Agenda

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

Meeting Agenda (Open Session)

Primary Care Commissioning Committee Wednesday 21 April 2021 09.00 -11.00 Zoom Meeting

Time Item Presenter Reference 09:00 Introductory Items 1. Welcome, introductions and apologies Eleri de Gilbert PCC/21/001 2. Confirmation of quoracy Eleri de Gilbert PCC/21/002 3. Declarations of interest for any item on the agenda Eleri de Gilbert PCC/21/003 4. Management of any real or perceived conflicts of Eleri de Gilbert PCC/21/004 interest 5. Questions from the public Eleri de Gilbert PCC/21/005 6. Minutes from the meeting held on 17 March 2021 and Eleri de Gilbert PCC/21/006 Addendum re: Clinical Director PCN payments 7. Action log and matters arising from the meeting held on Eleri de Gilbert PCC/21/007 17 March 2021 8. Actions arising from the Governing Body meeting held Eleri de Gilbert PCC/21/008 on 07 April 2021 09:05 Commissioning, Procurement and Contract Management 9. NHS England Memorandum of Understanding 2021/22 Joe Lunn PCC/21/009 10. Contract Management update Lynette Daws PCC/21/010 11. The Third way – working together across Primary Care Michelle Tilling PCC/21/011 Networks to deliver the Enhanced Health in Care Homes Care Homes Designated Enhanced Service 12. Leen View Surgery - Permanent Boundary reduction Joe Lunn PCC/21/012 13. Giltbrook Surgery – Permanent Boundary reduction Lynette Daws PCC/21/013 09:45 Quality Improvement 14. Nottingham and Nottinghamshire Heat Map Joe Lunn PCC/21/014 Development Plan 15. Extended Access Services Joe Lunn PCC/21/015 10:00 Covid-19 Recovery and Planning 16. Overview of GP Practice Additional Expenses in Joe Lunn PCC/21/016 Relation to Covid-19 17. General Practice Covid-19 capacity expansion fund Joe Lunn PCC/21/017 18. Primary Care – Additional Development Funding Joe Lunn PCC/21/018

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9.00 via Zoom-21/04/21 1 of 168 Agenda

19. Covid-19 Practice Level Update: Operational Pressures Joe Lunn PCC/21/019 Escalation Levels (OPEL) reporting

10.20 Strategy, Planning and Service Transformation 20. Primary Care Networks (PCN) End of year update Helen Griffiths PCC/21/020 21. Primary Care Estates update Lynne Sharp PCC/21/021 10.45 Risk Management 22. Risk Report Siân Gascoigne PCC/21/022 10.55 Closing Items 23. Any other business Eleri de Gilbert PCC/21/023 24. Key messages to escalate to the Governing Body Eleri de Gilbert PCC/21/024 25. Date of next meeting: Eleri de Gilbert PCC/21/025 19/05/2021 Zoom Meeting Confidential Motion: The Primary Care Commissioning Committee will resolve that representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960)

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2 of 168 9.00 via Zoom-21/04/21 Declarations of Interest for any item on the agenda

Register of Declared Interests

• As required by section 14O of the NHS Act 2006 (as amended), the CCG has made arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the CCG will be taken and seen to be taken without being unduly influenced by external or private interests.

•This document is extracted, for the purposes of this meeting, from the CCG’s full Register of Declared Interests (which is publically available on the CCG’s website). This document was extracted on 15 April 2021 but has been checked against the full register prior to the meeting to ensure accuracy.

• The register is reviewed in advance of the meeting to ensure the consideration of any known interests in relation to the meeting agenda. Where necessary (for example, where there is a direct financial interest), members may be fully excluded from participating in an item and this will include them not receiving the paper(s) in advance of the meeting.

• Members and attendees are reminded that they can raise an interest at the beginning of, or during discussion of, an item if they realise that they do have a (potential) interest that hasn’t already been declared.

• Expired interests (as greyed out on the register) will remain on the register for six months following the date of expiry.

Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest

(Name of the

DateTo:

Interests Interests

organisation Personal DateFrom:

and nature of Professional

Non-financial Non-financial

business) InterestIndirect FinancialInterest 9.00 via Zoom-21/04/21 via 9.00 AINSWORTH, David Locality Director Mid-Notts Erewash Borough Council Lay Member of the  01/01/2019 Present This interest will be kept under review Remuneration Committee and specific actions determined as required.

AINSWORTH, David Locality Director Mid-Notts Consultancy Ad hoc nurse consultancy to   01/03/2019 Present This interest will be kept under review provider organisations and specific actions determined as required.

AINSWORTH, David Locality Director Mid-Notts Saxon Cross Surgery Registered Patient  Present This interest will be kept under review and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making. AINSWORTH, David Locality Director Mid-Notts Merco Agency (nursing agency) Ad hoc clinical work in a variety  01/07/2020 Present Involvement in commissioning work of settings relevant to this interest will be kept under review and specific actions determined as required. AUDIS, Adrian NHS England/NHS No relevant interests declared Not applicable Not applicable Improvement Commissioning - - Manager

BEEBE, Shaun Non-Executive Director University of Nottingham Senior manager with the  Present This interest will be kept under review University of Nottingham and specific actions determined as - required.

BEEBE, Shaun Non-Executive Director Nottingham University Hospitals Patient in Ophthalmology  Present This interest will be kept under review NHS Trust - and specific actions determined as required. BURNETT, Danni Deputy Chief Nurse NHS England and Improvement Spouse employed as Senior   01/07/2018 Present This interest will be kept under review Delivery and Improvement Lead and specific actions determined as required. 3 of 168 3 of 4 of 168 4 of Declarations of Interest for any item on the agenda

Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest

(Name of the

DateTo:

Interests Interests

organisation Personal DateFrom:

and nature of Professional

Non-financial Non-financial

business) InterestIndirect FinancialInterest BURNETT, Danni Deputy Chief Nurse Nottingham and Nottinghamshire Family member employed as   01/07/2018 Present This interest will be kept under review CCG Head of Service Improvement and specific actions determined as and BCF required. BURNETT, Danni Deputy Chief Nurse Nottingham and Nottinghamshire Famiy member employed as   Present This interest will be kept under review CCG Primary Care Commissioning - and specific actions determined as Manager required. BURNETT, Danni Deputy Chief Nurse NEMS Community Benefit Services Family member employed as  01/07/2018 Present This interest will be kept under review Ltd Finance Accountant and specific actions determined as required. BURNETT, Danni Deputy Chief Nurse Academic Health Science Network Family member employed in   01/07/2018 Present This interest will be kept under review Project Team and specific actions determined as required. BURNETT, Danni Deputy Chief Nurse Castle Healthcare Practice Registered Patient  01/07/2018 Present This interest will be kept under review and specific actions determined as required - as a general guide, the individual should be able to participate in 9.00 via Zoom-21/04/21 via 9.00 discussions relating to this practice but be excluded from decision-making. CALLAGHAN, Fiona Locality Director - South Radcliffe on Trent Health Centre Registered Patient  Present This interest will be kept under review Nottinghamshire and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making. CAWLEY, Michael Operational Director of Castle Healthcare Practice Registered Patient  Present This interest will be kept under review Finance and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making. DADGE, Lucy Chief Commissioning Officer Mid Nottinghamshire and Greater Director  01/10/2017 Present This interest will be kept under review Nottingham Lift Co (public sector) and specific actions determined as required. DADGE, Lucy Chief Commissioning Officer Pelham Homes Ltd – Housing Director  01/01/2008 Present This interest will be kept under review provider subsidiary of and specific actions determined as Nottinghamshire Community required. Housing Association DADGE, Lucy Chief Commissioning Officer First for Wellbeing Community Director  01/12/2016 Present First for Wellbeing CIC is currently in the Interest Company (Health and process of being closed. This interest Wellbeing Company) remains on the register whilst this takes place. DADGE, Lucy Chief Commissioning Officer Valley Road Surgery Registered Patient  Present This interest will be kept under review and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making. DADGE, Lucy Chief Commissioning Officer Nottingham Schools Trust Chair and Trustee  01/11/2017 Present This interest will be kept under review and specific actions determined as required. Declarations of Interest for any item on the agenda

Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest (Name of the DateTo: Interests Interests organisation Personal DateFrom:

and nature of Professional Non-financial Non-financial

business) InterestIndirect FinancialInterest DADGE, Lucy Chief Commissioning Officer Primary Integrated Community Daughter has a temporary  01/09/2020 02/11/2020 Interest expired - no action required Services (PICS) Ltd working contract with PICS (as a Band 2 administrator) for the period 1st September to 2nd November 2020. DAWS, Lynette Head of Primary Care Rivergreen Medical Centre Family members are registered  01/04/2020 Present This interest will be kept under review patients and specific actions determined as required - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making. DAWS, Lynette Head of Primary Care Sherwood Medical Partnership – Registered Patient  Present This interest will be kept under review Farnsfield Surgery and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but 9.00 via Zoom-21/04/21 be excluded from decision-making. DE GILBERT, Eleri Non-Executive Director Middleton Lodge Surgery Individual and spouse registered  Present This interest will be kept under review patients at this practice and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making. DE GILBERT, Eleri Non-Executive Director Rise Park Practice Son and Daughter in Law  18/10/2019 Present This interest will be kept under review registered patients and specific actions determined as required - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making. DE GILBERT, Eleri Non-Executive Director Nottingham Bench Justice of the Peace  Present This interest will be kept under review - and specific actions determined as required. DE GILBERT, Eleri Non-Executive Director Major Oak Medical Practice, Son, daughter in law and  Present This interest will be kept under review Edwinstowe grandchildren registered patients and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making. GASCOIGNE, Sian Head of Corporate Nottingham University Hospitals Husband is the Integration   01/08/2019 Present This interest will be kept under review Assurance NHS Trust Manager and specific actions determined as required.

GASCGOIGNE, Sian Head of Corporate Radcliffe Health Centre Patient Father is a member  01/01/2019 Present This interest will be kept under review Assurance Participation Group and specific actions determined as required. 5 of 168 6 of 168 6 of Declarations of Interest for any item on the agenda

Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest

(Name of the

DateTo:

Interests Interests

organisation Personal DateFrom:

and nature of Professional

Non-financial Non-financial

business) InterestIndirect FinancialInterest GASCGOIGNE, Sian Head of Corporate Nottinghamshire Healthwatch Father is a volunteer  01/01/2019 Present This interest will be kept under review Assurance and specific actions determined as required.

GASCGOIGNE, Sian Head of Corporate Castle Healthcare Practice Registered Patient  Present This interest will be kept under review Assurance and specific actions determined as required - as a general guide, the individual should be able to participate in - discussions relating to this practice but be excluded from decision-making.

GASKILL, Esther Head of Quality Intelligence Mapperley and Victoria Practice Registered Patient  Present This interest will be kept under review and specific actions determined as required - as a general guide, the -

9.00 via Zoom-21/04/21 via 9.00 individual should be able to participate in discussions relating to this practice but be excluded from decision-making. GRIFFITHS, Helen Associate Director of Primary Musters Medical Practice Registered Patient  01/04/2013 Present This interest will be kept under review Care Networks and specific actions determined as required - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making. GRIFFITHS, Helen Associate Director of Primary Castle Healthcare Practice Spouse is GP Partner  01/10/2015 Present To be excluded from all commissioning Care Networks (Rushcliffe Practice) decisions (including procurement activities and contract management arrangements) relating to services that are currently, or could be, provided by this practice Declarations of Interest for any item on the agenda

Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest

(Name of the

DateTo:

Interests Interests

organisation Personal DateFrom:

and nature of Professional

Non-financial Non-financial

business) InterestIndirect FinancialInterest GRIFFITHS, Helen Associate Director of Primary Embankment Primary Care Centre Spouse is Director   01/10/2015 Present This interest will be kept under review Care Networks and specific actions determined as required. GRIFFITHS, Helen Associate Director of Primary NEMS Healthcare Ltd Spouse is shareholder   01/04/2013 Present This interest will be kept under review Care Networks and specific actions determined as required. GRIFFITHS, Helen Associate Director of Primary Partners Health LLP Spouse is a member   01/10/2015 Present This interest will be kept under review Care Networks and specific actions determined as required. GRIFFITHS, Helen Associate Director of Primary Principia Multi-specialty Community Spouse is a member   01/10/2015 Present This interest will be kept under review Care Networks Provider and specific actions determined as required. GRIFFITHS, Helen Associate Director of Primary Nottingham Forest Football Club Spouse is a Doctor for club   01/04/2013 Present This interest will be kept under review Care Networks and specific actions determined as required. LUNN, Joe Associate Director of Primary Kirkby Community Primary Care Registered Patient  Present This interest will be kept under review 9.00 via Zoom-21/04/21 via 9.00 Care Centre and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making. STRATTON, Dr Richard GP Representative Belvoir Health Group GP Partner  01/08/2012 Present To be excluded from all commissioning decisions (including procurement activities and contract management arrangements) relating to services that are currently, or could be, provided by GP Practices. STRATTON, Dr Richard GP Representative Partners Health LLP - a GP member and is entitled to  01/11/2015 Present To be excluded from all commissioning membership organisation of general receive profit shares (although decisions (including procurement practices in Rushcliffe. Provider of profit shares are not currently activities and contract management extended access service and non- paid out to members). Also acts arrangements) in relation to services core provider for Rushcliffe PCN in an advisory capacity to currently provided by Partners Health and employer for additional roles Partners Health Board which is LLP; and Services where it is believed staff for the PCN not remunerated. that Partners Health LLP could be an interested bidder. STRATTON, Dr Richard GP Representative Fosse Medicare Ltd: a property Director/Shareholder  01/11/2018 Present This interest will be kept under review company which owns the Cotgrave and specific actions determined as Surgery which Belvoir Health Group required. have a lease to occupy. STRATTON, Dr Richard GP Representative Nottingham University Hospitals NUH Clinical Director for  01/04/2021 Present To be excluded from all commissioning NHS Trust Integration decisions (including procurement activities and contract management arrangements) relating to services that are currently, or could be, provided by Nottingham University Hospitals Trust. SUNDERLAND, Sue Non-Executive Director Joint Audit Risk Assurance Chair  01/04/2018 Present This interest will be kept under review Committee, Police and Crime and specific actions determined as Commissioner (JARAC) for required. Derbyshire / Derbyshire Constabulary 7 of 168 7 of 8 of 168 8 of Declarations of Interest for any item on the agenda

Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest

(Name of the

DateTo:

Interests Interests

organisation Personal DateFrom:

and nature of Professional

Non-financial Non-financial

business) InterestIndirect FinancialInterest SUNDERLAND, Sue Non-Executive Director NHS Bassetlaw CCG Governing Body Lay Member  16/12/2015 Present This interest will be kept under review and specific actions determined as required.

SUNDERLAND, Sue Non-Executive Director Inclusion Healthcare Social Non-Executive Director  16/12/2015 Present This interest will be kept under review Enterprise CIC (Leicester City) and specific actions determined as required.

TILLING, Michelle Locality Director - City No relevant interests declared Not applicable Not applicable - -

TRIMBLE, Dr Ian Independent GP Advisor Victoria and Mapperley Practice, Registered Patient  01/10/2020 Present This interest will be kept under review Nottingham and specific actions determined as required - as a general guide, the individual should be able to participate in 9.00 via Zoom-21/04/21 via 9.00 discussions relating to this practice but be excluded from decision-making. TRIMBLE, Dr Ian Independent GP Advisor National Advisory Committee for Independent GP Advisor  01/04/2013 Present This interest will be kept under review Resource Allocation and specific actions determined as required - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making. WRIGHT, Michael LMC Representative, CEO Practice Support Services Limited - Support service as for profit  01/04/2016 Present This interest will be kept under review Nottinghamshire subsidiary of LMC and specific actions determined as required. WRIGHT, Michael LMC Representative, CEO LMC Buying Groups Federation Manager  01/04/2016 Present This interest will be kept under review and specific actions determined as required. WRIGHT, Michael LMC Representative, CEO GP-S coaching and mentoring Support service as for profit  01/04/2016 Present This interest will be kept under review subsidiary of LMC and specific actions determined as required. WRIGHT, Michael LMC Representative, CEO Nottinghamshire GP Phoenix Manager  01/04/2016 Present This interest will be kept under review Programme and specific actions determined as required. WRIGHT, Michael LMC Representative, CEO Castle Healthcare Practice Registered Patient  30/09/2016 Present This interest will be kept under review and specific actions determined as required - as a general guide, the individual should be able to participate in discussions relating to this practice but be excluded from decision-making. Declarations of Interest for any item on the agenda

Name Current position (s) Declared Nature of Interest Action taken to mitigate risk held in the CCG Interest

(Name of the

DateTo:

Interests Interests

organisation Personal DateFrom:

and nature of Professional

Non-financial Non-financial

business) InterestIndirect FinancialInterest WRIGHT, Michael LMC Representative, CEO Notspar and Trent Valley Surgery Chair  01/04/2016 Present This interest will be kept under review Special Allocation Schemes (violent and specific actions determined as patient schemes) required. WRIGHT, Michael LMC Representative, CEO Radcliffe-on-Trent Practice Parents are registered patients  Present This interest will be kept under review and specific actions determined as required - as a general guide, the - individual should be able to participate in discussions relating to this practice but be excluded from decision-making. 9.00 via Zoom-21/04/21 via 9.00 9 of 168 9 of Management of any real or perceived conflicts of interest

Managing Conflicts of Interest at Meetings

1. A “conflict of interest” is defined as a “set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”.

2. An individual does not need to exploit their position or obtain an actual benefit, financial or otherwise, for a conflict of interest to occur. In fact, a perception of wrongdoing, impaired judgement, or undue influence can be as detrimental as any of them actually occurring. It is important to manage these perceived conflicts in order to maintain public trust.

3. Conflicts of interest include:  Financial interests: where an individual may get direct financial benefits from the consequences of a commissioning decision.  Non-financial professional interests: where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their reputation or status or promoting their professional career.  Non-financial personal interests: where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit.  Indirect interests: where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision. The above categories are not exhaustive and each situation must be considered on a case by case basis.

4. In advance of any meeting of the Committee, consideration will be given as to whether conflicts of interest are likely to arise in relation to any agenda item and how they should be managed. This may include steps to be taken prior to the meeting, such as ensuring that supporting papers for a particular agenda item are not sent to conflicted individuals.

5. At the beginning of each formal meeting, Committee members and co-opted advisors will be required to declare any interests that relate specifically to a particular issue under consideration. If the existence of an interest becomes apparent during a meeting, then this must be declared at the point at which it arises. Any such declaration will be formally recorded in the minutes for the meeting.

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10 of 168 9.00 via Zoom-21/04/21 Management of any real or perceived conflicts of interest

6. The Chair of the Committee (or Deputy Chair in their absence, or where the Chair of the Committee is conflicted) will determine how declared interests should be managed, which is likely to involve one the following actions:  Requiring the individual to withdraw from the meeting for that part of the discussion if the conflict could be seen as detrimental to the Committee’s decision-making arrangements.  Allowing the individual to participate in the discussion, but not the decision-making process.  Allowing full participation in discussion and the decision-making process, as the potential conflict is not perceived to be material or detrimental to the Committee’s decision-making arrangements.

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9.00 via Zoom-21/04/21 11 of 168 Minutes from the meeting held on 17 March 2021

NHS Nottingham and Nottinghamshire Clinical Commissioning Group Primary Care Commissioning Committee (Public Session) Unratified minutes of the meeting held on 17/03/2021 09:00 - 10:05 Zoom Meeting Members present: Eleri De Gilbert Non-Executive Director (Chair) Shaun Beebe Non-Executive Director Danielle Burnett Deputy Chief Nurse Michael Cawley Operational Director of Finance Lucy Dadge Chief Commissioning Officer Joe Lunn Associate Director of Primary Care Dr Richard Stratton GP Representative Sue Sunderland Non-Executive Director Dr Ian Trimble Independent GP Advisor

In attendance: Louise Espley Corporate Governance Officer (minute taker) Daisy May Coster-Hollis Interim Head of Corporate Governance Lynette Daws Head of Primary Care Siân Gascoigne Head of Corporate Assurance Esther Gaskill Head of Quality – Primary Care Stuart Hague Practice Liaison Officer - Nottinghamshire Local Medical Committee

Apologies: Helen Griffiths Associate Director of Primary Care Networks

Cumulative Record of Members’ Attendance (2020/21) Name Possible Actual Name Possible Actual Shaun Beebe 12 11 Joe Lunn 12 9 Michael Cawley 12 11 Dr Richard Stratton 12 10 Lucy Dadge 12 12 Sue Sunderland 12 12 Eleri de Gilbert 12 12 Dr Ian Trimble 12 12 Helen Griffiths 12 10 Danielle Burnett 12 7

Introductory Items PCC 20 202 Welcome, Introductions and Apologies Eleri de Gilbert welcomed everyone to the public session of the Primary Care Commissioning Committee meeting, which was being held virtually due to the COVID- 19 pandemic.

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Stuart Hague, Practice Liaison Officer from Nottinghamshire LMC, representing Michael Wright was welcomed to the meeting as was Louise Espley, who has joined the CCG on an interim basis as Governance Officer. Apologies had been received from Helen Griffiths.

PCC 20 203 Confirmation of Quoracy The meeting was confirmed as quorate.

PCC 20 204 Declaration of interest for any item on the shared agenda No interests were declared in relation to any item on the agenda. The Chair reminded members of their responsibility to highlight any interests should they transpire as a result of discussions during the meeting. Stuart Hague confirmed he had no interests to declare in relation to any item on the agenda.

PCC 20 205 Management of any real or perceived conflicts of interest As no conflicts of interest had been identified, this item was not necessary for the meeting.

PCC 20 206 Questions from the public No questions have been received from the public.

PCC 20 207 Minutes from the meeting held on 17 February 2021. Page 11 of the minutes included a typographical error at PCC/20/195, bullet points to be re-organised with bullet point ‘n’ being re-labelled as ‘m’. Subject to this amendment the minutes were agreed as an accurate record.

PCC 20 208 Action log and matters arising from the meeting held on 17 February 2021 The action related to Nottingham City dashboard data would be addressed at item nine. All other actions were noted as complete and there were no matters arising.

Commissioning, Procurement and Contract Management PCC 20 209 Update on Platform One Practice Procurement Eleri de Gilbert invited Lucy Dadge to provide a verbal update to the Committee. Lucy Dadge provided an update highlighting the following points: a) Discussion had taken place at the Nottingham City Health and Scrutiny Committee on 11 March 2021 which highlighted some areas of learning for the CCG, particularly with respect to openness and transparency and timeliness of communication. b) The context of the Platform One procurement exercise had been clarified to the Health and Scrutiny Committee (i.e. that this was the result of work that had taken

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place over the last five years and that the CCG had not unilaterally taken the decision to undertake a procurement exercise). The contract does not represent a service change, rather a continuity of provision where Primary Medical Services will remain the same as before. The CCG acknowledged this should have been made clearer. c) The needs assessment for stakeholder engagement had been shared with the Health & Scrutiny Committee. The assessment had provided significant insight to enable the safe mobilisation and transfer of services to the new provision. d) With regard to the Local Enhanced Service (LES) – severe deprivation, the CCG confirmed the LES would be demand based and not subject to a finite budget. e) A positive conversation had taken place with Healthwatch who had raised some searching questions regarding the CCG’s commissioning policy. The CCG agreed to share a number of its policies with Healthwatch in response to this conversation. f) The CCG is due to return to the Health and Scrutiny Committee to discuss the Equality/Quality Impact Assessment (EQIA) process, with a focus on how it helps to assess population health needs. g) The Health & Scrutiny Committee requested a follow up session in private with GP Alliance to understand more about their business and their commitment to primary care in the city.

The Committee:  RECEIVED the update.

Quality Improvement PCC 20 210 Nottingham City Quality Data Triangulation and review The Chair reminded the committee that, at the February 2021 meeting, a discussion about the seemingly high number of practices in the City with an overall amber rating had taken place. Esther Gaskill and Dr Ian Trimble had undertaken further analysis of the position.

Esther Gaskill presented the report and highlighted the following key points: a) Four specific indicators had been identified that City practices had difficulty in achieving; Childhood immunisations (90% target), cervical screening (80% target), Breast screening (70% target), Flu vaccination over 65 years at risk (national average 49%) b) The indicators were compared with the Nottingham North and East previous CCG footprint along with Liverpool, Manchester and Birmingham as they all are considered ‘core’ cities in the same way that Nottingham is. c) Following analysis, the conclusion is that Nottingham City reports comparable performance with other core cities, with the exception of immunisation.

The following points were raised in discussion:

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a) The Committee noted that the data was comparable when benchmarked with other core cities but were keen to focus on what could be done to improve services to patients. b) The report highlighted the inequalities of being in a city and was considered to validate the City Integrated Care Partnership (ICP) as an entity. The importance of the strategic commissioner role in the design of ICP service delivery model was noted. c) Members noted the complexities that the report begins to expose. It was noted that Nottingham does not have metropolitan status, therefore, does not benefit from a complexity uplift to its budget. This has an impact on addressing other determinants of health e.g. housing, education, crime and disorder. The complexity of the geographical setting of the city and the county as a whole was also acknowledged. d) The Committee agreed this starts a broader piece of work to understand the plethora of issues and data in more detail. e) The current work already underway with outlier practices is proving to be successful and will continue. f) A multifactorial approach would be taken to bring streams of data together to create a ‘heat map’ to influence the commissioning of primary care going forward. A Primary Care Network (PCN) support strategy would ultimately sit alongside this. g) There was some debate as to the role of the ICP and the PCN which would be addressed in the further work. h) The importance of the EQIA process in driving commissioning intentions and decisions was acknowledged.

ACTION:

 Esther Gaskill and colleagues to develop a primary care heat map for consideration by the Committee in April 2021. This will influence the future development of a PCN support strategy.

The Committee:  NOTED the Quality dashboard City practices paper.

Covid-19 Recovery and Planning PCC 20 211 Overview of GP Practice Additional expenses in relation to COVID-19

Joe Lunn presented the item and highlighted the following key points: a) The paper provided the Committee with an update on exceptional COVID-19 support requests. No claims had been received during January 2021. b) With regard to the retrospective claiming process instigated by NHS England for the additional costs incurred for the purchase of COVID-19 related personal protective equipment, following confirmation of the process (and extension of the

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deadline) a total of 337 claims had been received. 316 were approved for payment. The remaining 21 claims (circa £8k) were not approved for payment as they did not meet the requirements set out in the Department of Health and Social Care (DHSC) guidance. c) In respect of the COVID claims audit, further validation had taken place of the 28 claims requiring additional information and subsequently three of those claims had been approved for payment, amounting to £511.67. The remaining 25 claims did not meet the criteria for payment.

No further points were raised in discussion

The Committee:  NOTED the paper for assurance purposes.

Financial Management PCC 20 212 Finance report – month eleven Michael Cawley presented the item and highlighted the following key points: a) The paper represents the financial position for primary care commissioning spend at month eleven 2020/21. b) For month eleven, the year to date position shows a £0.65 million underspend when compared to delegated budgets whilst the forecast out-turn position is a £0.10 million overspend. c) The main drivers of the financial position are additional slippage on the PCN additional roles offset by overspends in Alternative Provider Medical Services, prescribing/dispensing and Premises Costs Reimbursement spend lines. d) The CCG are expecting to remain within the delegated budgets that have been set for the rest of the year. e) A disclosure adjustment had taken place (detailed on page four of the report). This disclosure item does not change the reported position. No further points were raised in discussion.

The Committee:  NOTED the contents of the Primary Care Commissioning finance report.  APPROVED the Primary Care commissioning finance report for the period ending February 2021.

PCC 20 213 PCN Clinical Director uplift to support COVID-19 vaccination programme When introducing the item, the Chair referred to an email from Michael Cawley regarding the context of this item. Michael Cawley explained that the Covid Vaccination Programme (CVP) is commissioned by NHS England Improvement (NHSEI) as part of the NHS Public Health Functions Agreement under Section 7a of the NHS Act 2006. As such the commissioning/ contractual relationship is between NHSEI and providers

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undertaking the Section 7a service only. The function cannot be delegated by NHSEI to the CCG, so the CVP is not part of core CCG business; nor is it part of the CCG’s contracting and financial management responsibilities.

Instead, the paper to be presented is being considered because NHSEI have requested CCGs to “sign-off” before it makes payments to Clinical Directors. The Primary Care Co- Commissioning Committee was considered to be the most appropriate committee for such a discussion on the paper to take place and be recorded.

In respect of the proposed payments outlined in the paper, the CCG’s role is to provide assurance to NHSEI that the PCNs are meeting the conditions set by NHSE.

Joe Lunn presented the item and highlighted the following points: a) The paper provides an overview of the NHSE financial directive to fund Clinical Directors (on behalf of PCNs) for additional COVID-19 work for the period January to March 2021. b) This equates to an increase in Clinical Director time per PCN from 0.25wte to 1wte for the PCNs to help support the enhanced services required related to the COVID vaccination programme. c) Nationally, the directive equates to £32.5 million. d) The funding may be used flexibly across PCNs to support the leadership and management of the COVID response. It does not have to be specifically related to a Clinical Director. e) The funding equates to 54.2p per patient paid to the nominated practice on behalf of the PCN. This equates to circa £600k across the PCNs. f) NHSE will transact the payments, it will not flow through the CCG, although CCG sign off is required. g) Due diligence will be carried out with the PCNs to ensure that the funds are utilised appropriately and there is no duplication of payment. h) The Committee is asked to consider the use of the payment, the approach to accessing the funds and approval for payment of the funds.

The following points were made in discussion: a) Officers clarified that the payment is to PCNs (accepting they are not corporate entities) rather than Clinical Directors and that it is a definite rather than proposed payment covering retrospective work undertaken between January and March 2021. Concern was raised regarding the impact of this being a retrospective payment. b) Verbal assurance was provided that PCNs had met the eligibility criteria i.e. at least one practice per PCN is signed up to deliver the enhanced service. Committee members requested further information to confirm this position and agreed to receive this as an addendum to the minutes. c) It was clarified that details of arrangements from 01 April 2021onwards had not been received.

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ACTION:  Information to confirm that PCNs had met the eligibility criteria would be appended to the minutes of this meeting.

The Committee:  NOTED the NHSE guidance on the allocation of the PCN CD payment.  CONSIDERED the proposed approach to managing this transaction.  Had received verbal ASSURANCE that that the conditions for payment had been met and that further information would be appended to the minutes of this meeting.

Risk Management PCC 20 214 Risk Report Siân Gascoigne presented the item and highlighted the following points: a) There are seven risks relating to the Committee’s responsibilities, all of which have been reviewed by the Head of Corporate Assurance, Chief Commissioning Officer and the Associate Director of Primary Care since the last meeting. b) The narrative in relation to risk RR 032 (primary care workforce) had been amended to explicitly reflect the risk and mitigations identified in the primary care workforce update which was presented to the Committee in February 2021. c) There is currently one high/red risk in relation to the remit of the Committee, risk RR 126 (impact of COVID-19 on the sustainability of safe and effective delivery of primary care services). This risk has a risk score of 16 and would be reported to the Governing Body. Views were sought on whether this risk score could be reduced. d) There have been no new risks identified since the last meeting.

The following points were made in discussion: a) The Committee agreed to maintain the score of 16 in relation to RR 126 at this time. b) One potential new risk was highlighted arising from the discussion at item 12. The risk relates to PCNs financial vulnerability as a direct result of retrospective payments for services delivered.

ACTION:  Siân Gascoigne and Helen Griffiths to explore the potential risk and report to the Committee in April 2021.

The Committee:  COMMENTED on the risks shown within the paper (including the high/red risk) and those at Appendix A

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 IDENTIFIED a potential risk related to PCNs financial vulnerability during the course of the meeting. This would be explored further and reported to the Committee in April.

Closing Items PCC 20 215 Any other business No other business was raised.

PCC 20 216 Key messages to escalate to the Governing Body The Committee:  NOTED the Quality dashboard City practices paper. The next step would be development of a primary care heat map for consideration by the Committee in April 2021.  RECEIVED the monthly Risk Report and agreed to consider a potential new risk related to PCNs financial vulnerability as a result of retrospective payments for services delivered.  NOTED the NHSE. Guidance on allocation of PCN Clinical Director Payments and the approach to manage the transactions. It was confirmed that PCNs were meeting the conditions set by NHSE to be eligible for funding.  Would REVIEW the distribution of papers between the public and confidential agendas to ensure transparency of information and decision making.

PCC 20 217 Date of next meeting: 21/04/2021 Zoom Meeting

Confidential Motion: The Primary Care Commissioning Committee will resolve that representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960)

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Confirmation of practices signed up to deliver the Covid-19 Vaccination Enhanced Service

Practice code Practice name Response to deliver COVID Enhanced Service Ashfield North PCN C84012 Willowbrook Medical Practice Yes C84014 Woodlands Medical Practice Yes C84061 Kings Medical Centre Yes C84077 Brierley Park Medical Centre Yes C84114 Skegby Family Medical Centre Yes Ashfield South PCN C84067 Ashfield House (Annesley) Yes 9.00 via Zoom-21/04/21 via 9.00 C84074 Family Medical Centre (Kirkby) Yes C84076 Kirkby Health Centre Yes C84140 Lowmoor Road Surgery Yes C84142 Selston Surgery Yes C84629 Health Care Complex Yes C84654 Jacksdale Medical Centre (main) Yes Y05690 Kirkby Community Primary Care Centre Yes Mansfield North PCN C84016 Oakwood Surgery Yes C84031 St Peters Medical Practice (Dr Sharma) Yes C84051 Orchard Medical Practice Yes C84057 Pleasley Surgery Yes C84127 Riverbank Medical Services Yes C84637 Sandy Lane Surgery Yes C84658 Meden Medical Services Yes Rosewood PCN Minutes from the meeting held on 17 March 2021

C84020 Churchside Medical Practice Yes C84036 Forest Medical Yes C84069 Roundwood Surgery Yes C84106 Mill View Surgery Yes C84679 Acorn Medical Practice Yes Newark PCN C84049 Southwell MC Yes C84009 Barnby Gate Surgery Yes C84019 Fountain Medical Centre Yes C84029 Lombard Medical Centre Yes

9.00 via Zoom-21/04/21 via 9.00 C84045 Collingham MC Yes Y05369 Balderton PCC (C84648) Yes C84660 Hounsfield Surgery Yes Sherwood PCN C84037 Abbey Medical Group Yes C84087 Rainworth HC Yes C84123 Bilsthorpe Surgery Yes C84656 Hill View Surgery Yes C84021 Middleton Lodge Practice Yes C84059 Sherwood Medical Partnership Yes C84113 Major Oak MP Yes Bulwell and Top Valley PCN C84043 Leen View Surgery Yes C84064 Parkside Medical Practice Yes C84135 Queens Bower Surgery Yes C84129 Rise Park Surgery Yes C84717 Riverlyn Medical Centre Yes 21 of 168 21 22 of 168 22 Minutes from the meeting held on 17 March 2021

Y05622 Southglade Medical Practice Yes C84138 Springfield Medical Centre Yes C84004 St Albans Medical Centre/ Nirmala Medical Centre Yes BACHS PCN C84091 Aspley Medical Centre Yes C84704 Beechdale Surgery Yes Y06356 Bilborough Medical Centre/Assarts Farm MC Yes C84647 Bilborough Surgery Yes Y06792 Broad Oak Surgery Yes C84034 Churchfields Medical Practice Yes

9.00 via Zoom-21/04/21 via 9.00 C84694 Limetree Surgery No C84676 Greenfields Medical Practice Yes C84116 Melbourne Park Medical Centre No Radford and Mary Potter PCN C84105 Fairfields Practice Yes C84691 High Green Medical Practice No C84103 Forest Practice Yes C84117 Radford Medical Practice/NTU No C84136 St Luke’s Surgery Yes Bestwood and Sherwood PCN C84078 Hucknall Road Medical Centre Yes C84695 The Alice Medical Centre Yes C84628 Sherwood Rise Medical Centre Yes C84011 Elmswood Surgery Yes C84682 Sherrington Park Medical Practice Yes C84619 Tudor House Medical Practice Yes C84664 Welbeck Surgery Yes Minutes from the meeting held on 17 March 2021

C84151 The Medical Centre - Irfan Yes Nottingham City East PCN C84693 Bakersfield Medical Centre Yes C84018 Family Medical Centre Yes C84063 GreenDale Primary Care Centre Yes C84085 Victoria Health Centre/Mapperley Surgery Yes C84072 Wellspring Surgery Yes Y02847 NEMS - Platform One Practice Yes C84683 Windmill Practice Yes Nottingham City South PCN

9.00 via Zoom-21/04/21 via 9.00 C84044 Deer Park Family Medical Practice Yes C84039 Derby Road Health Centre Yes Y03124 Grange Farm Medical Centre Yes C84122 Wollaton Park Medical Centre Yes Clifton and Meadows PCN C84092 Bridgeway Practice Yes C84046 Clifton Medical Practice Yes C84081 John Ryle Medical Centre Yes C84144 Meadows Health Centre - Larner Yes C84060 Rivergreen Medical Centre Yes Unity (Nottingham) PCN C84023 Cripps Health Centre Yes C84714 Sunrise Medical Practice Yes Byron PCN C84095 Oakenhall Medical Practice Yes Y00026 The Om Surgery Yes C84053 Torkard Hill Medical Centre Yes 23 of 168 23 24 of 168 24 Minutes from the meeting held on 17 March 2021

Y06443 Whyburn Medical Practice Yes Arnold and Calverton PCN C84047 The Calverton Practice Yes C84055 Highcroft Surgery Yes C84026 Stenhouse Medical Centre Yes Arrow Health PCN C84066 Daybrook Medical Practice Yes C84646 The Ivy Medical Group - Burton Joyce Yes Y06507 Peacock Healthcare Yes C84115 Plains View Surgery Yes

9.00 via Zoom-21/04/21 via 9.00 C84150 Unity Surgery Yes C84033 Westdale Lane Surgery Yes Synergy Health C84613 Jubilee Park Medical Partnership Yes C84010 Trentside Medical Group Yes C84696 West Oak Surgery Yes Nottingham West PCN C84065 Abbey Medical Centre Yes C84112 Bramcote Surgery Yes C84120 Chilwell Valley & Meadows Practice Yes C84080 Manor Surgery Yes C84030 Oaks Medical Centre Yes C84032 Eastwood Primary Care Centre Yes C84667 Giltbrook Surgery Yes C84624 Hama Medical Centre Yes C84131 Newthorpe Medical Centre Yes C84705 Hickings Lane Medical Centre Yes Minutes from the meeting held on 17 March 2021

C84107 Linden Medical Group Yes C84042 Saxon Cross Surgery Yes Rushcliffe PCN C84605 Castle Healthcare Practice Yes C84703 Gamston Medical Centre Yes C84090 Musters Medical Practice Yes C84086 St Georges Medical Practice Yes C84621 West Bridgford Health Centre Yes C84017 Belvoir Health Group Yes C84025 East Bridgford Medical Centre Yes

9.00 via Zoom-21/04/21 C84084 Radcliffe on Trent Health Centre Yes C84005 Village Health Group Yes C82040 Orchard Surgery Yes C84028 Ruddington Medical Centre Yes 25 of 168 26 of 168 26 Action log and matters arising from the meeting held on 17 March 2021

Primary Care Commissioning Committee Action Log from the public Committee meeting held on 17 March 2021

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

ACTIONS OUTSTANDING

No actions outstanding

9.00 via Zoom-21/04/21 via 9.00 ACTIONS ONGOING/NOT YET DUE

No actions ongoing

ACTIONS COMPLETE

17/03/2021 PCC 20 210 Nottingham City To develop a primary care heat Esther Gaskill 21/04/2021 Plan for development of the Quality data map for consideration by the heat map is on the April triangulation and Committee in April 2021. This will agenda at item 14 PCC 21 review influence the future development 014. Development session of a PCN support strategy. to follow.

17/03/2021 PCC 20 213 PCN Clinical Confirmation of those who have Joe Lunn 21/04/2021 Attached as an addendum Director uplift to signed up the enhanced service to the March minutes. support Covid-19 would be appended to the

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Action log and matters arising from the meeting held on 17 March 2021

MEETING AGENDA AGENDA ITEM ACTION LEAD DATE TO BE COMMENT DATE REFERENCE COMPLETED vaccination minutes. programme

17/03/2021 PCC 20 214 Risk Report To explore the potential risk and Sian 21/04/2021 Meeting has been arranged report to the Committee Gascoigne/ with relevant CCG officers Helen Griffiths on the 21 April 2021 to explore potential risk relating to PCNs financial vulnerability. 9.00 via Zoom-21/04/21

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Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: NHS England Memorandum of Paper Reference: PCC 20 009 Understanding (MOU) 2021/22

Sponsor: Joe Lunn, Associate Director of Primary Attachments/ Appendix A: Care Appendices: Memorandum of Understanding Presenter: Joe Lunn, Associate Director of Primary 2021/22 Care

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

Executive Summary Arrangements for Discharging Delegated Functions – supporting all delegated functions

All CCGs across the NHS England and NHS Improvement Midlands Region are fully delegated; transferring decision-making responsibility relating to the provision of Primary Medical Services from NHS England and NHS Improvement to CCGs. To enable CCGs to discharge this responsibility in a secure and effective manner, the General Medical Advice and Support Team (GMAST) was established across the Midlands Region, providing support, advice and administrative services to all CCGs, to facilitate the delivery of delegated functions.

NHS England have prepared a Memorandum of Understanding (MOU) which sets out the principles and working arrangements between GMAST and the CCG from April 2021 to March 2022. This also includes a specification of the GMAST offer to the CCG (Appendix A).

The MOU includes the same overarching principles and working arrangements as the 2020/21 MOU. Page 6 within the MOU outlines the ‘Core Offer’, and Page 8 within the MOU outlines the ‘Extended Offer’ available to CCGs, at an additional cost.

The 2021/22 Activity and Performance reports, prepared by GMAST for the CCG on a quarterly basis, will be provided as follows:

Quarter 1 July (April – June data) Quarter 2 October (July – September data) Quarter 3 January (October – December data) Quarter 4 April (January – March)

The 2020/21 MOU included a section on ‘Transition Agreed with CCG’ which listed the Special Allocation Scheme, however other areas of work transferred to the Primary Care Commissioning Team last year. This section has been removed in the latest MOU with no further work areas identified to transfer to the CCG in 2021/22. Any areas of work transferring from NHS England to the Primary Care Commissioning Team are unlikely to transfer with any additional capacity or resource. Monitoring of additional areas transferred remains limited.

There are no direct financial implications for the CCG in relation to the MOU; this does however impact on Page 1 of 2

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the Primary Care Commissioning Team capacity to meet the increased workload.

The 2021/22 MOU will be signed and submitted to NHS England following presentation at April PCCC.

A review has started to consider options for the GMAST provision from 2022/23 onwards with all 11 systems in the Midlands engaged.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☒ Procurement and/or Contract Management ☒ Strategic Planning ☒ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Assessment (DPIA) Risk(s): Risk identified relating to Primary Care Commissioning Team capacity to absorb additional workload transferring from NHS England within the current structure. Primary Care Commissioning Team Capacity included on the risk register, following the CCGs restructure and NHS England announcement of their restructure which introduced GMAST. The NHS England restructure was effective from 1 April 2020. Capacity requirements are being reviewed as part of a wider strategic review in planning for the next phase of Integrating Care and following the publication of the White Paper. Confidentiality: ☒No Recommendation(s): 1. PCCC to NOTE the content of the 2021/22 Memorandum of Understanding. 2. PCCC to NOTE the commencement of the review of GMAST provision for 2022/23 onwards.

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Memorandum of Understanding

General Medical Advice and Support Team (GMAST) NHS England and NHS Improvement, Midlands

And

Nottingham and Nottinghamshire CCG

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Service description Midlands Primary Medical Services Hub (GMAST) will provide a range of support, advice and administrative services to all CCGs in the Midlands Region. The provision of this support across contracting and premises will enable CCGs to effectively commission primary medical services as per the delegation agreement. Provider NHS England and Improvement Senior Delivery Manager Head of Service, General Medical Advice and Support Team (GMAST) Period for service delivery 1st April 2021 to 31st March 2022

CONTENTS

Introduction...... 3 Principles ...... 3 Ways of working ...... 3 Required Capability, Skills and Expertise ...... 4 GMAST Governance Structure ...... 5 Reporting ...... 5 APPENDIX A ...... 6 APPENDIX B ...... 8 MEMORANDUM OF UNDERSTANDING 2021-22 ...... 9

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Introduction

By April 2021, all CCGs across the NHS England and NHS Improvement, Midlands region will be fully delegated. This will complete the transfer of decision-making responsibility, relating to the provision of Primary Medical Services, from NHS England and NHS Improvement to CCGs. To enable CCGs to discharge this responsibility in a secure and effective fashion, General Medical Advice and Support Team (GMAST) has been established across the Midlands region, providing support, advise and administrative services to all CCGs, to facilitate the delivery of their delegated functions.

Set out below are the principles and working arrangements between GMAST and CCG commissioners for the agreed term (April 2021 - March 2022) as well as a detailed specification of the GMAST offer to CCGs (Appendix A).

Principles

The following overarching principles supporting the proposal are: • GMAST will support and advise each CCG where appropriate, in line with regulations and directions. • GMAST will not be part of the NHS England and Improvement assurance process for CCGs. • Working arrangements have been co-designed between GMAST, CCG Commissioners & NHS England and Improvement Commissioners. • Arrangements will aim to make the best use of NHS resources, enhancing primary care commissioning to improve quality, outcomes and value. • Arrangements will be practical, reduce duplication and minimise additional workload. • GMAST and CCGs will conduct business in an open and transparent way.

Ways of working

Functions of GMAST

GMAST will support the delivery of functions specified in Appendix A. It is proposed that GMAST will provide a core specified service (Core Offer) to all CCGs in a consistent and equitable manner.

All work relating to the processes listed below will be carried out in line with the relevant regulations and NHS England and Improvement policies. This is irrespective of whether it is GMAST or the CCG carrying out the function in question.

A set of standard operating procedures aligned to the policies will underpin the day to day work of GMAST. These are defined in the Primary Medical Services, Policy Guidance Manual.

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In line with the Delegation Agreement[1], CCGs maintain the responsibility for:

I. Decisions in relation to Enhanced Services; II. Decisions in relation to Local Incentives Schemes, including the design of such schemes; III. Decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices; IV. Decisions about commissioning urgent care for out of area registered patients; V. The approval of practice mergers; VI. Planning primary medical care services in the Area, including carrying out needs assessments; VII. Reviewing primary medical services in the Area; VIII. Decisions relating to the management of poorly performing GP practices; IX. Managing the funds delegated to the CCG for the purpose of meeting expenditure in respect of the Delegated Functions; X. Premises Costs Directions Functions; XI. Co-ordinating a common approach to primary care commissioning with other commissioners in the Area; and XII. Such other ancillary activities that are necessary to support the above functions GMAST will support the delivery of these delegated functions as detailed in Appendix A.

These working arrangements will be kept under review and refined as necessary with updates reflected in further iterations of the Primary Medical Services, Policy Guidance Manual.

Required Capability, Skills and Expertise

Key interfaces between GMAST and teams within CCGs are included in Appendix. A. It is proposed that each STP area will have a designated Lead Manager, who would be the CCGs primary contact in GMAST.

GMAST comprises of experienced staff from:

• NHS England and Improvement • Contracting Services • Premises Teams

GMAST staffing structure is set at an appropriate level to undertake the functions outlined. The workload for primary care contracting and premises can however be variable and unpredictable. In recognition of this, a regular assessment of workload and capacity will be undertaken.

• GMAST will aim to provide equitable support to each CCG and will endeavour to effectively balance competing priorities.

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• In the rare event where a CCG requires support that exceeds the available resources or existing scope of GMAST, then the Head of Service Hub Lead will initiate a discussion with CCGs about how that can be resourced e.g. o CCG securing / funding additional resource o GMAST securing additional resource (potentially through a CCG). o CCG agreeing with other CCGs to focus GMAST resource temporarily on a specific issue o CCG divert internal resource and backfill as necessary o Solution may require a combination of the above

GMAST Governance Structure

Midlands Commissioning Group Director of Primary Care and Public Health Commissioning

Primary Care Transformation Team Senior Management Team

GMAST - Senior Management Team

GMAST Operational and Performance Group

Reporting Activity and performance reports will be generated quarterly for each CCG as follows:

Quarter Report Available

Quarter 1 July (April – June data)

Quarter 2 October (July – September data)

Quarter 3 January (October – December data)

Quarter 4 April (January – March)

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APPENDIX A

Delegated Duties – Core Offer

Schedule 1 Delegated Functions/Duties - In line with Schedule 2 of the Delegated Agreement Decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts, including but not limited to the following activities: Provide contract, procurement advice and general Management of GMS, PMS and APMS contracts including options appraisal. Preparation of annual GMS PMS APMS contract changes. Advice on caretaking options including STA and CEG. Draw up contract documentation. Resolving any legacy contractual issues – Working with CCG using their legal advice. Administering changes to GP contracts i.e. contract variation – mergers, partnership changes. Processing of all contract variations via a central process through the GP hub with notification to the commissioner to confirm/advise - via agreement with CCG. Advising CCGs with identifying and developing plans where there are risks to GP service provision; e.g. where a single hand provider is on sick leave or subject to an investigation Advising CCGs on requests from practices to change their practice boundary and the managing of boundary disputes. Authorise PCSE to process 24-hour retirements. Support and advisory service - in relation to workforce issues, succession planning, partnership issues, 24-hour retirements, seek/advise the CCG decisions. Support and advisory service – in relation to requests from practices to manage their list size, i.e. list closures. Administering and chasing the Strategic Data Collection System (SDCS) and annual E- declaration submissions; workforce, returns. Share intelligence with the CCG. Processing of locum payment to GP practices for sickness, maternity, paternity and adoptions leave, in line with the national policies. Decisions in relation to Enhanced Services; Share national specifications and templates for Directed Enhanced Services (DESs) when released in order to facilitate annual sign up process. CCG to produce letters inviting practices to participate in DESs, HUB to manage distribution Distribute, log and receive responses from practices. Routine reports will be relayed to CCGs, so they may contact practices who have not signed up Manage and respond to queries from practices relating to DESs Monitoring and reporting of quarterly and end of year submissions. Resolving issues relating to submissions via the Calculating Quality Reporting Services (CQRS) payment system. Keeping CCGs updated with any issues. Decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices; Advice and guidance due regard to NHSE policies and procedures for primary medical services Advice and guidance on mobilisation of new practices Advice and guidance regarding exit plans and managing list dispersals of closing practices Advice and guidance on caretaking arrangements for practices Advice and guidance on procurement of new practices Decisions about ‘discretionary’ payments; Advice and guidance in relation to ‘discretionary payments’

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The approval of practice mergers; Advice and guidance due regard to NHSE policies and procedures for primary medical services Share intelligence with the CCG Decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list); Advice and guidance around monitoring contractual and quality performance of all constituent GP practices. Advice and guidance in identifying practices of concern including nature of the issue (contractual versus quality) Advice and guidance with due regard to Regulation and NHSE policies and procedures for primary medical services including advice on taking contractual action (as required) and monitoring impact. Advice and guidance in identifying any individual performer issues and raising these with the NHSE medical directorate. Premises Costs Directions functions; (Strategic premises development support provided by the Transformation Team). Support the process for improvement grants once agreed by the Transformation Team. Liaise with individual practices to ensure implementation of proposals within required timescales for improvement grants. Support to CCGs/Practices where there are landlord issues that may impact on services/contractual obligations. Rent reviews: Produce and maintain a three-yearly schedule of rent reviews for each GP practice. Liaise with the District Valuer regarding the rent payment for each practice. Issue letter/form to each practice notifying them of their new rent reimbursement level Inform each CCG of agreed new rent reimbursement levels Manage associated challenges and any subsequent appeals related to rental figures Produce reports to enable financial updates to be made. The Contracting Team will deal with the administration of rent reviews. Co-ordinating a common approach to the commissioning of primary care services with other commissioners in the Area where appropriate; and Supporting the CCG with the dissemination and implementation of guidance relevant to medical contracts. Support and advice on the commissioning of SAS patient schemes Commissioning of a security support service for practices (where current arrangements are in place; future contracts would be transferred to CCG) Advising on the responses to letters from MPs, Councillors, Health Watch and other external bodies. Share intelligence with the CCG Such other ancillary activities as are necessary in order to exercise the Delegated Functions. Maintain up to date contact database and electronic /paper filing system Attendance at CCG Primary Care Committee and Primary Care Operational Group by exception Responding to day to day contract related queries raised by CCGs Liaison with PCSE regarding ad-hoc contract related matters where applicable raised by CCGs Advice and guidance on the management of patient allocations Advice and guidance on supporting the resolution of issues resulting from unexpected events impacting on practices (e.g. contractor death) with a view for CCGs to manage operationally and implement

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Support and implement the resolution of issues resulting from unexpected events impacting on practices (e.g. contractor death) Advice and guidance on use of CQRS Administration of Users on CQRS Offer Enhanced Services to practices on CQRS Process achievement approvals for Enhanced Services and QOF via CQRS APPENDIX B

Extended Offer CCGs will be able to approach GMAST for ad-hoc support outside of the core offer. These may include some of the potential areas outlined in the table below but would need to be agreed between CCG/s and GMAST. The decision to support will be made on a case by case basis depending on capacity within GMAST at the time.

Delegated Duties – Extended Offer Support the development and management of Local Incentive Schemes (LIS) Analysis of e-Dec (new system name to be added) and other national reporting outputs Intensive Support • CQC Closures Resignation of contract with immediate notice • Short term capacity support to CCGs e.g. staff sickness • Other emergencies Supporting implementation of mobilisation plan for new practices Supporting implementation of exit plans and managing list dispersals of closing practices Supporting implementation of caretaking arrangements Supporting implementation of merger process and action plans – support provided by negotiation Monitoring of contractual and quality performance of constituent GP practices

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MEMORANDUM OF UNDERSTANDING 2021-22 For the provision of GMAST services

Signed on behalf of the CCG:

Signed:

Print Name:

Designation:

CCG:

Date:

Signed on behalf of NHS England:

Signed:

Print Name: Anna Nicholls Head of Service, General Medical Advice and Support Team Designation: (GMAST)

Date: 1st March 2021

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Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: Contract management update Paper Reference: PCC 21 010

Sponsor: Joe Lunn, Associate Director of Primary Attachments/ Public Contract Log Care Appendices: Presenter: Lynette Daws, Head of Primary Care

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

Executive Summary Arrangements for Discharging Delegated Functions Delegated function 2 – Plan the primary medical services provider landscape, including considering and making decisions in relation to agreeing variations to the boundaries of GP practices. Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts Delegated function 7 – Approving GP practice mergers and closures Delegated function 10 – Decisions in relation to the management of poorly performing GP practices, including decisions and liaison with the CQC where the CQC has reported non-compliance with standards

This public contracts log provides an update on contractual action in respect of individual providers’ contracts, across Nottingham and Nottinghamshire, which have been discussed by the Primary Care Commissioning Panel in the previous 12 months.

Some items, due to their commercially sensitive and confidential nature, may have been previously discussed by the Primary Care Commissioning Committee in the confidential session of the meeting. These items will be included in the public contracts log as soon as they are able to be shared in public.

There are various contractual requests or changes which practices can apply to undertake including boundary changes, practice mergers, branch closures and formal list closures. This overview will be given to ensure the Committee is sighted on the progress of agreed contractual changes.

All contractual changes follow due process in line with the NHS England Primary Care Policy and Guidance Manual (PGM). The PGM provides Commissioners of GP services with the context and information to commission and manage GP contracts ensuring that all providers and patients are treated equitably.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☒ Procurement and/or Contract Management ☒

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Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (EQIA)

Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (DPIA)

Risk(s): No risks are identified within the paper

Confidentiality: ☒No

Recommendation(s): 1. RECEIVE the Contract Update.

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NHS Nottingham and Nottinghamshire Clinical Commissioning Group Primary Care Commissioning Committee – April 2021 Public Meeting

Contracts Update – Public Meeting

This public contracts log provides an update on contractual action in respect of individual providers’ contracts which have been discussed by the Primary Care Commissioning Committee in the previous 6 months. Some items due to their commercially sensitive and confidential nature may have been previously discussed by the Primary Care Commissioning Committee in the confidential session of the meeting; however, this decision can now be shared in the public domain.

Updates since the last meeting are highlighted in bold. This item is for information only.

Ref. Date last Description of Update Status reported to Contractual Issue Committee

9.00 via Zoom-21/04/21 1. March 2021 Queens Bower Surgery – GP took the decision to end the contract and a caretaking arrangement was put in place. Ongoing contract termination Rise Park Surgery is providing a temporary caretaking arrangement until 30 September 2021, from the Queens Bower Surgery premises. Patient engagement has taken place and a report is being prepared. An options appraisal will be presented to Confidential Committee in May 2021. 2. March 2021 Sherwood Medical The Sherwood Medical Partnership (SMP) informed the CCG of their decision to exit Ongoing Partnership – branch site providing services from Farnsfield Surgery (branch of Sherwood Medical Partnership). This (Farnsfield Surgery) decision was communicated to staff, patients and stakeholders in December 2020. Options for the future of the branch site were presented to the Confidential Committee, who approved a local expression of interest process to find a permanent solution. The outcome of this process was communicated to Confidential Committee in March 2021. Patient letters and stakeholder communications commenced 12 April 2021. The new provider; has completed their due diligence; the transition will take place in May 2021. 3. March 2021 Bilborough Surgery – In February 2021, the contract holder for Bilborough Surgery submitted three months’ notice Ongoing Practice Closure to terminate the GMS contract. The contract end date is the 5 May 2021. Confidential Committee approved the option to allocate patients to a practice closest to their home address in February 2021. Allocation of patients provided the safest way to avoid unnecessary attendance at practices to register during the COVID pandemic. Patients still

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NHS Nottingham and Nottinghamshire Clinical Commissioning Group Primary Care Commissioning Committee – April 2021 Public Meeting

Ref. Date last Description of Update Status reported to Contractual Issue Committee have a choice to register at another practice if they live within the practices boundary. Patient letters and stakeholder communications were sent week commencing 5 April 2021. Discussions undertaken with neighbouring practices who will receive encrypted patient details. The CCG continue to work with the contractor to monitor the exit process. 4. March 2021 Platform One Practice – The Platform One Practice contract will come to its natural end 30 June 2021. Following an Ongoing Contract Update external procurement process, Nottingham City GP Alliance (NCGPA) was awarded the contract to provide primary care services from Upper Parliament Street, Nottingham. The 9.00 via Zoom-21/04/21 new practice is called Parliament Street Medical Centre. The new contract with NCGPA will commence 1 July 2021. The new boundary for the practice means that 7,800 patients that reside in the boundary (currently registered with Platform One Practice) will transfer to the new practice. The remaining 3,000 patients that reside outside the boundary (currently registered with Platform One Practice) will be allocated to a practice closest to their home address. Communications have been sent to all patients, the CCG recognises that a letter is not the only or always the best method. A Stakeholder Group has been established as an expert panel to support patient engagement during the mobilisation period. Meetings have taken place on 3 March 2021 and 7 April 2021 with a number of agreed actions to progress highlight reports from the Group will be provided to the Committee. Regular mobilisation meetings are taking place with NCGPA and further communications will be shared with patients and stakeholders, as agreed by the Group. 5. October Leen View Surgery – A paper was presented at the October 2020 meeting with an update regarding the Ongoing 2020 Boundary Change temporary boundary reduction and request for a permanent boundary reduction. All recommendations were approved and communicated to the practice. The Committee deferred the decision on the boundary at the site of the Acer Court and Alder House care

Page 2 of 4 Contract Management update

NHS Nottingham and Nottinghamshire Clinical Commissioning Group Primary Care Commissioning Committee – April 2021 Public Meeting

Ref. Date last Description of Update Status reported to Contractual Issue Committee homes until the GP alignment of the Enhanced Health in Care Homes (EHCH) Directed Enhanced Service was agreed. The permanent boundary change will be re-presented to Committee at the April 2021 Open Session. 6. October Giltbrook Surgery – A paper was presented at the October 2020 meeting with an update regarding the Ongoing 2020 Boundary Change temporary boundary reduction and request for a permanent boundary reduction. All recommendations were approved and communicated to the practice. The Committee deferred the decision on the boundary at the site of the Acer Court and Alder House care

9.00 via Zoom-21/04/21 via 9.00 homes until the GP alignment of the Enhanced Health in Care Homes (EHCH) Directed Enhanced Service was agreed. The permanent boundary change will be re-presented to Committee at the April 2021 Open Session. 7. December Whyburn Medical Practice Primary care services for Whyburn Medical Practice patients are currently being provided Ongoing 2020 – Contract Update through a temporary caretaking arrangement. An external procurement process took place to secure a permanent provider; the successful provider is Primary Integrated Community Services (PICS) – the current temporary provider. The contract with PICS will start 1 July 2021. This is a contract change. There will be no change to patient care; patients will continue to receive primary care services from the current location. Contract documentation is currently being prepared and mobilisation is on schedule. 8. December Peacock Healthcare – Primary care services for Peacock Healthcare patients are currently being provided through Ongoing 2020 Contract Update a temporary caretaking arrangement. An external procurement process took place to secure a permanent provider; the successful provider is Primary Integrated Community Services (PICS) – the current temporary provider. The contract with PICS will start 1 July 2021. This is a contract change. There will be no change to patient care; patients will

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NHS Nottingham and Nottinghamshire Clinical Commissioning Group Primary Care Commissioning Committee – April 2021 Public Meeting

Ref. Date last Description of Update Status reported to Contractual Issue Committee continue to receive primary care services from the current location. Contract documentation is currently being prepared and mobilisation is on schedule. 9. December Bilborough Medical Centre Primary care services for Bilborough Medical Centre patients are currently being provided Ongoing 2020 – Contract Update through a temporary caretaking arrangement. An external procurement process took place to secure a permanent provider; the successful provider is Nottingham City GP Alliance (NCGPA) – the current temporary provider. The contract with NCGPA will start 1 July 2021. This is a contract change. There will be no change to patient care; patients will continue to receive primary care services from the current location. Contract

9.00 via Zoom-21/04/21 documentation is currently being prepared and mobilisation is on schedule. 10. December Grange Farm Medical The Grange Farm Medical Centre contract will come to its natural end 30 September 2021. Ongoing 2020 Centre – Contract Update An external procurement process took place to secure a provider; the successful provider is Nottingham City GP Alliance (NCGPA). The contract with NCGPA will start 1 October 2021. This is a contract change. There will be no change to patient care; patients will continue to receive primary care services from the current location. Contract documentation is currently being prepared and mobilisation is on schedule.

Page 4 of 4 The 3rd way - working together across PCNs to deliver the EHCH Care Homes DES

Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: The Third Way - Working together across Paper Reference: PCC 21 011 PCNs to deliver the Enhanced Health in Care Homes (EHCH) Designated Enhanced Service (DES) - border care home alignment project

Sponsor: Michelle Tilling Appendices: Appendix 1 Locality director CITY Memorandum of Nottingham and Nottinghamshire CCGs understanding (MOU) Presenter: Michelle Tilling Locality director CITY Nottingham and Nottinghamshire CCGs

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

Executive Summary

Arrangements for Discharging Delegated Functions

Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts Delegated function 5 – Decisions in relation to enhanced services

Summary: This paper is supplied to support general practice border changes and to update PCCC regarding two unaligned care homes from October 2020.

It describes the context, aims and governance of the project, including who was involved and which tools were employed and finally the outcome.

Using a collaborative cross-PCN project group, local engagement and nursing interventions, the two care homes have been aligned, meeting the request of PCCC by the stated deadline and the requirements of the EHCH DES.

Outcome: 1. Alder House is aligned to Bilborough Medical Centre and the lead clinician will be Dr Richard Churchill. BACHS PCN in City. 2. Acer Court is aligned to Parkside Medical Practice, shared with St Albans practice. The lead clinician will be Dr Andrew Foster from Parkside. Bulwell & Top Valley PCN in City.

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Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☒ (e.g. ICP, PCN development) Financial Management ☐ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☐ Conflicts of Interest: ☒ Conflict noted, conflicted party can participate in discussion and decision (GPs) GPs are conflicted but may take part in discussions Completion of Impact Assessments: Equality / Quality Impact Yes ☒ No ☐ N/A ☐ Assessment (EQIA) Data Protection Impact Yes ☒ No ☐ N/A ☐ Assessment (DPIA) Risk(s): No risks identified Confidentiality: ☒No Recommendation(s): 1. The committee RECEIVE & NOTE the outcome and use the information to inform any border change requests from local GP practices.

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PCCC open session KMc 15.4.21

The 3rd way: Working together across PCNs to deliver the EHCH Care Homes DES: Border care home alignment project.

Background This paper is supplied to support primary care with practice border changes and to update the PCCC regarding two unaligned care homes from October 2020. It explains the context, aims and governance of the project, who was involved and which tools were employed, finishing with nursing interventions and finally the outcome.

Following a Primary Care Commissioning Committee (PCCC) paper received on Friday 19 August 2020, locality deputy directors facilitated discussions to plan how agreed alignment would occur for 2 care homes which had no apparent GP alignment. The care homes historically received care from different GP practices and this had led to clinical variation for the residents and multiple processes for the staff to follow.

The Enhanced Health in Care Homes (EHCH) Designated Enhanced Service (DES) specification states that the CCG has the overall responsibility to align each care home within their geographical area to a single Primary Care Network (PCN). This alignment should be agreed jointly with the care home and the PCN where possible. In the case of Acer and Alder, since several local GP practice boundaries overlapped there was no obvious initial solution. Subsequent PCN discussions meant agreement was not reached In this example, the CCG can, acting reasonably, allocate a care home to a PCN if agreement cannot be reached. Where a care home is allocated to a PCN, that PCN must deliver the Enhanced Health in Care Homes service requirements in respect of that care home in accordance the DES. Locality teams and all PCN clinical directors wished to avoid any forced allocation. The preferred course of action was to understand more about the needs of the homes, alongside the pressures of general practice and how a PCN to PCN agreement could be facilitated.

Aim of the project ∑ Provide a joint approach between PCNs in the City and PCNs in South Nottinghamshire to find an agreed aligned PCN (or practice) for both Acer and Alder Care Homes. ∑ An opportunity for Clinical Directors who lead the PCNs to think innovatively about the provision of care ∑ The approach agreed must be cost neutral and align with current investment ∑ To meet DES requirements: this solution is required to be in place by 1st October 2020 ∑ A task and finish approach will provide motivation to find solutions quickly.

Role of localities: initiating and facilitating the project The deputy locality directors initiated the project, agreed aims and objectives and engaged the Local Medical Council (LMC). They organised meetings with their administrative and PCN development teams. This was all in the context that the clinical directors took the lead in discussions, ideas and meetings. This was in the context that clinical directors and PCNs that were only formed less than a year prior. The project team did not have formal terms of reference but used their clinical knowledge and professional approach to set the tone of meetings, creating an environment for to discussions. Attendees acknowledged everyone’s contributions and demonstrated their commitment to regularly meeting and making a difference to patient care.

Project governance: The locality leads fed back to the locality directors meetings, with verbal updates as standing agenda items. This is where advice and guidance was received about any next steps. There were no financial requirements or decisions for the CCG, so no additional papers were taken to PCCC. Risks and issues were managed within the project team and there were no concerns escalated to the locality directors. Each locality also provided updates as part of the clinical director/ICP care home updates.

Stakeholder engagement Page 1 of 4

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PCCC open session KMc 15.4.21

This was important to avoid any misunderstanding between care providers, GP contracts or quality of care. The project team wished to avoid any misunderstanding between care providers. This project was designed to align care homes to PCNs and ultimately wanted to hear and act upon the views of care home staff and their residents.

1 CityCare City locality engaged with the CityCare care homes team. This was initially to ask for resource or time commitment, but ultimately led to a deeper understanding and support for the project. Talking to colleagues and explaining the aim of the project made a difference. The care home team were able to work alongside the nurse colleague from PiCs (see nurse intervention below).

2 Care home staff Several virtual meetings took place with the lead nurses of each care home (one care provider). This included explanation of the project, which possible interventions might occur and reassurances about the objectives. The deputy locality directors answered questions and were able to hear lived experience of caring for complex patients when communication with GP practices in PCNs doesn’t always go smoothly. The care home leads were given time to tell their experiences of working with previous GP practices within several PCNs. This identified some complicated processes such as limitations on calls, outdated pre- conceptions of care home work, shared perceptions and continued use of fax machines. It also allowed the care home teams to suggest ways forward and share their enthusiasm for change. This provided a foundation for a Primary Integrated Community Services (PiCs) EHCH nurse to go to the home and provide hands-on education and more in-depth interventions

Role of the LMC Lucy Cassidy deputised for the chief executive of the local medical council (LMC) and played a key role in ensuring that the project process, approach and discussions were fair and open. This created a culture of “all in it together” rather than “being done to”. The group used LMC offices to meet when they required a venue for process mapping. The supportive nature of this project may not have been successful without the presence of the LMC. This is because they do not have a commissioner/provider relationship with any PCN and maintain a supportive role to general practice.

Meetings and MOU At the beginning of the project it was acknowledged that the best way to support collaboration was the use of an MOU. This meant that all parties could appreciate the commitment of the other. The MOU comprised roles and responsibilities and showed intent to work together with localities. This was embraced and signed by the clinical directors. The deputy locality directors, as CCG officers, signed this on behalf of the CCG. During meetings, clinical directors described local pressures regarding practice workforce and the ratio of care homes to practices in primary care was analysed. This gave a shared understanding of the task at hand and an agreement to find a solution. There was an acknowledgement that “something different” would be required to achieve a suitable outcome. Clinical directors suggested using quality improvement techniques such as process mapping.

Quality improvement tool: process mapping Use of the tool, process mapping enabled the team to create a visual picture of how the pathway currently works within a care home. It captured the reality of requesting home visits, calling GPs, GPs calling the home staff and exposed areas of duplication, waste, unhelpful variation and unnecessary steps. Mapping all views and perspectives helped to build working relationships and across functional and organisational boundaries. Everyone focused on making improvements that might have the biggest impact for patients and staff. The facilitation of the LMC allowed this to happen without blame and with the main focus remaining on reaching an agreement that would be best for the patients. The professionalism of the group meant that they were able to hear feedback and work through issues constructively.

People involved: ∑ Dr. Tim Heywood CD West PCN (South Nottinghamshire locality) ∑ Dr. Jonathan Harte GP Partner Aspley Medical and CD PCN BACHs City

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PCCC open session KMc 15.4.21

∑ Dr. Mark Salisbury GP Partner Rise Park and Deputy CD PCN Bulwell Top Valley City ∑ Dr. Andy Foster GP Partner Parkside Medical and CD PCN Bulwell Top Valley City ∑ Liz Harris deputy locality director South Nottinghamshire locality CCG staff ∑ Kate McCandlish deputy locality director City CCG staff ∑ Caroline Brew PCN development manager City CCG staff ∑ Lucy Cassidy LMC (local medical committee) ∑ Richard Murray locality administrator South Nottinghamshire locality CCG staff ∑ Jessica Waterhouse Advance Care Planning Nurse PiCs - Enhanced Health in Care Homes Service

Estimation of hours e.g. meetings Total hours education and training in both care homes 4hrs x 8 weeks = 36 hours 27th August 2020 – 3rd December 2020 6 meetings took place weekly 5 meetings took place fortnightly 3 engagement meetings 3 hour process mapping session 20.5 hours Spread sheet production 3 Plus planning, writing, calls and catch ups 15 ESTIMATED total 75 HOURS

The LMC observed: “The meetings were an excellent example of collaborative working across PCN boundaries. The group remained positive and solution focused throughout and each meeting had excellent engagement and attendance”.

PiCs nurse intervention

Nottingham West PCN arranged for a senior nurse to be released from her role for up to 8 weeks to work in the City on this project within both care homes. This was accepted as practical support to benefit the project by being able to detect improvement opportunities and find real solutions directly alongside care home staff. The PiCs nurse linked in with the CityCare care homes team, where there was already a strong relationship. However, PiCs were able to spend dedicated time listening to patients and staff and feeding back directly to all parties via the project group. The nurse supported each care home by reviewing their experiences and representing them at the process mapping. Some of the operational work and education included: ∑ Dietician referrals increased and created better support for Care Homes ∑ Agreed GP template (based on SBAR tool) to request home visits or clinical review ∑ New communication processes on each floor of each home including use of NHS.net email as an improved way of requesting non-urgent items such as prescription changes ∑ Insulin administration to be taken forward as part of CityCare training in Care Homes

Several weeks after PiCs had completed their work, improvements were reported by a visiting GP regarding staff training, in particular, the increased completeness of RESPECT (advanced care plan) forms. The GP also reported that staff appeared to be empowered to make improvements.

Summary Outcome: Care Home alignment has been agreed. 1. Alder House is aligned to Bilborough Medical Centre and the lead clinician will be Dr Richard Churchill. This is in City BACHS PCN.

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PCCC open session KMc 15.4.21

2. Acer Court is aligned to Parkside Medical Practice, shared with St Albans practice. The lead clinician will be Dr Andrew Foster from Parkside. City Bulwell & Top Valley PCN.

The project team identified the following additional outcomes:

∑ Clinical directors provided innovative solutions and took a leadership role. ∑ Practices heard feedback on their own systems or perception of their systems from care homes. ∑ Care home staff were heard and subsequently empowered to improve care for patients. ∑ Improved communication processes for each home to/from each GP practice ∑ This led to reduced “on the day” demand for the GP practices ∑ A shared understanding of care home issues across PCNs ∑ Planned pro-active care is now regularly provided by aligned GP practices. ∑ This was all provided with no cost to the CCG or ICS system.

Finally, all members of this project group have found the work hugely rewarding and enjoyable. This paper has therefore been created to acknowledge the success of the group working across traditional boundaries.

“Giving the PCNs time to reflect, plan and find solutions together for care home alignment meant that initial reservations expressed about additional PCN/practice workload could be addressed and managed.”

The committee is asked to NOTE the paper for acknowledgement of the outcomes

Appendix 1 Memorandum of understanding used in this project.

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Memorandum of Understanding between Bulwell & Top Valley PCN BACHS PCN Nottingham West PCN

For provision of the Enhanced Health in Care Homes Service Specification for Acer Court Care Home and Alder House Care Home

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1. Parties to this agreement are: Bulwell & Top Valley Primary Care Network, City Locality BACHS Primary Care Network, City Locality Nottingham West PCN, South Notts Locality

2. Purpose of this Memorandum of Understanding This memorandum of understanding is intended to define the relationship between the Parties to this Agreement in terms of operational, clinical and governance accountabilities and liability and accountability for clinical decisions made during any assessment with patients in Acer Court and Alder House Care Homes.

The arrangements are necessary to support the effective implementation and management of the Enhanced Health in Care Homes service specification in line with the Primary Care Network DES. There are clear benefits for patients and the care homes from the successful implementation of this service. Each of the Parties is committed to enhancing its reputation for practical delivery of innovative health services through effective team work through the implementation of the service specification.

3. Introduction Commissioners have overall responsibility for aligning each care home to a single PCN as identified within the Primary Care Network DES. Where possible, this alignment should be defined and agreed jointly with the care home and the PCN. In aligning homes to practices, PCNs and CCGs are expected to consider: • where the home is located in relation to practices/PCNs; • the existing GP registration of people living in the home; • what contracts are already held between CCG and practices to provide support to the homes • directly between the home and practices; and • existing relationships between care homes and practices.

Acer Court and Alder House care homes currently have no agreed alignment to a Primary Care Network. City GPs currently cover both these care homes, outside of their ICP boundary and have expressed a wish to change alignment. Community services for both homes are provided by CityCare. It is recognised that the alignment of care homes is complex and that significant work has taken place to ensure that the majority of care homes are aligned to Primary Care Networks with clinical leadership in place. An agreement is to be reached to ensure these care homes are aligned to a PCN or an alternative arrangement is in place.

4. Purpose and Scope Following the outcome of a paper presented to the Primary Care Commissioning Committee in August 2020, City locality and South locality are facilitating discussions to plan a “third way” to provide care for these two border homes as follows:

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• A joint approach between PCNs in the City and PCNs in South Nottinghamshire is agreed following facilitated discussions • An opportunity for Clinical Directors to think innovatively about the provision of care • The approach agreed must be cost neutral and align with current investment • For system partners to jointly support options with staffing resource, time and utilisation of the Network DES funding allocated to support Acer Court and Alder House. • Discussions must conclude with agreed solution by 30th September 2020. • To meet DES requirements: this solution is required to be in place by 1st OCT 2020

The Parties have agreed to work together to support these care homes from 1st October 2020 with a view to developing a third way agreement with all Parties as well as community providers in order to deliver the Enhanced Health in Care Homes service specification.

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Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: Leen View Surgery: Permanent Boundary Paper Reference: PCC 21 012 Reduction - Deferred Decision

Sponsor: Joe Lunn, Associate Director of Primary Attachments/ Appendix One: Care Appendices: Updated EQIA Presenter: Joe Lunn, Associate Director of Primary Care

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

Executive Summary Arrangements for Discharging Delegated Functions Delegated function 2 - Plan the primary medical services provider landscape, including considering and making decisions in relation to agreeing variations to the boundaries of GP practices. Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts

At the October 2020 meeting of the Nottingham & Nottinghamshire CCG Primary Care Commissioning Committee (PCCC), the decision to reduce the Leen View Surgery practice boundary, at the site of Acer Court and Alder House care homes, was deferred until GP alignment for the Enhanced Health in Care Homes (EHCH) DES was agreed. Agreement between the Primary Care Networks (PCNs), with support from the Locality Teams has been reached; a separate paper outlining this work is being presented to PCCC by the Nottingham City Locality Team (April 2021 meeting).

The purpose of this paper is to outline the proposed permanent boundary change for Leen View Surgery, following the agreed GP alignment for the EHCH DES. The practice request to reduce this area of their boundary is also a result of list size growth, capacity and workforce, and to enable the practice to focus on Bulwell patients living within the immediate areas surrounding the practice.

There are no financial implications for the CCG.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☐ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☐ Conflicts of Interest:

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☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☒ No ☐ N/A ☐ Included in the report Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not applicable to this item Assessment (DPIA)

Risk(s): A risk is that without a change in practice boundary Leen View Surgery would be required, under the terms of the GMS/PMS GP Contract, to register those patients’ that decline registration with the aligned Nottingham City GP practices.

Confidentiality: ☒No Recommendation(s): 1. The Primary Care Commissioning Committee is asked to APPROVE the application for a permanent boundary reduction.

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Leen View Surgery Application for Boundary Reduction

1. Introduction

The Primary Care Commissioning Committee (PCCC), at its October meeting, approved a boundary reduction for Area B of the Leen View Surgery practice boundary (removal of part of the central Cinderhill and the Old Basford areas). However, the decision to reduce Area A of the practice boundary, to remove the Acer Court and Alder House residential older persons care homes, was deferred.

The purpose of this paper is to outline the proposed permanent boundary reduction. This is following the agreed GP alignment to the care homes as required for the Enhanced Care in Care Homes DES; a service specification that is part of the Network Contract DES. The boundary reduction will also help to manage the growth of the practice list, challenges with workforce and capacity, and to enable the practice to focus on Bulwell patients living within the immediate areas surrounding the practice.

2. Background

On Friday 9th April 2021 the Leen View Surgery confirmed to the Primary Care Commissioning Team that it is still the intention of the practice to request a permanent boundary reduction. The request to reduce the practice boundary will remove the lower part of the Cinderhill area, nearest to the Broxtowe Country Park, that covers part of the NG8 6 and NG16 1 postcode areas. This area includes the two care homes, Acer Court and Alder House.

As noted in the paper presented to PCCC in September 2019, the practice cites several difficulties they are currently facing as justification for reducing the practice boundary, these include;

2.1. List Size Growth The practice was originally established to serve a patient list of circa 8,500 patients; the list size is currently 9,500 (raw) 10,300 when applying the car-hill formula (weighted). The Nottingham City Primary & Community Services Estates Strategy (Estates Strategy) published in 2016 also identified that Leen View Surgery had a higher than average number of patients per clinical room.

The practice list size has grown steadily since April 2018, increasing by 383 over the course of the 2018/19 financial year with an overall increase of 329 patients between April 2018 and January 2021. During this time a temporary boundary reduction was enacted (October 2019 and September 2020).

Between April 2019 and July 2019, the practice list size reduced by 318 patients, following a list cleansing exercise to remove out of area patients. The practice percentage growth has risen by 3.5% since April 2018; a quarterly breakdown of the list size growth and percentage change per quarter is detailed in the table below.

Month Raw List Size Quarterly Change in Practice list size % list size change April 2018 9,172 July 2018 9,237 65 0.7% October 2018 9,365 128 1.37% January 2019 9,483 118 1.25% April 2019 9,555 72 0.75% July 2019 9,237 - 318 -3.44% October 2019 9,339 102 1.09% January 2020 9,365 26 0.28% April 2020 9,418 53 0.56% July 2020 9,392 - 26 -0.28% October 2020 9,424 32 0.34%

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January 2021 9,501 77 0.81%

Since October 2019, and during the temporary boundary reduction period, the practice’s list size has grown by 162 patients. This indicates that the patients requesting to register at the practice reside within the Bulwell area and not necessarily within areas A or B of the practice boundary.

2.2. Capacity and Workforce The practice has 10 clinical rooms which are in full use daily. The Estates Strategy highlighted that Leen View Surgery has a higher than average number of patients per clinical room and has the highest number of patients per clinical room within their local ward area. The Estates Strategy indicated that due to its location, within a multi-occupied LIFT building, it does not have any site development potential. Therefore, the only practical solution is for the practice to collaborate with other tenants within the LIFT building to explore opportunities to optimise capacity. The practice does this, they share meeting rooms and staff rooms with their neighbouring practice, Parkside Medical Practice, and are jointly exploring whether a meeting room could be used as a hot desk room for clinical administration.

The practice has reviewed its room utilisation to ensure it is as efficient as possible, ensuring that rooms are utilised to maximum capacity. A hot-desk working environment is in operation whereby a clinical room is not assigned to a single GP. As well as rooms for GP appointments the practice accommodates various agencies who work closely with patients at the practice which include: Phlebotomists, Nurse, Health Care Assistants, Community Dietician, Mental Health team, Medical Student training and Research projects.

To help alleviate room pressures the practice have explored options such as home working for telephone consultations and are exploring converting meeting room space to be more beneficial for clinical work. The lack of room space for GP sessions impacts how the practice can expand the workforce in order to support the growing population.

The latest General Practice Workforce Data gathered in December 2020 and published in February 2021 showed that the practice has a Full Time Equivalent (FTE) GP (excluding Locums and Registrars) of 3.52 and a list size of 9,501; this makes the GP/ Patient ratio 2:699.

In October 2020, the practice informed commissioners of the potential forthcoming retirement of a full time partner at the practice which will have a direct impact on the clinical workload and the capacity to provide safe and high level care to the patients in Bulwell.

The practice has stated that if the boundary area is not reduced, access to appointments will become more difficult to manage, GPs workload will continue to increase, and the sustainability of the practice may be compromised, which may result in more intensive support needed in the future.

2.3. Local Area The area of Bulwell where the practice is situated is an area of high deprivation and patient need, this is reflected in their patient population. The practice has a deprivation score of 44.7 (IMD 2019) compared to an England average of 21.7. The practice reports higher incidences of cancers, diabetes and mental health issues, as well as higher levels of safeguarding issues and patients with complex needs. These patients often require more intensive support from clinical staff and this is reflected in the weighted list size which increases the list size by almost 1,000.

3. PCN Update

3.1. Proposed Area of Reduction Leen View Surgery is proposing to remove the area, identified within the black line, from their boundary (Area A). This area includes the site of Acer Court and Alder House Care Home, two primary schools (Horsendale County Primary School and Rosslyn Park Primary and Nursery School) and an area of residential dwellings.

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3.1.a Map 1 – NG8 6 and NG16 1 (Area A) 3.1.b Map 1 – GP Practice Boundaries that cover Area A The Area A outlined in black currently forms part of The colours shown on the map indicate the GP Practice the Leen View Surgery practice boundary. The boundaries that cover Area A. orange highlighted area is the Leen View Surgery practice boundary.

The above maps are taken from the SHAPE: place atlas portal. The number of patients registered with Leen View Surgery that reside within Area A totals circa. 300 patients, approximately 54 of these registered patients reside at Alder House and Acer Court care homes.

Area A is also covered by the boundary of 4 other Nottingham City practices. The table below shows the number of patients living in Area A that are registered with these practices:

Primary Care Network (PCN) GP Practice Density of Patients located within Area A Bulwell and Top Valley PCN (PCN 1) Leen View Surgery Circa. 300 patients Bulwell and Top Valley PCN (PCN 1) Parkside Medical Practice Circa. 300 patients BACHS PCN (PCN 3) Bilborough Medical Centre Circa. 600 patients BACHS PCN (PCN 3) Greenfields Medical Centre Circa. 30 patients BACHS PCN (PCN 3) Lime Tree Surgery Circa. 600 patients

There are approximately 1,830 patients that reside within the NG8 6 and NG16 1 postcode areas (Area A). 16.4% are registered with Leen View Surgery; this is a lot lower than patients registered with Bilborough Medical Centre and Lime Tree Surgery (both have 33% of the population each).

Patients that are registered with Leen View Surgery that reside within the residential dwellings in Area A will remain registered with the practice.

The Primary Care Commissioning Team informed the Bulwell and Top Valley PCN member practices that an update paper will be presented to PCCC, to re-consider Leen View Surgery’s request to permanently remove Area A from the practice boundary. There has been no further feedback from the member practices following this communication.

3.2. PCN Solution for Acer Court and Alder House An agreement has been reached between Nottingham West PCN and Nottingham City PCN 1 & PCN 3, with the support of the Locality Teams, for the alignment of GP practices to care homes under the Enhanced Health in Care Homes (EHCH) DES. Acer Court will be aligned with Parkside Medical Practice, supported by The Practice St Albans (both PCN 1), and Alder House with Bilborough Medical Centre (PCN 3). The agreement necessitates current and new care home residents to register with the aligned Nottingham City practices. However, if a resident decides not to transfer to or register with the GP practice aligned with the care home, the resident would continue to receive core GP service, as detailed in the GMS/PMS/APMS GP contract, at one of the five Nottingham City practices that have a boundary covering the site. If the proposed reduction to exclude Acer Court and Alder House from the practice boundary is not approved, Leen View Surgery would also be required to register patients. Page 5 of 6

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The committee is asked to note that a separate paper will be presented at a later date to propose the extension of The Practice St Albans boundary to cover the site of Acer Court Care Home.

The EHCH service requires GP practices to support MDTs and provide weekly care home rounds; these will only be delivered to residents registered with the aligned GP practice or PCN. Other elements of the DES will be provided to all residents, irrespective of the alignment by their registered GP practice, such as medication reviews. There may be some cross boarder complexity in the delivery of services given the homes are located within the County Council boundary and the registered GP practice is in the City. How community services and those services commissioned by the Local Authorities are to be delivered has been considered as part of the Locality Teams review. Community service providers will continue to provide those services they are commissioned to deliver in the care homes.

Should the EHCH DES cease or the requirements for alignment change, the PCNs would need to consider other arrangements for patient registrations outside of the agreement with Nottingham City PCN 1 and PCN 3. Equally, should a planning application for change of use to private dwellings be submitted, with Acer Court and Alder House no longer care homes, a new arrangement would need to be agreed.

4. Recommendation

It is recommended that committee APPROVE the permanent boundary reduction for Area A.

As Area A includes the site of Acer Court and Alder House care homes, to caveat that Leen View Surgery continue to provide primary care medical services, with support from Bulwell and Top Valley PCN and BACHS PCN, for those patients who wish to stay registered to Leen View Surgery.

Patients registered with Leen View Surgery that reside within the residential dwellings in Area A will remain registered with the practice.

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Nottingham and Nottinghamshire CCG’s Equality and Quality Impact Assessment

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

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

EQIA Standard V3 EQIA Process Operating Procedure Without Appendices EmbeddedFlowchart updatedJuly 2020.docx Sept2020.docx

The EQIA is designed to:

∑ Assess the impact of proposed changes in line with the CCG’s duty to reduce health inequalities in access to health services and in health outcomes ∑ Assess the impact of proposed changes to services in line with the CCG’s duty to maintain and improve the three elements of quality (patient safety, patient experience and clinical effectiveness) ∑ Assess whether proposed changes could have a positive, negative or neutral impact, depending on people's different protected characteristics defined by the Equality Act 2010 ∑ Identify any direct or indirect discrimination or negative effect on equality for service users, carers and the general public ∑ Consider the impacts on people from relevant inclusion health groups (e.g. carers, homeless people, people experiencing economic or social deprivation) ∑ Identify where any information to inform the assessment is not available, which may indicate that patient engagement is required ∑ Provide a streamlined process to enable the escalation of any risks and prevent equality and quality risks from being considered in isolation ∑ Support in determining whether a project can proceed, proceed with identified action, or not be progressed

EQIAs are ‘live’ documents, and as such, are required to be revisited at key stages of project development and implementation, particularly following the conclusion of any engagement and consultation activities to inform decision-making. Section 1: Project Overview

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Proposal / Project Title: Leen View Surgery Boundary Reduction (Bulwell and Top Valley PCN) Project / Commissioning Lead: Serena Broughton, Primary Care Commissioning Officer Senior Responsible Commissioning Lead: Lynette Daws, Head of Primary Care Quality Directorate Lead: Esther Gaskill, Head of Quality Primary Care Patient Engagement Lead: EQIA Completed By / Date: Fiona Warren, Primary Care Commissioning Manager / September 2019 EQIA Updated By / Date: Serena Broughton, Primary Care Commissioning Officer / April 2021 Description of Project: (Include all relevant documents) Proposal is for the GP practice to reduce its practice boundary. The main drivers for the application are: ∑ To help manage their growing list size and capacity issues of the practice. This is impacting upon their ability to provide timely access to services for their patients i.e. more patients, limited number of appointments, greater waiting lengths, could impact upon patient safety as patients wait longer for appointment or patients seek urgent care as an alternative. Access issues were recently raised by the CQC; ∑ The practice is unable to increase its workforce as they are limited with the physical space of their building and unable to expand this as it is a multi-occupancy LIFT building; ∑ The area includes 2 care homes and the practice advises this has a significant impact on their capacity as greater GP and Nurse input is required and home visits are requested on an almost daily basis. A large proportion of administration work is also required from these homes; ∑ The practice wishes to focus service delivery for the immediate Nottingham City area (Bulwell) which is a deprived high need area. The area affected by the proposal sits within Nottinghamshire County and does present some issues when referring patients to community and local authority services, however, this is not unique and is experienced by other practices located on the boundary of Nottingham City.

There are approximately 300 patients registered at Leen View from the affected area, this includes 54 patients registered across the two care homes.

If the boundary reduction is approved the patients already registered at the practice remain registered i.e. the practice cannot de-register them unless the patient moves outside of their boundary. The practice can however refuse any new registrations from the affected area.

Although the practice cannot remove the patients currently registered in the areas of reduction, if the proposed boundary reduction were approved, it will allow Leen View Surgery to decline new patients resident in these areas now and give them more control over the future list size growth. To note, new family members including babies joining a household located within the area of reduction that is registered at Leen View Surgery will be accepted as new patients by the practice.

The proposed removal of Acer Court & Alder House care homes is recommended to be deferred subject to approval of GP alignment for the purpose of the Enhanced Health to Care Homes (EHCH) DES. This EQIA will consider the impact on the registered population resident in these two care homes on the basis that if they were to remain within the boundary of Leen View Surgery or the boundary reduced to no longer cover the home, the residents will continue to have access to core GP services delivered primarily at the home, and receive an enhanced level of care as part of the EHCH DES from a variety of clinicians as part of the Care Home Team. The residents would not be advantaged nor disadvantaged by remaining registered at Leen View Surgery or registering at another local practice, as care would be delivered as part of standard GMS services and a defined service specification (EHCH).

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April 2021 Update Consideration of the proposed removal of Acer Court & Alder House care homes from the Leen View Surgery boundary was deferred at the PCCC October meeting subject to approval of GP alignment for the purpose of the Enhanced Health to Care Homes (EHCH) DES.

The Primary Care Networks (PCNs) of Nottingham West and Nottingham City PCN 1 & PCN 3, with the support of the Nottingham City and South Nottingham Locality Teams, have reached agreement on the alignment of practices with care homes for the Enhanced Health to Care Homes (EHCH) DES. A paper is to be presented to the April PCCC.

A separate EQIA with regards to the alignment and impact on patients/residents has been completed by the Locality Team.

Acer Court Care Home, 172 Nottingham Road, Nottingham NG8 6AX is to be aligned to Nottingham City PCN 1: Bulwell & Top Valley

∑ Parkside Medical Practice ∑ St Albans Medical Centre

The boundary of St Albans Medical Centre does not currently extend to Acer Court Care Home. A boundary extension application is to be submitted in due course; however the practice in the meantime is able to register patients.

Alder House Care Home, 172A Nottingham Road, Nottingham NG8 6AX is to be aligned to Nottingham City PCN 3: BACHS

∑ Bilborough Medical Centre

Leen View Surgery will not be aligned with Acer Court or Alder House for the purposes of the EHCH DES. This represents no change for patients.

PCCC will be recommended to approve the boundary reduction in light of this local decision.

Identify Area Affected (CCG wide / Locality / Primary Care Network (PCN)): Nottingham & Nottinghamshire CCG ∑ Nottingham City Locality o Bulwell & Top Valley PCN o BACHS PCN o Nottingham City South PCN ∑ Mid-Nottinghamshire Locality o Ashfield South PCN ∑ South Nottingham Locality o Nottingham West PCN Derby & Derbyshire CCG

April 2021 Update: Area Affected Nottingham & Nottinghamshire CCG ∑ Nottingham City Locality o PCN 1: Bulwell & Top Valley PCN o PCN 2: BACHS PCN ∑ South Nottingham Locality o Nottingham West PCN

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Details of Any Supporting Evidence: (When completing this section a review of the latest evidence should be undertaken. Use the checklist provided for sources of evidence and trusted websites to visit to find evidence. Describe the key findings from your evidence search and how they have informed this scheme) If you have been unable to find evidence, please describe what you have based this project on instead (e.g. activity data, population data, patient experience or public engagement intelligence, clinical opinion etc.):

Leen View Surgery: List size changes Month Raw List Size Quarterly Change in Practice list size % list size change April 2018 9,172 July 2018 9,237 65 0.7% October 2018 9,365 128 1.37% January 2019 9,483 118 1.25% April 2019 9,555 72 0.75% July 2019 9,237 - 318 -3.44% October 2019 9,339 102 1.09% January 2020 9,365 26 0.28% April 2020 9,418 53 0.56% July 2020 9,392 - 26 -0.28% October 2020 9,424 32 0.34% January 2021 9,501 77 0.81%

Workforce - as of 1st April 2020: 3.52 WTE GPs / GP to Patient Ratio 1:2,699.

CQC Rated Good December 2016 o Good: Safe, Effective, Caring, Responsive and Well-Led

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At its October 2020 meeting, PCCC approved the proposed boundary changes with the following amendments to be applied to ensure patient choice and access to primary care services: o Areas to remain within the practice boundary: part of the Highbury Vale and Cinderhill areas but mostly the Bulwell area The Committee deferred the decision on the boundary at the site of Acer Court & Alder House until agreement on GP alignment had been reached. Deadline for agreement 31 March 2021.

A separate EQIA has been completed by the Locality Team with regards to the impact on patients of the alignment of boarder care homes Acer Court and Alder House.

April 2021 Update The alignment of GP practices with care homes for the Enhanced Health to Care Homes (EHCH) DES has been agreed. Nottingham City PCN 1 & PCN 3 will continue to register patients resident in Acer Court and Alder House. The PCCC at its April 2021 meeting will be asked to consider the proposed Leen View Surgery boundary reduction at the site of Acer Court and Alder House Care Homes.

Leen View Surgery will not be aligned with Acer Court or Alder House for the purposes of the EHCH DES.

Should the terms of the EHCH DES change or the care homes are transferred to private dwellings, the agreement would need to be reviewed. Should PCCC reject the proposed boundary reduction and the two care homes remain within the Leen View Surgery boundary, the practice would be obliged under the terms of the GMS/PMS contract to register the residents. This would be against the terms of the local PCN agreement.

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Section 2: Health Inequalities Assessment

Identify the impact of the project on health inequalities in terms of both outcomes and access for service users? Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. Health inequalities arise because of the conditions in which people are born, grow, live, work and age. These conditions influence opportunities for good health, and how patients think, feel and act, and can shape a patient’s mental health, physical health and wellbeing. See” web based resources” document for further information Positive impact Negative impact No impact N/A Comments/rationale: When completing this section include: ∑ Details of the specific under-served people/groups that will benefit from the project (i.e. where health inequalities are likely to reduce) ∑ Details of the specific people/groups for which health inequalities are likely to increase and any proposed mitigations ie digital pathways to increase inclusion vs the impact on health inequalities ∑ Details of any differential impact between CCG populations.

Patients currently registered at Leen View Surgery may see a positive impact following boundary reduction as their ability to access services could be improved due to the practice not accepting new patients from such a wide geographical area and overall accepting fewer new patients. This results in less demand on the number of appointments available to the patient population which could result in patients accessing appointments more quickly. Travel time for home visits would be reduced.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

For those new patients moving into the areas no longer covered by Leen View Surgery, the majority will have a choice of practices to register with which will predominantly be closer to their home address than Leen View Surgery, thereby reducing travel time. Parkside Medical Practice, a member of the Bulwell & Top Valley PCN (who are co-located with Leen View) is keen to actively increase their list size.

Staff working within the practice would be positively impacted from the reduction in demand and work load pressures which could in turn have a positive impact on the service they offer to patients e.g. less sickness, more time to be spent with patients etc.

April 2021 Update Leen View Surgery will not be aligned with Acer Court or Alder House for the purposes of the EHCH DES. This represents no change for patients.

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Section 3: Protected Characteristics and Inclusion Health Groups Assessment:

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Could the project have a positive or negative impact on people who may, as a result of being in one or more of the following protected characteristic or inclusion health groups, experience barriers when trying to access or use NHS services? In addressing this question, consider whether the scheme could potentially have a positive or negative impact in any of the following areas:

∑ The CCG’s duty to maintain and improve the three elements of quality – patient safety, patient experience and clinical effectiveness ∑ Impact of Covid-19 – taking into account the behavioral shift of the population due to the impact of Covid-19 ∑ Access to services (including patient choice and physical accessibility – access to and within buildings, public transport routes, parking for disabled people) ∑ Accessibility in terms of communication (availability of spoken language interpreters, British Sign Language Interpreters, hearing loops, translated written information) ∑ Digital the shift needs to be carefully designed to ensure it does not affect health inequalities for others, due to barriers such as access, connectivity, confidence or skills ∑ Transfers between services (whether between specialties, care settings, or during a person’s life course) ∑ Safeguarding adults and children ∑ Dignity and respect (including privacy) ∑ Person-centered care (whether patients experience the service as culturally competent / welcoming – not just in terms of patients’ race, but also, for example, their gender identity, religion or belief and sexual orientation and whether patients feel that the service considers both their physical and mental health needs. ∑ NICE requirements ∑ Shared decision-making

It is also important to consider the combination of patients’ characteristics and how those combinations may impact on accessibility. An example is the combination of older age, certain types of disability and economic deprivation; potentially limiting access to services if they are not near a patient’s home or easy to get to by public transport. Also, many of the prompts under specific characteristic / health groups may apply to other groups.

∑ Try to put yourself in patients’ or carers’ shoes ∑ They are accessing health services because they have a physical and/or mental health need ∑ Think about your own experiences, or those of friends or family, when accessing health services. ∑ Not everyone has a regular income, drives, can see or hear, speaks English, is literate or health literate / understands the way health systems work, has a home or safe and supportive networks. Therefore we will all experience access to health services in different ways, often regardless of clinical need. The Equality Impact Assessment Checklist and Quality Impact Assessment Checklist below will help with your considerations:

EIA Assessment QIA Assessment Checklist July 2020.docxChecklist July 2020.docx

i) Impact on the protected characteristic of Age:

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Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

ii) Impact on the protected characteristic of Disability:

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

iii)Impact on the protected characteristic of Gender re-assignment:

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

iv)Impact on the protected characteristic of Pregnancy and maternity:

Positive impact Negative impact No impact N/A

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Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

v) Impact on the protected characteristic of Race (Includes Gypsies, Roma and Travellers):

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

vi)Impact on the protected characteristic of Religion or belief:

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

vii) Impact on the protected characteristic of Sex:

Positive impact Negative impact No impact N/A

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Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

viii) Impact on the protected characteristic of Sexual orientation:

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

ix) Impact on people in any of the following Inclusion Health and other Disadvantaged Groups: ∑ Carers ∑ Homeless people ∑ People who misuse drugs ∑ People working in stigmatised occupations (such as sex workers) ∑ New and emerging communities, including refugees and asylum seekers ∑ People experiencing economic or social deprivation, including those who are long-term unemployed / are geographically isolated / have limited family or social networks ∑ Members of the travelling community (who do not belong to an ethnic group recognised under the Equality Act)

Positive impact Negative impact No impact N/A

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Comments/rationale: (with an indication of which of the above groups have specifically influenced your impact conclusion) With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

Section 4: Assessment of Likely Impact of Controversy

a) Is the proposal likely to result in controversy due to: ∑ The nature of the service ∑ The patients or carers affected

Highly Likely Unlikely N/A Likely Comments/rationale: It is unlikely the proposal will attract controversy.

A small number of complaints may be received from residents moving into the area of reduction, whose neighbours remain registered with Leen View Surgery however following the formal process to reduce their practice boundary the new residents will be unable to register with Leen View Surgery. This is unlikely to cause controversy given the small patient numbers. April 2021 Update

Leen View Surgery will not be aligned with Acer Court or Alder House for the purposes of the EHCH DES. This represents no change to patients.

b) Has there been previous controversy around the service resulting in: ∑ Complaints / enquiries - Contact the CCG’s Patient Experience Team: [email protected] ∑ Media coverage - Contact the CCG’s Communications Team: [email protected]

Large Minimal None N/A Amount

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Comments/rationale: I am not aware of any in relation to this proposal.

c) Are you aware of any controversy (complaints or media coverage) when this proposal was introduced elsewhere?

Large Minimal None N/A Amount Comments/rationale: I am not aware of any in relation to this proposal. d) What engagement activity has been undertaken or planned to gain the views of patients and carers? Comments/rationale: N/A Patients resident within the boundary reduction area will not be asked to register elsewhere.

Section 5: Assessment of the Likely Impact on Privacy

Please review the questions below, answering yes or no, to assess the requirement for a Data Protection Impact Assessment (DPIA).

The project involves processing personal data and: Y / N 1 Evaluation or scoring? N

2 Automated decision-making with significant effects? N

3 Systematic monitoring? N

4 Processing of sensitive data or data of a highly personal nature? N

5 Processing on a large scale? N

6 Processing of data concerning vulnerable data subjects? N

7 Innovative technological or organisational solutions? N

8 Processing that involves preventing data subjects from exercising a right or using a service or contract? N

9 Using systematic and extensive profiling or automated decision-making to make significant decisions N about people?

10 Processing special-category data or criminal-offence data on a large scale? N

11 Systematically monitoring a publicly accessible place on a large scale? N

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12 Using innovative technology in combination with any of the criteria in the European guidelines? N

13 Using profiling, automated decision-making or special category data to help make decisions on N someone’s access to a service, opportunity or benefit?

14 Carrying out profiling on a large scale? N

15 Processing biometric or genetic data in combination with any of the criteria in the European guidelines? N

16 Combining, comparing or matching data from multiple sources? N

17 Processing personal data without providing a privacy notice directly to the individual in combination with N any of the criteria in the European guidelines?

18 Processing personal data in a way that involves tracking individuals’ online or offline location or N behaviour, in combination with any of the criteria in the European guidelines?

19 Processing children’s personal data for profiling or automated decision-making or for marketing N purposes, or offer online services directly to them?

20 Processing personal data that could result in a risk of physical harm in the event of a security breach? N

21 There has been a change to the nature, scope, context or purposes of existing personal data N processing?

If you have responded ‘Yes’ to any of the above questions please contact the Information Governance Team regarding completion of a DPIA ([email protected]).

Section 6: Impact Assessment Summary and Recommendation

Summary of any impacts / risks identified:

No significant impacts or risks have been identified.

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

No actions identified

Recommendation from project lead:

Submit completed EQIA to: [email protected]

Section 7: Quality Review Outcome

(Summary of Quality considerations and outcome – identifying any significant positive or negative implications / risks that commissioning decision makers need to be aware of)

The boundary change request will be considered at the April 2021 PCCC. It is evident that there are some potential benefits for patients currently registered at Leen View practice as the list size will reduce slightly with the boundary change and therefore a possible improvement in access to services may be noted.

The practice is unable to remove any patients currently registered and who wish to stay registered.

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The only potential adverse impact is therefore on new patients moving into the area of reduction who will no longer have Leen View surgery as a choice. However, they will have a choice of other practices to register with.

Leen View Surgery has 54 registered patients resident across Acer Court or Alder House Care Homes. However, the proposed removal of Acer Court & Alder House care homes has been deferred subject to approval of GP alignment for the purpose of the Enhanced Health to Care Homes (EHCH) DES and there is therefore no impact to be assessed currently.

Date of Quality Review: Comments: (see above) Date of Chief Nurse / Deputy Chief Nurse Review: Comments:

Date of Feedback to Project / Commissioning Lead

Date of Sign off Meeting Review: Comments (see below)

Date of Feedback to Project / Commissioning Lead

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Nottingham and Nottinghamshire CCG’s Equality and Quality Impact Assessment Standard Operating Procedure

Version: 1.1

Approved by: Quality and Performance Committee

Date approved:

Next review date: July 2022

Document authors: Esther Gaskill, Head of Quality Primary Care

Previous Versions

Version: 1.0

Approved by: Quality and Performance Committee

Date approved: April 2020

Next review date: April 2022

Document authors: Sue Barnitt, Head of Quality Out of Hospital Care Esther Gaskill, Head of Quality Primary Care and Quality Intelligence

Equality and Quality Impact Assessment SOP V. 1.1 July 2020

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1. Introduction When public sector organisations undertake any work involving changes that will impact service users there is a duty to consider the impacts of that change. The aim of such an impact assessment is not to eliminate risk, but for both project leads and organisations to be fully informed of any risks and impacts before deciding to proceed with a change. An Equality and Quality Impact Assessment (EQIA) is a mechanism for examining whether any proposed service changes have the potential to affect people differently (positively, negatively, no impact) and to assess the potential consequences on quality of services. An EQIA is designed to:

∑ Assess the impact of proposed changes in line with the CCG’s duty to reduce health inequalities in access to health services and in health outcomes

∑ Assess the impact of proposed changes to services in line with the CCG’s duty to maintain and improve the three elements of quality (patient safety, patient experience and clinical effectiveness)

∑ Assess whether proposed changes could have a positive, negative or neutral impact, depending on people's different protected characteristics defined by the Equality Act 2010

∑ Identify any direct or indirect discrimination or negative effect on equality for service users, carers and the general public

∑ Consider the impacts on people from relevant inclusion health groups (e.g. carers, homeless people, people experiencing economic or social deprivation)

∑ Identify where any information to inform the assessment is not available, which may indicate that patient engagement is required

∑ Provide a streamlined process to enable the escalation of any risks and prevent equality and quality risks from being considered in isolation

∑ Support in determining whether a project can proceed, proceed with identified action, or not be progressed

The Equality Act 2010 requires statutory authorities to provide evidence of equality monitoring, so by using the EQIA process evidence is maintained to demonstrate inclusive assessment and appropriate risk mitigation.

2. Purpose This Standard Operating Procedure (SOP) provides CCG staff with a framework to ensure that the EQIA process is clearly defined and robustly and consistently embedded within the organisation and its business processes. EQIAs must be completed for all changes to CCG commissioned services including:

∑ Reviews or changes to existing services directly commissioned by the CCG

∑ Service / pathway design for services directly commissioned by the CCG

∑ CCG Quality Innovation Productivity and Prevention (QIPP) schemes

∑ Any new CCG business where it is appropriate to assess the impact of the proposed piece of work

∑ Relevant new or revised CCG commissioning policies

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3. Roles and Responsibilities

Role Responsibilities Completion of EQIA Template, Data Protection Impact Assessment (DPIA), Engagement Plan, embedding of the Project Lead EQIA Panel outcome in the business case / change to service paper.

Provide support to project lead regarding quality and equality Quality & Equality Link impacts in relation to the proposed service change.

Lead and coordinate the EQIA process, including logging of EQIAs, facilitating EQIA meetings and EQIA panels and Health Inequality and identifying the appropriate quality and equality links to support Equality and Diversity Team the project lead. Collating the EQIA information to be included in the quarterly Equality, Diversity and Inclusion Report.

Review EQIAs to determine whether impacts and risks have been identified, assessed and appropriately mitigated against. Weekly EQIA Meeting Outcome of EQIA Meeting to be included on the EQIA Template and fed back to project leads.

Review and consider EQIAs, providing feedback to project leads with the Panel’s outcome and any areas where further Monthly EQIA Panel work is required. Outcome of EQIA Panel to be included on the EQIA Template.

Provide support to project lead or person initiating change Information Governance regarding Data Protection Impact Assessments and Team information governance issues.

Receive a quarterly overview of EQIA activity across the CCG, Quality and Performance including any emerging themes, risks or concerns. Committee

Commissioning Decision Ensure that EQIA requirements have been met and EQIA Makers (Prioritisation and Panel outcomes are considered prior to agreement of policy, Investment Committee, practice or service development changes. Governing Body, Primary Care Commissioning Committee, Accountable Officer, Chief Finance Officer)

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4. The EQIA Process (See Appendix 1: EQIA Process Flowchart)

4.1 The CCG’s EQIA Template (See Appendix 2) must be completed by the project lead for all proposed service changes. The Template has been designed to identify whether proposed projects or service changes have undergone due consideration as to any impact on service users, requirement for a Data Protection Impact Assessment (DPIA) / development of an engagement plan.

4.2 All EQIA Templates should be submitted to: [email protected] for consideration at the weekly EQIA Meeting.

4.3 Where large scale change is proposed or there are various options, an EQIA Template must be used for each individual component of the proposed change. Or, where there is a project with a clear, preferred, option, an EQIA Template can be completed for that specific option for consideration by the EQIA Meeting / EQIA Panel (EQIA Panel Terms of Reference See Appendix 3).

4.4 Where a change spans several providers (statutory and voluntary) or impacts on system change, a joint stakeholder EQIA Template should be completed to capture potential overlapping impacts.

4.5 EQIAs will be reviewed at the Weekly EQIA Meeting which will determine and advise the project lead as to whether further work (which may include review by a nominated Quality & Equality Link), completion of a DPIA / development of an engagement plan is required / recommended.

4.6 Where review by a nominated Quality & Equality Link is required, a Quality & Equality Link will be identified by the EQIA Meeting to support the project lead. The Quality & Equality Link will summarise their review on the EQIA Template; however, it is the responsibility of the project lead to respond to any points for clarification from the Quality & Equality Link and complete the assessment accordingly.

4.7 Once any required work is completed, EQIAs should be re-submitted to: [email protected] for further review by the EQIA Meeting and subsequently the EQIA Panel. Project leads should allow sufficient time for assessments to be reviewed. Requests for urgent review of EQIAs will only be considered in exceptional circumstances.

4.8 The EQIA Meeting will undertake an initial review of EQIAs to determine whether impacts and risks have been identified, assessed and appropriately mitigated against. The outcome of the EQIA Meeting will be fed back to project leads, including any areas where further work is required before EQIAs are progressed to the EQIA Panel.

4.9 An EQIA Log, including outcomes of EQIA Meetings and EQIA Panels, will be maintained by the Health Inequality and Equality and Diversity Team. Feedback / outcomes identified by the EQIA Meeting and EQIA Panel will be documented on the EQIA Template and shared with the appropriate project lead. Correspondence between the Health Inequality and Equality and Diversity Team and project leads will be stored to ensure an audit trail to support and underpin the EQIA process.

4.10 The EQIA Panel will undertake final review of EQIAs, providing feedback to project leads with the Panel outcome / recommendation / any areas where further work is required.

4.11 The project lead will embed the EQIA Panel outcome in the business case / change to service paper, for consideration by commissioning decision makers as part of any commissioning decision.

4.12 The Quality and Performance Committee will receive a quarterly overview of EQIA activity across the CCG, including any emerging themes, risks or concerns.

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Appendix 1: EQIA Process Flowchart

Appendix 2: EQIA Template

Appendix 3: EQIA Panel Terms of Reference

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Nottingham and Nottinghamshire CCG’s Equality and Quality Impact Assessment (EQIA) Process Flowchart

Service change identified / proposed (this includes):

Pilot (commence / cease) / extension of contract / service, commissioning / decommissioning service

Project lead to complete EQIA Template in full with support from relevant Quality Lead and Patient Engagement Lead (see appendix 1)

Completed EQIA to be submitted to: [email protected] for review at weekly EQIA Meeting with Quality and Patient Engagement Leads * *All EQIA’s to be submitted for review three working days prior to weekly meeting (held every Monday)

Further assurance required on EQIA following review at weekly meeting?

YES NO

Feedback provided to project lead regarding Feedback provided to project lead and EQIA assurance required progressed to next monthly EQIA Sign Off Meeting (see appendix B for Sign Off schedule)

Identified assurances considered by project lead EQIA reviewed at monthly EQIA Sign Off Meeting and and revised EQIA resubmitted to: further assurance required? [email protected]

YES NO

Revised EQIA reviewed at Feedback to Feedback to weekly EQIA Meeting until project lead project lead ready for Sign Off (see appendix B for Sign Off schedule)

Final EQIA to be embedded into business case by project lead and outcome to be considered by commissioning decision makers (Prioritisation and Investment Committee, Governing Body, Primary Care Commissioning Committee, Accountable Officer, Chief Finance Officer) as part of any commissioning decision

NB: All EQIA’s that require sign off must be submitted at least five working days prior to the monthly Sign Off meeting. Please see seperate EQIA Sign Off meeting schedule

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Nottingham and Nottinghamshire CCG’s Equality and Quality Impact Assessment (EQIA) Process Flowchart

Appendix 1: Quality Lead Contacts

Quality Lead Portfolio Email Tel Linda Shipman Head of Quality for Acute and Independent [email protected] 07384 878 438 Providers Services Includes inpatient acute services, acute service delivered in the community ie MSK, pain management, NEMS, Hospices etc

Julie Widdowson Quality Manager – Acute and Independent [email protected] 07818 522 201 Providers Services

Hayley Bipin Quality Manager – Acute and Independent [email protected] Providers Services

Vacant Head of Quality for Community and Mental [email protected] 07593021265 Health Services

Ryan Alsop Quality Manager – Community Services [email protected] 07584533854

Grace Kinsey – Quality Manager – Mental Health Services [email protected] 07827 873131 Oxspring Esther Gaskill Head of Primary Care [email protected] 07920 812539 Includes all GP Practices

Helen Horsfield Quality Manager – Primary Care [email protected] 07557 079027

Jean Gregory Head of Nursing Homes and Home Care [email protected] 07593021265 Quality Assurance

Maseline Sarson Quality Manager (Mental Health & Learning [email protected] 07867143328 Disability) Nursing Homes & Home Care et

Emma Holloway Quality Manager – Nursing Homes & Home [email protected] 07827827121 Care Quality Team

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Equality Impact Assessment Checklist

All commissioning activities should be assessed to identify any potential impacts (positive, negative or neutral) on Equality. The CCG is required to have due regard to the aims of the Public Sector Equality Duty (PSED) of the Equality Act 2010, which means understanding the potential effect of commissioning proposals on people in protected characteristic groups defined by the Equality Act. This will help to consider whether the proposals and resulting services will be effective for all people in relation to their health outcomes. Specifically, the CCG should give due regard to the need to eliminate discrimination, harassment and victimisation, advance equality of opportunity and foster good relations between people who share a relevant protected characteristic and those who don’t. Completing EQIAs are a way of doing this and therefore demonstrating compliance with the PSED. As part of the EQIA process the CCG also considers the specific health needs of a number of other groups of people who are traditionally excluded or disadvantaged, face a wide range of health inequalities and experience poor health outcomes. The following checklist of equality considerations can be used for supporting an equality review of EQIAs. Bear in mind that relevant considerations will vary from one proposal/service to another. It is also important to consider ‘intersectionality’ – ie where aspects of more than one protected characteristic/excluded group may combine to form overlapping discrimination or disadvantage.

Protected Characteristic and Equality Comments Inclusion Health/Disadvantaged Groups risk? Age ∑ If service is age-specific, do other age groups have access to similar services? ∑ Do eligibility criteria for services potentially discriminate against older or younger people without just cause? ∑ Are correct assumptions being made about different age groups? ∑ Have needs of certain older people been considered – eg is information easy to read; services easily accessible/close to public transport links? Disability ∑ This protected characteristic is very wide-ranging and some people may be disabled in more than one way. ∑ Consider whether disabled people can access and benefit from the service in the same way as non-disabled people. Are access support needs considered - eg physical access to and within buildings, alternative methods of making appointments, Interpreting and Translation services, carer support, signage? ∑ Does the service consider people who have both physical and mental health needs? ∑ Does service information take account of communication needs of people who are variously disabled and is it easy to understand? Gender Re-assignment ∑ Does service information reflect trans people and people exploring their gender identity? ∑ Is confidentiality about patients’ gender identity maintained? ∑ Sex-specific screening may be required by people who have transitioned – eg cervical and breast screening for trans men. Pregnancy and Maternity ∑ Services should not treat unfavourably women who are pregnant, breastfeeding or have recently given birth. Protection is for up to 26 weeks, after which any discrimination would be sex discrimination. ∑ Is the service accessible for women with babies – eg access for pushchairs, flexible appointments, breast-feeding friendly?

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Protected Characteristic and Equality Comments Inclusion Health/Disadvantaged Groups risk? Race (Includes Gypsies, Roma and Travellers) ∑ Consider this characteristic with Religion or Belief, but do not combine the two. ∑ Consider any cultural factors that may impact on people accessing the service. ∑ Is provision of the service culturally appropriate? ∑ Does the service use assessment materials and methods relevant to people from different cultures? ∑ Is service information available in a range of appropriate languages? ∑ Is service information and imagery culturally appropriate/sensitive/inclusive? ∑ Does the service offer patients the support of Interpreting and Translation services and are extended/double appointments available for patients who use an Interpreter? Religion or belief ∑ Is the service religiously and culturally sensitive to meet the needs of people from various religions and beliefs? ∑ Is service information and imagery religiously appropriate/sensitive/inclusive? ∑ Where appropriate, does the service cater for religious observance requirements of patients and carers? Sex ∑ Is it potentially easier/more difficult for either men or women to access the service - eg because of where information is displayed, opening times? ∑ Is the service appropriate for women from certain Black, Asian and other minority ethnic groups? ∑ There are situations where single sex services can be lawfully provided, as long as they can be justified – eg offering a women- only support service to women experiencing domestic violence is likely to be justifiable even if there is no parallel service for men due to insufficient demand. Sexual orientation ∑ Does the service information use images and terminology that could apply to all sexualities? ∑ Does the service ensure that its staff treat lesbian, gay and bisexual and people of other sexualities with dignity and respect? ∑ Is service provision culturally appropriate for LGB people? ∑ Is confidentiality about patients’ sexuality maintained? Carers ∑ Are carers’ needs recognised by the service and is their ability to access the service when supporting the cared-for person taken into account – eg flexible appointment times, impact of caring on their own health? ∑ Is extra support available to carers who require it - eg emotional support, relief from isolation? ∑ Does the service identify or signpost to any initiatives that might improve carers’ lives?

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Protected Characteristic and Equality Comments Inclusion Health/Disadvantaged Groups risk? People who misuse drugs and alcohol ∑ Consider whether the service addresses the needs of patients experiencing Severe Multiple Disadvantage (SMD) aka ‘complex patients’ - a combination of substance misuse, homelessness, offending and mental ill health. This cohort of patients is complex and often present with multiple issues but experience significant barriers to accessing services. Homeless people ∑ Homeless people often present with SMD - see above. ∑ Homeless people and those with SMD experience significant barriers to accessing health services; consequently their life expectancy gap is often a result of exacerbation of treatable medical conditions. ∑ Consider different types of homelessness, not just rough sleeping; most homeless young people stay temporarily at the homes of friends, family members or acquaintances - sofa surfing. ∑ There may be a prevalence of hidden homelessness amongst women who will seek accommodation options with family/friends to avoid rough sleeping. ∑ An estimated 88% of rough sleepers are male and it is often cited that two thirds of single homeless people accessing accommodation and support are male. ∑ As the complexity of homeless people increases they become more reliant on friends and family over healthcare professionals but their barriers to services may increase. ∑ Consider intersectionality of homelessness and unemployment - amongst young people from BME groups. Evidence suggests higher rates of over-crowding in rental properties amongst Black African and Bangladeshi groups, with consequent negative impact on health and wellbeing. ∑ Research indicates that young LGBT homeless people believed their sexual and/or gender identity was a causal factor in rejection from home. ∑ Does the service offer flexible service models for people who live in insecure accommodation or are rough sleepers – eg in relation to SMD, DNAs, location and length of appointments? New and emerging communities, including refugees and asylum seekers (Also look at considerations under Race) ∑ Consider what the service needs are of people who may have experienced trauma before arriving in Nottinghamshire and have originated from or passed through regions where they may have come into contact with reportable/rare diseases. ∑ Consider whether the service is accessible to communities that may be located in specific geographical areas. People experiencing economic or social deprivation ∑ Includes those who are long-term unemployed or working in unsecured employment contracts, have limited family or social networks, and sex workers. ∑ Consider whether the service has good public transport links and consider cost of travel. ∑ Consider cost to patients of accessing services that are not NHS funded – eg when there is a proposal to decommission a service and signpost patients to alternatives.

Members of the travelling community (who do not belong to an ethnic group recognised under the Equality Act) ∑ Look at relevant considerations above, such as Race and People

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Protected Characteristic and Equality Comments Inclusion Health/Disadvantaged Groups risk? experiencing economic or social deprivation.

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Quality Impact Assessment Checklist

All commissioning decisions/projects, QIPP plans, organisational cost improvement plans and business cases are required to undergo assessment to identify any potential impacts (positive, negative or neutral) on quality from any proposed changes. Quality can be defined as encompassing three key dimensions as outlined by the Darzi principle, namely, safety, experience and effectiveness: Patient safety - rating the impact of the proposal on patient safety Clinical effectiveness - rating the impact of the proposal on the clinical effectiveness of patient care Patient experience – Rating the impact of the proposal on the patient experience of care delivery

For Quality Impact Assessments the following checklist and considerations can be used:

Area of Quality Quality Comments Risk? Duty of Quality ∑ Compliance with NHS constitution ∑ Impact on partner organisations ∑ Impact on organisations duty to safeguard children and vulnerable adults ∑ Impact on other services within the organisation Any other risk indicators relevant to the Duty of Quality? Patient Safety ∑ Impact on avoidable harm ∑ Impact on reliability of safety systems and processes ∑ Impact on clinical workforce levels, competencies and experience ∑ Impact on treatment times and procedures ∑ Impact on safeguarding ∑ Impact on systems and processes for ensuring that the risk of HCAIs is reduced ∑ Impact upon clean and safe environments Any other risk indicators relevant to patient safety? Patient Experience ∑ Impact on patient informed choice and autonomy ∑ Impact on patient access ∑ Impact on dignity, respect and compassion ∑ Impact on patients self-reported satisfaction on national/local surveys/ FFT ∑ Impact on patients self-reported experience through the complaints process/PALS contacts ∑ Impact on patient waiting times ∑ Impact on the provision of individualised care Any other risk indicators relevant to patient experience? Clinical effectiveness ∑ Impact on provision of NICE compliant treatment ∑ Impact on the implementation of evidence based practice ∑ Impact on clinical outcomes ∑ Impact on clinical leadership ∑ Impact on the promotion of self-care ∑ Impact on clinical engagement Any other risk indicators relevant to clinical effectiveness? Non clinical/operational impact ∑ Impact on cost effectiveness ∑ Impact on infrastructure ∑ Impact on staff satisfaction and welfare ∑ Impact on the public perception of the organisation ∑ Social value impact

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Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: Giltbrook Surgery: Permanent Boundary Paper Reference: PCC 21 013 Reduction - Deferred Decision

Sponsor: Joe Lunn, Associate Director of Primary Attachments/ Appendix One: Care Appendices: Updated EQIA Presenter: Lynette Daws, Head of Primary Care

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

Executive Summary Arrangements for Discharging Delegated Functions Delegated function 2 - Plan the primary medical services provider landscape, including considering and making decisions in relation to agreeing variations to the boundaries of GP practices. Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts

At the October 2020 meeting of the Nottingham & Nottinghamshire CCG Primary Care Commissioning Committee (PCCC), the decision to reduce the Giltbrook Surgery practice boundary, at the site of Acer Court and Alder House care homes, was deferred until GP alignment for the Enhanced Health in Care Homes (EHCH) DES was agreed. Agreement between the Primary Care Networks (PCNs), with support from the Locality Teams has been reached; a separate paper outlining this work is being presented to PCCC by the Nottingham City Locality Team (April 2021 meeting).

The purpose of this paper is to outline the proposed permanent boundary change for Giltbrook Surgery, following the agreed GP alignment for the EHCH DES.

There are no financial implications for the CCG.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☐ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments:

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Equality / Quality Impact Yes ☒ No ☐ N/A ☐ Included in the paper Assessment (EQIA)

Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (DPIA) Risk(s): A risk is that without a change in practice boundary Giltbrook Surgery would be required, under the terms of the GMS/PMS GP Contract, to register those patients’ that decline registration with the aligned Nottingham City GP practices. A condition of the 12 month list closure (approved September 2019) required Giltbrook Surgery to reduce their practice boundary. Confidentiality: ☒No Recommendation(s): 1. The Primary Care Commissioning Committee is asked to APPROVE the application for a permanent boundary reduction.

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Giltbrook Surgery Application for Boundary Reduction

1. Introduction

The Primary Care Commissioning Committee (PCCC), at its October meeting, approved a boundary reduction for Giltbrook Surgery to support the need to further reduce the list size following a 12 month list closure. The decision to reduce the boundary at the site of Acer Court and Alder House residential older persons care homes was deferred.

The purpose of this paper is to outline the proposed permanent boundary reduction. This is following the agreed GP alignment to the homes as required for the Enhanced Care in Care Homes DES; a service specification that is part of the Network Contract DES.

2. Background

2.1. List Size Update The Giltbrook Surgery practice list had an approved one year list closure. Since the patient list re-opened on the 21 September 2020 the number of registered patients has increased by 54.

Date Raw List Size April 2017 4,495 April 2018 4,711 April 2019 5,009 September 2019 5,096 January 2020 5,039 April 2020 4,966 July 2020 4,948 21 September 2020 4,873 24 February 2021 4,927

The practice is actively asking patients resident outside the historic practice boundary (pre-boundary reduction) to re-register with a local GP practice; however this process has been stalled due to COVID- 19.

2.2. Proposed Area of Reduction Giltbrook Surgery proposes to reduce the practice boundary to that of the black line, removing the area in red which is the site of the Acer Court and Alder House Care Homes. The two other premises within the red area are a petrol station and small supermarket. There are no private dwellings and no proposed housing developments.

The maroon line is the Nottingham West PCN, Nottinghamshire County / Nottingham City Council boundary. This area is covered by the boundary of five Nottingham City practices: PCN 1 Parkside Medical Practice PCN 1 Leen View Surgery PCN 3 Bilborough Medical Centre

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PCN 3 Greenfields Medical Centre PCN 3 Lime Tree Surgery

2.3. Eastern Boundary: Nottingham City PCNs An agreement has been reached between Nottingham West PCN and Nottingham City PCN 1 & PCN 3, with the support of the Locality Teams, for the alignment of GP practices to care homes under the Enhanced Health in Care Homes (EHCH) DES. Acer Court will be aligned with Parkside Medical Practice, supported by The Practice St Albans (both PCN 1), and Alder House with Bilborough Medical Centre (PCN 3). The agreement necessitates current and new care home residents to register with the aligned Nottingham City practices. However, if a resident decides not to transfer to or register with the GP practice aligned with the care home, the resident would continue to receive core GP service, as detailed in the GMS/PMS/APMS GP contract, at one of the five Nottingham City practices that have a boundary covering the site. If the proposed reduction to exclude Acer Court and Alder House from the practice boundary is not approved, Giltbrook Surgery would also be required to register patients.

The committee is asked to note that a separate paper will be presented at a later date to propose the extension of The Practice St Albans boundary to cover the site of Acer Court Care Home.

The EHCH service requires GP practices to support MDTs and provide weekly care home rounds; these will only be delivered to residents registered with the aligned GP practice or PCN. Other elements of the DES will be provided to all residents, irrespective of the alignment by their registered GP practice, such as medication reviews. There may be some cross boarder complexity in the delivery of services given the homes are located within the County Council boundary and the registered GP practice is in the City. How community services and those services commissioned by the LAs are to be delivered has been considered as part of the Locality Teams review. Community service providers will continue to provide those services they are commissioned to deliver in the care homes.

Giltbrook Surgery does not, and never has had, residents from the care homes registered at the practice due in part to the location of the practice and the historic agreement between Nottingham City practices to rotate new patient registrations.

Should the EHCH DES cease or the requirements for alignment change, the PCNs would need to consider other arrangements for patient registrations outside of the agreement with Nottingham City PCN 1 and PCN 3. Equally, should a planning application for change of use to private dwellings be submitted, with Acer Court and Alder House no longer being care homes, a new arrangement would need to be agreed.

South Locality was invited to comment on this proposal, Dr Tim Heywood, Clinical Director Nottingham West PCN, provided the following:

“As a PCN we are aware of the request from Giltbrook Surgery for a boundary reduction. The PCN is not itself a legal entity, but an organisation created by the mutual agreement and consent of 12 member practices. The decision relating to which patients those practices offers services is a matter for the commissioners of Primary Care services and those practices individually. It is our understanding that the request from Giltbrook has been made with the quality and safety of care to its patients as its highest priority, and so the other practices in the Network support the application on those grounds.

We are not clear how the PCN, as an organisation only created by the mutual agreement of constituent member practices and not a legal entity in its own right, can have a boundary that is different to the amalgamated boundaries of its member practices, nor of the consequences if that situation is to persist. We would acknowledge this difficulty, and be happy to engage in discussion with commissioners and other interested parties about this issue in the future.”

3. Recommendation

It is recommended that the Committee APPROVE the proposed permanent boundary reduction at the site of Acer Court and Alder House care homes.

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Nottingham and Nottinghamshire CCG’s Equality and Quality Impact Assessment

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

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

EQIA Standard V3 EQIA Process Operating Procedure Without Appendices EmbeddedFlowchart Julyupdated 2020.docx Sept2020.docx

The EQIA is designed to:

∑ Assess the impact of proposed changes in line with the CCG’s duty to reduce health inequalities in access to health services and in health outcomes ∑ Assess the impact of proposed changes to services in line with the CCG’s duty to maintain and improve the three elements of quality (patient safety, patient experience and clinical effectiveness) ∑ Assess whether proposed changes could have a positive, negative or neutral impact, depending on people's different protected characteristics defined by the Equality Act 2010 ∑ Identify any direct or indirect discrimination or negative effect on equality for service users, carers and the general public ∑ Consider the impacts on people from relevant inclusion health groups (e.g. carers, homeless people, people experiencing economic or social deprivation) ∑ Identify where any information to inform the assessment is not available, which may indicate that patient engagement is required ∑ Provide a streamlined process to enable the escalation of any risks and prevent equality and quality risks from being considered in isolation ∑ Support in determining whether a project can proceed, proceed with identified action, or not be progressed

EQIAs are ‘live’ documents, and as such, are required to be revisited at key stages of project development and implementation, particularly following the conclusion of any engagement and consultation activities to inform decision-making.

Nottingham and Nottinghamshire CCG EQIA Template V1 July 2020

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Section 1: Project Overview

Nottingham and Nottinghamshire CCG EQIA Template V1 July 2020

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Proposal / Project Title: Giltbrook Surgery Boundary Reduction (Nottingham West PCN) Project / Commissioning Lead: Rachael Harrold, Primary Care Commissioning Manager Senior Responsible Commissioning Lead: Lynette Daws, Head of Primary Care Quality Directorate Lead: Esther Gaskill, Head of Quality Primary Care Patient Engagement Lead: EQIA Completed By / Date: Rachael Harrold, Primary Care Commissioning Manager / October 2020 EQIA Updated By / Date: Rachael Harrold, Primary Care Commissioning Manager / April 2021 Description of Project: (Include all relevant documents) As part of the approval by the Primary Care Commissioning Committee at its February meeting to extend the list closure at the practice for a further six months, Giltbrook Surgery was required to consider a boundary change in order to reduce their growing list size. The proposed reduced boundary will be considered by the Committee at its October meeting.

The current, historic boundary was set by a previous partnership prior to the current partners taking on the contract. The contracted boundary extends beyond the boundary of Nottingham West CCG and the Nottingham West PCN footprint into Derbyshire, Mansfield & Ashfield and Nottingham City. Due to a growing list size and restricted physical capacity, the practice is reporting that its having a negative impact on their ability to provide timely access to services for their patients; growing list size, limited number of appointments and longer waits for an appointment could impact upon patient safety as patients wait longer for appointments or patients seek urgent care as an alternative. The practice is unable to increase its workforce as they are limited with the physical space of their building and are unable to expand.

There are approximately 59 patients registered at Giltbrook Surgery resident in the area of reduction. 199 registered patients are resident outside the current boundary and will be contacted in line with the practice policy requesting they register with a GP practice closer to home.

Although the practice cannot remove the patients currently registered in the areas of reduction, if the proposed boundary reduction were approved, it will allow Giltbrook Surgery to decline new patients resident in these areas now that their list has re-opened, and give them more control over the future list size growth. To note, new family members including babies joining a household located within the area of reduction that is registered at Giltbrook Surgery will be accepted as new patients by the practice.

This EQIA has been written for the recommended permanent boundary that retains New Bagthorpe, Strelley Village and the area surrounding Trowell Service Station (M1) which will ensure GP coverage and choice of GP practice.

The proposed removal of Acer Court & Alder House care homes is recommended to be deferred subject to approval of GP alignment for the purpose of the Enhanced Health to Care Homes (EHCH) DES. This EQIA will consider the impact on the registered population resident in these two care homes on the basis that if they were to remain within the boundary of Giltbrook Surgery or the boundary reduced to no longer cover the home, the residents will continue to have access to core GP services delivered primarily at the home, and receive an enhanced level of care as part of the EHCH DES from a variety of clinicians as part of the Care Home Team. The residents would not be advantaged nor disadvantaged by remaining registered at Giltbrook Surgery or registering at another local practice, as care would be delivered as part of standard GMS services and a defined service specification (EHCH).

April 2021 Update Consideration of the proposed removal of Acer Court & Alder House care homes from the Giltbrook Surgery boundary was deferred at the PCCC October meeting subject to approval of GP alignment for the purpose of the Enhanced Health to Care Homes (EHCH) DES.

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The Primary Care Networks (PCNs) of Nottingham West and Nottingham City PCN 1 & PCN 3 with the support of the Nottingham City and South Nottingham Locality Teams have reached agreement on the alignment of practices with care homes for the Enhanced Health to Care Homes (EHCH) DES. A paper is to be presented to the April PCCC.

A separate EQIA with regards to the alignment and impact on patients/residents has been completed by the Locality Team.

Acer Court Care Home, 172 Nottingham Road, Nottingham NG8 6AX is to be aligned to Nottingham City PCN 1: Bulwell & Top Valley

∑ Parkside Medical Practice ∑ St Albans Medical Centre

The boundary of St Albans Medical Centre does not currently extend to Acer Court Care Home. A boundary extension application is to be submitted in due course; however the practice in the meantime is able to register patients.

Alder House Care Home, 172A Nottingham Road, Nottingham NG8 6AX is to be aligned to Nottingham City PCN 3: BACHS

∑ Bilborough Medical Centre

Giltbrook Surgery will not be aligned with Acer Court or Alder House for the purposes of the EHCH DES. This represents no change for patients. Due to the location of Giltbrook Surgery and the historic agreement with Nottingham City practices to register patients’ resident at Acer Court and Alder House, Giltbrook Surgery has not and never has had registered patients’ resident at either of these care homes.

PCCC will be recommended to approve the boundary reduction in light of this local decision.

Identify Area Affected (CCG wide / Locality / Primary Care Network (PCN)): Nottingham & Nottinghamshire CCG ∑ Nottingham City Locality o Bulwell & Top Valley PCN o BACHS PCN o Nottingham City South PCN ∑ Mid-Nottinghamshire Locality o Ashfield South PCN ∑ South Nottingham Locality o Nottingham West Derby & Derbyshire CCG

April 2021 Update: Area Affected Nottingham & Nottinghamshire CCG ∑ Nottingham City Locality o PCN 1: Bulwell & Top Valley PCN o PCN 2: BACHS PCN ∑ South Nottingham Locality o Nottingham West

Details of Any Supporting Evidence: (When completing this section a review of the latest evidence should be undertaken. Use Nottingham and Nottinghamshire CCG EQIA Template V1 July 2020

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the checklist provided for sources of evidence and trusted websites to visit to find evidence. Describe the key findings from your evidence search and how they have informed this scheme) If you have been unable to find evidence, please describe what you have based this project on instead (e.g. activity data, population data, patient experience or public engagement intelligence, clinical opinion etc.): The proposal will be presented to the Primary Care Commissioning Committee on the 21st October 2020

Giltbrook Surgery: List size changes

Date Raw List Size April 2017 4,495 April 2018 4,711 April 2019 5,009 September 2019 5,096 November 2019 5,068 January 2020 5,039 April 2020 4,966 July 2020 4,948 21 Sept 2020 4,873

Workforce As of 1st April 2020: 1.84 WTE GPs / GP to Patient Ratio 1:2,700.

CQC Rated Outstanding March 2016 o Good: Safe, Effective, Well-Led o Outstanding: Caring, Responsive

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November 2020 Update At its October 2020 meeting, PCCC approved the proposed boundary changes with the following amendments to be applied to ensure patient choice and access to primary care services: o Areas to remain within the practice boundary: New Bagshot, Strelley Village, area surrounding M1 Motorway Service Station –Trowell The Committee deferred the decision on the boundary at the site of Acer Court & Alder House until agreement on GP alignment had been reached. Deadline for agreement 31 March 2021.

A separate EQIA has been completed by the Locality Team with regards to the impact on patients of the alignment of boarder care homes Acer Court and Alder House.

April 2021 Update The alignment of GP practices with care homes for the Enhanced Health to Care Homes (EHCH) DES has been agreed. Nottingham City PCN 1 & PCN 3 will continue to register patients resident in Acer Court and Alder House. The PCCC at its April 2021 meeting will be asked to consider the proposed Giltbrook Surgery boundary reduction at the site of Acer Court and Alder House Care Homes. No private dwellings are located within the site.

Giltbrook Surgery will not be aligned with Acer Court or Alder House for the purposes of the EHCH DES.

Due to the location of Giltbrook Surgery and the historic agreement with Nottingham City practices to register patients’ resident at Acer Court and Alder House, Giltbrook Surgery has not and never has had registered patients’ resident at either of these care homes. Nottingham and Nottinghamshire CCG EQIA Template V1 July 2020

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Should the terms of the EHCH DES change or the care homes are transferred to private dwellings, the agreement would need to be reviewed. Should PCCC reject the proposed boundary reduction and the two care homes remain within the Giltbrook Surgery boundary, the practice would be obliged under the terms of the GMS/PMS contract to register the residents. This would be against the terms of the local PCN agreement.

Section 2: Health Inequalities Assessment

Identify the impact of the project on health inequalities in terms of both outcomes and access for service users? Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. Health inequalities arise because of the conditions in which people are born, grow, live, work and age. These conditions influence opportunities for good health, and how patients think, feel and act, and can shape a patient’s mental health, physical health and wellbeing. See” web based resources” document for further information Positive impact Negative impact No impact N/A

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Comments/rationale: When completing this section include: ∑ Details of the specific under-served people/groups that will benefit from the project (i.e. where health inequalities are likely to reduce) ∑ Details of the specific people/groups for which health inequalities are likely to increase and any proposed mitigations ie digital pathways to increase inclusion vs the impact on health inequalities ∑ Details of any differential impact between CCG populations.

Patients currently registered at Giltbrook Surgery may see a positive impact following boundary reduction as their ability to access services could be improved due to the practice not accepting new patients from such a wide geographical area and overall accepting fewer new patients. This results in less demand on the number of appointments available to the patient population which could result in patients accessing appointments more quickly. Travel time for home visits would be reduced.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

For those new patients moving into the areas no longer covered by Giltbrook Surgery, the majority will have a choice of practices to register with which will predominantly be closer to their home address than Giltbrook Surgery, thereby reducing travel time. Parkside Medical Practice (Bulwell & Top Valley PCN) is keen to actively increase their list size.

Whilst Giltbrook Surgery had a large practice boundary there are few registered patients living within the areas of reduction; 59 in total which indicates this practice may not be the practice of choice in those particular areas given the numbers of practices in closer proximity with capacity to register new patients.

The rural areas of New Bagthorpe and Jacksdale will be provided with a choice of practice as Giltbrook Surgery is planning to extend their boundary into these areas in recognition of their rural location and in response to Jacksdale Surgery’s concern about the impact on their list size should Giltbrook Surgery withdraw completely from that area.

It is unlikely given the numbers registered currently at Giltbrook Surgery from the areas of reduction, and the choice of practices, that any one practice would see a large increase in new patient registrations.

Staff working within the practice would be positively impacted from the reduction in demand and work load pressures which could in turn have a positive impact on the service they offer to patients e.g. less sickness, more time to be spent with patients etc.

April 2021 Update Giltbrook Surgery will not be aligned with Acer Court or Alder House for the purposes of the EHCH DES. This represents no change for patients.

Due to the location of Giltbrook Surgery and the historic agreement with Nottingham City practices to register patients’ resident at Acer Court and Alder House, Giltbrook Surgery has not and never has had registered patients’ resident at either of these care homes.

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Section 3: Protected Characteristics and Inclusion Health Groups Assessment:

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Could the project have a positive or negative impact on people who may, as a result of being in one or more of the following protected characteristic or inclusion health groups, experience barriers when trying to access or use NHS services? In addressing this question, consider whether the scheme could potentially have a positive or negative impact in any of the following areas:

∑ The CCG’s duty to maintain and improve the three elements of quality – patient safety, patient experience and clinical effectiveness ∑ Impact of Covid-19 – taking into account the behavioral shift of the population due to the impact of Covid-19 ∑ Access to services (including patient choice and physical accessibility – access to and within buildings, public transport routes, parking for disabled people) ∑ Accessibility in terms of communication (availability of spoken language interpreters, British Sign Language Interpreters, hearing loops, translated written information) ∑ Digital the shift needs to be carefully designed to ensure it does not affect health inequalities for others, due to barriers such as access, connectivity, confidence or skills ∑ Transfers between services (whether between specialties, care settings, or during a person’s life course) ∑ Safeguarding adults and children ∑ Dignity and respect (including privacy) ∑ Person-centered care (whether patients experience the service as culturally competent / welcoming – not just in terms of patients’ race, but also, for example, their gender identity, religion or belief and sexual orientation and whether patients feel that the service considers both their physical and mental health needs. ∑ NICE requirements ∑ Shared decision-making

It is also important to consider the combination of patients’ characteristics and how those combinations may impact on accessibility. An example is the combination of older age, certain types of disability and economic deprivation; potentially limiting access to services if they are not near a patient’s home or easy to get to by public transport. Also, many of the prompts under specific characteristic / health groups may apply to other groups.

∑ Try to put yourself in patients’ or carers’ shoes ∑ They are accessing health services because they have a physical and/or mental health need ∑ Think about your own experiences, or those of friends or family, when accessing health services. ∑ Not everyone has a regular income, drives, can see or hear, speaks English, is literate or health literate / understands the way health systems work, has a home or safe and supportive networks. Therefore we will all experience access to health services in different ways, often regardless of clinical need.

The Equality Impact Assessment Checklist and Quality Impact Assessment Checklist below will help with your considerations:

EIA Assessment QIA Assessment Checklist July 2020.docxChecklist July 2020.docx

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i) Impact on the protected characteristic of Age:

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

Giltbrook Surgery has no registered patients resident within Acer Court or Alder House Care Homes (as of 9th October). The practice will continue to support and register the residents of Giltbrook Care Home which remains within their boundary

ii) Impact on the protected characteristic of Disability:

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

iii)Impact on the protected characteristic of Gender re-assignment:

Positive impact Negative impact No impact N/A

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Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

iv)Impact on the protected characteristic of Pregnancy and maternity:

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

v) Impact on the protected characteristic of Race (Includes Gypsies, Roma and Travellers):

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

vi)Impact on the protected characteristic of Religion or belief:

Positive impact Negative impact No impact N/A

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Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

vii) Impact on the protected characteristic of Sex:

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

viii) Impact on the protected characteristic of Sexual orientation:

Positive impact Negative impact No impact N/A Comments/rationale: With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

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ix) Impact on people in any of the following Inclusion Health and other Disadvantaged Groups: ∑ Carers ∑ Homeless people ∑ People who misuse drugs ∑ People working in stigmatised occupations (such as sex workers) ∑ New and emerging communities, including refugees and asylum seekers ∑ People experiencing economic or social deprivation, including those who are long-term unemployed / are geographically isolated / have limited family or social networks ∑ Members of the travelling community (who do not belong to an ethnic group recognised under the Equality Act)

Positive impact Negative impact No impact N/A

Comments/rationale: (with an indication of which of the above groups have specifically influenced your impact conclusion) With a reduced patient list due to the reduced boundary, it’s likely that existing registered patients would see a positive impact on access to services as capacity and workload pressures on the practice reduce (less demand on the service, shorter waiting times, increased likelihood of seeing GP of choice) and improve the experience for patients.

The practice cannot remove those patients currently registered who are resident in the areas of reduction and therefore they too will benefit from a reduced list size and boundary.

New patients moving into the area of reduction will have a choice of GP practice to register with the majority of which will be closer to home.

Section 4: Assessment of Likely Impact of Controversy

a) Is the proposal likely to result in controversy due to: ∑ The nature of the service ∑ The patients or carers affected

Highly Likely Unlikely N/A Likely

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Comments/rationale: It is unlikely the proposal will attract controversy.

As part of list cleansing those patients resident outside the current, large boundary registered with Giltbrook Surgery will be contacted in line with practice policy to advise them to register with a practice closer to home. This is likely to attract a small number of complaints from patients; however it’s unlikely to cause controversy given the small patient numbers.

A small number of complaints may be received from residents moving into the area of reduction, whose neighbours remain registered with Giltbrook Surgery however following the formal process to reduce their practice boundary the new residents will be unable to register with Giltbrook Surgery. This is unlikely to cause controversy given the small patient numbers. April 2021 Update

Giltbrook Surgery will not be aligned with Acer Court or Alder House for the purposes of the EHCH DES. This represents no change to patients.

Due to the location of Giltbrook Surgery and the historic agreement with Nottingham City practices to register patients’ resident at Acer Court and Alder House, Giltbrook Surgery has not and never has had registered patients’ resident at either of these care homes.

b) Has there been previous controversy around the service resulting in: ∑ Complaints / enquiries - Contact the CCG’s Patient Experience Team: [email protected] ∑ Media coverage - Contact the CCG’s Communications Team: [email protected]

Large Minimal None N/A Amount Comments/rationale: I am not aware of any in relation to this proposal. c) Are you aware of any controversy (complaints or media coverage) when this proposal was introduced elsewhere?

Large Minimal None N/A Amount Comments/rationale: I am not aware of any in relation to this proposal. d) What engagement activity has been undertaken or planned to gain the views of patients and carers?

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Comments/rationale: N/A Patients resident within the boundary reduction area will not be asked to register elsewhere.

Section 5: Assessment of the Likely Impact on Privacy

Please review the questions below, answering yes or no, to assess the requirement for a Data Protection Impact Assessment (DPIA).

The project involves processing personal data and: Y / N 1 Evaluation or scoring? N

2 Automated decision-making with significant effects? N

3 Systematic monitoring? N

4 Processing of sensitive data or data of a highly personal nature? N

5 Processing on a large scale? N

6 Processing of data concerning vulnerable data subjects? N

7 Innovative technological or organisational solutions? N

8 Processing that involves preventing data subjects from exercising a right or using a service or contract? N

9 Using systematic and extensive profiling or automated decision-making to make significant decisions N about people?

10 Processing special-category data or criminal-offence data on a large scale? N

11 Systematically monitoring a publicly accessible place on a large scale? N

12 Using innovative technology in combination with any of the criteria in the European guidelines? N

13 Using profiling, automated decision-making or special category data to help make decisions on N someone’s access to a service, opportunity or benefit?

14 Carrying out profiling on a large scale? N

15 Processing biometric or genetic data in combination with any of the criteria in the European guidelines? N

16 Combining, comparing or matching data from multiple sources? N

17 Processing personal data without providing a privacy notice directly to the individual in combination with N any of the criteria in the European guidelines?

18 Processing personal data in a way that involves tracking individuals’ online or offline location or N behaviour, in combination with any of the criteria in the European guidelines?

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19 Processing children’s personal data for profiling or automated decision-making or for marketing N purposes, or offer online services directly to them?

20 Processing personal data that could result in a risk of physical harm in the event of a security breach? N

21 There has been a change to the nature, scope, context or purposes of existing personal data N processing?

If you have responded ‘Yes’ to any of the above questions please contact the Information Governance Team regarding completion of a DPIA ([email protected]).

Section 6: Impact Assessment Summary and Recommendation

Summary of any impacts / risks identified:

No significant impacts or risks have been identified.

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

No actions identified

Recommendation from project lead:

Submit completed EQIA to: [email protected]

Section 7: Quality Review Outcome

(Summary of Quality considerations and outcome – identifying any significant positive or negative implications / risks that commissioning decision makers need to be aware of)

The boundary change request was approved at the October 2020 PCCC. It is evident that there are some potential benefits for patients currently registered at Giltbrook practice as the list size will reduce slightly with the boundary change and therefore a possible improvement in access to services may be noted.

The practice is unable to remove any patients currently registered and who wish to stay registered.

The only potential adverse impact is therefore on new patients moving into the area of reduction who will no longer have Giltbrook surgery as a choice. However, they will have a choice of other practices to register with.

Giltbrook Surgery has no registered patients resident within Acer Court or Alder House Care Homes (as of 9th October). However, the proposed removal of Acer Court & Alder House care homes has been deferred subject to approval of GP alignment for the purpose of the Enhanced Health to Care Homes (EHCH) DES and there is therefore no impact to be assessed currently.

Date of Quality Review: Esther Gaskill 14.11.2020 Comments: (see above) Date of Chief Nurse / Deputy Chief Nurse Review: EQIA meeting: 16.11.2020

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Comments: Overall it was felt this is a positive change to help existing patients and they are clearly thinking about the care of the patients they have. EQIA team happy to progress this to panel 24/11/2020.

Date of Feedback to Project / Commissioning Lead 16/11/2020

Date of Sign off Meeting Review: Sign off meeting Comments (see below) 24/11/2020 The panel agreed that the final EQIA adequately assessed the equality and quality impact against the overall pathway change. This has been signed off. Date of Feedback to Project / Commissioning Lead 24/11/2020

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Nottingham and Nottinghamshire CCG’s Equality and Quality Impact Assessment Standard Operating Procedure

Version: 1.1

Approved by: Quality and Performance Committee

Date approved:

Next review date: July 2022

Document authors: Esther Gaskill, Head of Quality Primary Care

Previous Versions

Version: 1.0

Approved by: Quality and Performance Committee

Date approved: April 2020

Next review date: April 2022

Document authors: Sue Barnitt, Head of Quality Out of Hospital Care Esther Gaskill, Head of Quality Primary Care and Quality Intelligence

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1. Introduction When public sector organisations undertake any work involving changes that will impact service users there is a duty to consider the impacts of that change. The aim of such an impact assessment is not to eliminate risk, but for both project leads and organisations to be fully informed of any risks and impacts before deciding to proceed with a change. An Equality and Quality Impact Assessment (EQIA) is a mechanism for examining whether any proposed service changes have the potential to affect people differently (positively, negatively, no impact) and to assess the potential consequences on quality of services. An EQIA is designed to:

∑ Assess the impact of proposed changes in line with the CCG’s duty to reduce health inequalities in access to health services and in health outcomes

∑ Assess the impact of proposed changes to services in line with the CCG’s duty to maintain and improve the three elements of quality (patient safety, patient experience and clinical effectiveness)

∑ Assess whether proposed changes could have a positive, negative or neutral impact, depending on people's different protected characteristics defined by the Equality Act 2010

∑ Identify any direct or indirect discrimination or negative effect on equality for service users, carers and the general public

∑ Consider the impacts on people from relevant inclusion health groups (e.g. carers, homeless people, people experiencing economic or social deprivation)

∑ Identify where any information to inform the assessment is not available, which may indicate that patient engagement is required

∑ Provide a streamlined process to enable the escalation of any risks and prevent equality and quality risks from being considered in isolation

∑ Support in determining whether a project can proceed, proceed with identified action, or not be progressed

The Equality Act 2010 requires statutory authorities to provide evidence of equality monitoring, so by using the EQIA process evidence is maintained to demonstrate inclusive assessment and appropriate risk mitigation.

2. Purpose This Standard Operating Procedure (SOP) provides CCG staff with a framework to ensure that the EQIA process is clearly defined and robustly and consistently embedded within the organisation and its business processes. EQIAs must be completed for all changes to CCG commissioned services including:

∑ Reviews or changes to existing services directly commissioned by the CCG

∑ Service / pathway design for services directly commissioned by the CCG

∑ CCG Quality Innovation Productivity and Prevention (QIPP) schemes

∑ Any new CCG business where it is appropriate to assess the impact of the proposed piece of work

∑ Relevant new or revised CCG commissioning policies

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3. Roles and Responsibilities

Role Responsibilities Completion of EQIA Template, Data Protection Impact Assessment (DPIA), Engagement Plan, embedding of the Project Lead EQIA Panel outcome in the business case / change to service paper.

Provide support to project lead regarding quality and equality Quality & Equality Link impacts in relation to the proposed service change.

Lead and coordinate the EQIA process, including logging of EQIAs, facilitating EQIA meetings and EQIA panels and Health Inequality and identifying the appropriate quality and equality links to support Equality and Diversity Team the project lead. Collating the EQIA information to be included in the quarterly Equality, Diversity and Inclusion Report.

Review EQIAs to determine whether impacts and risks have been identified, assessed and appropriately mitigated against. Weekly EQIA Meeting Outcome of EQIA Meeting to be included on the EQIA Template and fed back to project leads.

Review and consider EQIAs, providing feedback to project leads with the Panel’s outcome and any areas where further Monthly EQIA Panel work is required. Outcome of EQIA Panel to be included on the EQIA Template.

Provide support to project lead or person initiating change Information Governance regarding Data Protection Impact Assessments and Team information governance issues.

Receive a quarterly overview of EQIA activity across the CCG, Quality and Performance including any emerging themes, risks or concerns. Committee

Commissioning Decision Ensure that EQIA requirements have been met and EQIA Makers (Prioritisation and Panel outcomes are considered prior to agreement of policy, Investment Committee, practice or service development changes. Governing Body, Primary Care Commissioning Committee, Accountable Officer, Chief Finance Officer)

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4. The EQIA Process (See Appendix 1: EQIA Process Flowchart)

4.1 The CCG’s EQIA Template (See Appendix 2) must be completed by the project lead for all proposed service changes. The Template has been designed to identify whether proposed projects or service changes have undergone due consideration as to any impact on service users, requirement for a Data Protection Impact Assessment (DPIA) / development of an engagement plan.

4.2 All EQIA Templates should be submitted to: [email protected] for consideration at the weekly EQIA Meeting.

4.3 Where large scale change is proposed or there are various options, an EQIA Template must be used for each individual component of the proposed change. Or, where there is a project with a clear, preferred, option, an EQIA Template can be completed for that specific option for consideration by the EQIA Meeting / EQIA Panel (EQIA Panel Terms of Reference See Appendix 3).

4.4 Where a change spans several providers (statutory and voluntary) or impacts on system change, a joint stakeholder EQIA Template should be completed to capture potential overlapping impacts.

4.5 EQIAs will be reviewed at the Weekly EQIA Meeting which will determine and advise the project lead as to whether further work (which may include review by a nominated Quality & Equality Link), completion of a DPIA / development of an engagement plan is required / recommended.

4.6 Where review by a nominated Quality & Equality Link is required, a Quality & Equality Link will be identified by the EQIA Meeting to support the project lead. The Quality & Equality Link will summarise their review on the EQIA Template; however, it is the responsibility of the project lead to respond to any points for clarification from the Quality & Equality Link and complete the assessment accordingly.

4.7 Once any required work is completed, EQIAs should be re-submitted to: [email protected] for further review by the EQIA Meeting and subsequently the EQIA Panel. Project leads should allow sufficient time for assessments to be reviewed. Requests for urgent review of EQIAs will only be considered in exceptional circumstances.

4.8 The EQIA Meeting will undertake an initial review of EQIAs to determine whether impacts and risks have been identified, assessed and appropriately mitigated against. The outcome of the EQIA Meeting will be fed back to project leads, including any areas where further work is required before EQIAs are progressed to the EQIA Panel.

4.9 An EQIA Log, including outcomes of EQIA Meetings and EQIA Panels, will be maintained by the Health Inequality and Equality and Diversity Team. Feedback / outcomes identified by the EQIA Meeting and EQIA Panel will be documented on the EQIA Template and shared with the appropriate project lead. Correspondence between the Health Inequality and Equality and Diversity Team and project leads will be stored to ensure an audit trail to support and underpin the EQIA process.

4.10 The EQIA Panel will undertake final review of EQIAs, providing feedback to project leads with the Panel outcome / recommendation / any areas where further work is required.

4.11 The project lead will embed the EQIA Panel outcome in the business case / change to service paper, for consideration by commissioning decision makers as part of any commissioning decision.

4.12 The Quality and Performance Committee will receive a quarterly overview of EQIA activity across the CCG, including any emerging themes, risks or concerns.

Equality and Quality Impact Assessment SOP V. 1.1 July 2020

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Appendix 1: EQIA Process Flowchart

Appendix 2: EQIA Template

Appendix 3: EQIA Panel Terms of Reference

Equality and Quality Impact Assessment SOP V 1.1 July 2020

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Nottingham and Nottinghamshire CCG’s Equality and Quality Impact Assessment (EQIA) Process Flowchart

Service change identified / proposed (this includes):

Pilot (commence / cease) / extension of contract / service, commissioning / decommissioning service

Project lead to complete EQIA Template in full with support from relevant Quality Lead and Patient Engagement Lead (see appendix 1)

Completed EQIA to be submitted to: [email protected] for review at weekly EQIA Meeting with Quality and Patient Engagement Leads * *All EQIA’s to be submitted for review three working days prior to weekly meeting (held every Monday)

Further assurance required on EQIA following review at weekly meeting?

YES NO

Feedback provided to project lead regarding Feedback provided to project lead and EQIA assurance required progressed to next monthly EQIA Sign Off Meeting (see appendix B for Sign Off schedule)

Identified assurances considered by project lead EQIA reviewed at monthly EQIA Sign Off Meeting and and revised EQIA resubmitted to: further assurance required? [email protected]

YES NO

Revised EQIA reviewed at Feedback to Feedback to weekly EQIA Meeting until project lead project lead ready for Sign Off (see appendix B for Sign Off schedule)

Final EQIA to be embedded into business case by project lead and outcome to be considered by commissioning decision makers (Prioritisation and Investment Committee, Governing Body, Primary Care Commissioning Committee, Accountable Officer, Chief Finance Officer) as part of any commissioning decision

NB: All EQIA’s that require sign off must be submitted at least five working days prior to the monthly Sign Off meeting. Please see seperate EQIA Sign Off meeting schedule

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Nottingham and Nottinghamshire CCG’s Equality and Quality Impact Assessment (EQIA) Process Flowchart

Appendix 1: Quality Lead Contacts

Quality Lead Portfolio Email Tel Linda Shipman Head of Quality for Acute and Independent [email protected] 07384 878 438 Providers Services Includes inpatient acute services, acute service delivered in the community ie MSK, pain management, NEMS, Hospices etc

Julie Widdowson Quality Manager – Acute and Independent [email protected] 07818 522 201 Providers Services

Hayley Bipin Quality Manager – Acute and Independent [email protected] Providers Services

Vacant Head of Quality for Community and Mental [email protected] 07593021265 Health Services

Ryan Alsop Quality Manager – Community Services [email protected] 07584533854

Grace Kinsey – Quality Manager – Mental Health Services [email protected] 07827 873131 Oxspring Esther Gaskill Head of Primary Care [email protected] 07920 812539 Includes all GP Practices

Helen Horsfield Quality Manager – Primary Care [email protected] 07557 079027

Jean Gregory Head of Nursing Homes and Home Care [email protected] 07593021265 Quality Assurance

Maseline Sarson Quality Manager (Mental Health & Learning [email protected] 07867143328 Disability) Nursing Homes & Home Care et

Emma Holloway Quality Manager – Nursing Homes & Home [email protected] 07827827121 Care Quality Team

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Equality Impact Assessment Checklist

All commissioning activities should be assessed to identify any potential impacts (positive, negative or neutral) on Equality. The CCG is required to have due regard to the aims of the Public Sector Equality Duty (PSED) of the Equality Act 2010, which means understanding the potential effect of commissioning proposals on people in protected characteristic groups defined by the Equality Act. This will help to consider whether the proposals and resulting services will be effective for all people in relation to their health outcomes. Specifically, the CCG should give due regard to the need to eliminate discrimination, harassment and victimisation, advance equality of opportunity and foster good relations between people who share a relevant protected characteristic and those who don’t. Completing EQIAs are a way of doing this and therefore demonstrating compliance with the PSED. As part of the EQIA process the CCG also considers the specific health needs of a number of other groups of people who are traditionally excluded or disadvantaged, face a wide range of health inequalities and experience poor health outcomes. The following checklist of equality considerations can be used for supporting an equality review of EQIAs. Bear in mind that relevant considerations will vary from one proposal/service to another. It is also important to consider ‘intersectionality’ – ie where aspects of more than one protected characteristic/excluded group may combine to form overlapping discrimination or disadvantage.

Protected Characteristic and Equality Comments Inclusion Health/Disadvantaged Groups risk? Age ∑ If service is age-specific, do other age groups have access to similar services? ∑ Do eligibility criteria for services potentially discriminate against older or younger people without just cause? ∑ Are correct assumptions being made about different age groups? ∑ Have needs of certain older people been considered – eg is information easy to read; services easily accessible/close to public transport links? Disability ∑ This protected characteristic is very wide-ranging and some people may be disabled in more than one way. ∑ Consider whether disabled people can access and benefit from the service in the same way as non-disabled people. Are access support needs considered - eg physical access to and within buildings, alternative methods of making appointments, Interpreting and Translation services, carer support, signage? ∑ Does the service consider people who have both physical and mental health needs? ∑ Does service information take account of communication needs of people who are variously disabled and is it easy to understand? Gender Re-assignment ∑ Does service information reflect trans people and people exploring their gender identity? ∑ Is confidentiality about patients’ gender identity maintained? ∑ Sex-specific screening may be required by people who have transitioned – eg cervical and breast screening for trans men. Pregnancy and Maternity ∑ Services should not treat unfavourably women who are pregnant, breastfeeding or have recently given birth. Protection is for up to 26 weeks, after which any discrimination would be sex discrimination. ∑ Is the service accessible for women with babies – eg access for pushchairs, flexible appointments, breast-feeding friendly?

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Protected Characteristic and Equality Comments Inclusion Health/Disadvantaged Groups risk? Race (Includes Gypsies, Roma and Travellers) ∑ Consider this characteristic with Religion or Belief, but do not combine the two. ∑ Consider any cultural factors that may impact on people accessing the service. ∑ Is provision of the service culturally appropriate? ∑ Does the service use assessment materials and methods relevant to people from different cultures? ∑ Is service information available in a range of appropriate languages? ∑ Is service information and imagery culturally appropriate/sensitive/inclusive? ∑ Does the service offer patients the support of Interpreting and Translation services and are extended/double appointments available for patients who use an Interpreter? Religion or belief ∑ Is the service religiously and culturally sensitive to meet the needs of people from various religions and beliefs? ∑ Is service information and imagery religiously appropriate/sensitive/inclusive? ∑ Where appropriate, does the service cater for religious observance requirements of patients and carers? Sex ∑ Is it potentially easier/more difficult for either men or women to access the service - eg because of where information is displayed, opening times? ∑ Is the service appropriate for women from certain Black, Asian and other minority ethnic groups? ∑ There are situations where single sex services can be lawfully provided, as long as they can be justified – eg offering a women- only support service to women experiencing domestic violence is likely to be justifiable even if there is no parallel service for men due to insufficient demand. Sexual orientation ∑ Does the service information use images and terminology that could apply to all sexualities? ∑ Does the service ensure that its staff treat lesbian, gay and bisexual and people of other sexualities with dignity and respect? ∑ Is service provision culturally appropriate for LGB people? ∑ Is confidentiality about patients’ sexuality maintained? Carers ∑ Are carers’ needs recognised by the service and is their ability to access the service when supporting the cared-for person taken into account – eg flexible appointment times, impact of caring on their own health? ∑ Is extra support available to carers who require it - eg emotional support, relief from isolation? ∑ Does the service identify or signpost to any initiatives that might improve carers’ lives?

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Protected Characteristic and Equality Comments Inclusion Health/Disadvantaged Groups risk? People who misuse drugs and alcohol ∑ Consider whether the service addresses the needs of patients experiencing Severe Multiple Disadvantage (SMD) aka ‘complex patients’ - a combination of substance misuse, homelessness, offending and mental ill health. This cohort of patients is complex and often present with multiple issues but experience significant barriers to accessing services. Homeless people ∑ Homeless people often present with SMD - see above. ∑ Homeless people and those with SMD experience significant barriers to accessing health services; consequently their life expectancy gap is often a result of exacerbation of treatable medical conditions. ∑ Consider different types of homelessness, not just rough sleeping; most homeless young people stay temporarily at the homes of friends, family members or acquaintances - sofa surfing. ∑ There may be a prevalence of hidden homelessness amongst women who will seek accommodation options with family/friends to avoid rough sleeping. ∑ An estimated 88% of rough sleepers are male and it is often cited that two thirds of single homeless people accessing accommodation and support are male. ∑ As the complexity of homeless people increases they become more reliant on friends and family over healthcare professionals but their barriers to services may increase. ∑ Consider intersectionality of homelessness and unemployment - amongst young people from BME groups. Evidence suggests higher rates of over-crowding in rental properties amongst Black African and Bangladeshi groups, with consequent negative impact on health and wellbeing. ∑ Research indicates that young LGBT homeless people believed their sexual and/or gender identity was a causal factor in rejection from home. ∑ Does the service offer flexible service models for people who live in insecure accommodation or are rough sleepers – eg in relation to SMD, DNAs, location and length of appointments? New and emerging communities, including refugees and asylum seekers (Also look at considerations under Race) ∑ Consider what the service needs are of people who may have experienced trauma before arriving in Nottinghamshire and have originated from or passed through regions where they may have come into contact with reportable/rare diseases. ∑ Consider whether the service is accessible to communities that may be located in specific geographical areas. People experiencing economic or social deprivation ∑ Includes those who are long-term unemployed or working in unsecured employment contracts, have limited family or social networks, and sex workers. ∑ Consider whether the service has good public transport links and consider cost of travel. ∑ Consider cost to patients of accessing services that are not NHS funded – eg when there is a proposal to decommission a service and signpost patients to alternatives.

Members of the travelling community (who do not belong to an ethnic group recognised under the Equality Act) ∑ Look at relevant considerations above, such as Race and People

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Protected Characteristic and Equality Comments Inclusion Health/Disadvantaged Groups risk? experiencing economic or social deprivation.

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Quality Impact Assessment Checklist

All commissioning decisions/projects, QIPP plans, organisational cost improvement plans and business cases are required to undergo assessment to identify any potential impacts (positive, negative or neutral) on quality from any proposed changes. Quality can be defined as encompassing three key dimensions as outlined by the Darzi principle, namely, safety, experience and effectiveness: Patient safety - rating the impact of the proposal on patient safety Clinical effectiveness - rating the impact of the proposal on the clinical effectiveness of patient care Patient experience – Rating the impact of the proposal on the patient experience of care delivery

For Quality Impact Assessments the following checklist and considerations can be used:

Area of Quality Quality Comments Risk? Duty of Quality ∑ Compliance with NHS constitution ∑ Impact on partner organisations ∑ Impact on organisations duty to safeguard children and vulnerable adults ∑ Impact on other services within the organisation Any other risk indicators relevant to the Duty of Quality? Patient Safety ∑ Impact on avoidable harm ∑ Impact on reliability of safety systems and processes ∑ Impact on clinical workforce levels, competencies and experience ∑ Impact on treatment times and procedures ∑ Impact on safeguarding ∑ Impact on systems and processes for ensuring that the risk of HCAIs is reduced ∑ Impact upon clean and safe environments Any other risk indicators relevant to patient safety? Patient Experience ∑ Impact on patient informed choice and autonomy ∑ Impact on patient access ∑ Impact on dignity, respect and compassion ∑ Impact on patients self-reported satisfaction on national/local surveys/ FFT ∑ Impact on patients self-reported experience through the complaints process/PALS contacts ∑ Impact on patient waiting times ∑ Impact on the provision of individualised care Any other risk indicators relevant to patient experience? Clinical effectiveness ∑ Impact on provision of NICE compliant treatment ∑ Impact on the implementation of evidence based practice ∑ Impact on clinical outcomes ∑ Impact on clinical leadership ∑ Impact on the promotion of self-care ∑ Impact on clinical engagement Any other risk indicators relevant to clinical effectiveness? Non clinical/operational impact ∑ Impact on cost effectiveness ∑ Impact on infrastructure ∑ Impact on staff satisfaction and welfare ∑ Impact on the public perception of the organisation ∑ Social value impact

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Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: Nottingham and Nottinghamshire Heat Paper Reference: PCC 21 014

Map Development Plan

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

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

Executive Summary Arrangements for Discharging Delegated Functions Delegated function 2 – Plan the primary medical services provider landscape, including considering and making decisions in relation to agreeing variations to the boundaries of GP practices. Delegated function 3 – Management of the delegated funds Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts Delegated function 5 – Decisions in relation to enhanced services Delegated function 7 – Approving GP practice mergers and closures Delegated function 10 – Decisions in relation to the management of poorly performing GP practices, including decisions and liaison with the CQC where the CQC has reported non-compliance with standards

Following the presentation of the 2020/21 Quarter 3 Primary Care Quality Dashboard at the PCCC in February 2021 and the follow on paper comparing Nottingham City practices to similar ‘core’ cities presented at the March 2021 committee; consideration has now commenced on the development of a Heat Map for all practices across Nottingham and Nottinghamshire to triangulate the information held across and available to the CCG.

This paper outlines the headline considerations being made, input requested from teams and PCCC members and timelines for the development of the Heat Map as a method of identifying pressures and risks for General Practice.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☒ Procurement and/or Contract Management ☒ Strategic Planning ☒

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Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (EQIA)

Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (DPIA) Risk(s): No risks are identified within the paper

Confidentiality: ☒No

Recommendation(s): 1. RECEIVE the Heat Map Development Plan. 2. ENDORSE the approach to development.

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Nottingham & Nottinghamshire Heat Map Development Plan

1. Background

Following the presentation of the 2020/21 Quarter 3 Primary Care Quality Dashboard at the PCCC in February 2021 and the follow on paper comparing Nottingham City practices to similar ‘core’ cities presented at the March 2021 committee; the PCCC asked for a Heat Map to be developed to triangulate information available for all practices across Nottingham and Nottinghamshire.

2. Development to Date

The Primary Care Commissioning and Primary Care Quality Teams have been working together to establish and understand the data available to the CCG to include as part of the Heat Map in addition to the indicators currently reviewed as part of the quarterly Primary Care Quality Dash Board.

Early consideration has also been given to how to score the information and whether there is a need to weight any areas more highly than others.

Areas for inclusion are listed below:-

 Quality Dashboard – RAG for individual indicators or overall rating  CQC Rating – outstanding/good, requires improvement, inadequate. Adhoc visits and outcomes  Patient Experience – complaints, NHS Choices, National Survey  Contract – remedial or breach notices, meeting contractual requirements, wider EHS signup  Workforce – no. of GPs, pending retirements, clinical and non-clinical vacancies, use of locums  Estates – not purpose built, capacity, condition or state of repair, lease concerns including disputes or debt, future developments  Infection Prevention & Control – complaints, engagement with IPC, failure to respond to IPC  Pharmacy – medication incidents, engagement with the CCG pharmacy team, adoption of guidance  Incidents & Professional Standards – complaints, patient safety or safeguarding concerns, FTP

Each area identified would be scored to give an overall position for the practice; which would then feed into the agreed overall Heat Map for each practice – scoring could be 1-3, 0-5, RAG etc.

The team have linked in with the Corporate Governance team in relation to exploring options for the presentation of this information – dashboard, speedometer, geographical maps.

Data analysts to be engaged further in the presentation of the Heat Map once the criteria and scoring methodology has been tested and agreed.

3. Next Steps and Timeline

Committee members will have received an invite to a Primary Care Development session where the Primary Care Commissioning and Quality Team would like to jointly develop the next stages of the Heat Map with you to ensure that the output product is a useful tool for the CCG whilst also providing assurance to committee members in relation to the provision of general practice across Nottingham & Nottinghamshire.

Key dates in relation to further development of the Heat Map:-

 PC Development session to be held Weds/Thurs 28 or 29 April (dates tbc subject to members availability) – key questions for consideration by members will be circulated in advance with paper

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 Papers for PC Development session to be circulated by Thursday 22 April 2021 – to include a mock-up of data and a proposed look of the Heat Map  Outputs from PC Development session to be formulated into the Heat Map product by the teams with a view to testing and presenting back to the committee in May 2021.  Mobilisation and Implementation – updates to be aligned to the work plan dates for the Primary Care Quality Dashboard on a quarterly basis during 2021/22

4. Recommendation

The committee is asked to:-

1. RECEIVE the Heat Map Development Plan 2. ENDORSE the approach to development

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124 of 168 9.00 via Zoom-21/04/21 Extended Access Services

Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: Extended Access Services Paper Reference: PCC 21 015

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

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

Executive Summary Arrangements for Discharging Delegated Functions Delegated function 2 – Planning the provider landscape: The procurement of new Primary Medical Services Contracts Delegated function 3 – Management of the delegated funds Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts

NHS England published a letter dated 21 January 2021 entitled ‘Supporting General Practice in 2021/22’, this was shared with the Primary Care Commissioning Committee at the February 2021 Open Session. The letter included a reference to Extended Access Services, advising that the new national specification would be developed by Summer 2021 and will go live nationally April 2022. It also referenced that PCNs could start delivering Extended Access Service before April 2022 if the PCN can demonstrate its readiness.

A communication was sent to all PCN Clinical Directors asking them to discuss with their PCN practices their readiness to provide Extended Access services before April 2022. The purpose of this paper is to share this feedback, considerations and recommendations.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☒ Procurement and/or Contract Management ☒ Strategic Planning ☒ Conflicts of Interest: ☒ Conflict noted, conflicted party can participate in discussion, but not decision GPs are conflicted as providers of primary care services and as a PCN member Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Page 1 of 4

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Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (DPIA)

Risk(s): There are no risks associated with this paper. Confidentiality: ☒No Recommendation(s): 1. PCCC to NOTE the feedback from PCNs on the delivery of Extended Access Services from 1 October 2021. 2. APPROVE the extension of the direct award for an additional six months until 31 March 2022.

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Extended Access Services

1. Introduction

The delivery of Extended Access services formed part of the General Practice Forward View, published in April 2016. This set out plans to enable Clinical Commissioning Groups (CCGs) to commission and fund additional capacity across England to ensure that, by 2020, everyone has improved access to GP services. The Extended Access service is for routine appointments at evenings and weekends (outside core hours, 8:00am to 6:30pm Monday to Friday), including bank holidays.

In line with NHS England requirements the predecessor Nottingham and Nottinghamshire CCGs commissioned a seven day service which is delivered by:

 Nottingham City CCG: Nottingham City GP Alliance (NCGPA)  Nottingham North & East and Nottingham West: Primary Integrated Community Services (PICs)  Mansfield & Ashfield CCG: Mansfield & Ashfield PCNs and PICs  Newark & Sherwood CCG: Newark & Sherwood PCNs  Rushcliffe CCG: Partners Health

Extended Access services were awarded as Alternative Provider Medical Services (APMS) contracts. These contracts have been extended by 6 months to 30 September 2021, approved by the Primary Care Commissioning Committee (PCCC) at the December 2020 Open Session. Contract Variations were sent to all providers in March 2021.

2. PCN engagement

NHS England published a letter ‘Supporting General Practice in 2021/22’ on 21 January, which outlined areas of support to general practice in 2021/22, from April 2021. The letter included the following reference to Extended Access services:

Extended access services have been used to support the general practice pandemic response, including the delivery of the COVID vaccination programme. The transfer of funding for the CCG commissioned Extended Access Service will now take place in April 2022. A nationally consistent enhanced access service specification will be developed by summer 2021, with the revised requirements and associated funding going live nationally from April 2022. Commissioners are strongly encouraged to make local arrangements for a transition of services and funding to PCNs before April 2022, where this has been agreed with the PCN, and the PCN can demonstrate its readiness. This has already happened in many parts of England.

A communication was sent to all Nottingham & Nottinghamshire PCN Clinical Directors and Deputy Clinical Directors in February 2021. This communication highlighted the reference to Extended Access services in the 21 January 2021 letter and asked PCNs to consider readiness in being able to respond to the requirements of the national specification from 1 October 2021.

PCN Clinical Directors and Deputy Clinical Directors discussed this within their PCN meetings and forwarded feedback to the CCG. Of the 20 PCNs feedback has been received from 15 PCNs to date.

In summary, 67% of the PCNs that responded stated that the PCN would not be ready to deliver Extended Access services from 1 October 2021. The reasons provided were:

 The practices do not anticipate being in a position to deliver the service themselves by October 2021  There is not sufficient time to develop a PCN solution/delivery model  The PCN could not commit to delivering the service without knowing the content of the new national service specification  The PCN could not implement a new service, in the timescales, without knowing the ask of the PCN

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All PCNs confirmed that they would like to continue with the current Extended Access services until 31 March 2022.

Whilst the remaining 33% of the PCNs indicated they could be in a position to deliver Extended Access services from 1 October 2021, it was still subject to the specification being published and the funding being confirmed. Responses received below:

 The PCN would like to provide Extended Access services subject to there being no significant variation to the new national specification compared to the current specification  The PCN is happy to take on responsibility to deliver Extended Access services but unable to confirm this until the new national specification is published  The PCN would like to deliver Extended Access services but query the funding available and what the delivery requirements will be

Whilst NHS England has not confirmed a date that the new national specification will be published, they have indicated that it is likely to be late August/early September.

3. Finance

A review of current APMS contracts in place from predecessor CCGs has commenced, to ensure there is equity in both funding and service delivery across the Integrated Care System (ICS).

4. Summary

Feedback from PCNs does indicate a willingness to provide Extended Access services, as part of the Network Contract DES; however, it also highlights that this could not realistically be achieved by 1 October 2021 without:

 The new national service specification being published  Sufficient time to be ready to deliver the requirements of the new national service specification  Confirmation of funding available to deliver Extended Access services

The new national service specification will not be published until late August/early September and is therefore unlikely to allow time for PCNs to mobilise and commence service delivery from 1 October 2021. In addition, as outlined in point 3, work is currently taking place to ensure funding and service delivery, across all PCNS, is equitable.

In order for the Primary Care Commissioning Team to support the mobilisation of Extended Access services, and monitor service delivery through the contract, the start dates would need to be concurrent.

It is therefore proposed to extend the direct award for the current Extended Access services (approved by PCCC in December 2020 Open Session) for a further 6 months, ending 31 March 2022. However, it is acknowledged that whilst this can be communicated to providers, Contract Variations will not be issued until the work to review equity of funding and service delivery has been completed.

If, at a later date, a PCN confirms they are in a position to deliver Extended Access services before 1 April 2022, this will be considered whilst ensuring it does not destabilise the current commissioned Extended Access services.

5. Recommendation

PCCC are asked to:

 NOTE the feedback from PCNs on the delivery of Extended Access services from 1 October 2021  APPROVE the extension of the direct award for an additional 6 months until 31 March 2022

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128 of 168 9.00 via Zoom-21/04/21 Overview of GP Practice Additional Expenses in relation to Covid-19

Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: Overview of GP Practice Additional Paper Reference: PCC 20 016

Expenses in Relation to COVID-19

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

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

Executive Summary Arrangements for Discharging Delegated Functions Delegated function 3 – Management of the delegated funds

This paper provides the Committee with an update on guidance and restrictions set out by NHS England and NHS Improvement in the letter published 4th August 2020. The claiming period covered in this paper is up to February 2021.

From 1st October 2020 onwards, only claims with CCG prior approval have been accepted. Requests for exceptional COVID support are reviewed 2 – 3 times per week by the COVID exceptional support group.

This paper also provides the Committee with an update on a further additional £120 million of funding to support General Practice between April and September 2021.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☐ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☐ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Page 1 of 3

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Assessment (DPIA) Risk(s): There are no risks identified with this paper. Confidentiality: ☒ No Recommendation(s): 1. The committee is asked to NOTE the paper for assurance purposes.

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Exceptional COVID Support Requests for GP Practices

1. Exceptional COVID Support Fund

Pre-approved Exceptional COVID Support Funds can be claimed from the CCG until 31 March 2021. This is for COVID sickness for practice staff and to support the priorities of the General Practice COVID Capacity Expansion Fund.

On the 19 March 2021, NHS England and NHS Improvement published a letter informing GP practices of an additional £120 million of funding to support General Practice during April to September 2021. The letter states that the additional funding is to be used to support the priorities identified for the General Practice COVID Expansion Fund, published November 2020.

A separate paper has been prepared for the April Primary Care Commissioning Committee meeting.

2. Overview of claims processed in February 2021

2.1. Exceptional COVID Support

When a practice submits a request for exceptional COVID support, requests are reviewed either the same or the following working day. Responses are sent to practices once the group have considered the request. Only claims received from 1 October 2020 are considered for exceptional COVID support.

There were 3 claims processed in February 2021 for exceptional COVID support funds totalling £5,208.

2.2. Retrospective PPE Claims

This has now closed, in total 316 claims were approved for payment totalling £34,352.90. Payments have been made to practices.

2.3. COVID Claims

To finalise the outcome of the COVID claims audit the following payments have been made:-

 A total of 12 claims were reviewed on behalf of 3 GP Practices across Nottingham and Nottinghamshire  6 claims were approved for payment totalling the sum of £714.20 for COVID related expenditure. These claims were processed in February 2021.  6 claims were approved for payment totalling the sum £3,600 and reimbursed via the COVID Expansion Fund, to support staff cover due to COVID related sickness

3. Summary and Recommendation

The team continue to review and process requests for exceptional COVID support from general practice. When not supported the team provide clear rationale for decisions including reference to the changes in guidance over the claiming period.

The committee is asked to NOTE the paper for assurance purposes.

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Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: General Practice COVID-19 Capacity Paper Reference: PCC 21 017 Expansion Fund

Sponsor: Joe Lunn, Associate Director of Primary Attachments/ Appendix A: NHS Care Appendices: England Letter dated 19 March 2021 Presenter: Joe Lunn, Associate Director of Primary Care

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

Executive Summary Arrangements for Discharging Delegated Functions Delegated function 3 – Management of the delegated funds

NHS England wrote to General Practice on 19 March 2021 outlining an Additional £120 Million of Funding – General Practice COVID Capacity Expansion Fund. This funding is to provide further support to General Practice by extending the General Practice COVID Capacity Expansion Fund (£150m, December 2020 – March 2021).

This letter is included as part of this paper and, as before, states that the funding is ring fenced exclusively for general practice to support the expansion of capacity until the end of September 2021.

The CCG is required to confirm how this funding will be used to continue to support the achievement of priority goals and to confirm the money has been spent fully within general practice, within the time period.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (EQIA)

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Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (DPIA) Risk(s): There are no risks identified with this paper. Confidentiality: ☒No Recommendation(s): 1. The committee is asked to NOTE the information for assurance purposes.

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General Practice COVID Capacity Expansion Fund

1. Background

NHS England wrote to General Practice on 19 March 2021 outlining an Additional £120 Million of Funding – General Practice COVID Capacity Expansion Fund.

This additional funding is to provide further support to General Practice, to support the expansion of capacity in primary care until the end of September 2021.

The letter states that the ‘conditions attached to the allocation and use of this funding are as set out in the initial General Practice COVID Capacity Expansion Fund letter of 9 November 2020’. It is ring fenced for primary care and ‘systems are expected to use the funding to make further progress on the seven priorities identified in that letter’.

2. Seven priorities

In accordance with the letter, the General Practice COVID Capacity Expansion Fund is to be used to provide further support to these seven priorities:

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

The CCG is currently collating how this funding was used by practices to support these priorities and this will be presented to the Primary Care Commissioning Committee May meeting. This information will help identify areas of focus for the additional £120m funding.

3. Finance

NHS England has specified that the funding is ring fenced exclusively for general practice; however, it does state that systems are expected to use the funding to make further progress on these priorities.

The funding will be made available nationally in monthly allocations with £30m in April and May, £20m in each of June and July and £10m in August and September. The funding is non-recurrent and should not be used to fund commitments running beyond this period. The estimated total value for Nottingham and Nottinghamshire CCG is £2.134m.

As this funding is made available through CCG allocations; processes to agree the release of funding needs to be finalised and discussions in relation this have commenced. Current proposal is that the funding is apportioned, as before, using the Carhill formula with an adjustment to reflect the demography, deprivation and ethnicity of the population across the CCG, alongside any adjustment to support pulse oximetery at home.

4. Recommendation

The PCCC is asked to NOTE the content of the letter and this paper.

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Classification: Official

Publications approval reference: C1216

Copy: ICS leads

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

19 March 2021

Dear CCGs and GPs,

SUPPORTING GENERAL PRACTICE: ADDITIONAL £120m FUNDING FOR APRIL-SEPTEMBER 2021

Thank you for the work you have done, and continue to do, to support the response to the pandemic, including the successful delivery of the COVID-19 vaccination programme alongside wider patient care. The work of general practice is greatly valued and appreciated.

It remains a priority to maintain and expand general practice capacity in order to support the ongoing response to COVID-19, tackle the backlog of care, and continue to support delivery of the vaccination programme. That must include making full use of PCN entitlements under the Additional Roles Reimbursement Scheme, with an objective of 15,500 FTE roles in place by the end of the year, as well as ensuring active support for GP recruitment and retention initiatives.

To provide further support to general practice at this critical moment, we are extending the General Practice Covid Capacity Expansion Fund for the period from 1 April to 30 September 2021. £120 million of revenue funding will be allocated to systems, ringfenced exclusively for general practice, to support the expansion of capacity until the end of September. Monthly allocations will be £30m in April and May, £20m in each of June and July and reach £10m in August and September. The funding is non-recurrent and should not be used to fund commitments running beyond this period.

The conditions attached to the allocation and use of this funding are as set out in the initial General Practice Covid Capacity Expansion Fund letter of 9 November 2020, and systems are expected to use the funding to make further progress on the seven

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Classification: Official

priorities identified in that letter. Though this funding is not allocated to support COVID-19 vaccination directly, we expect systems to prioritise spending on any PCNs committed to deliver the Covid Vaccination Enhanced Service (including for cohorts 10-12) whose capacity requirements are greater.

With our appreciation and thanks for everything you are doing.

Ed Waller Dr Nikita Kanani Director of Primary Care, Medical Director for Primary Care NHS England and NHS Improvement NHS England and NHS Improvement

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Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: Primary Care - Additional Development Paper Reference: PCC 21 018 Funding

Sponsor: Joe Lunn, Associate Director of Primary Attachments/ Appendix A: Primary Care Appendices: Care – Additional Development Presenter: Joe Lunn, Associate Director of Primary Funding MOU Care

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

Executive Summary Arrangements for Discharging Delegated Functions Delegated function 3 – Management of the delegated funds

In November 2020 NHS England issued a Memorandum of Understanding to Nottingham and Nottinghamshire CCG for ‘Primary Care – Additional Development Funding’. The additional funding was to provide further support to deliver increased benefits aligned to the Long Term Plan priorities, intended to support areas of Primary Care. The total ‘Additional Development Funding’ transferred (December 2020) to the CCG was £138,317. The Memorandum of Understanding (MOU) is included as Appendix A.

The purpose of this paper is to provide a summary of the schemes to utilise this funding.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☒ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☐ Conflicts of Interest: ☒ Conflict noted, conflicted party can participate in discussion, but not decision GPs are conflicted as providers of primary care services Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (DPIA) Page 1 of 3

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Risk(s): There are no risks identified with this paper. Confidentiality: ☒No Recommendation(s): 1. The committee is asked to RECEIVE the paper and APPROVE the utilisation of funding which is in line with the requirements of the MOU.

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Primary Care – Additional Development Funding

1. Background

NHS England issued a Memorandum of Understanding for the use of ‘Primary Care – Additional Development Funding’. The value of this funding was £138,317; this transferred to the CCG in December 2020.

The purpose of this paper is to provide a summary of the schemes to utilise this funding.

2. Funding requirements

The funding enables initiatives in General Practice which respond to the NHS Long Term Plan; intended to support areas of Primary Care that may not be funded through other routes such as (but not limited to):

∑ IT equipment for staff recruited under the Additional Roles Reimbursement Scheme ∑ IT support for staff working remotely where this is not otherwise funded (e.g. administrative staff) ∑ Increasing PCN capabilities as the emerging footprint for delivery e.g. management of patients outside of hospital ∑ Cancer facilitators ∑ System support for access programmes: Improving Access to Primary Care / GP Direct referral to Community Pharmacy Consultation Service, including communications and engagement support.

3. Summary of Schemes

All 20 PCNs identified schemes that deliver the requirements of the funding, many were replicated across PCNs and a summary is provided below:

∑ Purchase of IT equipment for new staff as part of the Additional Roles Reimbursement Scheme (ARRS) to support the delivery of PCN initiatives by new staff, this included Dieticians, Paramedics and Pharmacy roles. ∑ Purchase of IT equipment to enable staff to work remotely to support PCNs capacity ∑ Purchase of equipment to support patient care, including pulse oximeters and blood pressure monitors ∑ Provision of workflow training to enable staff to manage blood test results ∑ Delivery of weight management programmes and direct referral to Community Pharmacy Consultation Service to support patients ∑ Funding cancer facilitators to support PCNs in relation to cancer prevention and early diagnosis, increased screening, improve recognition and promote healthy lifestyles

These schemes will contribute to future health impacts and continue to support the PCNs deliver the Long Term Plan.

4. Finance

The funding has been apportioned to PCNs based on their combined weighted population as at 1 January 2021.

5. Recommendation

The committee is asked to RECEIVE the paper and APPROVE the utilisation of funding which is in line with the requirements of the MOU.

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Primary Care – Additional Development Funding

MEMORANDUM OF UNDERSTANDING (MOU) between: Trish Thompson, Director of Primary Care and Public Health Commissioning, Midlands Region, on behalf of the NHS England and Improvement (Party A); and Amanda Sullivan, Accountable Officer, Nottingham and Nottinghamshire CCG on behalf of Nottingham and Nottinghamshire Health and Care STP (Party B)

PURPOSE The purpose of this MOU is to clearly identify the expected deliverables regarding additional development funding support for General Practice and the roles and responsibilities of each party in ensuring key deliverables are achieved.

BACKGROUND As part of the continued support for development of General Practice across the Midlands Region, additional funding has been identified to enable STPs/ICS to offer further support to deliver increased benefits aligned to Long Term Plan priorities. Allocating the funding to STPs will enable close collaboration with CCG and PCN Clinical Directors to decide how best to spend the budget in the most effective way, considering local needs and circumstances and current priorities. This MOU confirms additional development support for 2020/21.

REQUIREMENTS The funding and the spending of it has specific requirements attached to it. The funding can only be invested in initiatives that support General Practice to respond to the NHS Long Term Plan and manifesto commitments; it is intended to support areas of Primary Care that may not be funded via other routes such as (but not limited to): - IT equipment for staff recruited under the Additional Roles Reimbursement Scheme - IT support for staff working remotely where this is not otherwise funded (eg: administrative staff) - Increasing PCN capabilities as the emerging footprint for delivery eg: management of patients outside of hospital - Cancer facilitators - System support for access programmes: Improving Access to Primary Care / GP Direct referral to Community Pharmacy Consultation Service, including communications and engagement support.

• The funding is to be spent in 2020/21 • The STP will work with PCN Clinical Directors and CCG leads to establish the local approach(es)

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ASSURANCE Decision rights about the best way of spending the additional funding will sit jointly with each CCG lead and the STP lead; the STP will confirm that the fund is being spent according to the requirements in this MOU. REPORTING Under this methodology, we want to operate on a ‘light-touch’ basis where clinical prioritisation is key; the STP will submit a brief summary of how the fund has been used at the end of March 2021. STP RESPONSIBILITIES UNDER THIS MOU The Accountable Officer on behalf of the system undertakes to:

• Develop a clear plan that ensures funding is allocated in the most effective and efficient ways across the STP • Deliver all deliverables that are linked to the funding • Maintain adequate records and ensure funding spend is coded correctly at CCG level and tracked • Manage the budget efficiently and provide reasonable notice if they identify a forecast underspend • Work closely with CCGs and General Practice to ensure lessons learned and good practice are adopted across the STP • Support each of their CCGs to ensure decisions about how funding is shared between them is clearly understood and agreed (if applicable) • Update the Region as part of the usual relationship arrangements to ensure adequate assurance without creating unnecessary additional reporting burden • Provide a summary of how the funding has supported General Practice.

It is mutually understood and agreed by and between the parties that: Modification of this MOU may only be done writing, through discussion and subsequent clear agreement between both parties as to the changes required and the impact upon the agreed deliverables set out within this MOU.

FUNDING The total 2020/21 additional development funding for the STP is £138,317. This will be allocated in December 2020.

The CCG the funding shall be transferred to is: Nottingham and Nottinghamshire CCG.

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EFFCTIVE DATE AND SIGNATURE: This MOU shall be effective upon the signature of Parties A and B authorised officials. It shall be in force from date of signature until 31 March 2021.

Parties A and B indicate agreement with this MOU by their signatures.

Signatures and dates: Signed on behalf of Party A: ……………………………………………………………..

Trish Thompson Director of Primary Care and Public Health Commissioning NHS England and NHS Improvement

Date:

Signed on behalf of Party B: ……………………………………………………………..

Amanda Sullivan Accountable Officer, Nottingham and Nottinghamshire CCG

Date:

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142 of 168 9.00 via Zoom-21/04/21 Covid-19 Practice Level Update: OPEL

Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: COVID – GP Practice OPEL Reporting – Paper Reference: PCC 21 019

5 weeks to 2 April 2021

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

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

Executive Summary Arrangements for Discharging Delegated Functions Delegated function 2 – Planning the provider landscape Delegated function 4 – Decisions in relation to the commissioning, procurement and management of primary medical services contracts

General Practice continues to progress through the COVID 19 outbreak with practices, across all three Localities (South Nottinghamshire, Mid Nottinghamshire and Nottingham City), reporting their Operational Pressures Escalation Levels (OPEL) on a daily basis. This enables the CCG to understand where there are pressures on service delivery across General Practice each day.

General Practices and Primary Care Networks (PCNs) continue to review business continuity plans to ensure robust arrangements are in place for individual practices or multiple practices within a PCN. Considering the implications when a practice becomes less resilient including the need to work with a neighbouring practice or step up Clinical Management Centres (CMCs) if / when needed to ensure continued service delivery for patients. One CMC remains operational in Nottingham City to support General Practice.

This paper provides an overview of OPEL reporting over the five week period to 2 April 2021 and the CMC utilisation.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☐ Wider system architecture development ☐ (e.g. ICP, PCN development) Financial Management ☐ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☒ Strategic Planning ☐

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Conflicts of Interest: ☒ No conflict identified

Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (DPIA) Risk(s): General Practice continues to manage the risk of service delivery on a daily basis and the impact varies across all practices. Reporting continues to enable practices, PCNs and the CCG to understand the risks for General Practice service delivery as a result of the COVID outbreak.

Confidentiality: ☒ No

Recommendation(s): 1. ToNOTE the OPEL Reporting overview for General Practice for the five weeks to 2 April 2021.

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General Practice OPEL Reporting

1. Introduction

Nottingham and Nottinghamshire practices started reporting their Operational Pressures Escalation Levels (OPEL), on a daily basis in the early stages of the COVID-19 pandemic, reporting from March 2020.

All practices submit their OPEL status by 11:00am each day.

OPEL reporting was introduced for General Practice to help triangulate the overall pressures and to feed into the wider system reporting across the NHS in Nottingham and Nottinghamshire due to the impact of COVID.

The agreed definitions for OPEL reporting are as follows:

OPEL Level 1 - GREEN Practice is able to meet anticipated demand within its available resources. Additional support is not anticipated.

OPEL Level 2 - AMBER Practice is showing signs of pressure. Demand is higher than expected levels or capacity is reduced.

OPEL Level 3 - RED Practice under extreme pressure, unable to deliver all required services. Practice is only able to provide services for urgent medical needs. Practices seek additional support from neighbouring practice(s) in order to minimise disruption to services.

OPEL Level 4 - BLACK Practice closed.

2. OPEL reporting

This paper provides an overview of OPEL reporting for Nottingham and Nottinghamshire practices and the Clinical Management Centre (CMC). The reporting period includes one bank holiday.

2.1. Practice summary

During the 5 weeks to 2 April 2021 (24 working days), practices reported the following:

 5/126 practices reported days where they were OPEL Level 3 – Red (having previously reported Amber.  66/126 practices reported days where they were OPEL Level 2 - Amber  55/126 practices reported they were consistently OPEL Level 1 - Green

2.2. Nottingham City Clinical Management Centre (CMC) summary

The CMC sees patients that are COVID positive / symptomatic on behalf of practices where the zoning of premises or staff capacity is challenging.

One CMC continues to remain operational in the Nottingham City Locality based on Upper Parliament Street. The CMC continues to report activity and Personal Protective Equipment (PPE) levels daily.

During the 5 weeks to 2 April 2021 (24 working days), the CMC continued to have 22 appointments available each day with utilisation varying across the period from 3 to 17 appointments per day.

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3. Recommendation

The Primary Care Commissioning Committee is asked to NOTE the OPEL Reporting overview for General Practice for the five weeks to 2 April 2021.

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146 of 168 9.00 via Zoom-21/04/21 Primary Care Networks (PCN) end of year update

Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: Primary Care Networks End of Year Paper Reference: PCC 21 020 Update

Sponsor: Lucy Dadge Attachments/ App. 1 PCN Presenter: Chief Commissioning Officer Appendices: Workforce Summary App. 2 Regional Helen Griffiths workforce graphs Associate Director of PCN Development App.3 Nottingham & Nottinghamshire PCN Dashboard

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

Executive Summary This paper provides an overview of the development of the Primary Care Networks (PCN) within Nottingham and Nottinghamshire over the past 12 months, summarising the key deliverables and achievements, as well as highlighting on-going considerations as we move into year three of the five year NHSE PCN development programme. Relevant CCG priorities/objectives: Compliance with Statutory Duties ☐ Wider system architecture development ☒ (e.g. ICP, PCN development) Financial Management ☐ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☐ Strategic Planning ☐ Conflicts of Interest: ☒ No conflict identified ☐ Conflict noted, conflicted party can participate in discussion and decision ☐ Conflict noted, conflicted party can participate in discussion, but not decision ☐ Conflict noted, conflicted party can remain, but not participate in discussion or decision ☐ Conflict noted, conflicted party to be excluded from meeting

Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (EQIA)

Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Page 1 of 2

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Assessment (DPIA) Risk(s): On-going considerations have been highlighted. Confidentiality: ☒No ☐Yes (please indicate why it is confidential by ticking the relevant box below) ☐The document contains Personal information ☐The CCG is in commercial negotiations or about to enter into a procurement exercise ☐The document includes commercial in confidence information about a third party ☐The document contains information which has been provided to the CCG in confidence by a third party ☐The discussion relates to policy development not yet formalised by the organisation ☐The document has been produced by another public body ☐The document is in draft form

Recommendation(s): 1. NOTE the progress and continued development of the PCNs over the last 12 months.

2. NOTE and CONSIDER the on-going priorities and considerations for 2021/22.

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Primary Care Networks End of Year Update 1. Introduction PCNs were established in July 2019 to deliver the NHSE PCN Network Directly Enhanced Service (DES). This paper provides an overview of the development of the Primary Care Networks (PCN) within Nottingham and Nottinghamshire over the past 12 months, summarising the key deliverables and achievements, as well as highlighting on-going considerations, as we move into year three of the five year NHSE PCN development programme. Over the last year the PCNs have worked extremely hard to continue to deliver the PCN Network DES despite facing the increased challenges of providing primary care during the pandemic, both in terms of increased workload, as well the ever changing focus of primary care.

2. Achievements 2.1 Delivery of Three Service Specifications from 1 October 2020 2.1.1 Enhanced Health in Care Homes The PCNs worked with the Locality Teams to align the 363 care homes, across Nottingham and Nottinghamshire, to their practices and to also identify a designated care home lead. They have been working closely with the community service providers and other relevant partners to establish and coordinate a multidisciplinary team (MDT) who support delivery of the weekly reviews in line with the service specification requirements. Over the coming months they will continue to develop PCN protocols between the care home and system partners to support information sharing, shared care planning, use of shared care records, and clear clinical governance.

2.1.2 Structured Medication Reviews All of the PCNs have employed Clinical Pharmacists and many of the roles have been supporting the Structured Medication Review (SMR) Specification. This requires PCNs to prioritise patients who would benefit from a SMR, which includes patients: ∑ Living in care homes ∑ With complex and problematic polypharmacy, specifically those on 10 or more medications ∑ On medicines commonly associated with medication errors ∑ With severe frailty, who are particularly isolated or housebound or who have had recent hospital admissions and/or falls ∑ Using potentially addictive pain management medication. It is important to note that many of the pharmacists have also supported the Covid Vaccination programme across the system.

2.1.3 Early Diagnosis of Cancer The PCNs have been working to link the Quality & Outcome Framework (QOF) Cancer quality specifications with the PCN DES Requirements, working closely with the Cancer Research UK to identify actions plans and support the delivery of care. PCN’s are required to: ∑ Review referral practice for suspected cancers, including recurrent cancers. ∑ Contribute to improving local uptake of National Cancer Screening Programmes; ∑ Establish a community of practice between practice-level clinical staff to support delivery through peer to peer learning events that look at data and trends in diagnosis across the PCN, including cases where patients presented repeatedly before referral and late diagnoses; and engage with local system partners, including Patient Participation Groups, secondary care, the relevant Cancer Alliance, and Public Health Commissioning teams.

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Much of this work has been driven as part of the PCN meetings and will continue into 2021/22 with a view to support continued learning and drive development opportunities.

2.2 Workforce and Additional Roles The PCN Network DES contract allowed the PCNs to recruit against twelve roles of which there was a total increase of workforce of 122.44 WTE during 2020/21. The graph shown in appendix 1 shows the number of new roles as at 31st March 2021.

The additional roles budget is to expand further in 2021/2022 with an expected budget of £12.314 per weighted population. There will be an introduction of three further roles; Mental Health Practitioner, Emergency Care Paramedic and Advanced Practitioners. Discussions are underway with Nottinghamshire Health Care Trust and East Midlands Ambulance Service to develop the models of care.

2.3 PCN Workforce Planning – 2024 The PCN Network DES required each PCN to complete and submit workforce plans, to the CCG using the agreed national workforce planning template, providing details of their recruitment plans for 2020/21 and indicative intentions through to 2023/24. The workforce plans indicated that an additional 600+ WTE staff are expected to be supporting the delivery of Primary Care by 2023/24.

The graph, as seen in appendix 2, provided by NHS England Regional Workforce Team shows how the PCNs are progressing against their plans as of 31 December 2020. It is well recognised that the delivery of this aspect of the PCN Network DES is time consuming and has remained a challenge over the last year. The CCG will continue to work with the PCNs to support their needs to deliver this significant agenda, as well as liaise with Health Education England and system partners to support the new roles.

2.4 Impact and Investment Fund (IIF) & PCN Dashboard The Investment and Impact Fund (IIF) has been introduced as part of the amended 2020/21 Network DES. The initial six months of this scheme was provided to the PCNs as a dedicated support payment (0.27p). From the 1 October 2020 until 31 March 2021 PCNs have been working towards an Impact and Investment Fund (IIF) that has focused around six indicators: ∑ % 65+ who received a seasonal flu vaccination ∑ % on Learning Disability register who received Learning Disability health check ∑ % referred for social prescribing ∑ % 65+ prescribed NSAID without gastro-protective medication ∑ % 18+ prescribed oral anticoagulant & antiplatelet without gastro-protective medication ∑ % 18+ prescribed aspirin & another anti-platelet without gastro-protective medication The achievements against the six indicators are expected to be confirmed by NHS England towards the end of May 2021. Nottingham and Nottingham CCG have developed a local dashboard to support the PCN in their developments. An indication of the PCN achievements against the IIF indicators is shown in appendix 3 and will be verified once the NHS England data has been received.

The launch of the National PCN Dashboard was due on 1 April 2020, but was delayed until 12 March 2021. Over the coming year the PCN Dashboard will support PCNs to understand their local population health priorities, as well as the benefits they are delivering for their patients. It includes data on performance and indicative earnings against the Investment and Impact Fund, delivery of PCN services and progress with recruitment.

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2.5 Primary Care Transformation Monies The Primary Care Transformation Monies were confirmed for 2020/21 in Quarter 3 as £1.7m. This funding and the allocation to a range of schemes were presented to the Primary Care Commissioning Committee in November 2020. The delivery plan aligns to the four NHSE National Priority Areas: Workforce; Integration; Access; and Health Inequalities; work is underway to progress all 21 schemes across the system.

2.6 Response to Covid The PCNs have continued to support the Covid response and played an active role in the development of the Clinical Management Centres, as well as the Covid Vaccination Centres, and the ‘Pop-up’ Clinics which are located in general practice and within the community centres such as the local mosques. The PCNs involvement has been instrumental in the delivery of vaccinations within the care home settings, with housebound patients, as well as supporting the uptake in hard to reach groups.

One great example of the PCN support is the rollout of our Covid oximetry @home programme. This involves the remote monitoring of patients with coronavirus symptoms. Patients use a pulse oximeter, a small monitor clipped to their finger, to measure their oxygen saturation levels three times a day. We have seen 426 patients locally benefit from this programme of work.

2.7 Leadership & Development Due to the demands of the pandemic the local PCN Leadership Programme, which commenced early in 2020, was paused. Monthly ICS Clinical Directors Network meetings have continued to be held and provide dedicated time to enable the PCN Clinical Directors to share information and learning across the system.

A Training Needs Analysis (TNA) was repeated, to build on the TNA position from 2019, and allow the Clinical Directors the opportunity to review their individual and PCN development needs. The leadership programme for 2021/22 is now being developed and finalised in conjunction with the NHSE Leadership and Lifelong Learning Team. The programme will support the needs identified in the TNA, as well as extend support to new emerging leaders as we move towards year three of the PCN development programme.

Despite conflicting pressures within the PCNs, the PCN Development Team have shared the Midlands Leadership and Lifelong Learning team offers, which include: coaching, personalised care programmes, and talent management programmes.

2.8 PCN Involvement in Wider Healthcare Provision Over this last year there have been several programmes of system transformation which are seen to be key enablers for the PCNs as they continue to evolve. These include: the Community Transformation Programme; the Mental Health Transformation Programme; Tomorrow’s NUH; and the ICS Organisational Collaborative. It is recognised that PCN engagement and leadership input into these significant programmes is key to both shape the outcomes and support the PCNs in their evolvement. Representation at a range of meetings has been managed across the CCG, the GP Federations, and the Primary Care Clinical Leads, to enable primary care to be represented and feed into these significant on-going programmes of work.

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2.9 Embedding Social Prescribing Nottingham and Nottinghamshire have four Social Prescribing Providers covering the 20 Primary Care Networks: Primary Integrated Community Services, Partners Health, Nottingham City GP Alliance and Age UK. There are currently 54 Link Workers in post across the PCNs, which has resulted in the system already reaching the NHSE recruitment performance target as determined by March 2022.

Referrals into the Social Prescribing Services have continued to support patients and referral rates can be seen in appendix 3 shown within the Impact and Investment Fund.

A successful ICS webinar was held In November 2020 which was attended by 70 delegates across the system. The focus of the event was on the impact of the Link Worker to support increased levels of loneliness as a result of COVID-19, and evaluated positively.

Additional to the main referrals, the Link Worker role has really come into its own during the pandemic response. Link Workers have been at the heart of the local support offer for vulnerable and shielded patients. This is a practical demonstration of the role that primary care can play in building community resilience and tackling health inequalities.

Nottingham & Nottinghamshire is 1 of 7 ‘Test and Learn’ sites that were successful when bidding against a further 15 sites through a national bidding process. Each site has secured £500K for a 2 year period, from April 2021 to March 2023, to run a Green Prescribing project.

3 On-going considerations 3.1 Workforce The PCN workforce plans highlight the scale of the increase in PCN workforce expected over the next three years. These plans not only demonstrate the desire for the PCNs to develop their models of care but also the transition and offer of care within the community. The biggest challenge continues to be the availability of workforce. The CCG are working closely with the Training Hub, Health Education England, and the ICS People and Culture Board to ensure that PCNs are informed of local training provision and support, as well as explore more creative employment models, such as rotational positions.

A further challenge is the remit of the Additional Roles Reimbursement Scheme. The scheme is very prescriptive regarding how the roles that can be employed and the level of reimbursement that can be received by the PCN. The scheme does not recognise the appropriate ‘on costs’ associated with the posts, which can restrict recruitment and impact on financial risk for the PCNs which in turn may limit the ambitions of the PCNs.

Despite the new roles being created to support general practice and release clinical time, the variety of the now, 15 new roles, adds further complexities for PCNs due to the increased time that has to be dedicated to the emerging roles in the supporting their induction, developmental needs, training, supervision both clinical and non-clinical and day to day management and leadership and the impact this has on general practice time.

All of the above constraints highlight the on-going need to have a focus and dedicated resource within the system to support the primary care workforce portfolio.

3.2 IT Infrastructure IT infrastructure for the emerging roles continues to be a challenge as there has not been any allocated funding nationally to support the provision of their IT equipment. This has

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been further heightened due to the required agile working due to the Covid restrictions. The CCG was successful in obtaining additional funds through a Regional IT Capital Funds to support the IT infrastructure for the additional roles in the short term. There is a risk that as more additional roles are appointed within PCNs over the coming years that the funds will not be sufficient to support the equipment required. This is being monitored on a monthly basis and further discussions around Primary Care IT are taking place. The establishment of the GP IT Steering Group has assisted bringing together Clinical Leads and CCG officers to discuss the needs and future requirements collectively.

3.3 PCN Estates Needs As the transformation of primary and community care takes place and more roles develop within the PCNs, the capacity within the primary care estate will increasingly become a focus of attention across the system. Early discussions with the PCNs are taking place to start to identify the future estate needs based on their emerging priorities which will then be developed into an ICS Primary Care Estates strategy. It recognised that it is important that the development of the strategy has a ‘bottom up’ approach and that PCNs fully engage in the process.

3.4 Financial Flow The PCN Network DES is supported by a range of payments which for 2020/21 included: Practice Participation (£1.76); Clinical Director (O.25WTE); Core PCN Funding (£1.50); Additional Roles and Reimbursement Scheme (£7.13); Extended Hours (£1.45); Care Home Premium (£7.50 per bed per month); Impact and Investment Fund (£111.00 per point). Locally it is fortunate that all PCNs are supported by GP Federations to manage the PCN finances. Monthly meetings are now held with the Federations to assist and support in understanding this new finance regime. Work is also underway to understand PCN financial resilience and will be reported back to the Primary Care Commissioning Committee.

3.5 Transformation Agenda It is recognised that there is a significant transformational agenda facing PCNs as we progress through this financial year. Early consideration is being given to the resources and infrastructure to support the business unit delivery of primary care as well as the policy and transformational resource to enable PCNs to be represented in the statutory ICS from April 2022.

Furthermore, although the pandemic has enabled PCNs to build relationships, trust and resilience across practices it is important that there is an increasing broader focus to build engagement with wider system partners, community assets and the ‘patient voice’.

3.6 Network DES Contract The PCN Network DES was released on 31 March 2021. Work is underway to summarise this significant contract specification, to highlight both the contractual requirements as well as the financial details. The summary slide deck will be shared with PCNs, Federations and Locality Teams to ensure there is a consistent understanding, and delivery, of the contract.

4 Next Steps and Priorities Key priorities that the PCNs will be focusing for 2021/22 include: ∑ Deliver the implementation of the PCN DES Specification from 1st April 2021. ∑ Consider the delivery, impact and outcomes of the Network DES at PCN, ICP and ICS level. ∑ Implementation of four service specifications: Cardio-vascular Disease Diagnosis and Prevention; Tackling Health Inequalities; Personalised Care; and Anticipatory Care.

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∑ Continued enhancement of the multidisciplinary models of working; drawing on the wider skill sets the new roles and teams can offer. ∑ Establish a broader workforce as identified in the PCN workforce plans; consider the additional three roles that will become reimbursable for PCNs to recruit from 2021. ∑ Improved access, including provision of extended access hours, as well as support total triage and remote consultation. ∑ Progress the implementation of Population Health Management. ∑ Continue to support the Covid vaccination programme. ∑ Make the best use of people and technology to improve efficiency maximise income and strengthen their workforce including; remote consultations, Patients Knows Best and TeamNet. ∑ ICS PCN Conference arranged for 24th June 2021, supported by The Kings Fund and national representatives from NHSE/I. ∑ Delivery of a Leadership Programme to support the Clinical Director’s both across the system and in localities, as well as support succession planning and broadening the multi-professional leadership. ∑ Consider allocation of PCN Development Funds, which will be potentially confirmed in Q1 2021/22. Work is underway to develop a local PCN Maturity Matrix Framework to support PCNs to continue to evolve and contribute to the system delivery in line with the ICS Primary Care Strategy.

5 The Primary Care Commissioning Committee is asked to:

∑ NOTE the progress and continued development of the PCNs over the last 12 months ∑ NOTE and CONSIDER the on-going considerations, priorities and considerations for 2021/22

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Appendix 1 – PCN Workforce summary

PCN Additional Roles – workforce comparison between 31/03/20 and 31/03/21

Sum of WTE Column Labels Row Labels 31/03/2020 31/03/2021 Care Coordinator 13.53 Clinical Pharmacist 33.26 71.1 Dietician 2.05 First Contact Physio 28.28 Occupational Therapist 7.6 Pharmacy Technician 12.29 Physician Associate 1.64 SP Link Worker 28.66 47.87 Grand Total 61.92 184.36

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Appendix 2 - Regional workforce graphs

The graph, below, provided by NHS England Regional Workforce Team shows how the Nottingham and Nottinghamshire PCNs are progressing against their plans as of 31 December 2020. NHS England Regional Team are pleased with Nottingham and Nottinghamshire progress to date.

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Appendix 3 – Nottingham & Nottinghamshire PCN Dashboard Please Note – The below data is taken from the local Nottingham and Nottinghamshire PCN Dashboard and will provide a guide only to the PCN achievements. The Impact & Investment Fund verified data is not expected until late May 2021.

Mid Notts PCN Name PCN Group Value (%) Snapshot Date Numerator Denominator Target Patients aged 65 and over who have received the flu vaccine (PR01) p Newark N 89.1 06/04/2021 15372 17245 70-77% Sherwood S 88.7 06/04/2021 11430 12892 70-77% Ashfield South AS 89.1 06/04/2021 6920 7769 70-77% Rosewood RW 85.9 06/04/2021 7321 8520 70-77% Ashfield North AN 93.0 06/04/2021 9169 9864 70-77% Mansfield North MN 90.6 06/04/2021 10248 11315 70-77% Learning disability patients (14+) with an annual learning disability health check (HI01) p Newark N 75.3 06/04/2021 292 388 49-80% Sherwood S 66.3 06/04/2021 265 400 49-80% Ashfield South AS 47.8 06/04/2021 110 230 49-80% Rosewood RW 25.9 06/04/2021 68 263 49-80% Ashfield North AN 88.5 06/04/2021 348 393 49-80% Mansfield North MN 56.0 06/04/2021 206 368 49-80% Patients aged 65+ with two oral NSAID issues without ulcer-healing drug (MS01) q Newark N 7.5 06/04/2021 37 494 30-43% Sherwood S 6.7 06/04/2021 23 345 30-43% Ashfield South AS 4.1 06/04/2021 10 241 30-43% Rosewood RW 4.5 06/04/2021 10 222 30-43% Ashfield North AN 1.6 06/04/2021 3 184 30-43% Mansfield North MN 8.2 06/04/2021 19 233 30-43% Patients (18+) on warfarin or NOAC and antiplatelet drug without ulcer-healing drug (MS02) q Newark N 8.4 06/04/2021 13 155 25-40% Sherwood S 18.5 06/04/2021 28 151 25-40% Ashfield South AS 6.3 06/04/2021 6 96 25-40% Rosewood RW 10.3 06/04/2021 12 117 25-40% Ashfield North AN 6.4 06/04/2021 9 140 25-40% Mansfield North MN 13.0 06/04/2021 17 131 25-40% Patients (18+) on aspirin and another antiplatelet drug without ulcer-healing drug (MS03) q Newark N 11.1 06/04/2021 21 190 25-42% Sherwood S 11.1 06/04/2021 22 199 25-42% Ashfield South AS 6.7 06/04/2021 11 164 25-42% Rosewood RW 3.0 06/04/2021 4 133 25-42% Ashfield North AN 1.1 06/04/2021 2 182 25-42% Mansfield North MN 7.3 06/04/2021 14 192 25-42% Patients (All) referred to social prescribing (PC01) p Newark N 0.5 06/04/2021 408 77128 0.4-0.8% Sherwood S 0.9 06/04/2021 557 61174 0.4-0.8% Ashfield South AS 0.8 06/04/2021 325 39816 0.4-0.8% Rosewood RW 1.1 06/04/2021 536 48297 0.4-0.8% Ashfield North AN 0.9 06/04/2021 472 51172 0.4-0.8% Mansfield North MN 0.7 06/04/2021 430 58625 0.4-0.8%

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Please Note – The below data is taken from the local Nottingham and Nottinghamshire PCN Dashboard and will provide a guide only to the PCN achievements. The Impact & Investment Fund verified data is not expected until late May 2021

South Notts PCN Name PCN Group Value (%) Snapshot Date Numerator Denominator Target Patients aged 65 and over who have received the flu vaccine (PR01) p Byron NNE1 90.4 06/04/2021 6253 6915 70-77% Arnold and Calverton NNE2 91.6 06/04/2021 7192 7853 70-77% Arrow Health NNE3 91.2 06/04/2021 8506 9324 70-77% Synergy Health NNE4 90.5 06/04/2021 4804 5306 70-77% Nottingham West NW 93.7 06/04/2021 21094 22523 70-77% Rushcliffe RUS 94.0 06/04/2021 26394 28092 70-77% Learning disability patients (14+) with an annual learning disability health check (HI01) p Byron NNE1 65.7 06/04/2021 119 181 49-80% Arnold and Calverton NNE2 76.0 06/04/2021 95 125 49-80% Arrow Health NNE3 64.1 06/04/2021 116 181 49-80% Synergy Health NNE4 37.7 06/04/2021 40 106 49-80% Nottingham West NW 81.8 06/04/2021 381 466 49-80% Rushcliffe RUS 87.4 06/04/2021 361 413 49-80% Patients aged 65+ with two oral NSAID issues without ulcer-healing drug (MS01) q Byron NNE1 5.2 06/04/2021 10 193 30-43% Arnold and Calverton NNE2 1.0 06/04/2021 2 193 30-43% Arrow Health NNE3 1.7 06/04/2021 3 178 30-43% Synergy Health NNE4 4.6 06/04/2021 7 152 30-43% Nottingham West NW 2.6 06/04/2021 13 509 30-43% Rushcliffe RUS 1.4 06/04/2021 9 623 30-43% Patients (18+) on warfarin or NOAC and antiplatelet drug without ulcer-healing drug (MS02) q Byron NNE1 15.6 06/04/2021 10 64 25-40% Arnold and Calverton NNE2 12.1 06/04/2021 4 33 25-40% Arrow Health NNE3 7.1 06/04/2021 3 42 25-40% Synergy Health NNE4 6.7 06/04/2021 2 30 25-40% Nottingham West NW 10.2 06/04/2021 13 127 25-40% Rushcliffe RUS 12.1 06/04/2021 21 174 25-40% Patients (18+) on aspirin and another antiplatelet drug without ulcer-healing drug (MS03) q Byron NNE1 15.7 06/04/2021 16 102 25-42% Arnold and Calverton NNE2 6.0 06/04/2021 5 84 25-42% Arrow Health NNE3 5.3 06/04/2021 6 113 25-42% Synergy Health NNE4 9.9 06/04/2021 7 71 25-42% Nottingham West NW 11.6 06/04/2021 27 233 25-42% Rushcliffe RUS 12.9 06/04/2021 31 241 25-42% Patients (All) referred to social prescribing (PC01) p Byron NNE1 0.5 06/04/2021 201 37181 0.4-0.8% Arnold and Calverton NNE2 1.0 06/04/2021 329 33277 0.4-0.8% Arrow Health NNE3 0.3 06/04/2021 146 42106 0.4-0.8% Synergy Health NNE4 0.3 06/04/2021 81 30018 0.4-0.8% Nottingham West NW 0.8 06/04/2021 842 106053 0.4-0.8% Rushcliffe RUS 1.0 06/04/2021 1270 131424 0.4-0.8%

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Please Note – The below data is taken from the local Nottingham and Nottinghamshire PCN Dashboard and will provide a guide only to the PCN achievements. The Impact & Investment Fund verified data is not expected until late May 2021.

Nottingham City

PCN Name PCN Group Value (%) Snapshot Date Numerator Denominator Target

Patients aged 65 and over who have received the flu vaccine (PR01) p Unity (Nottingham) City PCNU 92.1 06/04/2021 314 341 70-77% City South City PCN7 91.1 06/04/2021 5832 6403 70-77% Bestwood & Sherwood City PCN5 90.6 06/04/2021 6316 6973 70-77% Clifton & Meadows City PCN8 88.3 06/04/2021 4515 5115 70-77% Nottingham City East City PCN6 85.6 06/04/2021 5877 6862 70-77% Radford & Mary Potter City PCN4 87.2 06/04/2021 1959 2246 70-77% Bulwell & Top Valley City PCN1 89.0 06/04/2021 6115 6870 70-77% BACHS City PCN3 84.8 06/04/2021 6526 7700 70-77% Learning disability patients (14+) with an annual learning disability health check (HI01) p Unity (Nottingham) City PCNU 0.0 06/04/2021 0 3 49-80% City South City PCN7 69.9 06/04/2021 72 103 49-80% Bestwood & Sherwood City PCN5 71.7 06/04/2021 225 314 49-80% Clifton & Meadows City PCN8 70.0 06/04/2021 126 180 49-80% Nottingham City East City PCN6 61.8 06/04/2021 165 267 49-80% Radford & Mary Potter City PCN4 83.0 06/04/2021 137 165 49-80% Bulwell & Top Valley City PCN1 65.6 06/04/2021 185 282 49-80% BACHS City PCN3 50.0 06/04/2021 152 304 49-80% Patients aged 65+ with two oral NSAID issues without ulcer-healing drug (MS01) q Unity (Nottingham) City PCNU 0.0 06/04/2021 0 5 30-43% City South City PCN7 5.7 06/04/2021 9 157 30-43% Bestwood & Sherwood City PCN5 1.3 06/04/2021 2 158 30-43% Clifton & Meadows City PCN8 1.0 06/04/2021 1 96 30-43% Nottingham City East City PCN6 4.9 06/04/2021 7 142 30-43% Radford & Mary Potter City PCN4 0.0 06/04/2021 0 51 30-43% Bulwell & Top Valley City PCN1 5.3 06/04/2021 9 170 30-43% BACHS City PCN3 0.0 06/04/2021 0 143 30-43% Patients (18+) on warfarin or NOAC and antiplatelet drug without ulcer-healing drug (MS02) q Unity (Nottingham) City PCNU 0.0 06/04/2021 0 1 25-40% City South City PCN7 9.8 06/04/2021 5 51 25-40% Bestwood & Sherwood City PCN5 1.8 06/04/2021 1 57 25-40% Clifton & Meadows City PCN8 5.1 06/04/2021 3 59 25-40% Nottingham City East City PCN6 11.9 06/04/2021 7 59 25-40% Radford & Mary Potter City PCN4 16.7 06/04/2021 4 24 25-40% Bulwell & Top Valley City PCN1 3.6 06/04/2021 2 56 25-40% BACHS City PCN3 11.3 06/04/2021 8 71 25-40% Patients (18+) on aspirin and another antiplatelet drug without ulcer-healing drug (MS03) q Unity (Nottingham) City PCNU 20.0 06/04/2021 1 5 25-42% City South City PCN7 8.6 06/04/2021 7 81 25-42% Bestwood & Sherwood City PCN5 4.4 06/04/2021 6 137 25-42% Clifton & Meadows City PCN8 8.6 06/04/2021 9 105 25-42% Nottingham City East City PCN6 9.0 06/04/2021 12 133 25-42% Radford & Mary Potter City PCN4 2.8 06/04/2021 2 72 25-42% Bulwell & Top Valley City PCN1 7.4 06/04/2021 9 122 25-42% BACHS City PCN3 4.2 06/04/2021 6 142 25-42% Patients (All) referred to social prescribing (PC01) p Unity (Nottingham) City PCNU 0.2 06/04/2021 111 49719 0.4-0.8% City South City PCN7 1.0 06/04/2021 365 37442 0.4-0.8% Bestwood & Sherwood City PCN5 0.3 06/04/2021 178 51581 0.4-0.8% Clifton & Meadows City PCN8 0.4 06/04/2021 120 32420 0.4-0.8% Nottingham City East City PCN6 0.3 06/04/2021 175 65906 0.4-0.8% Radford & Mary Potter City PCN4 0.2 06/04/2021 75 46848 0.4-0.8% Bulwell & Top Valley City PCN1 0.4 06/04/2021 163 45522 0.4-0.8% BACHS City PCN3 0.7 06/04/2021 420 59863 0.4-0.8%

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Meeting Title: Primary Care Commissioning Committee Date: 21 April 2021 (Open Session)

Paper Title: Primary Care Estates Update Paper Reference: PCC 21 021

Sponsor: Stuart Poynor Attachments/ Presenter: Chief Finance Officer Appendices: Lynne Sharp Associate Director of Estates

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

Executive Summary The purpose of this paper is to bring members of the Primary Care Commissioning Committee up to date with developments in primary care estates across the CCG over the last six months.

Progress has been slow and in some areas paused due to the COVID pandemic incident over the last 12 months. This has been due to the halting of national estates programmes and practices have not been in a position to engage whilst they are dealing with the pandemic. In addition, in September 2020, three of the five team members were redeployed full-time into the Vaccination Programme and are just returning to their permanent roles.

The paper gives the current position statement and highlights some key areas of work for this year.

Relevant CCG priorities/objectives: Compliance with Statutory Duties ☐ Wider system architecture development ☒ (e.g. ICP, PCN development) Financial Management ☐ Cultural and/or Organisational ☐ Development Performance Management ☐ Procurement and/or Contract Management ☐ Strategic Planning ☒ Conflicts of Interest: ☐ No conflict identified ☒ Conflict noted, conflicted party can participate in discussion and decision ☐ Conflict noted, conflicted party can participate in discussion, but not decision ☐ Conflict noted, conflicted party can remain, but not participate in discussion or decision ☐ Conflict noted, conflicted party to be excluded from meeting

GPs are conflicted as potential leaseholders

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Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ Not required for this paper. Assessment (DPIA) Risk(s): None Confidentiality: ☒No

Recommendation(s): 1. The Committee is asked to NOTE the paper for information.

Report Summary

Business Cases Work has been on going on the production of Outline Business Cases covering priority areas across the CCG in:  Hucknall  Eastwood  East Leake  Newark At the October meeting an indicative programme was given for the OBC completion and on-ward delivery of the schemes. This was predicated on the possible announcement of capital funding through the ICS/STP in the autumn budget. No such announcement was made however, initiatives were announced which could favourably impact on the delivery of some of these projects. i) Cavell Centres Hucknall was put forward to be one of six pioneer projects for a new community hub concept called a Cavell Centre aimed at supporting the health and wellbeing of the population they serve rather than just treating their illnesses. The centres provide an opportunity for wider integration of services tailored to the needs of the population. The centres are intended to be system owned and managed providing flexible strategic assets that can flex to meet the needs of service change over the years in line with the Long Term Plan. The Hucknall centre has passed the first stage, having received approval of its PID on 9 April 2021. First stage funding has been secured to support the production of the OBC subject to NHS budget announcements expected imminently. The programme includes six phases with an expected operational date of April 2024, including five Gateway stages which must be passed. The next steps for the Hucknall Cavell Centre are to establish the multi-stakeholder governance arrangements and identify project management capacity.

ii) Levelling Up Funding At the Spending Review, the UK Government committed an initial £4 billion for the Levelling Up Fund for England over the next four years (up to 2024-25). Funding will be delivered through local authorities – predominantly district led. Bids are for up to £20m (£50m for transport projects). Rushcliffe Borough Council has contacted the CCG with a view to developing a bid for East Leake Health Centre. Preliminary discussions are also taking with Newark and Sherwood District Council.

iii) OPE Feasibility Study

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The final report for the community hub element commissioned by Nottinghamshire County Council with One Public Estate funding is still awaited. Meanwhile public consultations, enabling junction work and planning applications are progressing for the residential scheme which forms part of the overall site with the hub.

iv) Ashfield Towns Fund The Government is making £3.6bn available to regenerate over 100 towns across the UK. Sutton in Ashfield and Kirkby in Ashfield have been chosen as two of the towns to receive funding. Each town is set to receive up to £25m of investment. Plans are being developed including the regeneration of Kirkby town centre. Ashfield District Council is discussing these plans with the estates and Mid-Notts locality teams in terms of the impact on the four practices located in that area.

v) Cotgrave Surgery – Wave 1 STP Capital NHS Rushcliffe CCG approved the development of a new health centre as part of an overall regeneration programme led by Rushcliffe Borough Council and linked to a new housing development on the closed colliery site. At the same time both ETTF funding and STP capital wave 1 were announced and subsequent bids were submitted. The scheme was successful in both but due to the STP capital being a higher amount the CCG withdrew its ETTF bid. However, the timing of the successful STP bid was not in line with the overall regeneration programme and as an integral part of it, delaying approval of the health component would have put at risk the funding package put together by the Borough Council. The CCG took a pragmatic approach and approved the project as a revenue scheme with a view to applying the capital retrospectively. The Project Assessment Unit (PAU) reviewed the approved FBC and advised the CCG to produce an addendum to the FBC covering a number of points including the application of the STP capital. The CCG is working with the practice on the final parts of the addendum before it is submitted to the Treasury for approval.

Section 106

Contributions from developers for infrastructure services as a result of housing developments are requested from each of the district councils in Nottinghamshire when planning applications are being proposed. The CCG is consulted where applications or requests for advice are received for developments over 25 dwellings. The CCG responds initially with a formula for funding and for the larger developments is included in development meetings held by the planning authorities as a key stakeholder.

The major developments in progress are (not an exhaustive list):

Mansfield DC: Lindhurst development – 1700 Dwellings Rushcliffe BC: Fairham Pastures south of Clifton 3000 dwellings Newark and Sherwood DC:Fernwood – 1800 Dwellings Ashfield DC: Rolls Royce 900 dwellings plus a further 4 applications totalling c700 dwellings Gedling BC: Top Wighay 800 dwellings Broxtowe BC: Chetwynd Barracks 1500+ also linked to the HS2 Toton development

The City Council does not currently have policy in place to allow the CCG to request section 106 contributions but do consult on major developments.

Estates and Technology Transformation Fund (ETTF)

The following two improvement grant schemes are in progress in this final year of ETTF:  Rise Park – approved by the PCCC at the last meeting, site preparation has started and construction should begin at the end of April.  Deer Park, Wollaton Vale Health Centre – the design of the scheme has been progressed as far as possible. The project is straightforward involving primarily a reconfiguration of vacant space. However, the outstanding issue is the debt position with NHSPS. The CCG and NHSE/I are both working with the practice to resolve this however it remains a risk to the scheme which must complete by 31 December 2021.

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Primary Care Estates Strategy

It has not been possible to progress this work during the COVID pandemic. As reported in the last update the national Primary Care Data Gathering Pilot which is designed to underpin the strategy was halted after the initial data validation and no contact with practices during the pandemic was permitted including any communication messages. The CCG is advised that this embargo is soon to be lifted and practices can be asked to start to fill in the missing data. The second part of this is the three facet surveys which are outstanding for approximately 70 practices across the patch. This will provide a robust picture of the estate on which the CCG and PCNs can start to shape their thinking around the future estate plans. In order to kick start this work again, the Primary Care Development Team has reviewed NHSE/I documents issued last year to support PCNs with their estates reviews and developed a template to crystallise some of the current thinking around the estate. This should dovetail into the data gathering exercise and identify the support required to inform an overarching estates strategy.

Commissioner Capital (Business as Usual Capital)

The CCG has been notified about its allocation for 21/22 Commissioner Capital. £600k has been identified for GP Improvement Grants (business as usual capital) for this year. The 5 year plan submitted last year included this amount also for 22/23 and 23/24. This gives an opportunity to develop some more robust plans across the three ICP places. The CCG will work with NHSE/I to request bids from PCNs which focus on adding capacity and schemes that support the extended roles in PCNs, using intelligence from COVID new ways of working.

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Meeting Title: Primary Care Commissioning Date: 21 April 2021 Committee (Open Session)

Paper Title: Risk Report Paper PCC 21 022 Reference:

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

Presenter: Siân Gascoigne, Head of Corporate Assurance

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

Executive Summary The purpose of this paper is to present the Primary Care Commissioning Committee with risks relating to the Committee’s responsibilities. The paper provides assurance that primary care risks are being systematically captured across NHS Nottingham and Nottinghamshire CCG and sufficient mitigating actions are in place and being actively progressed. Relevant CCG priorities/objectives: Compliance with Statutory Duties ☒ Wider system architecture development (e.g. ☐ ICP, PCN development) Financial Management ☐ Cultural and/or Organisational Development ☐

Performance Management ☐ Procurement and/or Contract Management ☐

Strategic Planning ☒

Conflicts of Interest: ☒ No conflict identified

Completion of Impact Assessments: Equality / Quality Impact Yes ☐ No ☐ N/A ☒ None required for this paper. Assessment (EQIA) Data Protection Impact Yes ☐ No ☐ N/A ☒ None required for this paper. Assessment (DPIA) Risk(s): Report contains all risks from the CCG’s Corporate Risk Register which fall under the remit of the Primary Care Commissioning Committee.

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Confidentiality: ☒No

Recommendation(s): 1. COMMENT on the risks shown within the paper (including the high/red risk) and those at Appendix A; and 2. HIGHLIGHT any risks identified during the course of the meeting for inclusion within the Corporate Risk Register.

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Primary Care Commissioning Committee Monthly Risk Report

1. Introduction 1.1 The purpose of this paper is to present the Primary Care Commissioning Committee with risks relating to the Committee’s responsibilities. It provides assurance that primary care risks are being systematically captured across NHS Nottingham and Nottinghamshire CCG and sufficient mitigating actions are in place and being actively progressed.

2. Risk Profile 2.1 There are currently seven risks relating to the Committee’s responsibilities (as detailed in Appendix A). This is the same number

of risks as presented to the previous Risk Matrix meeting. 5 - Very High 2.2 Since the last meeting, risks have been 4 – High 2 1 reviewed by the Head of Corporate 3 – Medium 4

Assurance, in conjunction with the Chief Impact 2 – Low Commissioning Officer and Associate 1- Very low Director of Primary Care. 2.3 The table to the right shows the current

risk profile. There is currently one high / Certain 1- Rare 4- Likely 5- Almost 2- unlikely red risk within the Committee’s remit, as 3- Possible outlined below: Likelihood

Risk Current Risk Risk Narrative Ref Score

COVID-19 may present a risk to the sustainability of safe and effective delivery of primary care services to members of the CCG's population. More specifically, this may be due to: ∑ increased likelihood of Primary Care workforce having to 'shield' or self- isolate due to being at risk and/or due to delays in COVID tests/results; Overall Score RR 16: 126 ∑ challenges with GP Practice estate not meeting infection, prevention and control (IPC) requirements; Red (I4 x L4) ∑ pressures on primary care capacity due to requirements to deliver flu and COVID vaccinations.

Update: OPEL reporting remains in place and is reported, routinely, to the

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Incident Management Team (IMT) and the Primary Care Commissioning Committee (PCCC). PCCC reporting has been strengthened to enable trend analysis to be undertaken, although it has recognised that this is 'under' reporting. Work has been undertaken to review the metrics/triggers for OPEL reporting to ensure these are being clearly and consistently applied across all our GP Practices; work is also underway regarding system OPEL reporting. Digitalisation of primary care delivery is a key mechanism to support Practices to manage this risk, along with the ability to 'step up' Clinical Management Centres (CMCs) if required. Roving workforce support is also in place across GP Practices, alongside Primary Care Network (PCN) resilience and workforce planning arrangements.

3. Risk Identification 3.1 There have been no new risks identified since the last meeting.

4. Archiving of Risks 4.1 There are no risks proposed for archiving since the last meeting.

5. Amendments to Risk Score/Narrative 5.1 The scores in relation to two separate risks have been reduced from a 12 (Amber/Red) to a 9 (Amber) in response to the reduced risk of COVID infection, alongside the roll-out of the vaccination programme. These risks relate to RR 137 (impact of COVID-19 infection on CEV and BAME primary care workforce) and RR 138 (impact of ‘track and trace’ on primary care workforce).

6. Recommendations 6.1 The Committee is asked to: ∑ COMMENT on the risks shown at Appendix A; and ∑ HIGHLIGHT any risks identified during the course of the meeting for inclusion within the Corporate Risk Register.

Siân Gascoigne Head of Corporate Assurance

April 2021

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NHS Nottingham and Nottinghamshire CCG Corporate Risk Register (April 2021)

Directorate Date Risk Current Risk Last Review Risk Ref Oversight Committee Risk Description Risk Category Initial Risk Rating Existing Controls Mitigating Actions Mitigating Actions Progress Update: Trend Identified Rating Date

(Relevant committee in the (Movement (Actions required to manage / mitigate the identified risk. Actions should support CCG's governance structure (Date risk (These are operational risks, which are by-products of day-to-day business delivery. They arise from in risk score (as per April 2021 achievement of target risk score and be SMART (e.g. Specific, Measurable, Assignable, (To provide detailed updates on progress being made against any mitigating actions identified. Actions taken should bring risk to level which can be

responsible for monitoring originally definite events or circumstances and have the potential to impact negatively on the organisation and its Owner Risk (The measures in place to control risks and reduce the likelihood of them occurring). since

ExecutiveLead Score

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

risks relating to their identified) objectives.) Impact previous

Likelihood Likelihood delegated duties) month)

RR023 Primary Care Commissioning Finance and Jul-19 As practices have seen an increase in charges for non-reimbursable costs for premises from Property Finance 3 3 9 • CCG meetings with NHS Property Services and Community Health Partnerships (quarterly). Action: To continue to work with local GP practices, the LMC and property companies 3 3 9 April 2021: There has been no significant change in the risk and/or mitigations since the last update. The Estates Team continues to focus on the 12/04/2021 ↔ Committee Resources Services and from CHP (Community Health Partnerships), there is a risk that (for some practices) this may (NHSPS and CHP) to ensure management plans are in place. COVID vaccination programme. When capacity allows, focus will be given on progressing GP Premises debt and the Team will work with those impact viability of providing primary care services from their current location. • Engagement with NHS England/Improvement Primary Care national and local teams Practices/Health Centres which have pressing issues linked to expansions and partner retirement as and when they arise. Nationally the NHSE/I Action: To escalate larger GP practice debts to NHSE/I for further national support. Team is taking forward concerns with NHSPS. This may, in turn, lead to service disruption, inability to invest and/or risks to patient access to primary • LMC support to Practices

care services. For reimbursable debt (pass through), the CCG writes to each Practice as soon as we are aware and these are, generally, resolved fairly quickly.

Lynne Sharp Lynne StuartPoynor

RR032 Primary Care Commissioning Finance and Jul-19 There is a potential risk that there may be insufficient primary care workforce to meet the needs of the Commissioning 4 4 16 • Role and remit of the Primary Care Commissioning Committee (and supporting governance structures - e.g. Action: To ensure that routine Primary Care workforce updates are provided to PCCC. 4 3 12 April 2021: An update in relation to primary care workforce was presented to the February 2021 PCCC meeting. The paper provided an update in 12/04/2021 ↔ Committee Resources CCG's population. Factors contributing to this include, but are not limited to, the following: primary care quality / contracting teams). relation to the forums in place (locally and regionally) in relation to workforce and transformation plans which are in place. Assurance was provided Action: To continue to deliver requirements of ICS Primary Care Workforce Strategy: to in relation to work undertaken in conjunction with PCNs around primary care workforce development. An update was also undertaken in relation to • Uncertainty around funding and reliance, in short term, on non-recurrent external funding does not • Routine Primary Care workforce updates in PCCC's committee work programme for August 2020 and January request further update regarding delivery of the Strategy to the CCG's PCCC. the Nottinghamshire Alliance Training Hub. enable sustainable workforce development; 2021. • Engagement with Primary Care Networks on workforce planning, of both traditional and additional The Committee agreed that a risk score of 12 remained appropriate following receipt of the workforce report and presentation at item PCC 20 191. roles, is not fully informed due to the operational pressures and competing development pressures and • Establishment of Primary Care Cell, as part of CCG's COVID-19 incident response. Consideration was also given as to whether the frequency of future scheduled workforce report updates should be increased. expectations; and • The impact of COVID-19 on the workforce may result in reduced resilience that will impact on staff • ICS Primary Care Workforce Strategy, ICS Primary Care Board and ICS Primary Care Workforce Group. career decisions.

StuartPoynor • Establishment of Primary Care Networks (PCNs) (and/or other collaboration/federation activities) and PCN The above risk may be exacerbated due to lack of capacity within Primary Care to establish, and embed, workforce plans. recruitment processes, as well as challenges in the supply and adaptability of staff to transition to working

within Primary Care. AndreaBrown Griffiths Helen / • System Planning approach to primary care development and transformation ensuring the best use of System Transformation funding via NHSE/I and System Workforce Development/CPD funding via HEE.

RR126 Primary Care Commissioning Commissioning May-20 COVID-19 may present a risk to the sustainability of safe and effective delivery of primary care services to Commissioning 4 4 16 • Primary Care 'Cell' within the CCG's emergency response infrastructure; Action: To continue with incident response structures as described. 4 4 16 April 2021: OPEL reporting remains in place and is reported, routinely, to the Incident Management Team (IMT) (x2 weekly) and the PCCC 12/04/2021 ↔ Committee members of the CCG's population. (monthly). PCCC reporting has been strengthened to enable trend analysis to be undertaken, although it has recognised that this is 'under' • Roll-out of IT infrastructure/technology to support virtual working (e.g. telephone appointments, etc.); Action: To establish a working group to review the OPEL reporting in Primary Care; reporting. IMT and PCCC requested the Primary Care Cell to revisit the metrics/triggers for OPEL reporting to ensure these are being clearly and More specifically, this may be due to: establishing short and longer terms actions that need to be taken to address cultural consistently applied across all our GP Practices. • increased likelihood of Primary Care workforce having to 'shield' or self-isolate due to being at risk • Routine OPEL reporting and escalation processes; challenges. and/or due to delays in COVID tests/results; Digitalisation of primary care delivery is a key mechanism to support Practices to manage this risk, along with the ability to 'step up' Clinical

9.00 via Zoom-21/04/21 via 9.00 • challenges with GP Practice estate not meeting infection, prevention and control (IPC) requirements; • Establishment of CMCs and ability to step up/step down if needed; Management Centres (CMCs) if required. CMC utilisation increased during the second lockdown. Roving workforce support is also in place across GP

• pressures on primary care capacity due to requirements to deliver flu and COVID vaccinations. Practices, alongside Primary Care Network (PCN) resilience and workforce planning arrangements. JoeLunn

Lucy Dadge Lucy • PCN 'buddying' processes in place; Further pressures to primary care capacity have arisen in response to the roll out of the COVID vaccination programme. • 'Roving' workforce support across Practices; The risk score increased to 16 in response to the current pressures on primary care capacity to support the delivery of the COVID vaccination • Clinical vulnerable COVID risk assessment for all primary care workforce. programme.

RR137 Primary Care Commissioning Commissioning May-20 There is an increased risk of COVID-19 infection to clinically vulnerable (including BAME) primary care Workforce 3 4 12 • Primary Care 'Cell' within the CCG's emergency response infrastructure; Action: To continue to seek assurance regarding the completion of risk assessments and 3 3 9 April 2021: The main mitigation to this risk continues to be the digitalisation of the Primary Care service provision. The CCG has sought assurance 12/04/2021 ↓ Committee workforce which may impact the provision of primary care services across the CCG's population. • Roll-out of IT infrastructure/technology to support virtual working (e.g. telephone appointments, etc.); progressing any actions identified from these (or the IPC Estates Reviews). from all GP Practices that risk assessments have been completed and any subsequent actions identified. Further actions have also been identified • Routine OPEL reporting and escalation processes; following a review of Primary Care Estate to determine whether it is compliant with new IPC requirements. 100% of GP Practices have now This may particularly impact areas of Mid-Nottinghamshire and Nottingham City. • Establishment of CMCs and ability to step up/step down if needed; responded, providing assurance that appropriate mitigations are in place for their staff. • PCN 'buddying' processes in place; • 'Roving' workforce support across Practices; Mitigations are also via the GP Practice business continuity plans and the ability to 'step up' and 'step down' CMCs.

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

Lucy Dadge Lucy COVID vaccinations are now being delivered to all front line health and social care staff; and all clinically vulnerable staff and members of the population, as part of roll out to Cohort 6 (CEV, health and social care and 60+).

Given the above, it is proposed that the likelihood score is reduced from 4 to 3, resulting in an overall risk score of 9.

RR138 Primary Care Commissioning Commissioning Jun-20 The impact of COVID-19 test, track and trace on workforce may impact primary care service provision. Workforce 3 4 12 • Primary Care 'Cell' within the CCG's emergency response infrastructure; Action: To continue to seek assurance regarding the completion of risk assessments and 3 3 9 See update for risks RR 126 and RR 137 above. It is proposed that the likelihood score is reduced from 4 to 3, resulting in an overall risk score of 9. 12/04/2021 ↓ Committee The likelihood of this risk materialising is greater for smaller/single-handed practices. • Roll-out of IT infrastructure/technology to support virtual working (e.g. telephone appointments, etc.); progressing any actions identified from these (or the IPC Estates Reviews). • Routine OPEL reporting and escalation processes; • Establishment of CMCs and ability to step up/step down if needed; • PCN 'buddying' processes in place;

• 'Roving' workforce support across Practices; JoeLunn Lucy Dadge Lucy • Clinical vulnerable COVID risk assessment for all primary care workforce.

RR157 Primary Care Commissioning Commissioning Dec-20 There is a potential risk to the delivery of primary care services to the population of Farnsfield if a robust Commissioning 3 4 12 • Role and remit of the Primary Care Commissioning Committee Action: To respond accurately and promptly to the local Parish Council. 3 3 9 April 2021: There is a six month contractual notice period for Sherwood Medical Partnership. PCN solution has been explored. 12/04/2021 ↔ Committee solution is not promptly identified and acted on. • CCG's Comms and Engagement Teams Action: To ensure robust comms and engagement plans are in place to support future plans around the Practice.

• Establishment of PCNs; PCN business continuity plans JoeLunn Lucy Dadge Lucy • 6 month contractual notice period

RR160 Primary Care Commissioning Commissioning Jan-21 Sustained levels of significant pressure on primary care workforce, due to the COVID vaccination Commissioning 4 4 16 • ICS HR Directors HR Group (weekly meetings) Action: To seek assurance regarding the support and well-being initiatives been taken 4 3 12 April 2021: The quality of primary care services continues to be monitored by the CCG; LMC also continues to provide support to GP Practices as and 12/04/2021 ↔ Committee programme, presents a potential risk in relation to staff exhaustion and 'burn out'. forward at PCN and locality level. when required. The primary care OPEL reporting has been revised; reporting level 1 (green) indicates that resource is able to be provided in support • Locality Teams' relationships with GP Practices of other GP practices. PCN workforce planning and 'roving' workforce support is also in place. Action: To receive assurance at PCCC in relation to the quality of primary care services. • Local workforce resilience programmes; informal team meetings

• Flexible working/shift patters (eRostering)

• OPEL reporting (sharing of resources); PCN workforce and well-being support

Griffiths / Esther Gaskill Esther / Griffiths Gaskill StuartDadge Poynor Lucy /

JoeLunn Andrea / Brown Helen / • LMC pastoral support.