PRIMARY CARE COMMISSIONING COMMITTEE
HELD IN PUBLIC SESSION ON FRIDAY 19 JANUARY 2018 1:00pm – 3:00pm THE BOARD ROOM, 3RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE, VENTURE WAY, BRIERLEY HILL, DY5 1RU
QUORACY A meeting of the Committee will be quorate provided that at least 4 members are present of which: one must be either the Chair or Vice-Chair of the Committee one must be the Chief Finance Officer/Deputy Chief Finance Officer or Chief Nursing Officer
PUBLIC AGENDA
Time Item Attachment Presented by 1.00 pm 1 Apologies Mr S Wellings Declarations of Interest 2.1 To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest will not be allowed to take part in the consideration or discussion or vote on any questions relating to that item.
1.00 pm 2 2.2 This meeting is being held in public and is being recorded purely to Mr S Wellings assist in the accurate production of minutes, decisions and actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded. 1.00 pm 3 Questions from the Public Mr S Wellings 1.05 pm 4 Minutes of last meeting held on Friday 17 November 2015 Enclosed Mr S Wellings 1.10 pm 5 Matters Arising/Action Log Enclosed Mr S Wellings
1.20 pm 6 Report from the Primary Care Operational Group Enclosed Mrs J Robinson
1:50 pm 7 Risk Register Enclosed Mrs C Brunt 2 :05 pm 8 Report from the Quality and Safety Team Enclosed Mrs C Brunt 2:15pm 9 Finance Report Enclosed Mr P Cowley
2:30pm 10 Long Term Conditions Prevalence Local Improvement Scheme Enclosed Mrs J Taylor Date and Time of Next Meeting Friday 16 February 2018
16:30 to 18:30 Venue to be confirmed
1 | P a g e Title First Name Surname Job Title Declarations of Interest
Mrs Caroline Brunt Chief Nurse None Senior Finance Manager – Mr Philip Cowley Partner works for Central Midlands CSU Primary Care Chief Officer of Dudley Mrs Jayne Emery None Healthwatch
Chief Executive, Accord Group Visiting Professor at Birmingham City University Board Member of: - Black Country LEP Board Lay Member for Quality & Dr Christopher Handy - Matrix Safety - Redditch Co-operative Homes - Black Country Consortium - Birmingham Chamber of Commerce - Walsall Housing Regeneration Agency - Direct Health
Director of Dudley Infracare Lift LTD Director of Whitbrook Management Company Member of Chartered Institute of Public Chief Operating & Finance Mr Matthew Hartland Finance and Accountancy Officer Interim Strategic Chief Finance Officer, Walsall CCG Interim Strategic Chief Finance Officer, Wolverhampton CCG Sessional GP - Netherton Health Centre. Clinical Executive for Primary Dr Tim Horsburgh Member of the Local Medical Committee Care & LMC Representative Clinical Lead for Partners in Paediatrics Lay Member - Sandwell and West Birmingham CCG Lay Member – Patient & Mrs Julie Jasper Managing Director of Westland’s Public Involvement Associates Ltd Member of CIPFA Primary Care Contracts Ms Teresa Jeavons None Support Officer Director of Membership Mr Daniel King None Development & Primary Care GP Representative at Primary GP at Crestfield Surgery Dr Vippin Mittal Care Commissioning Membership MDU Committee Membership GMC
Senior Contract Manager - Mrs Anna Nicholls None NHS England Primary Care Commissioning Committee Member at Dudley CCG Consultant in Public Health Medicine, Public Health Representative Dudley MBC Dr David Pitches - Primary Care Wife is a Consultant Obstetrician at Heart Commissioning Committee of England Foundation Trust Occasional Church organist fees received for giving recitals or playing for services Primary Care Contracts Mrs Julie Robinson None Manager Non-Executive Director _ Black Country Patient Opportunity Panel Mr David Stenson Partnership NHS Foundation Trust Representative Volunteer, Healthwatch Dudley Dudley Local Pharmaceutical Dudley LPC Member Mr Thomas Thomik Committee Representative Royal Pharmaceutical Society Member Wife employed by Dudley MBC Housing Department Mr Steve Wellings Lay Member - Governance One Niece employed by DGFT as a nurse Member of CIPFA
PRIMARY CARE COMMISSIONING COMMITTEE
MINUTES OF THE MEETING HELD IN PUBLIC ON FRIDAY 15 DECEMBER 2017 THE BOARD ROOM, 3RD FLOOR, BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE, VENTURE WAY, BRIERLEY HILL, DY5 1RU
Quorum: A meeting of the Committee will be quorate provided that at least four members are present of which one must be either the Chair or Vice Chair of the Committee and one must be the Chief Finance Officer/Deputy Chief Finance or Chief Nursing Officer.
ATTENDEES:
Members Mr S Wellings Non-Executive Director for Governance, Dudley CCG (Chair) Mrs C Brunt Chief Nurse, Dudley CCG Mrs J Jasper Non-Executive Member for Patient and Public Involvement, Dudley CCG Ms S Johnson Deputy Chief Finance Officer, Dudley CCG
In Attendance Mr P Cowley Senior Finance Manager, Dudley CCG Dr T Horsburgh Clinical Executive for Primary Care, Dudley CCG/LMC Representative Mrs J Robinson Primary Care Contracts Manager, Dudley CCG Mrs J Taylor Primary Care Commissioning Manager, Dudley CCG Mr T Thomik Dudley LPC Representative Mr D Stenson Patient Opportunity Panel Representative Mrs J Emery Chief Executive, Healthwatch Dudley Mr J Young Quality & Patient Safety Manager - Dudley CCG Mr G Giffiths-Dale Programme Manager – Dudley CCG
Minute Taker: Ms T Fear Commissioning Support Secretary, Dudley CCG
1. APOLOGIES FOR ABSENCE
Dr C Handy and Mrs A Nicholls
Mr Wellings informed members that Committee will not be quorate until two other members arrived and therefore no decisions could be made before that time.
2. DECLARATIONS OF INTEREST
To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item.
No changes or additional declarations made.
3. QUESTIONS FROM THE PUBLIC
Mr Wellings had received no questions from the public.
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4. MINUTES FROM THE PREVIOUS MEETING HELD ON 11 AUGUST 2017
The minutes of the Committee held on Friday 20 October 2017 were accepted as a true and accurate record with the exception of the minor grammatical errors and the following amendment to be made outside of the meeting.
Mr Wellings raised concerns with item 10.1, the wording for paragraph three to be amended to the following as agreed at the meeting on the 17 November - “There is still a concern that CQC inspectors are not taking account of the contractual framework information which the CCG is using instead of QOF measures. If this cannot be resolved locality it was suggested that we approach Dr Steve Field directly to discuss this, as it is very important that CQC inspectors understand and appreciate Dudley’s new framework.“ This change was further agreed at the December meeting.
Item 11 - Mr Cowley was asked to bring a report on the reserves to this committee, although this was not recorded in the minutes.
5. MATTERS ARISING/ACTION LOG
MATTERS ARISING
The action log was discussed and updated accordingly with the following points noted:
PCCC/SEPT/2017/7.0 Alternative Service Locations The deadline for this action was extended to February 2018
PCCC/SEPT/2017/9.0 Finance Report This item was included in the agenda and can be closed from the action log.
PCCC/OCT/2017/6.0 Extended Access Assurance Visit Action Closed
PCCC/OCT/2017/9.0 DPMA Training Budget Business Plan Assurance given that the DPMA as of next year will only be using one website. Action Closed
PCCC/NOV/2017/6.2 Review of Premises A proposal will go to the Estates Operational meeting in January 2018 and a verbal update to be given at the next meeting ACTION: MR COWLEY
PCCC/NOV/2017/8.0 Chaperoning Policy Jane Atkinson is composing a policy, once this has been completed and LMC advice given the Policy will be brought to the March Committee. ACTION: DR HORSBUGH
PCCC/NOV/2017/9.0 Dudley Quality Outcomes for Health Framework Phase Three Pilot Draft Evaluation Report The evaluation team are checking their methodology on the assumption of bands. In addition the team are looking for local guidance on what a GP per hour costs for the final report to back to this committee in January 2018.
PCCC/NOV/2017/10.0 Coseley Medical Centre Amend to be made to the action “improvement and responsiveness domain.” This action related to the outcomes of the GP survey specifically around access. CQC have acknowledged there have been significant improvements but the practice weren’t able to demonstrate how they were going to sustain this improvement. A practice visit is scheduled for April 2018 the team are
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reasonably happy with the situation at the moment however should anything else come to light then the practice visit will be brought forward. This will be picked up through PCOG. Action Closed
PCCC/NOV/2010/10.0 Holistic Assessment
This actions relates to the Holistic Assessment which is undertaken as part of the Dudley Quality Outcomes for Health Framework. Mrs Taylor has since meet with CQC with both the local inspector Paul Cope and his manager and the issue does not relate to Dudley’s framework but to practices not being able to clearly articulate their achievement against the indicators. The CCG continue to work closely with the CQC.
Action Closed
6. REPORT FROM THE PRIMARY CARE OPERATIONAL GROUP (PCOG)
Mrs Robinson spoke to this item to update the Committee following the Primary Care Operational Group (PCOG) meeting held on 6 December 2017.
The group received initial proposals for discussion from Stourside Medical Practice in respect of the closure of the two branch surgeries.
The consultation with patients and key stakeholders started on Monday 11 December and will run for six weeks through to 22 January 2018. It is anticipated that the report will be presented to Committee in February 2018. Mr Wellings asked for the Committee meeting to be held in Halesowen.
An issue was raised via the Clinical Executive Team with regards to the poor attendance at both the GP Education and GP Members events. PCOG made a recommendation to the Clinical Executive Team that in the first instance the report should be shared at Localities to generate peer pressure and a strong message was needed to go out. The Primary Care team have carried out a spot check on the evening of the GP Education Event; some surgeries that had closed had not attended the event.
Mrs J Jasper arrived
Mr Wellings suggested after this issue was raised at localities to keep a record of those practices who continue not attend and further action will be taken.
In light of this issue the Practice Engagement Scheme will be reviewed for next year.
Mrs Taylor to feedback to the Clinical Executive Team that Committee intends for those Practices who have not attended GP Education and Members events, to be raised at Locality meetings and monitored over the next six months. ACTION: MRS TAYLOR
Mrs Brunt arrived
Mr Wellings informed all that the Committee was now quorate.
Resolved: 1) The Committee noted the report for assurance 2) Mrs Taylor to address the poor attendance at GP Education and Members Events
7.0 RISK REGISTER
Mrs Robinson spoke to this item to provide the Committee with an updated Board Assurance Framework and Risk Register for those risks assigned to Primary Care Commissioning Committee. Each risk was
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discussed individually and Committee agreed that given the assurance provided in respect of the contractual and premises position of one practice the risk scores were still appropriate and should remain the same.
Mrs Brunt & Mrs Taylor provided assurance to Committee around general data protection regulations(GPDR). Mrs Taylor had liaised with Ms Sarah Hurst the Information Governance lead for the CCG and she had assured Mrs Taylor that as long as the practices are completing their IG toolkit and submitting it then the practice should be fully covered, however Mrs Taylor is awaiting confirmation from Paul Couldrey. Mr Couldrey provides the IG support for practices and it needed to be ascertained whether he has carried out relevant training. Mrs Taylor flagged an area raised by the Information Governance team in respect of the need for fair processing notices to be included on practices websites. Mrs Taylor informed the committee that a reminder for this needs to be sent out and audit to be carried out to ensure this is in place. Mr Wellings asked Mrs Taylor if a form of working could be given to practices relating to this; Mrs Taylor assured the chair that this was standard process for practices adding corporate messages to their websites.
Mrs Robinson raised that it was appropriate that GPDR was owned by an individual within the CCG, Mrs Brunt advised that this should sit with the Caldicott Guardian which is Dr Jonathan Darby. Mr Wellings advised both that the best solution to this would be to seek the advice of the SIRO, Matt Hartland as to who should take ownership. ACTION: MRS TAYLOR
Resolved: 1) Committee noted the report 2) Committee agreed the report
8. 0 GP IT SYSTEMS - BEST PRACTICE
Mr G Griffiths-Dale arrived
Committee received a report from the IT Strategy Group in respect of the GP Best Practice review.
Committee was assured by the report and agreed that further updates in respect of IT and associated systems should be presented to Committee through the Primary Care strategy Group.
Resolved: 1) Committee noted the report
9.0 Value Proposition Funding Review
Mr G Griffiths-Dale spoke to this item to consider the evaluation of the two Value Proposition schemes, Integrated Plus and the Care Co-Ordinators which have significant relevance to the merging model of the Multi-Disciplinary Teams (MDT’s)
Mrs J Emery declared her interested in Integrated Plus as an employee of Dudley Council for Voluntary Service, to which Integrated Plus is a part of.
Mr G Griffiths-Dale advised the Committee that a number of other Committees have considered these however it was asked by the Commissioning Development Committee that this Committee was consulted on whether it felt these schemes were beneficial at delivering the benefits as described by the report and to seek a view on whether they should be maintain going into 18/19.
Mr G Griffiths-Dale noted that there is not funding for this schemes going forward so a decision to continue would represent a cost pressure on the CCG.
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Mr G Griffiths-Dale noted that the report for Integrated Plus was very positive in terms of cultural impact, the way it works, the changes it’s making to patient flow, its potential for future care planning and also suggesting a significant productivity benefit in Primary Care as the Integrated Plus workers are supporting the work of GP’s and their staff enabling them to signpost into packages. However what has been less evident in the evaluation is the cash benefit in terms of how the cost of the scheme is recovered.
Mr G Griffiths-Dale then spoke about the scheme for consideration, the Care Co-Ordinators which was designed to be the bridge between Dudley Group and Primary Care in terms of supporting discharges from hospital, and further supporting the risk stratification of those patients who were identified as being at a high risk of repeat admissions into the hospital and therefore supporting Primary Care to develop alternative care planning. It was noted that this is a new scheme therefore there isn’t a lot of evidence in terms of its pay back however by the nature of this scheme it should be easier track savings of that by looking at the impact of re-admissions for a particular group of patients. It has therefore been proposed by the Finance Committee that this is treated as spend to save where the CCG would see a reduction in Secondary care admissions.
Mr G Griffiths-Dale advised that a particular discussion point for this Committee would be in regards to Integrated Plus and whether there is any Primary Care Development funding going forward would contribute to the mainstream funding. Mr G Griffiths-Dale noted that Primary Care was not expected to fund the whole scheme and that the CCG were looking a number of different funding streams.
Mr Wellings took the Committee through each scheme individually. After long discussions by the Committee it was agreed to support Integrated Plus in principle. It was also requested that a joint approach with the local authority would appropriate way forward as there are multiple organisations that benefit from this service. Assurance were given by Mr G Griffiths-Dale that this could be a solution of 19/20 and that the Better Care Fund was been looked at for 18/19.
The committee then discussed the Care Co-Ordinators again after a lengthy discussion it was agreed that further work is needed to understand the value of the Care Co-Ordinators.
Resolved: 1) The Committee noted the report 2) The Committee agreed to support Integrated Plus in principle. 3) The Committee noted that further work is needed to understand the value of the Care Co- Ordinators Mrs Brunt and Mr G Griffiths-Dale left
Agenda item 10 was discussed later and is recorded under 11.0
10.0 UPDATE FROM THE PRIMARY CARE STRATEGY GROUP – GPFV WORK 8.1 FINANCE REPORT Mrs J Taylor spoke to this item to provide an update to Committee following the Primary Care Strategy Group (PCSG) meeting held on 12 October 2017.
Mrs J Taylor advised Committee that a project plan is in place and there are no significant risks on delivery of the work programmes.
The Primary Care Development Group continues to work with the Black Country Partners across the STP looking at ways in which the CCG can work collaboratively as detailed in the report.
Mrs J Taylor noted that there were a number of elements taking place in terms of workforce training and needs assessment for nurses that will inform the Nurse Education programme moving forward.
The GP international recruitment was unsuccessful as this was not done as an STP but as a partnership with Birmingham. However Sandwell is currently running a refugee scheme to attract clinicians into working within Primary Care who may have had relevant skills within their own country. Mr Wellings then
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clarified the meaning of the refugee scheme and stated it was not a scheme that placed refugees into work within Primary Care it was looking at who may have the relevant skills in their own country to work within Primary Care.
Resolved: 1) The Committee noted the report 2) The Committee agreed the report
Mr J Young arrived
11.0 REPORT FROM THE QUALITY AND SAFETY TEAM
Mr J Young spoke to this item to provide on-going assurance to Committee regarding primary care quality and safety in accordance with the CCG’s statutory duties.
Three CQC visits have taken place since the last meeting including a re-visit to Bath Street Medical Centre to which Mr Young was invited by the practice to receive feedback.
The CCG are working with the local authority and have agreed to fund Care Home staff having Flu Vaccinations.
Five practices and the Urgent Care Centre are now actively using Datix.
Resolved: 1) The Committee noted the report for assurance
12. 0 FINANCE REPORT
Mr Cowley spoke to this item to provide an overview of financial performance against budgets delegated to the Committee for the period end November 2017.
Mr Cowley reported an additional allocation of £159,000 to support an STP bid for additional urgent primary care and NHS111 capacity over the winter period. It was noted that this funding has been committed in full, and that a break-even position continued to be forecast to be achieved against co-commissioning and GP Forward View budgets, with a small underspend reported against core CCG budgets.
Mr Cowley then spoke about a proposed LIS for the Identification and Education of patients at Risk of Diabetes which was being drawn up by Mrs J Taylor.
Mr Wellings stated that this was the right thing to be looking at in principle.
Resolved: 1) Committee noted the report for assurance
13.0 PRIMARY CARE COMMISSIONING COMMITTEE WORK PLAN 17/18
Mrs Robinson spoke to this item to present to the committee the work plan for 17/18 for approval and assurance.
It was noted that this report should be prefaced by a few key lines which underpin what the Committee’s purpose is.
Resolved: 1) Committee noted the report for assurance 2) Committee agreed the report
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14.0 DATE AND TIME OF NEXT MEETING
Friday 19th January 2018 1pm – 3pm The Board Room, Third Floor, Brierley Hill Health & Social Care Centre
MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD
Name Title Signed Date
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PRIMARY CARE COMMISSIONING COMMITTEE
OUTSTANDING ACTION LIST – 19 January 2018
MEETING REFERENCE ACTION LEAD STATUS DEADLINE DATE
Performance Report – Children’s Attendance PCCC/JAN/2017/1(c) Report to be presented to Committee regarding findings of Mrs Brunt In progress February 2018 children’s attendance.
Quality & Safety Immunisations Report PCCC/MAR/2017/7.1(b) The Committee requested a detailed report from Public Mrs Brunt In progress February 2018 Health for further details on the immunisation landscape.
Supporting Professional Decisions PCCC/APR/2017/13.0 The Committee requested further detail around the Dr Horsburgh In progress February 2018 membership of the panel and how that would work.
Dementia Local Improvement Scheme PCCC/JUNE/2017/9.0 Evaluation of the Dementia LIS to be reported back to Mr Hindle In progress December 2017 Committee in 6 months time.
Alternative Service Locations PCC/SEPT/2017/7.0 Report on practice Alternative Service Locations to be Mr Cowley In progress February 2018 presented to Committee.
Premises Review PCCC/NOV/2017/6.2 To establish who will be undertaking the review of Mr Cowley In progress January 2018 premises.
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MEETING REFERENCE ACTION LEAD STATUS DEADLINE DATE
Chaperoning Policy PCCC/NOV/2017/8.0 Policy to be considered at LMC where GPs within the Dr Horsburgh In progress March 2018 group should discuss how to take this matter forward. Dudley Quality Outcomes for Health Framework Phase Three Pilot Draft Evaluation Report PCCC/NOV/2017/9.0 Clarification required in respect of the methodology used in Mrs Taylor In progress January 2018 the evaluation especially in relation to the assumption of bands on page 43
Dudley GP Education and Membership event attendance Mrs Taylor In progress January 2018 a) Feedback required to Clinical Executive Team that
PCCC/DEC/2017/6.0 Committee endorse that this matter must be raised at
locality meetings Mrs Taylor In Progress April 2018 b) Attendances to be monitored over the next 6 months
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PRIMARY CARE COMMISSIONING COMMITTEE
Date of Committee: 19 January 2018 Report: Update from the Primary Care Operational Group Agenda Item: 6.0
TITLE OF REPORT: Update from the Primary Care Operational Group To update the Committee following the Primary Care Operational PURPOSE OF REPORT: Group meeting held on 10 January 2018 AUTHOR OF REPORT: Mrs J Robinson, Primary Care Contracts Manager MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care The Primary Care Operational Group:
Provides assurance that there are no contractual breaches to be issued for any Dudley practice KEY POINTS: Considered and recommends the contractual changes set out below in the recommendations Received the quality and safety issues that are set out in the quality and safety report
Committee is asked to:
Note the actions of the primary care operational group for assurance RECOMMENDATION: Approve the contractual changes recommended by the group as follows: 24 Hour retirement of 2 partners at Norton Medical Practice
FINANCIAL IMPLICATIONS: Not applicable WHAT ENGAGEMENT HAS Not applicable TAKEN PLACE: Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINICAL COMMISSIONING GROUP – PRIMARY CARE COMMISSIONING COMMITTEE UPDATE FROM THE PRIMARY CARE OPERATIONAL GROUP
1.0 INTRODUCTION
1.1 This report provides an update from the Primary Care Operational Group (PCOG) following its meeting held on 6 December 2017.
2.0 GMS CONTRACTING
Contractual changes
2.1 The group considered and supported the following contractual changes for approval by Committee:
Norton Medical Practice 24 hour retirement of two Effective dates: 28th and 30th partners March 2018
The group was assured that the practice has plans in place to continue to deliver the full range of services during the period of reduced working.
Merger proposals – Norton Medical Practice and Lion Health
2.2 The group had expected the merger application and business plan to be presented however the application had not been received. In addition to this both partners of Norton Medical Practice are unable to attend Januarys Primary Care Commissioning Committee therefore it is likely that Committee will be asked to consider the application at the next meeting due to be held on 16 February 2018.
3.0 PRIMARY CARE QUALITY & SAFETY
3.1 The group considered the quality and safety issues and report from the GP Engagement lead that is set out in detail in the Quality and Safety report to Committee.
3.2 There are no issues in the quality and safety report that require contractual actions to be taken against any practice.
4.0 RECOMMENDATION The Committee is asked to: Approve the contractual changes recommended by the group as follows: . 24 Hour retirement of 2 partners at Norton Medical Practice
Note the actions of the primary Care Operational Group for assurance
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PRIMARY CARE COMMISSIONING COMMITTEE
Date of Committee: 19 January 2018 Report: Board Assurance Framework & Risk Register Agenda Item: 7.0
Board Assurance Framework (BAF) & Risk Register (RR) for Primary TITLE OF REPORT: Care Commissioning Committee
PURPOSE OF REPORT: To provide the Committee with an updated BAF & RR
AUTHOR OF REPORT: Mrs J Robinson, Primary Care Contracts Manager
MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse
CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care KEY POINTS: Enclosed is the BAF & RR as at 12 January 2017
Committee is asked to: RECOMMENDATION: o Review the current status of risks.
FINANCIAL IMPLICATIONS: n/a WHAT ENGAGEMENT HAS n/a TAKEN PLACE: Decision ACTION REQUIRED: Approval Assurance
1 | P a g e Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2017/18 12-Jan-17 MASTER Document with full Risk Review Information
ID Original Date Last Review Last Update Risk Description Accountable Accountability Management Lead Initial Risk Key Controls Gaps in Control Internal Assurances External Assurances Gaps in Assurance Residual Risk Trend Actions Timescales COMMENTS (Committee (Risk Committee Sponsor & Owner Score (PxI) What controls/systems are in Where are we failing to put Board Reports, Minutes of Internal and External Audit Where are we failing to gain Risk Score To improve control, ensure delivery of Date action will be Date) Amended) Score place to assist in securing delivery controls/ systems in place / Where meetings Reports, CQC Reports evidence that our controls/ (PxI) principal objectives, gain assurance completed P I before any of our are we failing in making them systems, on which we place (R) P (R) I Score
controls objective. Such as strategies, effective. For example lack of reliance, are effective. Such as no following LINK TO TO LINK
are in policies and procedures training or no regular review of assurance a strategy or policy is controls put
KEY ABOVE) KEY CORPORATE
OBJECTIVE (SEE (SEE OBJECTIVE place. performance effective in place Work regular with CQC & NHS England (Via PPIGG) to ensure that 1) Contribute to the review of the PPIGG 1) Fed back initial comments to Receiving timely information from Report to PCCC regarding formal There is a risk that the provision of any concerns are addressed early. Gaps in reporting to Committee structure and function PPIGG. NHSE, There is no robust performance issues Appraisal process for individual GPs 1) August 2017 Primary Care Medical Services are needs to be clarified as some of the 21/07/2017 15/12/2017 20/10/2017 4B PCC Steve Wellings Caroline Brunt 3 4 12 mechanism in place for the CCG to carried out by NHS England (Moved 3 4 12 135 adversely affected partially or fully Primary Care Team visits with soft intelligence is not suitable for a = 2) Discuss with NHSE regarding better 2) Pilot process agreed with be informed of issues early on eg. Feedback from individual practices is from Key controls) 2) November 2017 due to individual performer issues practice to obtain soft intelligence public meeting. ways of receiving timely complaints NHSE for timely complaints Complaints, GMC investigations etc. reported through PCOG information information to be provided
Annual Workforce Audit for clinical and non-clinical staff carried out
Recruitment Fayres/ Joint working and raising profiles in Primary Care
Training needs and skills set assessment 1) Develop and implement the new Report to PCCC regarding training Gaps in reporting to Committee Primary Care Team visits with model of care - Dudley Multispecialty needs and workforce analysis needs to be clarified as some of the practice to obtain soft intelligence Community Provider (MCP). As part of soft intelligence is not suitable for a There is a risk that the provision of Workforce plan to be developed the new model, developing and investing Feedback from individual practices is public meeting. 1) April 2019 Primary Care Medical Services are Engagement with NHS England, in the clinical and non clinical workforce 21/07/2017 15/12/2017 29/09/2017 4B PCC Steve Wellings Caroline Brunt 4 4 16 reported through PCOG 2 3 6 136 adversely affected partially or fully Health Education England and Local No current model of care available to = 2) 2017/18 TBC due to insufficient workforce Workforce Advisory Board committed address the workforce gaps 2) Develop a joint action plan with Report to PCC regarding EPIC CCG do not currently receive to training and professional external partners (eg. HEE) to establish Programme progress notification from NHSE in respect of development. future workforce needs moving into an outstanding appraisals MCP provider. Joint working with local Community Provider Education Network (CPEN) to maximise opportunities for Primary Care Workforce development
Enabling practices to improve and change (EPIC Programme) There is no requirement upon CCG Estates Strategy in place 1) Develop and implement the new practices to report issues with Alternative suitable space is not model of care - Dudley Multispecialty premises to the CCG. There is a risk that the provision of Rent Reviews in place readily available in the event of an Feedback on individual practice Community Provider (MCP). As part of Primary Care Medical Services are unplanned loss. issues is provided to PCOG. the new model, developing infrastructure 1) April 2019 GMS Contract responsibilities in 21/07/2017 15/12/2017 29/09/2017 4B adversely affected partially or fully PCC Steve Wellings Caroline Brunt 2 4 8 Review of Leases None 2 3 6 and estate to deliver the model 137 respect of premises are not robust. = due to unplanned loss of Estates or The CCG has no power to compel Issues are discussed at the monthly 2) November 2017 infrastructure Regular contact with practices to the relocation of practices from Estates Operational Group 2) Develop and maintain a log of the No assurance regarding Business highlight premises issues unsuitable premises. alternative service locations included in Continuity Plans include alternative Business Continuity Plans locations GPFV related increases in Primary Care Strategy Group investment in Primary Care Develop and implement the new model There is a risk that the provision of of care - Dudley Multispecialty Primary Care Medical Services are As independent businesses, the CCG 21/07/2017 15/12/2017 29/09/2017 4B PCC Steve Wellings Caroline Brunt 2 4 8 General Practice Resilience GPFV Transformation Board 2 4 8 Community Provider (MCP). As part of Apr-19 138 adversely affected partially or fully have no oversight of financial issues = Programme Report To PCCC re investment in the new model, developing and investing due to Financial issue DQOFH in the back-office efficiency of practices Reinvestment of PMS Premium There is a risk that there is PCCC will monitor the capacity of the Review capacity and inform PCCC and insufficient workforce within the PC team following restructure due to agree a way forward. primary care team to deliver the MCP development. No additional resources have been Monitoring has not been reported 21/07/2017 15/12/2017 29/09/2017 4B delegated Primary Care PCC Steve Wellings Caroline Brunt 5 3 15 identified to support the PC team on None None 3 3 9 139 back to PCCC = Establish a robust process for Commissioning functions and Work allocation, work plans and delivery of the GP Forward View monitoring capacity issues on an on- projects such as the GP Forward capacity is discussed at 1:1 and going basis View Plan primary care team meetings
DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE
Date of Meeting: 19th January 2018 Report: Quality & Safety Report Agenda Item No: 8.0
TITLE OF REPORT: Quality and Safety Report
To provide on-going assurance to the Primary Care Commissioning PURPOSE OF REPORT: Committee (PCCC) regarding quality and safety in accordance with the CCG’s statutory duties
AUTHOR(s) OF REPORT: Mr J Young, Quality and Patient Safety Manager
MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse
CLINICAL LEAD: Dr Ruth Edwards, Clinical Lead, Quality & Safety
KEY POINTS: There have been three CQC reports published since the last meeting The Primary Care Commissioning Committee is asked to: RECOMMENDATION: Note this report for assurance
FINANCIAL IMPLICATIONS: None to report WHAT ENGAGEMENT HAS N/A TAKEN PLACE:
ACTION REQUIRED: Assurance
Page 1 of 1 Primary Care Analysis Report PCCC, 19/01/18
Produced : 11/01/18
Robert Franklin – BI Developer & Analyst Jim Young – Head of Quality Assurance Primary Care Analysis Report – Summary
Care Quality Commission (CQC) Infection Prevention & Control (IPC) • Stourside Medical Practice have been rated as requires improvement overall • There has been one audit carried out since the last meeting and for the caring and responsive domains following a previous inadequate rating • The Waterfront Surgery have been rated as requires improvement overall and Serious Incidents (SIs) for the caring, responsive and well-led domains following a previous requires improvement rating • Currently, there is one SI open. The initial RCA has been reviewed and • Bean Medical Practice have been rated as good overall and for all domains feedback provided to the practice except well-led which requires improvement. This inspection was as a result of a new registration. Service Developments • Datix - six practices are currently using Datix for incident reporting • PCAT - immunisation data has now been included in the PCAT analysis
Performance indicators – action taken • A number of practice visits have been completed or are scheduled following review of the Primary Care Assurance Tool (PCAT) dataset at recent PCOG meetings • The January PCOG analysis has identified one further practice as potentially requiring follow-up; there was no focussed analysis carried out this month.
All other practices not listed above are rated as good or outstanding for all domains and therefore not due for re-inspection unless chosen as part of the 10% re-inspection schedule
DUDLEY CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE
Date of Report: 19 January 2018 Report: Finance Report Agenda item No: 9
TITLE OF REPORT: Primary Care Commissioning Finance Report
The report provides an overview of financial performance against PURPOSE OF REPORT: budgets delegated to Committee.
AUTHOR OF REPORT: Mr P Cowley, Senior Finance Manager
MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care The report highlights two changes to the budgets reported to this Committee, increasing the budget to £44.218m A break-even position is forecast against co-commissioning and GP Forward View Allocations, and a small underspend is forecast against core CCG budgets. The report highlights the current position in respect of the non- KEY POINTS: recurrent reserves, with £526,000 available to be committed immediately following the release of the contingency reserve. A separate proposal has been received to utilise a significant portion of the reserves on a scheme to incentivise the cleansing of practice disease registers. The report details the utilisation of the GP Forward View ring- fenced allocation for GP Transformation
Committee is requested to note the reported financial position for RECOMMENDATION: assurance.
FINANCIAL IMPLICATIONS: As above
WHAT ENGAGEMENT HAS None TAKEN PLACE: Decision ACTION REQUIRED: Approval Assurance √
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Finance Report (December 2017)
This report submitted to Dudley CCG Primary Care Commissioning Committee provides a provisional breakdown of financial performance for Co-commissioned Primary Care and other budgets within the remit of the committee during the month of December.
Contents
Financial Overview p2
Financial Detail p3 Financial Overview
Budget Allocations Budgets reported to the committee have an annual value at December 2017 of £44,218,000, including both the delegated co- commissioning allocation and core CCG budgets.
There has been one allocation change in December, with the GP Resilience Programme allocation of £32,000 being withdrawn and the funding for this scheme now due to be received as income.
There has also been one reporting change, with the budget of £1.50 per head in respect of GP transformation support being reported against GP Forward View budgets (the budget had previously been shown elsewhere as a consequence of NHS England financial reporting requirements).
Allocation Breakdown
GP Forward Primary Care Co- View Commissioning £2,453k £41,217k
CCG Core Commissioning £548k
2 Delegated Co-Commissioning
Summary Position Annual Forecast Budget Budget Variance The forecast expenditure level against delegated budgets Area (WTE) (£'000) (£'000) continues to reflect a break-even position, with small overspends GP Contract 27,333 (8) against Enhanced services and Other GP services being offset by a QOF and Enhanced Services 6,441 28 reported underspend against uncommitted reserves. Premises Costs 4,731 (1) Dispensing/Prescribing Drs 273 (4) The Q4 list size changes for 2017/18 will take effect in January, Other GP Services 1,362 60 resulting in further changes to GP contract payments at this stage. Development and Training Funds 0.80 187 (13) Non-Core GPIT 143 - Non-recurrent Commitments 263 15 Reserves 747 (62) Total - 41,217 (0)
Reserves Position
As at December 2017, there remains a balance of reserves totalling £747,000, of which £62,000 is being utilised to offset overspends in other areas, and £159,000 is committed in support of additional winter pressures. This leaves a balance of leaving a balance of uncommitted reserves totalling £526,000, all of which is available to be committed immediately following the release of the primary care contingency reserve in January.
A separate proposal will be presented to Committee to und a practice disease register cleansing exercise and this proposal, should it be approved by Committee, is expected to utilise approximately a significant proportion of these reserves.
3 CCG Core Commissioning and GP Forward View
Core Commissioning Annual Forecast Budget Budget Variance • Small forecast underspends continue to be reported against both Area (WTE) (£'000) (£'000) the GP with Special Interest and Practice Engagement LIS budgets. GP with Special Interest 0.50 64 (8) Practice Engagement LIS 484 (6) Total 0.50 548 (14) GP Forward View A break-even position is currently reported against all GP forward View allocations. Updates in respect of the individual programmes Annual Forecast Budget Budget Variance show that: Area (WTE) (£'000) (£'000)
Reception and Clerical Staff Training 54 - • Reception and Clerical Staff Training – following the completion of GPFV Extended Access 1,923 - a procurement exercise, a contract for the provision of Document Non-Recurrent Transformation Support 476 - Management services has been awarded and the budget for this will be spent in full Total 1,977 - • All localities have signed up to provide increased extended hours coverage over the winter period, with the effect that the budget for GP Forward View Extended Access is now committed in full. • The Non-Recurrent Transformation Support Funding allocation of £476,000 is expected to be spent in full, as shown below Non-Recurrent Transformation Funding As Committee will be aware, the CCG has been mandated by NHS England as part of the GP Forward View (GPFV) to spend £3 per head across the 2-year period from 2017/18-2018/19, totalling £952,000, in support of the transformation of General Practice.
This funding has been split equally between the two financial years, with £476,000 made available in each financial year to support the CCG’s plans to implement the GPFV, prioritising:
• Supporting practices to engage with the development and procurement of the Multispecialty Community Provider • Providing support to practices to enable them to effectively deliver the new Long Term Conditions Framework • Supporting non-recurrent projects to facilitate the provision of Primary Care at Scale • Supporting the implementation of the 10 High Impact Actions
The use of the funding was to be determined by the Primary Care Strategy Group and reported to PCCC for assurance purposes, and this is detailed overleaf. 4 Non-recurrent Transformation Support
Expenditure against the fund Forecast A breakdown of the forecast utilisation of the transformation funds is shown YTD Spend Spend opposite, and currently shows a small over-commitment against the fund. Scheme (£'000) (£'000) However, should this overspend materialise, any expenditure in excess of this Extended Access 7 94 level will be transferred to the Primary Care Co-Commissioning budget, ensuring a Patient Online Promotional Work - 3 break-even position is achieved. Docman Share - 20 Telephone Consultation Training - 10 The utilisation plan for the fund is as follows: Integrated Plus 263 350 Total 270 477
• Forecast costs in respect of GP Forward View extended access exceed the allocation by £94,000, mainly due to the extension of cover over the winter period, including the Urgent Care Centre and NHS111 diversion service that has been put in place over the Christmas and New Year period. These costs have been funded from the transformational support allocation.
• Promotional work in support of increased uptake of Patient Online services, costing £3,000.
• The purchase of Docman Share Licences, to enable the practices providing remote consultations to access Docman information, at a cost of £20,000.
• Training for staff on providing telephone consultations, at a cost of £10,000.
• Funding of the Integrated Plus scheme, providing locality link workers in support of practice MDTs. This scheme, which was funded from Value Proposition allocations in previous years, provides a vital part of the CCG’s New Care Model, and the cost of this scheme is supported non-recurrently from this allocation in 2017/18 in advance of a decision on recurrent funding.
Recommendation: • Committee is asked to note the reported financial position for assurance.
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Tom robinson
PRIMARY CARE COMMISSIONING COMMITTEE
Date of Report: 16 January 2018 Report: Long-term Conditions Prevalance Local Incentive Scheme (LIS) Agenda item 10.0
TITLE OF REPORT: Long term Conditions Prevalance Local Incentive Scheme (LIS) To present to Committee a proposal for a Long-term Conditions PURPOSE OF REPORT: Prevalance Local Incentive Scheme (LIS) AUTHOR OF REPORT: Mrs J Taylor, Primary Care Commissioning Manager MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care • Outlines a proposal to undertake a focussed review of the LTC registers for: • ‘At risk’ of Diabetes • Diabetes • Atrial Fibrillation • Chronic Obstructive Airways Disease • Coronary Heart Disease • Practices will be provided with a clear mandate, baseline position KEY POINTS: and an individualised target for each of the LTC areas • Practices will need to review the searches provided by the CCG on EMIS and submit an action plan to the CCG by 15th March 2018 • Practices will need implement their proposed action plan to undertake a review (notes and face to face where appropriate) to appropriately address coding issues by 31st September 2018 • Practices will need to complete a template provided by the CCG as a measure of completing the specification
The Committee is asked to Approve RECOMMENDATION: • The Long-term Conditions Prevelance Local Incentive scheme (LIS)
• This scheme is to funded from the uncommitted primary care FINANCIAL IMPLICATIONS: reserves for 2017/18, which currently total £526,000 • Clinical Executive for Primary care WHAT ENGAGEMENT HAS • GP Engagement Lead TAKEN PLACE: • Clinical Executive for Finance and Performance Decision ACTION REQUIRED: Approval Assurance
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DUDLEY CLINCAL COMMISSIONING GROUP
PRIMARY CARE COMMISSIONING COMMITTEE – 16 JANUARY 2018 LONG-TERM CONDITIONS PREVELANCE LOCAL INCENTIVE SCHEME
1.0 PURPOSE OF REPORT
1.1 To present to Committee a proposal for a Long-term Conditions Prevelance Local Incentive Scheme (LIS)
2.0 BACKGROUND
2.1 Dudley CCG predicates itself on having robust systems in place to idenitify, appropriately treat and monitor people with a long-term condition (LTC). In the past there has been significant investment particularly around Hypertension (through the Quality Premium Scheme) to ensure robust disease registers are in place which has demonstrated a significant impact on the Cardiovasular disease of our local population;
2.2 Although the CCG has undertaken a focused disease finding approach in the past, in accordance with both our local data and National Right Care data packs there are still some significant gaps in our current prevalence compared to expected prevalence around certain long-term condition areas notidly registers for ‘at risk of diabetes’, diabetes, atrial fibrillation (AF), coronary heart disease (CHD) and chronic obstructive airways disease (COPD);
2.3 We recommend that the CCG makes an investment to address the current gaps identified by offering primary care the opportunity to undertake a focused disease finding approach under a local incentive scheme. Through previous work which has been undertaken with Hypertension this has proven to be be an extremely effective mechanism of significantly addressing the prevalence gaps.
3.0 PREVALANCE GAPS IDENTIFIED
In accordance with both our local data sets and National Right Care data packs the CCG have identified the following gaps in our disease registers:
‘At risk’ of Diabetes The CCG recognised some years ago the importance of recognition and intervention of people ‘at risk’ of developing diabetes as a preventative strategy, which led to us previously investing in an annual review of our ‘at risk’ population as part of the requirements of the Diabetes Local Improvement Scheme (LIS). The CCG participated as a phase 1 site for the National Diabetes Prevention Programme (NDPP) .and for the last 2 years practices has been actively assessing and referring people to a targeted intervention programme of support. It is during this work programme the CCG have created searches centrally on the EMIS system to identify potential cohorts of people who meet the criteria for being ‘at risk’ of developing diabetes. In accordance with our records we currently have 8495 people on our ‘at risk’ register however 4843 of these now fall out of the criteria range (due to successful intervention) and therefore need to be removed. In addition we have 22,822 people who meet the criteria for being ‘at risk’ (fasting glycaemia or HbA1c in line with NDPP criteria) but are not currently on register and therefore are not benefitting from any clinical review or targeted intervention. However for practical reasons due to the volume of reviews
we will focus on the people falling into the higher risk category (fasting glucose 6.1-6.9 or HbA1c 42-47mmol/mol) which equates to 7082 people.
Diabetes In Dudley we currently have 19,938 people (actual prevalence 6.3%) currently diagnosed with Diabetes and coded on the disease register. This figure is increasing at an alarming rate with an additional 2500 patients being added to the disease registers on an annual basis. In addition we have one of the highest rates of childhood obesity (a key factor which increases the risk of developing diabetes) in the U.K. The Right Care LTC data packs estimate that the prevalence in Dudley should be around 9.2% suggesting the current prevalence gap equates to around 9300 people. Through searches on the EMIS system the CCG have identified there are currently 1767 people who meet the criteria for having Diabetes (from their last blood test) who are not currently coded with a diagnosis code.
Atrial Fibrillation Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia, and estimates suggest its prevalence is increasing (due to age). If left untreated atrial fibrillation is a significant risk factor for stroke and other morbidities, accounting for some 14% of all strokes. In addition strokes attributable to AF are more likely to be fatal and to result in greater neurological impairment than strokes not associated with this arrhythmia. Within Dudley the local prevalence rate is 2.3%; currently we have 8904 people on primary care registers which was significantly increased in 2013/14 through a previous Quality Premium scheme. The estimated prevalence is 2.8% giving us a prevalence gap of potentially 1500 people. Our local searches in EMIS have identified potentially 1900 people who require a review.
COPD Nationally an estimated 3 million people have COPD in the UK. About 900,000 have been diagnosed with an estimated 2 million people have COPD which remains undiagnosed, which predominately gets diagnosed when people are in their fifties. In Dudley we currently have 7055 people (2.2%) on the COPD register however in accordance with the Right Care data packs our estimated prevalence is around 3.9% (12,402) which subsequently means we have only diagnosed 57% of our potential population. Although a data quality exercise has been previously undertaken around this clinical area, our local searches in EMIS have identified potentially 1700 people who require a review.
CHD Heart and circulatory disease causes more than a quarter (26 per cent) of all deaths in the UK; that’s nearly 160,000 deaths each year – an average of 435 people each day or one death every three minutes. There are around 7 million people living with heart and circulatory disease in the UK: 3.5 million men and 3.5 million women. Coronary heart disease (CHD) is the most common type of cardiovascular disease and is the most common cause of heart attack. In the UK there are 188,000 hospital visits each year due to heart attacks: that's one every three minutes. In Dudley we currently have 12,922 people (4.1% of the population) on the CHD register, where as in accordance with the Right Care data packs it is estimated that this should be closer to 5.5% (17,490 people). In accordance with our local EMIS searches we have 1666 people who we have identified with CHD without a diagnosis code on their records.
At risk CHD AF Diabetes COPD Diabetes
Estimated Register 17490 8904 29256 12402 22,822
Estimated Prevalence (%) 5.5% 2.8% 9.2% 3.9% 7.2%
Actual Register 12922 7388 19938 7055 8495
Actual Prevalence (%) 4.1% 2.3% 6.3% 2.2% 2.7%
% of expected prevalence on register 74% 83% 68% 57% 37%
Estimated Registers Gap 4568 1516 9318 5347 14327
Patients Identified through EMIS S&R 1666 1991 1767 1756 7082
4.0 LONG-TERM CONDITIONS PREVALANCE PROPOSAL
4.1 We propose that the CCG provide individual practices with a clear mandate, baseline position (current register size) and an individualised target for each of the LTC areas outlined previously;
4.2 Monitoring will be done by monthly data extraction (using EMIS S&R), analysis of the practice diease registers and progress will be reported to Committee once practices have completed the register validation process;
4.3 In signing up for this LIS scheme practices will be asked to undertake the following:
• Review the list of people for all four disease areas where the EMIS coding suggests they may have the condition • Submit a plan to the CCG by Friday 16th March 2018, detailing how the practice will review the lists, comfirm diagnosis including communication to individuals and add appropriate diagnosis code to the register by no later then 31st September 2018 • Undertake a review (as a combination of notes and face to face review where appropriate) prior to 31st September 2018 and submit to the CCG the outcomes on the template provide as evidence of completing the process. The review should include an aspect of educational intervention to advice and appropriately manage any risks identified, including onward referral to other services where appropriate.
5.0 FINANCE
5.1 On the submission of the action plan, practices will receive a payment of £1.50 per head of registered population (based upon October list sizes), totalling £477,887 at a CCG level. This
payment will be made to the practice prior to 31st March 2018 and is broken down to the individual areas as follows, in line with the level of work involved in achieving the action plan for that area:
Per-head Payment Total Area (£) Payable
At high risk of Diabetes 0.40 £127,436
Diabetes 0.40 £127,436
COPD 0.40 £127,436
CHD 0.15 £47,789
AF 0.15 £47,789
Total 1.50 £477,887
5.2 The payments made to practices in respect of the action plan will be subject to a clawback exercise, should the practice not deliver upon the requirements of the plan. This clawback will be made at a disease area level, with the full payment made in respect of that disease area being clawed back should the plan not be delivered in line with the agreed timetable or within the terms of any agreed rectification plan.
6.0 FUNDING SOURCE
6.1 This scheme is to funded from the uncommitted primary care reserves for 2017/18, which currently total £526,000.
7.0 RECOMMENDATION
7.1 The Committee is asked to approve the Long-term Conditions Prevalance LIS.