access to primary care by October 2018.

Risks:

• Being able to localise the National Campaign materials • Be clear on what the countywide offer is (and understanding the changes if any to existing SW access service) • Managing patient expectations

Timescales – Subject to change

1st April 2018

Audience:

Worcestershire will focus on the following three key groups:

- Patients, carers, families and the wider public - Clinicians and staff working in the services - Place based stakeholders

The key delivery partners and key influencers for this are the GP Practices, staff and PPG groups

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 1 of 9

Method

- An online survey; ‘Improved access to Primary Care’ - Social Media – Twitter and Facebook led - Broadcast and print media releases and conversations - Digital communications and engagement through all partner websites o This will be the central point for signposting and survey responses - Briefings with key place based stakeholders - Use of existing partner Patient Engagement channels including Patient Participation Groups - Staff electronic communications via organisational channels

Proposed action plan:

Action Timescale Lead Collate national and local data March – April 18 Dani Hopley around extended hours Agree key messages/narrative Agreed April 18 Dani Hopley/Denise Goddard/Robert Conner Creation of May 2018 Comms/Practice managers materials/resources/collateral Stakeholder briefings on TBC Comms proposed plans

Draft survey Open till end of June Engagement/Comms

Focus Groups/ patients TBC Engagement/Comms engagement and experience

Key Stakeholders and staff

GPs and Practice staff All patient groups All providers and staff CCG Staff Media

Communication resources:

• National Campaign resources (www.england.nhs.uk/gpaccess) • Press Release: Announcing the new extended hours and how to access them • Update on CCGs and all relevant websites across Worcestershire • Posters in urgent care settings, libraries and other outdoor spaces • Email updates

To be considered

- Budget - Channels to engage - Resources

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 2 of 9

Agreed wording: (To be agreed by the board)

‘Patients in Worcestershire can now book routine appointments to access GP services on evenings and weekends.

If you need to book an appointment for these times please contact the GP practice you are registered at and ask for an ‘extended access appointment’

Action Log to date:

Action Media/Channel Date Promoted in April Commissioning for You

Promotion in A4 National Posters April MIUs Promotion in Posters (both National and adapted to local) April GP Practices GP Websites E.G. https://www.demontfortmedicalcentre.co.uk/clinics-and-services/south- April worcestershire-gp-services/

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 3 of 9

Localised May Resource creation (Appendix A)

Survey link Emailed through MPU, Stakeholder contact lists and Social Media status’s May promoted https://www.surveymonkey.co.uk/r/WorcsAccess (291 responses to date – 12th June 2018)

Practice Email/Phone -feedback on plans and poster May Managers Feedback National https://www.england.nhs.uk/gp/gpfv/redesign/improving- May Toolkit access/communications-guide/ provided by NHS England • Range of posters (various sizes) (Appendix B) • Social Media content • Website banners Upcoming/Ongoing:

Action Media/Channel Date Continue promote survey Stakeholders/Social Ongoing – deadline 29th June media/Practices/Libraries etc Analyse Survey Desk based analysis Mid July Ensure all Practices using Email Ongoing campaign resources Press Release Press End of June PPG Meetings Meetings TBC Ongoing Update/promote Webpages as CCG websites/stakeholder Ongoing appropriate websites/Practice websites Focus Groups/ patients Meetings TBC Ongoing engagement and experience National Toolkit – encourage to • Range of posters (various Ongoing use the resource materials sizes) • Social Media content • Website banners Hard to reach communities Social Ongoing

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 4 of 9

Communications Plan Appendix A:

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 5 of 9

Communications Plan Appendix B:

July 2018 Actions:

• Press release – 03/07/18 (Appendix C) • Re-promoted Survey extension – 01/07/18 – 09/07/18 (deadline 15th July)

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 6 of 9

Read and action:

https://www.england.nhs.uk/wp-content/uploads/2017/09/improving-access-to-general- practice-guide-v2.pdf

Poster (A3, A4 available) • A5 flyer (with space for local information) • Label (e.g. for prescription bags) • Freestanding desktop display (tent card) • A4 table top display (strut card) • Pull up banner

There are a number of options to consider when thinking about advertising improved access in the local area. Depending on the budget available, places to consider include: • In a practice, using the patient noticeboard or digital patient information screens • Local community newsletters, magazines or other publications • Billboard advertising • Bus stop advertising/adverts on-board local public transport • Roadside posters • Digital posters at local train or bus stations • Press advertising

It will also be important to ensure local services are advertised in other health settings. As a minimum, information about access to general practice services should be advertised in local A&E departments as well as other relevant areas in hospital or NHS buildings.

Text messages • Use the practice’s SMS texting service to inform patients about any new or extended services. Phone messages • Record a message on the practice phone line which patients can access before selecting the service they require. Websites • Place a promotional banner on the practice website advertising any new or extended services and the times they are available. A template web banner is available at www.england.nhs.uk/gpaccess. As a minimum, ensure that information regarding improved access to general practice services is placed on each practice’s website, and that this information can be easily accessed i.e. on the website homepage. Emails • Place a promotional banner at the bottom of practice emails advertising any new or extended services and times they are available. A template email banner is available on www.england.nhs.uk/gpaccess.

Communications plan Appendix C:

Press release – for immediate release

Tuesday 3 July 2018

Know your health service options

Health bosses across Worcestershire are encouraging people to know their health services options.

Patients are urged to remember that A&E is for serious and life-threatening emergencies only and there are a number of other health services available to help them.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 7 of 9

Patients can contact their own GP during surgery hours to request in-hours appointments or ask for a routine extended access appointment, visit their local pharmacist, dial 111 for medical advice and information. There are five Minor Injury Units across the county in Malvern, Evesham, Kidderminster, Tenbury and Bromsgrove.

GP services

GPs can help you with many health problems and complaints and can provide a wide range of family health services. Patients in Worcestershire can now book appointments to access GP services on evenings and weekends, please contact the GP Practice you are registered at and ask for an ‘extended access appointment’. If you are not registered with a GP visit www.nhs.uk to find a surgery in your area.

Useful resources (websites): Our CCG site - http://www.worcestershire.nhs.uk/e-a-t/

National - https://www.england.nhs.uk/gp/gpfv/redesign/improving-access/gp-access-fund/

Useful - http://www.nhsemployers.org/case-studies-and-resources/2014/04/social-media-toolkit-for-the- nhs

http://www.napp.org.uk/Practices%20and%20patient%20engagement.pdf

https://gcs.civilservice.gov.uk/guidance/campaigns/guide-to-campaign-planning-2/

https://www.health.org.uk/collection/communications-health-care-improvement-toolkit

https://www.england.nhs.uk/gp/gpfv/redesign/improving-access/communications-guide/

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 8 of 9

Appendix D:

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 9 of 9 Appendix E

GP Access survey results: Top level ndings

1. 2. Appointment booking is easy: 3. Booking Evening / Weekend We received at least 1 appointments are important: response from every 14% practice in Worcestershire. 22% 49% The most we received from 37% 47% a single practice was 53. 31%

Total responses were 631. Agree / Disagree / Neither Agree / Disagree / Neither

4. GP / Clinician access from 5. Awareness of Government 6. another practice is acceptable Commitment of 7 day access 50% 9% of patients asked wanted 35% evening appointments 31% 60% 65% 44% of patients wanted Interested / Not / Don’t Know Aware / Unaware appointments pre 8am

7. 8. 9.

79% 33%

As well as face-to-face, 79% of 78% of respondents preferred respondents wanted telephone Saturday, 44% would also like 70% of respondents drive to their contact with GPs, 33% also access on Sunday afternoons. GP, with 22% walking. wanted videocalling 15% wouldn’t want a weekend appointment.

10. 11. Distance willing to travel: 12. Weekend services required: 100 33% 80 60 % 47 40 20 12% 89% 70% 27% 53% 30% % % 20 40 60 80 100 GP Transport would not be an issue HCA Physio to 93% of respondents 0-15 mins / 15-30 mins / Non-issue Nurse P. Pharmacy

Respondent Breakdown:

Gender Breakdown: Age Breakdown: Ethnic Groups: 16 - 29: 3% 93% White British 73% Female 30 - 44: 17% 45 - 64: 40% Sexuality: 26% Male 65 - 84: 36% 90% Heterosexual Primary Care Commissioning Committee

Wednesday, 31 October 2018

Agenda item 9

Worcestershire GPFV – Work Programme Highlight Report October/November 2018

General Practice Forward View Highlight report – Progress against Local Delivery Plan (Oct/Nov) Activity planned next month Oct/Nov Summary of work stream/activities incl Key achievements/deliverables (Stock take/next steps, resourcing, analytics/BI) Progress Workstream identified leads & project benefits. Key Actions achieved since last report RAG Issues escalated to STP Delivery Board plus risks & issues. (August/September) rating outcome Project Leads: Resilience support to practices registering patients Resilience Team Meeting – to be rebranded as The CCG – Sally Everton & as a result of a local practice closure. General Practice Support Team. Key priorities LMC – Dr Gill Farmer Continued support to practices already on the identified to support practices – IT and Enhanced Key Risks – none identified resilience programme. GPs and PMs are working in Services claims. The internal peer support team will partnership with practice teams. Team to focus on providing support to practices re- continue to build on its support to practices registering Woodrow patients Workload with workforce, organisational issues, Green

premises, finance and safety. There are Working alongside PM mentoring programme – Practice Manager Handbook to be launched at currently a number of practices who are on recently appointed practice business manager to November Development Day the Peer Support Team’s caseload for receive support from Resilience funded PM mentor. these issues and we envisage that there will be others requiring this additional support during 2018 and 2019. Signposting patients to care and support The data collection from the providers is well There are plans for Public Health and CCG to visit services which increase wellbeing and underway now and there is 6 months’ worth of data. Practices soon to discuss how practices are finding independence. There have been around 650 referrals into the the service and to get some feedback that will feed service across Worcestershire and approx. 450 into the final evaluation. patient who have had a face to face appointment or Social a telephone appoint with the social prescribers. The Green Prescribing top 3 reasons for referrals are: 28% for low mood/anxiety/stress depression, 22% for social isolation and 12% for debt/money/finance. There should be some future feedback from Public Health as to the results of the WEMWBS tool outcomes from the patients.

Definition of RAG rating Rating Interpretation Green Demonstration that all key elements have been carefully considered and is delivering as planned. Amber/green Key elements have been carefully considered, but delivery of the project is impending delivery. Amber/red Reservations that a number the key elements of the project are under analysis and not fully articulated at present. Red Few of the key headline themes have been considered or articulated (project could be either on hold or in the pipeline).

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 1 of 10

Countywide Telephony Online Consultations Online Consultations Online Consultations Funding stream for this year has Soft Market Testing starts w/c 15th Oct with 17 suppliers who have asked NHS App been confirmed ie £200k. This has to to participate. High level milestones below. Docman 10 be spent by the end of this financial Milestone Start Date End Date EMIS Anywhere Laptops year. Project team assembled Soft Market Testing Mid Oct 2018 Mid Oct 2018 111 Direct Booking managed by the CSU. GP Practices Refining and Questions Mid Oct 2018 End Oct 2018 EPaCCS/Black Pear have been asked to complete a Tender Pack Issued to Potential Start Nov 2018 Start Nov 2018 EVIE survey to see if there is sufficient Bidders appetite and engagement to support Bids Closed (30 days) Start Dec 2018 Start Dec 2018 the project. Initial Evaluations Start Dec 2018 Early Jan 2018 Clarifications/Demonstrations (30days) Early Jan 2018 End Jan 2018 Final Evaluation End Jan 2018 Mid-Feb 2018 Standstill Letters to suppliers End Feb 2018 End Feb 2018 Contract Award Mid-March 2018 Mid-March 2018 Deployment Start April 2019 March 2020 Project team will also liaise with Stafford to discuss their approach in greater detail and progress to-date. Other CCGs also to be contacted via a template to seek out lessons learnt, NHS App especially what didn’t work IT & The CCGs were approached to technology participate in testing of the NHS App. NHS App and Amber Three Practices (one in each CCG There has been a delay in the launch for the three Worcestershire infrastructure area) are involved in the testing of the practices, which was originally planned for October. The launch is

app taking place in the coming dependent on an Emis patch, however, the patch schedule for Nov has weeks. The three Practices are: not yet been released by Emis. The launch is expected to be re-planned Grey Gable Surgery, Davenal House for November, with dates to be confirmed when the patch date is known. Surgery and Stanmore House Surgery

Extranet/Document Management Extranet/Document Management In recent months there has been Following further review a project of work will review needs and desires in consideration of extending use of a respect of a collaboration tool across the CCG and GP estate to produce collaboration platform known as a specification towards selection and procurement of a best fit solution. Huddle in the county. In South Some exploration of existing software will be included with a view to Worcestershire the GP Federation minimising the variation of systems and looking towards more purchased Egton’s IntraDoc247 for standardisation, for example reviewing the collaboration product used in their GP Practices. However Egton Herefordshire (GP TeamNet), and the CCGs O365 environment against have failed to deliver on their the specification of need. development roadmap and support in general has been poor. Therefore, the Federation are looking at alternatives but waiting to see what the CCG will be doing.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 2 of 10

HSCN HSCN The tender pack for suppliers was Award of contract for HSCN provision is schedule for 5th Nov, following released back in June. which deployments will be planned to progress at best pace.

Docman 10 37 GP Practices are live with Docman 10 Docman 10. However, migration has Migration will continue when the GP Surgery has migrated to HSCN. been paused at 6 remaining practices at the CCG’s request due to theperformance issues associated with N3 Countywide Telephony Countywide Telephony Deployments of X-on’s Surgery Connect telephony solution continues Project continues with the migration across the County over a number of sites - 12 initially within next 8-10 of a number of sites weeks: • Severn Valley Group - Henwick Halt • Severn Valley Group - Lyppard Grange • Ombersley Medical Centre • St Martins' Gate Surgery IT & • St Martins' Gate Surgery (Branch) technology • Riverside Surgery and • Farrier House Surgery Amber infrastructure • Hagley Surgery WF (cont’d) • Stourport Health Centre WF

• York House Medical Centre WF • Salters Medical Practice

EPACCS/Black Pear EPACCS/Black Pear GP Surgeries need to be aware of the licensing arrangements for Black Pear’s eSP platform (that EPACCS and their needs to be further engagement to encourage them delivers the EPaCCS service) is now to use the service. Further dialogue is happening with the Acute and a GPSoC service so licenses are now Black Pear to see how the County can use eSP to deliver GP records to centrally funded. The licenses for eSP other services such as ED, COPD and other opportunities for delivering were renewed in September. additional Comprehensive Assessment shared care plans across the county for Long Term Conditions supporting frailty and single disease templates

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 3 of 10

NHS 111 Direct Booking NHS 111 Direct Booking NHS England are currently trialling The CCG is monitoring implementation elsewhere in the West Midlands. direct booking of GP appointments by NHS 111, as part of their plans to roll this out 'universally'. The 'lessons learned... will inform' next year's contract negotiations. In the Midlands, Black Pear’s eRA system licenses have been procured by Sandwell and West Birmingham CCG for 580 GP Practices so they are in a position to pilot as and when there is agreement. There is an access standard within the Primary Care Commissioning Framework that requires practices to release 3 appointments per 1000 population. This includes capacity for IT & 111, A&E, WMAS and OOH. technology and EMIS Anywhere Laptops EMIS Anywhere Laptops Amber infrastructure Licenses for the EMIS Anywhere Redditch & Bromsgrove have used their Transformation Funds to (cont’d) laptops (now branded Anywhere purchase 2 year licenses for their 40 laptops across their patch. This has Consult by Egton) finished across been completed as a single procurement South Worcestershire and R&B in Some South Worcestershire Practice have used their Transformation September. Whilst there was no Funding for other incentives so the CCG are looking to see if there are further funding from the CCG, alternative funding streams. Because of the fragmented circumstances Practices were informed they could of available Transformation Funds in South Worcestershire it has been use their Transformation Funds. decided that the best approach is each GP Practice is invoiced individually from Egton and they can make their own decisions if they wish to renew. Those that have Transformation Funding available can ask the CCG to reimburse them for the cost of the licenses. The Wyre Forest Health Partnership are aware of TF opportunities. The NIPS practices have either already renewed their licenses or do not wish to.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 4 of 10

Project Lead: Broadway – new GP practice Awaiting approval of Outline Business Case by NHS England CCG – Jo Hall premises for Barn Close Estates & Technology Outline Business Case (OBC) Transformation Fund (ETTF) – approved by Primary Care programme for investment in GP Commissioning Committee on infrastructure 19 September. Benefits include: improved access, increased capacity for primary care Stourport – new GP practice Awaiting completion of Outline Business Case services out of hospital, wider range premises for Stourport Health Centre of services to reduce unplanned and York House Medical Centre admissions, value for money Risks: still awaiting new Premises Barnt Green Surgery – Given approval to proceed Costs Directions, NHS England improvement seeking approval for alternative Modular extension at back of solution to fund practices for new premises to provide 2 new GP builds consulting rooms Scheme approved by NHS England

IT & Church Street Surgery – Awaiting quotes technology improvement and Conversion of top floor to provide 2 Amber infrastructure additional consulting rooms and office (cont’d) for visiting service

New Road Surgery, Bromsgrove – Awaiting quotes improvement Room conversion to create additional consulting rooms, conversion of WC to disabled, reception rearrangement, lift installation

Whiteacres Medical Centre – Awaiting approval of quotes by landlord improvement Conversion of 2 ground floor offices to consulting rooms

Winyates Health Centre – Awaiting quotes improvement Internal reorganisation to provide additional consulting rooms, waiting area and disabled toilet

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 5 of 10

Workforce Local workforce priorities to support NHSE retention fund proposal • Retention fund - Finalise the GP Portfolio role description and implementation of the GPFV have • A revised GP Retention Scheme requirements with the Trusts and begin engagement with practices. been identified for 17/18 by a county was proposed to NHSE in August. Begin recruiting to the GP Portfolio posts. wide workforce group to support Due to the significant reduction in • Continue development of the STP wide General Practice Nursing practices. The primary areas are: funding received the focus will now strategy. • GP Recruitment and Retention be on supporting 4 GP Portfolio • Analyse data received from the Herefordshire and Worcestershire • Practices Nursing development roles as a proof of concept. Quarterly Workforce Survey and succession planning • The Project Manager resource • Engage practice managers to determine the training which is needed • Wider team development allocated to STP to support in Q3&4. including practice management delivery, has been determined and • Finalise the pathway and documentation for the Practice Manger has been incorporated into the Mentorship Programme. • Introduction and scoping of new team. • Roll out the Training Hub’s job advertising service across roles/ functions to support International GP recruitment Worcestershire. sustainability of general practice scheme • Explore ways to increase GP Trainee and GP Trainers with HEE and • The local target of 50 has been NHSE colleagues reduced to 23 based on NHSE • Developing Practice and Community Nursing training pilot advice as national schemes are not delivering as expected. There may be a further reduction in this target. GP Fellowships • Currently in the second wave of Red/ expressions of interest for 18/19. Amber • To date there have been no appointments but the scheme continues to be supported and promoted. Nursing • Four General Practice Nurse Mentors have been recruited (one per CCG) and will commence post in October. They will work in partnership with University of Worcester to support the growth of pre-registration nurse placements and nurse mentors in General Practice. • A pilot similar to the GP Fellowship scheme is being proposed for HEE funding to train community and practice nurses together across the STP. • STP wide General Practice Nursing strategy is in development

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Workforce Workforce survey (cont’d) • The local survey has been returned with a 100% completion rate. The data is now being analysed to determine areas for focus.

Physician Assistants • The role has been promoted in primary care by the PA Ambassador, which has facilitated the increase of student placement numbers in GP practices. • A 1 year PA preceptorship pilot is being rolled out across our STP

Practice Manager Training programme • Rolling programme of training in place in collaboration with Herefordshire PMs. • A mentorship programme is in place across the STP with formalised training for mentors taking place in November. • An annual update session for PMs is set to be delivered in January 2019.

Recruitment • A centralised advertising function has been developed in Herefordshire through the Training Hub web site. The initial pilot resulted in applications for each GP practice job advertised. There are now plans to upscale this to Worcestershire from November.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 7 of 10

Features of improved access as per South Worcestershire 100% population coverage across all 3 CCGS. GPFV national guidance include: Monitoring of the revised service Push on website advertising. • Service delivery by a primary delivery model in line with the Planning for NHSE visits in December 2018. clinical team comprising for contract requirements. example GPs, Practices Nurses, Nurse Practitioners, Redditch and Bromsgrove/Wyre Physiotherapists, Physician Forest Associates, Paramedics. Continue to work with both lead • Skill mix to ensure patients’ needs providers on the delivery model and are met by the right clinician. monitoring in line with the contract • Access to telephone, face-to-face requirements. Improved appointments and on-line A huge amount of work was access consultations undertaken in order to deliver access Green • Data sharing across all practices in line with the revised national • Appointments bookable on trajectories by 1 October 2018. individual practice systems Delivery is now 100% • Coverage – Monday to Friday 6.30- 8pm additional appointments mainly pre-bookable across sites

• Coverage – Weekends, demand led, across sites • New requirement in Planning Guidance – 100% access by 1 October. Worcestershire Alliance Continue to support Neighbourhood Teams and the Integrated Care Sustainable The three local Alliance Boards are groups of System plans. key to delivering local ambitions to practices provide better and more responsive (working at The Neighbourhood Teams’ plans which were approved earlier this year care for our more frail and vulnerable scale) patients in their own homes. are being delivered.

The plans’ progress is being monitored via the Verto system monthly.

Green In preparation of the midterm review of the delivery of the NT plans, each NT CCG lead is working with their NT GP lead to produce 1 slide with key achievements such the introduction of the teams. These will be presented to the assurance group on 6th November.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 8 of 10

Promoting Clinical Excellence (PCE) A PCE Clinical Leads Event was held A PCE Clinical Leads Event was held on 27 September and the Sustainable CCG investment in general practice on 27 September and the evaluation evaluation indicates that the afternoon was valued by GPs. groups of using combined CCG funding and indicates that the afternoon was The monitoring dashboard completed by PCE Leads has been updated to practices PMS premium. A critical part of valued by GPs. capture all key deliverables within the PCE Service Specification. This (working at ensuring delivery of the Financial The monitoring dashboard completed serves as a prompt to escalation if groups/practices are not complying with scale) Recovery Programme savings by PCE Leads has been updated to requirements. Green requirements. capture all key deliverables within the PCE Service Specification. This serves as a prompt to escalation if groups/practices are not complying with requirements. Bids are invited from groups of 2 submitted bids are still outstanding practices to access the transformation as further information is required fund money to support delivery (WC3 and P4). improved access or 10 high impact actions. A number of practices in R&B have GPFV submitted a request to continue with Transformation EMIS Anywhere Laptops & the same Green Support exercise is happening within SW.

WFNIPS have had a second bid turned down, there will be further discussion with the WFNIPS regarding their bid. Care Care Navigation has the ability to 119 staff are now trained in SW, Focus on EMIS templates Navigation/ increase patient choice by 126 in R&B and 74 in WF Active signposting patients to the range of Signposting clinicians and other services available There have been 4 carousel events – to meet their requirements, enabling 2 in SW and 2 in WF but they were patients to make informed choices for poorly attended due to staff not their health need, whether this is realising they were on. There was urgent, routine or to effectively good engagement from the manage a long term condition. organisations so we may look to do another one in Spring following Green further engagement with the HCN’s. Ongoing engagement is required via Practice Managers to ensure any needs are identified going forward. There have been numerous requests for support with the EMIS templates so this will delay the start of the hard launch date of 1st November while this task is completed.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 9 of 10

Care Navigation/ There will be a carousel event Active planned for R&B Practices, but also Signposting the training needs require (cont’d) reassessment and further engagement with PM’s is planned in October. All pharmacies locally have now been written to and notified of the upcoming potential changes in November and that they may see more patients coming through the door stating that the practice had suggested they should speak to the Pharmacy.

Further meetings with Taurus Healthcare regarding the BI offer from them to assist with ongoing data collection and evaluation and the work is ongoing and progressing, there will be further updates to follow.

Productive Workflows is one of the 10 22 more staff trained in Note Continue to promote future course dates with practices; High Impact Actions, to release GP Summarising bringing the total to 80. time. Another session is planned for 14th Explore potential opportunities with Trainer the Trainers – build GP November. networks of trained staff to support others with EZ Doc staff have been, 87 trained in Medical Terminology. also look at refresher days being run in 2019 with AT Medics. Document Training sessions have evaluated Handling very well by those attended and Collate course evaluations for summary, potentially include within IQSP Green George Henry – GP SW has Autumn Visits commented how welcome it has been in practice having staff trained, they have noticed a considerable difference within practice with reduced workload to GP’s Quality Application for further funding was Improvement not approved. support RED

Time for Care programme

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 10 of 10

Agenda item 10 Primary Care Commissioning Committees of Redditch and Bromsgrove CCG South Worcestershire CCG Wyre Forest CCG ‘Meetings in common’ Wednesday, 31 October 2018 at 10:30am Bewdley Medical Centre, Dog Lane, Bewdley, DY12 2EF

Improving Quality Supporting Practices – update

Report author Sally Everton, Primary Care Manager Presented by Lynda Dando, Director – Primary Care Target CCG RBCCG ☐ SWCCG ☐ WFCCG ☐ All CCGs ☒ Primary Care Commissioning Committee members are invited to note the contents Recommendation of the report.

Purpose Assurance ☐ Decision ☐ Approval ☐ Discussion ☒ Information/noting ☒

Executive Summary The agenda for the Autumn/Winter programme of Improving Quality Supporting Practices (IQSP) meetings has now been agreed. The second IQSP meeting with the County’s 63 practices will commence in November and will conclude in January. For information and to note, the agreed areas of focus are shown below:

IQSP Agenda – Autumn/Winter 2018/19 1 Feedback and Actions • Dementia Diagnosis Rates and Patient Services available • Antibiotic Audit - Updates 2 GPFV – Updates 3 Mental Health: • Depression and Antidepressant prescribing • Asperger’s/Autism/ADHD 4 Launch of New Gynae pathways document for Primary Care 5 Obstetrics - a shared learning 6 Self-Care – Update on Local and National policies 7 COPD – 9 Key Interventions and changes to Inhaler Treatments 8 CCG Updates and Events

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG 1 |

Agenda item: 11

Primary Care Commissioning Committees of Redditch and Bromsgrove CCG South Worcestershire CCG Wyre Forest CCG ‘Meetings in common’ Wednesday, 11 July 2018 at 10:30am Bewdley Medical Centre, Dog Lane, Bewdley, DY12 2EF

Applications to change partners on GMS/PMS contracts

Report author Ray Giles, Primary Care Contracts & Data Quality Officer

Presented by Denise Goddard, Primary Care Commissioning Manager

Target CCG RBCCG ☐ SWCCG ☐ WFCCG ☐ All CCGs ☒

Recommendation To note partnership changes listed

Purpose Assurance ☐ Decision ☐ Approval ☐ Discussion ☐ Information/noting ☒

Executive Summary

• The Purpose of this paper is to inform the Committee of proposed PMS & GMS contract amendments for changes of partnership. • The CCGs have received applications for partnership changes. These changes require contract variations to be issued to reflect the revised signatories to the contract. All other terms of the contract remain unchanged. • The report is for notification purposes only.

Recommendation

To note partnership changes listed.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Summary of applications received:

Summary

• Aylmer Lodge – New Partner • Albany House – New Partner • Spring Gardens – New Partner • St Johns Surgery – New Partner • St Stephens Surgery – Partner Retirement – Replacing with a New Partner • Glebelands – New Partner • Merstow Green – Partner Retirement – Replacing with Salaried GP • Knightwick – 24 Hour Retirement • Catshill – New Partner (Practice Manager becoming partner) • Maple View – Partner Retirement – Replacing with a New Partner

The CCG will vary GMS contracts and PMS agreements to reflect the above partnership changes.

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Agenda item: 12i

Board Assurance Framework Report

Report author Tony Ciriello, Corporate Governance Manager

Presented by Hana Taylor, Head of Governance and Corporate Affairs

Target CCG RBCCG ☐ SWCCG ☐ WFCCG ☐ All CCGs ☒

The Primary Care Commissioning Committees in Common are requested to: • Actively monitor delivery against the corporate objectives ensuring that milestones are being met and reviewing the remedial actions that have been identified, where appropriate • Review the strategic risks which fall within the remit of the committees, Recommendations including associated mitigating actions, controls and assurances, considering whether they are adequately managed and whether any additional risks should be captured; • Consider the impact of mitigating actions, controls and assurances on the risk scores that have been identified • Report back to Audit Committee, as appropriate

Purpose Assurance ☐ Decision ☐ Approval ☒ Discussion ☒ Information/noting ☐

Executive Summary

Review of strategic risks contained within the Board Assurance Framework which fall within the remit of the Primary Care Commissioning Committees in Common, along with the associated corporate objective quarterly milestones.

Produced by: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 1 of 6 Review of Progress against Quarterly Milestones

Progress against delivery of the Q3 milestones has been undertaken, in order to assess whether these are on track for achievement. As can be observed within appendix 1, the most challenged area remains workforce; which continues to be red rated. Please note that detail relating to Q1 and Q2 milestones has been included, should these continue to be red/amber rated and link into Q3.

Risk Closure

In light of the progress in delivering the mandated Improving Access trajectory, the following risk has now reached target score and is in a position to be closed.

Risk: 2.2B - Potential inability to achieve the national improving access trajectory in 18/19 for 100% coverage of the practice population and meeting national criteria; due to a number of factors including funding streams and non-delivery of the enablers highlighted above.

Rationale: 100% population coverage in place. Trajectory achieved by the nationally mandated 1st October 2018 deadline.

Areas of High Risk

Risk 2.2a which relates to GP Workforce is currently red rated. The committees are asked to review this risk and specifically consider the questions outlined below:

• Are the risk controls and assurances in place sufficiently robust? • Are adequate mitigating actions in place to manage the risk? • Are the risk scores that have been applied representative of the current position?

Full detail is enclosed within appendix 1.

Summary and Next Steps The BAF as a whole will be continuously reviewed throughout the course of the year, with the relevant strategic risks and milestones pertaining to objective 2 regularly submitted to each Primary Care Commissioning Committees meeting.

Appendices: Appendix 1 – Objective 2 BAF Extract

Recommendations: • Actively monitor delivery against the corporate objectives ensuring that milestones are being met and reviewing the remedial actions that have been identified, where appropriate • Review the strategic risks which fall within the remit of the committees, including associated mitigating actions, controls and assurances, considering whether they are adequately managed and whether any additional risks should be captured; • Consider the impact of mitigating actions, controls and assurances on the risk scores that have been identified • Report back to Audit Committee, as appropriate

Produced by: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG Page 2 of 6 Objective 2 Executive Lead and Lead Committee Developing a new model of care and delivery plan that supports sustainable primary care, delivery of the GP Forward View and the effective integration between primary, secondary, community and social care services consistent with integrated care principles. Ruth Lemiech, Director of Strategy/Lynda Dando, Director of Primary Care Clinical Executive/Primary Care Commissioning Committee Workstreams and Milestones

Workstreams Q1 Q1 RAG Rating & Commentary Remedial Actions Planned Q2 Q2 RAG Rating & Commentary Remedial Actions Q3 Q3 RAG Rating & Remedial Actions Q4

Planned Commentary Planned

2.2 - Deliver the Improving Access: Contracts signed off and contract Improving Access: 100% population coverage in place. Improving Access: Sustainable Worcestershire By the end of Q1, assurance monitoring arrangements in place By the end of Q2, Lead Trajectory achieved by the nationally By the end of Q3, General Practice: GP Forward View st will be obtained from the GP providers across mandated 1 October 2018 deadline. Redditch and By the end of Q4,

lead GP providers across the Redditch and Bromsgrove and full utilisation of the Worcestershire CCGs in Bromsgrove and Wyre Wyre Forest will have 18/19 £1.50 per

respect of the mobilisation of Forest will achieved 100% head transformation at scale working through demonstrate evidence population coverage fund will be realised, access hubs (In line with of attainment against for increased together with national criteria); and robust trajectory through Q2, consultation capacity outcomes contractual arrangements with a view to meeting (30 mins per 1000 demonstrated will be in place, including 100% population population) subcontracting with practices coverage

CCGs submitted bids at the Sustainable General On track for achievement Workforce: NHSE set wider recommendation of the Quality and Risk Practice – Resilience workforce trajectories, Sustainable General Practice By the end of Q3, Subcommittee, which will support at risk Bids awaiting targets – Resilience Bids progress against the practices. A number of bids have been By the end of Q2, By the end of Q1, resilience formally agreed by NHSE, including a expected 18/19 bids will be agreed with resilience plans will be trajectories for GP joint STP bid. Memorandum of in place CCGs, LMC and NHSE Understanding has been signed. Funds recruitment should to be received shortly. be evidenced, supported by Sustainable General Achieved Practice: recovery plans where NHSE monitoring to commence from appropriate By the end of Q2, 10th August 2018 practices will be working across population groups of 30-50,000 to deliver

the PCE contract and

working as neighbourhood teams

At the end of Quarter 1, CCGs have • Further communication with Bid submitted to NHSE for GP retention • Wider workforce Sustainable General Practice Workforce: received 6 proposals. These proposals practices during June and July will schemes completed. trajectories anticipated – Transformation Funds By the end of Q2, an have been put forward by 5 of the 15 continue to both highlight the Submission of NHSE retention fund By the end of Q1, proposals approved set of PCE groups (1 group submitting 2 scheme to practices and to expedite proposal for £977K. Awarded £106K - for use of transformation initiatives will be in • NHSE only able to supply proposals). submission of proposals, as allocated on funding per head of funds in 18/19 will be place, in order to high level workforce data. GPFV Access and Transformation panels evidencing successful deployment population. One scheme approved by approved for implementation support delivery of the Local workforce survey in April and May have met and of funds during 18/19 will influence NHSE to support proof of concept, against the truncated priority GP workforce completed for all practices, determined that: funding received in 19/20 relating to GP Portfolio Pilot for 4 GPs. of improving access trajectories by 20/21 which will provide a

- 3 bids accepted (I.E closure of the GP Recommended to note the gap of 61 baseline. Report expected in - 2 bids require further information • Further work to communicate gap of 61 WTE GPs) FTEs November with practices including Members - 1 bid rejected as did not meet Project Manager resource allocated to Practice Update to try and stimulate “Improving Access Criteria” STP to support workforce activity further interest / bids

From the four further bids received during July – 1 bid has been successful with the other 3 awaiting further clarification before final decision

As at October, 3 bids continue to await confirmation, CCGs working with the

practices to ensure the applications are relevant. A large number of practices are updating their Emis Anywhere laptop licences using TF bid money. All but 2 SW practices have done undertaken

this, awaiting on RB and WF figures.

Workforce: Partial assurance from NHSE against the • Revised GP and wider workforce By the end of Q1, full Hereford and Worcestershire GPFV trajectories submitted in April and assurance of the GP Forward Workforce Plan submission in February will be reviewed quarterly. This was View workforce plan for 2018. reviewed and endorsed by NHSE in Herefordshire and May. Worcestershire will be Regionally, no plans gained full secured from NHSE assurance due to the international • NHSE advised future action plans recruitment programmes not delivering to include the following: in line with expectations. This is due to o Primary care at scale both the flow of international recruits o Workforce supply and the conversion of those becoming o Workforce retention – successfully embedded within practices Bid submitted to NHSE being lower than anticipated. for GP retention NHSE have mandated GP FTE gap to be schemes reported as zero, offset by recruitment o Improvement of data schemes delivering. High risk of delivery quality noted and articulated in delivery plans o Mechanisms for tracking and monitoring progress

Enablers

Engagement and Partnership Working Communications Contract & Performance Management Governance Organisational Development

• Develop collaborative working with key partners to enable the • Development of a communication and patient engagement plan, • Integrated reporting systems and processes will be devised which • Continuing development of countywide data sharing processes to • Development of a combined, Worcestershire Alliance OD plan, smooth implementation of an accountable care system which will support delivery for the Alliance Boards will provide robust mechanisms through which progress against facilitate collaborative working between practices in natural along with locality focussed OD plans new model of care plans can be managed during the transitional neighbourhoods to support successful delivery of extended access

phase and integrated care • Identification of the personal and organisational development • Arrangements for tactical and strategic commissioning defined • Provision of regular progress updates regarding the new models needs for key personnel involved in the delivery of integrated care and implemented of care workstream, including responding to feedback and • Promoting Clinical Excellence 18/19 will act as a contractual • Agreement and implementation of integrated care governance incorporating into future plans, as appropriate incentive to support delivery of primary care commissioning structures • Ensuring appropriate and adequate capacity and capability exists • Plan for shared support functions to facilitate the delivery of intentions and working at scale across the system, in order to ensure successful delivery of this integrated care models, including quality, BI, finance, • Development of an effective communications and patient • Strengthen Neighbourhood Team development, increasing range objective communications and population health management engagement strategy to support improved access to general of aligned health & care professionals and scope of services

practice services across Worcestershire • Through the STP, establish roles, responsibilities and governance • GPs and Neighbourhood team staff will report improved job processes for the integrated care system and integrated care satisfaction and an increased ability to meet the needs of their • Ensure that best practice is shared in respect of organisation patients transformational opportunities which will promote at scale working and transformation

• Continuation of targeted IQSP visits to practices in order to address variation and support delivery of the GP Forward View

• Establish collaborative arrangements and relationships with key partners including integrated care partners, STP partners, urgent care providers, NHSE, HEE and deaneries in order to achieve successful system wide implementation of the GPFV Summary of Strategic Risks

Risk ID Risk Description Initial Risk Score 18/19 Current Risk Score Target Risk Score Projected Risk Score

R2.2A Schemes will not deliver as planned to meet trajectories and close the GP workforce gap due to potential non achievement of a number of key factors as L4xI4=16 L4xI4=16 L3xI4=12 L4xI4=16 detailed below:

- GPs in training not converting to local posts and uptake of GP retention schemes being lower than planned - Inability to recruit sufficient GPs through local marketing and schemes such as TERS and international recruitment - Joint initiatives with acute and community trusts not being successfully mobilised R2.2B Potential inability to achieve the national improving access trajectory in 18/19 for 100% coverage of the practice population and meeting national criteria; L3xI3=9 L1xI3=3 L1xI3=3 due to a number of factors including funding streams and non-delivery of the enablers highlighted above. Risk Closed

Executive Lead Lynda Dando, Associate Director of Primary Care Lead Committee: PCCC Date Last Reviewed: Oct-18 Date of Next Nov-18 Review Risk 2.2A: Schemes will not deliver as planned to meet trajectories and close the GP workforce gap due to potential non achievement of a number of key factors as detailed below: 20 - GPs in training not converting to local posts and uptake of GP retention schemes being lower than 15 planned - Inability to recruit sufficient GPs through local marketing and schemes such as TERS and 10 Current international recruitment 5 Target - Joint initiatives with acute and community trusts not being successfully mobilised 0 Risk Scores Initial: L4xI4=16 Projected Current: L4xI4=16 Target: L2xI4=8 Projected: L4xI4=16

Controls Current Performance & Rationale for Current Score Controls Implemented Requesting allocation of 50 GP whole time equivalent recruits between 2018 – 2020 in line with GP Forward View STP GP Workforce Trajectory of 37 additional WTE GPs across Herefordshire and Worcestershire by 2020. An alternative workforce model is required to bridge this gap, including the introduction of new roles of practitioners in primary such as physician associates, enhanced care 1. GP Workforce survey has been included within the PCE 2017/18, which will enable local intelligence to be practitioners and paramedics. Furthermore, practice nurse succession planning is a critical issue as 40% of practice nurses are over 50. obtained and therefore inform progress against the GP workforce trajectories The impact of WAHT junior doctor training posts is a significant risk in terms of maintaining statutory levels of clinical supervision for posts, which in turn will impact upon the pipeline of future GP training posts. 2. Revised GP and wider workforce trajectories submitted in April and will be reviewed quarterly Partial assurance from NHSE against the Hereford and Worcestershire GPFV Workforce Plan submission in February 2018. Regionally, no plans gained full assurance due to the international recruitment 3. Paper and presentation relating to primary care workforce delivered to STP Local Workforce Action Board programmes not delivering in line with expectations. This is due to both the flow of international recruits and the conversion of those becoming successfully embedded within practices being lower than anticipated. 4. Practice Manager appraiser /training programme rolled out with plans to scale up across STP footprint The other key actions are centred around: - Strengthening local initiatives to close the GP workforce gap 5. STP expression of interest made to HEE for GP Fellowship Programme. Full engagement with both Trusts - Strengthening data assumptions for supply and demand of the workforce trajectory, up until 20/21 offering 2 training places each - Defining “how” alternative workforce solutions will be deployed across primary care home/neighbourhood teams

6. Workforce survey for use across the STP footprint completed Mitigating Actions Action Due Date Lead Status Development of workforce survey for use quarterly across the STP footprint Roll-out to practices in August Lynda Dando – Director of Primary Complete 18 Care Working up of NHSE GP retention funding proposal with CCG, HEE and LMC GPs July-18 Lynda Dando – Director of Primary Complete Care Project management support for the understanding of NHSE trajectories and workforce data (0.5 WTE) expected up Discussions continue Lynda Dando – Director of Primary Ongoing to 2020. Care Establish GP Career Plus Programme (New GP Retention Schemes) across Worcestershire to support the wider offer May-18 Lynda Dando – Director of Primary Complete to GPs nearing retirement (GP retention), with particular focus upon reviewing a menu of retention initiatives as Care part of the STP Workforce Plan. Jonathan Leach – RBCCG Governing Body GP Update: During Q4, roll-out and engagement of practices regarding applications to the NHS GP retainer scheme (17/18) will take place. This scheme includes GPs nearing retirement, but the offer is also open to all GPs at risk of/considering leaving the profession. This is financially supported by NHSE as a national scheme Signposting/care navigation implemented in 2 of 3 CCGs (Wyre Forest likely to be covered in 17/18) to support the May/June 18 Lynda Dando – Director of Primary Complete signposting of patients to the right professional and releasing GP capacity appropriately Care

Update: The approach adopted in Redditch and Bromsgrove will be mirrored across Wyre Forest and South Worcestershire. Significant engagement has taken place in Q3 and Q4. The 17/18 national funds for care navigation are committed locally. Now in the process of rolling Health Care navigation training out in South Worcestershire (23rd May is the first course) and then again in Wyre Forest in June Identify wider CCG team understanding of NHSE trajectories and workforce data, as this expertise presently lies with May-18 Lynda Dando – Director of Primary Complete a single individual across the STP footprint and could possibly create business continuity issues. Interim workforce Care data support from NHSE commenced Action plans to be produced for the following areas Production of action plans Lynda Dando – Director of Primary Ongoing O Primary care at scale – Ongoing through the Neighbourhood Teams complete, but follow up actions Care O Workforce supply – Waiting for NHSE Guidance in place O Workforce Retention – As directed by NHSE O Improvement of data quality – Supported by NHSE - Ongoing O Mechanisms for tracking and monitoring progress – Driven by NHSE and monthly reporting Assurances Gaps in Controls/Assurances & Assurances Commentary 1. Countywide workforce group meets every 6-8 weeks as the delivery vehicle for the programme and connects with Herefordshire via 1. Potential that the CCGs cannot proactively address the workforce gap due to the timeliness and completeness of GP workforce datasets that are received, which also has reliance upon NHSE to provide HR the STP footprint to support delivery of the programme. This has multiagency representation including LMC, practice staff, GPs, expertise to interpret the workforce data HEE/CEPN (Health Education England/Community Education Provider Networks)

2. NHSE Transformational workforce group which is attended by primary care team and provides strategic oversight, sharing practice and promotes identification of opportunities as part of the regional/national GP Forward View programme

Agenda item: 12ii

Risk Register Report

Report author Tony Ciriello, Corporate Governance Manager Presented by Hana Taylor, Head of Governance and Corporate Affairs Target CCG RBCCG ☐ SWCCG ☐ WFCCG ☐ All CCGs ☒ The Primary Care Commissioning Committees in Common are requested to: • Review those operational risks which fall within the remit of the committees, including associated controls and mitigating actions Recommendations • Identify any new risks related to the remit of the committees • Report back to the Audit Committees as appropriate. • Note the actions being taken to strengthen the process for identification and management of operational risks

Purpose Assurance ☐ Decision ☐ Approval ☒ Discussion ☒ Information/noting ☐

Executive Summary

Review of operational risks contained within the Worcestershire risk register which fall within the remit of the Primary Care Commissioning Committees in Common, noting the actions being taken to strengthen the process for identification and management of operational risks

Strengthening Process for Identification and Management of Operational Risks

At the Audit Committees in Common meeting in October, it was acknowledged that the Worcestershire CCGs Risk register predominantly comprises of quality risks pertaining to secondary care.

It is believed that this is due to the nature of the quality agenda and the various, well documented challenges that exist within secondary care, but it was questioned whether risks relating to areas such as primary care, transformation and contracting for instance have been adequately captured.

Furthermore, risk management has also been firmly embedded within the quality team’s operations, whereby there is a clear, multi-layered approach as detailed below.

• Potential, new areas of risk are picked up through various reporting mechanisms (Service concerns, quality assurance visits etc)

• Triangulation occurs and subsequent discussion takes place at Quality Subgroup, validating areas of operational risk

• Quality Subgroup routinely reviews the amber rated quality risks which are not reported to the lead committee. Members of quality team then routinely link in with Corporate Governance Manager, which informs the production of reports

In terms of primary care specifically, the following key actions have been identified:

• Corporate Governance Manager to attend PC Quality and Risk Management Subcommittee to observe discussions and whether this could be a forum through which primary care risks could be actively reviewed, thereby introducing more formal structure within the risk identification and management process

• Development of a process map to denote how risks are identified, managed and escalated within primary care; acknowledging the split between a primary care quality issue (PCCC) or system wide quality issue that should be monitored through the Quality, Performance and Resources Joint Committee (QPR)

• Explore possibility of tabling bi-annual report on practice specific quality and risk issues for review by Audit Committees in Common.

In doing so, this will provide assurance to the Audit Committees that risk management processes are firmly embedded at each organisational layer, the key issues are being discussed and assessed with the appropriate rigour; and that this is reflected through the reporting channels that exist.

Operational Risks Summary

There are currently 3 operational risks which fall within the remit of the Primary Care Commissioning Committees in Common. Members are advised to note that risk PC1 relating to Woodrow has been reframed to reflect the focus upon dispersal of the patient list and a decrease in risk score applied, in light of the robustness of processes and controls that have been implemented. Consequently, this is no longer a red rated risk.

PC1: Following the removal of Woodrow Medical Centre’s provider licence due to significant quality concerns, there is presently unclear assurance regarding the viability to successfully and efficiently disperse the patient list, which could adversely impact upon the continuity of care; particularly for the most vulnerable patients

Risk Score reduction from 16 to 12

Full detail of this risk has been enclosed within appendix 1 for the committees’ information.

Summary and Next Steps The risks will continue to be reviewed and horizon scanning undertaken, with reports presented to each PCCC meeting.

Appendices Appendix 1 – Risk Register Extract

Recommendations: • Review those operational risks which fall within the remit of the committees, including associated controls and mitigating actions

• Identify any new risks related to the remit of the committees

• Report back to the Audit Committees as appropriate

• Note the actions being taken to strengthen the process for identification and management of operational risks

Appendix 1: Risk Register Extract

Risk Date Risk Lead Lead Risk Description Initial and Current Key Risk Factors and Controls (Latest Committees and Groups Further Remedial Actions Planned Planned Completion Reference Risk and Committee Target Actions Delivered) Responsible for Management Date and Lead for and Opened Executive Scores Mitigating Action Subject Lead Matter PC1 - May 2018 Lynda Dando, Primary Care Following the removal of Woodrow Initial: 16 12 (3x4) • Adequacy of governance framework and • NHSE responsible for individual clinical 1.NHSE undertaking an investigation, Dr Francis Woodrow Director of Commissioning Medical Centre’s provider licence oversight mechanisms employed by partner performance concerns via PPIGG liaising with General Medical Council (GMC) Campbell/Jacqueline

Medical Primary Care Committees due to significant quality concerns, organisations structure (Practice Performance and Nursing and Midwifery Council (NMC) Barnes – NHSE Centre Quality there is presently unclear assurance Target: 8 Information Gathering Group) • Setting up of processes for identifying and Concerns regarding the viability to managing any potential patient harm successfully and efficiently disperse • Primary Care Quality & Risk Ongoing the patient list, which could - Removal of the current provider’s license to Subcommittee responsible for GMS

adversely impact upon the practice at Woodrow Medical Centre, Redditch Contract performance and monitoring 2. Ongoing review of issues identified by continuity of care; particularly for thus rendering the provider unable to deliver current implementation plan in respect of CQC and assessment of patients through Dr Richard Davies – Chair the most vulnerable patients patient services under the General Medical issues identified by CQC attendance at practice. of RBCCG/ Services contract. Lynda Dando – Director • Project team, with clinical lead - In order to minimise disruption for the existing of Primary Care established, with responsibility for day to patient list, the current Medical Centre building day management via weekly meetings remains open from where a contracted ‘caretaker’ Partially completed for service is providing core General Practice services. high risk clinical areas and This is a temporary arrangement whilst more • Clinical lead for caretaker provider, who anticipated to be ongoing medium term arrangements are established is a member of the project team which for the next 6-12 months meets weekly - Weekly logs being compiled by the CCGs for any concerns/patient harm • Weekly oversight of this patient re- identified/complaints/incidents. This is also being registration will ensure that all patients reported to the Care Quality Commission (CQC) are accounted for and NHSE - The Care Quality Commission chaired a reflective round table on 21st August, with NHSE and CCG attendance, regarding the circumstances that led up to the service failure for Woodrow Medical Centre, which will form part of a formal review

- The caretaker contract will end on 31 December 2018, the CCG Primary care team is therefore supporting a ‘managed dispersal’ of patients to three other practices in the area. Weekly oversight of this patient re-registration will ensure that all patients are accounted for.

Agenda item 14

Primary Care Commissioning Committee – ‘meetings in common’ Forward Planner Wednesday, 31 October 2018

Agenda item Lead Applicable 12 Dec 30 Jan 13 Mar May 2019 Sept July 2019 Oct 2019 to xx CCG 2018 2019 2019 2019 All meetings/regular items Minutes & Action Log LD/SK ALL X X X X X X X Open Forum/public TH ALL X X X X X X X Sub Committees PC Quality & Risk Sub Committee DG/JH ALL X X X X X X X Estates Strategy & Technology ETTP JH Various X Ad hoc Strategy GPFV Local Delivery Plan incl LD/HS SW X X X X X X X workforce PCE/PMS Contractual Offer CS/DG/JH ALL X X X X X Dashboard LD ALL X STP – update LD ALL X X X X X X X GP Access LD/DG ALL X X X X • improved access SW/R&B/WF Contractual changes GMS/PMS contract variations plus DG/JH/CS ALL X X X X X X X DES Enhanced Services CS ALL X X X

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG

Agenda item Lead Applicable 12 Dec 30 Jan 13 Mar May 2019 Sept July 2019 Oct 2019 to xx CCG 2018 2019 2019 2019 Quality & Assurance PCCC Committee Effectiveness HT/TC ALL Board Assurance Framework HT/TC ALL X X X X X X X Resources Financial Update NM/MD ALL X X X X X X X Governance and Risk Terms of reference HT ALL X X Ad hoc / specific purpose Boundary changes – process JH ALL Medicines Optimisation JF ALL

On behalf of: NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG