Public Document Pack

PRIMARY CARE COMMITTEE

Day: Wednesday Date: 7 October 2020 Time: 1.30 pm Place: via Microsoft Teams

Item AGENDA Page No. No PART A

1. WELCOME, INTRODUCTIONS AND APOLOGIES 1 - 2 2. DECLARATIONS OF INTEREST 3. MINUTES, MATTERS ARISING AND ACTION LOG OF PREVIOUS 3 - 10 MEETING To review and confirm the minutes and action log of the meeting held on 2 September 2020. 4. ENGAGEMENT UPDATE 11 - 42 Karen Huntley/Simon Brunet/Jody Smith 5. ENHANCED HEALTH IN CARE HOMES FUNDING 43 - 46 Tori O’Hare 6. GENERAL PRACTICE CONTRACT UPDATE 47 - 66 Tori O’Hare 7. PRIMARY CARE RISKS UPDATE 67 - 72 Christopher Martin 8. 2019/20 QOF ACHIEVEMENT AND 2020/21 CHANGES 73 - 80 Christopher Martin 9. PPE IN GENERAL PRACTICE 81 - 84 Martin Ashton 10. FINANCE :- a) FINANCIAL POSITION/PLANNING 2020/21 To receive a presentation on the day. b) MIAA - PRIMARY MEDICAL CARE COMMISSIONING: PRIMARY CARE 85 - 98 FINANCE - DRAFT REPORT 2020/21 David Milner 11. SAFEGUARDING CHILDREN AND VULNERABLE ADULTS : GENERAL 99 - 104

From: Tameside and Glossop CCG – any further information may be obtained from the reporting officer or from Shelley Taylor, to whom any apologies for absence should be notified.

Item AGENDA Page No. No

PRACTICE REPORTING 12. SPECIAL ALLOCATION SERVICE - CONTRACTING 105 - 108 13. PARTNERSHIP OVERSIGHT GROUP REPORT 109 - 112 14. PRIMARY CARE NETWORK ADDITIONAL ROLES REIMBURSEMENT 113 - 114 15. ANY OTHER BUSINESS 16. NEXT MEETING Scheduled to take place on Wednesday 4 November 2020.

From: Democratic Services Unit – any further information may be obtained from the reporting officer or from Shelley Taylor, to whom any apologies for absence should be notified.

Agenda Item 1

Extract from the Primary Care Committee Terms of Reference

Membership

The Primary Care Committee members are:

The 3 CCG Lay Members A Clinical Co-Chair of the Governing Body The Clinical Governing Body Member with the lead responsibility for Primary Care The GP Clinical Lead for Quality Improvement The Director of Commissioning (or a nominated deputy) The Director of Quality and Safeguarding (or a nominated deputy) The Deputy Chief Finance Officer (or a nominated deputy)

(The Clinical Vice-chair may deputise for any of the above GP roles)

Representatives invited to be in attendance (Non-voting):

A representative of the Greater Manchester Health & Social Care Partnership A Local Medical Committee representative A Primary Care Network Clinical Director The CCG Heads of Primary Care Representatives of Tameside MBC and Derbyshire County Council HealthWatch Representatives of Tameside and Derbyshire Health and Wellbeing Boards A representative of the Public Health directorate of Tameside Metropolitan Borough Council and of Derbyshire County Council

Quorum

The quorum for the Committee is five of the nine members. There must be clinical representation however, in the interests of sound management of actual or potential conflicts of interest; there will be a non-clinical majority.

Chairing

1. The Committee Chair is the Lay Member for Commissioning. In the event of the Chair being unavailable the Lay Member with responsibility for Public and Patient Involvement will deputise.

2. Should a situation arise where neither the Lay Member for Commissioning nor the Lay Member for Public and Patient Involvement is available the Lay Member with responsibility for Governance can assume the role of Chair. In the event of this situation arising consideration will be given towards any further safeguards that may be required during the meeting to maintain the integrity of that individual’s role as the Conflicts of Interest Guardian. This consideration will be documented within the minutes of the meeting.

3. The Committee Chair shall manage and advise as required on all conflict of interest matters. An escalation policy is in place that will allow any issues arising to be resolved through Governing Body Members and CCG Executives.

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PRIMARY CARE COMMITTEE PART A – DRAFT MINUTES

Wednesday 2 September 2020 held via Microsoft Teams

Members: Carol Prowse (Chair) CCG Lay Member for Commissioning Asad Ali GP and CCG Governing Body Co-Chair David Swift CCG Lay Member for Audit and Governance Jessica Williams CCG Director of Commissioning Kate Hebden GP and CCG GB Member for Primary Care Tracey Simpson CCG Deputy Chief Finance Officer

Attendees: (non-voting) Alan Dow GP and LMC Secretary Angela Osei GM Health and Social Care Partnership Ashwin Ramachandra GP and CCG Governing Body Co-Chair Elaine Richardson CCG Strategic Lead for Ageing Well and Urgent Care Liz Sabel CCG Finance Manager Lyndsey Whitwam CCG Primary Care Commissioning Manager Martin Ashton CCG Associate Director of Commissioning – Living Well Peter Denton Healthwatch Tameside, Manager Ram Jha GP and Ashton PCN Clinical Director Catherine Cane CCG Executive Support (minutes)

Apologies: Christopher Martin CCG Primary Care Development and Quality Manager Gill Gibson CCG Director of Quality and Safeguarding Karen Huntley CCG Lay Member for Patient and Public Involvement Tori O’Hare CCG Head of Primary Care

1. Welcome and Introductions

The Chair welcomed the group to the meeting, held via MS Teams. Apologies were given as above and the Chair noted that the meeting was quorate.

2. Declarations of Interest

The Chair noted the following declarations of interest made over and above those already formally notified to the CCG.

Name Position Held Declared Interest Type of Interest Nature of the Interest Action to Mitigate Risk

Item 4 – Blood Test Backlog Reduction Service Direct Financial Chair accepted Professional Item 6 – Covid-19 Funding – NHS the declarations All GPs present England Letter and agreed to See above continue with Item 7 – Care Home discussions. Premium/Enhanced Health in Care Home Funding

Item 8 – Primary Care Network Additional Roles Reimbursement Scheme 2020/21 Local Intentions

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3. Minutes of the previous meeting/Matters Arising/Action Log

The minutes of the meeting held on 5 August 2020 were approved as a correct record.

All outstanding matters arising, as highlighted in the action log, were discussed and the log updated accordingly.

4. Blood Test Backlog Reduction Service

Committee received a proposal to offer Primary Care Networks the equivalent of three months funding to provide additional capacity to reduce the backlog of carrying out blood tests across their network and to capture activity data to inform decisions on the need for additional resources to manage requests from secondary care.

All Tameside and Glossop practices to carry out blood tests to support their primary care diagnosis and management of patients. In addition 36 practices had signed up to the Locally Commissioned Services (LCS) to carry out blood tests requested by Secondary Care.

The suspension of some proactive and preventative care services in General Practice during the peak period of COVID resulted in a backlog of these tests and this along with a suspected increase in requests from secondary care, perhaps linked to a changed model in delivery of outpatients, would continue to increase the number of people waiting or result in the need for additional capacity.

Funding was proposed in line with the existing LCS funding of £1.10 x weighted list size (WLS) per year. A recommendation was set at £0.30 per WLS for the three month service to include the coded information returns and confirmation that the current LCS is operating.

CP enquired about the accessibility of obtaining blood tests and it was noted that all practices would be mandated to undertake routine tests to reduce their backlog.

AD mentioned that this was a large national issue and a change in out-patient based care was imminent. He wondered if the service could be provided over a longer period if the demand was there.

AA wondered if colleagues could review the Trafford Phlebotomy model to ascertain what the spend was in that locality. It was noted that in the absence of data this would prove difficult to assess, although colleagues were continuing with discussions and reviews of the models used in different localities.

TS asked that as practices had already been paid for this service, which had ceased during the pandemic, why they were now requesting the extra funding plus a premium. It was noted that the Phlebotomists, although not blood testing, continued to carry out other services and therefore continued to be funded.

Committee agreed the proposal, in the short term, to offer PCNs funding for additional blood testing capacity to reduce the backlog and capture activity to inform future commissioning. TS requested that a caveat be included in the proposal, which depended on funding, that after the three month period had ceased and appropriate data had been evaluated a further proposal be brought back to Committee to consider the continuation of the service if necessary.

5. Developments in Urgent Care

Committee was led through a presentation on the UEC by Appointment project which would ensure residents could access the right care, at the right time and in the right place. When calling 111, they would initially be assessed and then signposted to the right place at the right time.

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It was noted that the project was already part of the GM UEC programme and would be a continuation of the current GM Clinical Assessment Service (CAS) and would be classed as a ‘call before you go’ service. It was further noted that a set of GM CAS Standards had been produced. Tameside and Glossop had been assigned to take part within phase 3 of the implementation programme and had a go live date set for week commencing 27 October 2020.

AD mentioned that there had been various pilots undertaken in other localities that had taken the ruthless view that you could not just turn up at A&E and if did were turned away and requested to ring first. He was also concerned at the timescale of turnaround that primary care was requested to abide by when a resident had been signposted to them from 111. He further mentioned that if we were to re-direct residents to the right place there needed to be appropriate funding in place. ER clarified that the NHS pathways had been audited and developed by clinicians; a model was being built which had flexibility within it that would hopefully overcome those challenges.

PD mentioned that there were challenges with access across T&G and the Healthwatch Team were coming across residents who did not have suitable access to services (without smart phones to access the internet, use of a car etc) and requested colleagues be aware of those issues. ER mentioned that a Digital Strategy was being worked up and would take into account the varying challenges.

Committee noted the presentation.

6. Covid-19 Funding - NHS England Letter

Committee had previously received papers that had detailed the finance aspects and impact of NHSE letters and guidance as part of the Covid-19 pandemic response. The timing of the NHSE letter, dated 4 August 2020, detailing general practice funding came significantly later than decisions that had to be made locally. Committee, therefore, received a further paper which set out the detail, alignment or variation to the local decision and a number of considerations.

At its May meeting Committee approved the local Covid claims process and decisions made but was now requested to consider whether to extend the deadline. If the CCG wanted to extend the deadline it should be under guidance.

Action: AO to double check status on GM guidance.

KHe raised concerns that it was fundamentally wrong to claw back funding already given to practices. TS clarified that the CCG had to honour commitments to Q2 but could not treat primary care different to other providers, it could not renege and be at a financial loss.

LS mentioned that practice income had been assured in 2020/21 based on 2019/20 funding, a further letter, dated 19 July, assured income protection for Q1 only but did not mentioned Learning Disabilities healthchecks. Committee was asked to consider whether the CCG should stand by the decision made in April to support for a full financial year or only support for Q1 or for Q1 and Q2.

TS commented that she could not see the CCG supporting for full financial year; there needed to be some tapering off as it did not have the funding. It was confirmed that this issue was seen across GM, and other localities were doing a phased phasing out in a managed structured taper way. TS could not recommend to continue and requested Committee be pragmatic and take a structured approach with a caveat that without knowing what the allocation would be for the rest of 2020/21 it could be revisited once known.

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JW also requested the Committee to be pragmatic and not put the CCG at risk. Need all to maintain substantial control. It was felt that it was very inequitable that secondary care providers were able to spend until end of September and that primary care should be treated the same and provided with more support.

LS highlighted the last section of the paper which was to provide funding to deliver extra support for care homes up to 30 September 2020. Finance colleagues were unsure as to know how much this was going to be but could confirm it would be paid net. Committee was also asked to consider if a PCN needed support that partnership fund payments could be paid but once the national element was known monies could potentially be clawed back. TS confirmed that this was a pragmatic approach to take.

Committee therefore

1. supported the maintenance of the local Covid claims process and decisions made; 2. agreed to support a local extension, up to 30 September 2020, to the Covid claims process in line with the financial arrangements set out in the NHS England Third Phase of NHS response letter; 3. agreed the financial support decision made through the April and May meetings, up to 30 September 2020, for the activity based DES /LCS elements and to re-visit if further guidance was issued; 4. agreed the care home funding, up to 30 September 2020, approved under the Partnership LCS bundle should be made net of the Care Home additional support funding indicated in the 4 August letter, noting the value was to be confirmed, including agreeing the advance payment, with retrospective recovery be permitted if required by PCNs.

7. Care Home Premium/Enhanced Health in Care Home Funding

Committee was provided with a written report on the Enhanced Health in Care Home Funding. It was noted that the Primary Care Network (PCN) Contract DES introduces from 2020/21 Network Specifications for PCN delivery. In 2020/21 this would bring in three specifications, one of which is the Enhanced Health in Care Homes Network specification.

This specification set out the provision to be in place across the locality, reflecting the delivery by a range of partners, for care home patients ensuring continuity of care. These patients remain registered with general practice and therefore all the existing funding for those patients remained. A Care Home Premium payment of £120 per year, per care home bed, would also be introduced from 1 October 2020; in line with the start date of the Network specification. Practices would receive £60 per bed from October 20 to March 21 (funded for 6 months in this financial year).

AA mentioned that some PCNs had already agreed a care home funding model, so subject to evaluation of their model, were they asking that the service would continue or how would this affect that? LW confirmed that the national specification required PCNs to undertake this service and the CCG would be happy to support them.

ER mentioned that some services were almost impossible to measure through hard outcomes, some parts could be measured but the service needed to be looked at as a whole. CCG colleagues were requested to seek clarification from Dr Jane Harvey, PCN Clinical Director Lead for this service, to clarify the collective response and ask from all PCN leads. LW believed that the PCN Leads had requested additional funding on top of the £120 but would seek clarification.

Committee noted the report and requested for an update be provided at the next meeting.

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8. Primary Care Network Additional Roles Reimbursement Scheme 2020/21 Local Intentions

Committee received a further update on the Additional Roles Reimbursement Scheme which formed part of the Primary Care Network DES and provided financial support to Primary Care Networks (PCNs). The initial reimbursable roles included within the scheme were clinical pharmacists, social prescribing link workers, physician associates, first contact physiotherapists and first contact community paramedics. From April 2020 the list had been added to include pharmacy technicians, care co-ordinators, health coaches, dietitians, podiatrists and occupational therapists.

Committee approved the Wave 3 applications, against the Additional Roles Reimbursement Scheme, for Ashton, Glossop, Denton and Stalybridge PCN’s.

9. General Practice Patient Survey

It was noted that the GP Patient Survey takes place every year. Committee, therefore, received a written report which discussed the 2020 survey, including a heat map benchmarking practices against each other.

The findings would be shared with practices during a workshop at a future Practice Managers’ Forum to share best practice and utilising more immediate forms of patient feedback such as individual practice patient satisfaction surveys and the Friends and Family Test to evaluate interventions when implemented.

MA raised concerns that there needed to be more proactive forums to share the findings with wider groups. AD agreed that practices should be routinely asking and learning from those achieving higher positive results, although he was concerned that there was insufficient time and costs to do this.

Committee was requested to reflect and accept that the results of the next survey would be even worse; as could potentially be seen across the country, and be prepared to improve on access.

PD mentioned that he would be happy to liaise with CCG colleagues to ascertain what could be done going forwards and how data collected by Healthwatch could help.

Committee noted the report, and specifically noted the work programme to be overseen by the Primary Care Delivery and Improvement Group.

10. Finance Report

Committee received, for information, the financial position for July 2020, Month 4 (M4) of 2020/21 for the Primary Care, Delegated Commissioning and CCG allocation.

The CCG financial position reported was based on the 2020/21 financial plans approved through governance. With the outbreak of Covid-19-19 in March, emergency planning procedures were instigated by NHS England and Improvement (NHSE&I) and it was declared that the NHS would operate within a national command and control framework. As such NHSE assumed responsibility for elements of commissioning and procurement and CCGs were advised to assume a break-even financial position in 2020/21. The position of command and control continued in month 4.

For the purpose of financial reporting, it was important to note the caveat underlying the CCG’s financial position; the CCG was working on the assumption that the pre-Covid-19 financial plans prepared in line with the published allocations stand.

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Primary Care Covid-19 claims were being processed in line with national guidance and being reviewed by a local panel. The recording of these claims sits within the CCG Covid-19 spend and was therefore not reported within the report.

Committee noted the report.

11. Any other business

(a) Mental Health recruitment bid – LW verbally reported that Stalybridge Primary Care Network had submitted, under the Partnership LCS Bundle/Partnership Investment Fund, a supplementary bid for Mental Health practitioners to support Adults and Children. The bid had been received and approved by the Partnership Oversight Group and therefore sought Committee’s ratification.

Committee approved the bid as proposed by the Partnership Oversight Group.

a) Healthwatch snapshot – PD mentioned that two snapshots of the Healthwatch Tameside Covid Survey would be imminently published which specifically looked at access and technology. The results would be uploaded onto Healthwatch’s website.

Action: CC to circulate a copy of the survey results to members. Post script – Survey results received and duly circulated.

12. Date and time of next meeting: set for Wednesday 7 October 2020; starting at 1.30 p.m.

Page 8 Updated from 2 September 2020 meeting

Primary Care Committee – Action Log – PART A

Item Action Owner Status

Wednesday 3 June 2020 Primary Care Access – The Impact of There was an intention to move the Diabetes DESMOND 11.06.20 - MA confirmed that the Diabetes Nurses were Workforce, IT and Estates on provision Service to be web based – who made decision and where Martin Ashton temporarily recommending use of the My Diabetes app at did it come from? AD felt it would disadvantage those who this time as this also allowed patients to self-manage. They did not have access to the internet. would restart the face to face DESMOND courses when it MA to take forward issues and include Karen Huntley in any was safe to do so during the COVID-19 pandemic. discussions. Martin Ashton 01.07.20 – Concerns had been raised with the LMC over the DESMOND service and that patients cannot access support at this time. MA to action.

05.08.20 – Need to introduce face to face meeting asap. GM guidance awaited – on-going. Page 9 Page Wednesday 5 August 2020 Partnership Oversight Group proposals TOH was seeking additional clarification on the funding 02.09.20 – on-going; date moved for reconciliation. available to commissioners, from 1 May to 30 September, to Tori O’Hare support care homes. AO mentioned that a national reconciliation was be carried Angela Osei and would provide an update at a later date.

Second Phase of General Practice AO to ask for timescales to be flagged as a matter of urgency 02.09.20 – AO flagged through both. Response through the North West NHSE Primary Care Cell. Angela Osei TS raised through GM group – locally also raised at CFOs TS to raise through GM finance meetings for consistency of group. GM team to undertake a stocktake and will provide approach. Tracey Simpson feedback at next meeting.

JW mentioned both issues had been raised at the Delegated Management Oversight Group. Issue on-going.

Wednesday 2 September 2020 Covid-19 Funding – NHS England If the CCG wished to extend the deadline it was requested to Letter do so under guidance. Angela Osei AO to double check status on GM guidance

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PRIMARY CARE COMMITTEE

Title of Subject: Primary Care Committee

Date of paper: 7 October 2020

Prepared By: Simon Brunet – Head of Policy, Performance and Intelligence (Tameside and Glossop Strategic Commission)

History of paper: This paper has been presented to Single Leadership Team (8 September), Executive Board (16 September), Executive Cabinet and Strategic Commissioning Board (30 September)

Executive Summary: This report provides Primary Care Committee with an update on the delivery of engagement and consultation activity in 2019/20 (to date). Much of the work is undertaken jointly – coordinated through the Tameside and Glossop Partnership Engagement Network (PEN) – by NHS Tameside and Glossop Clinical Commissioning Group, Tameside Council and Tameside and Glossop Integrated Care NHS Foundation Trust. However, it should be noted that each of the three agencies undertake work individually where necessary and appropriate for the purposes of specific projects. Engagement is relevant to all aspects of service delivery, all the communities of Tameside and Glossop, and wider multi-agency partnership working. The approach is founded on a multi-agency conversation about ‘place shaping’ for the future prosperity of our area and its communities.

Recommendations Primary Care Committee is asked to note the contents of the report required of the and support future engagement and consultation activity with the Committee (for communities of Tameside and Glossop. Discussion and Decision):

Principles addressed by Section 242, of the NHS Act 2006, places a duty on the NHS proposal (QIPP, (including CCGs) to make arrangements to involve patients and the national/regional policy public in planning services, developing and considering proposals etc): for changes in the way services are provided and decisions to be made that affect how those services operate.

Section 14Z2 of the Health and Social Care Act 2012 places a duty on CCGs to ensure that patients and the public are involved in the

Page 11 planning of services, developing proposals for any changes to services, and the operation of services.

Direct questions to: Simon Brunet (Head of Policy, Performance and Intelligence) [email protected]

Jody Smith (Policy & Strategy Service Manager) [email protected]

Page 12 1.0 PURPOSE OF THE REPORT

1.1 The report provides the Strategic Commissioning Board and Executive Cabinet with an update on the delivery of engagement and consultation activity from beginning of 2019 to date. Much of the work is undertaken jointly – coordinated through the Tameside and Glossop Partnership Engagement Network (PEN) – by NHS Tameside and Glossop Clinical Commissioning Group, Tameside Council and Tameside and Glossop Integrated Care NHS Foundation Trust. However, it should be noted that each of the three agencies undertake work individually where necessary and appropriate for the purposes of specific projects.

1.2 Engagement is relevant to all aspects of service delivery, all the communities of Tameside and Glossop, and wider partnership working. The approach is founded on a multi-agency conversation about ‘place shaping’ for the future prosperity of our area and its communities.

2.0 KEY HEADLINES

2.1 The key headlines from January 2019 to date are summarised in the box below.

 Facilitated 50 thematic Tameside and/or Glossop engagement projects

 Received 4,753 engagement contacts1 (excluding attendance at events / drop-ins) – 2,875 in 2019 and 1,878 in 2020 so far.

 Supported 39 engagement projects at the regional and Greater Manchester level

 Promoted 46 national consultations where the topic was of relevance to and/or could have an impact on Tameside and/or Glossop

 Delivered four Partnership Engagement Network (PEN) conferences attended by over 280 delegates.

 Delivered four virtual Partnership Engagement Network sessions focusing on the impact of COVID-19 and how we can build back better. These were attended by over 50 participants.

 Held a virtual engagement session with young people to understand the impact of the pandemic on them and how they feel things can be done differently in the future.

 Undertook the second joint budget consultation exercise for Tameside Council and NHS Tameside and Glossop Clinical Commissioning Group with planning for the budget conversation 2021/22 underway.

 Delivered two stakeholder ‘summits’ bringing a range of public service leaders, VCFSE groups and public / patient representatives together to guide

1 Engagement contacts refer to the number of responses made to Tameside & Glossop Strategic Commission led engagement and consultation activity outlined in Appendix 1.

Page 13 future planning on key issues – Neighbourhood Summit (January 2019) and Co-operative Summit (October 2019).

 Achieved ‘Green Star’ top rating for public and patient engagement as part of the CCG Improvement and Assessment Framework (IAF). Tameside and Glossop CCG attained the highest score possible, one of only 13 out of 195 areas in the country to do so *

(*) Note: CCG only. The Council and ICFT are not assessed under an engagement IAF.

2.2 A table listing all engagement activity facilitated, supported or promoted in the last two years is attached at Appendix 1 for information.

2.3 The outcomes of our COVID-19 specific engagement to date are detailed at section 4.0.

3.0 FUTURE OF THE PARTNERSHIP ENGAGEMENT NETWORK (PEN)

3.1 At its best, meaningful and effective public and patient engagement is a range of different activities where each element informs the development of specific projects or plan. And the whole provides a strategic view to guide forward plans for the area – ‘place shaping’. In Tameside & Glossop the Partnership Engagement Network (PEN) delivers our strategic approach to engagement and consultation.

3.2 In late 2019 it was proposed to review the work of PEN so far and develop ideas to inform its approach. In early 2020 a survey was shared with PEN members seeking views on how they felt PEN was working. A total of 32 members responded to the survey. Of those respondents who had attended PEN conferences the average rating was 4/5 stars, and 72% of respondents said they found the conferences very useful. 64% of respondents reported they found the monthly PEN update e-mails very useful. When asked about the positive/negative aspects and possible areas for improvement, they gave the following (summarised) feedback:

 Wider range of workshop topics  More diverse membership of PEN  Use of social media and networks to raise the profile of PEN  Sharing of materials and key points from conferences  More ‘you said we did’ presentations and feedback  PEN participants to take a lead on feeding back into their networks

3.3 Further consideration will now be given to a medium and long term plan to reintroduce PEN conferences and large showpiece events when it is safe to do. New opportunities like online forums will continue to be used in conjunction with face to face activity, alongside an increasing move to take conversations out into communities and settings.

3.4 Other ideas and opportunities for consideration and possible development are outlined below:

 Temperature testing with the community of Tameside & Glossop on key issues / priorities – in-depth insight work commissioned from third sector organisations such as Action Together, The Bureau and Diversity Matters North West.

Page 14  Targeted communication activity to further promote opportunities for local residents to participate (e.g. PEN database, PEN conferences, and Big Conversation surveys).  Encourage a diverse eco-system of engagement mechanisms. Support the further development of vibrant PPGs across the area and the establishment of Patient Neighbourhood Groups (PNGs) in West (Denton / Audenshaw / Droylsden) and East (Stalybridge / Dukinfield / Mossley) – dependent on there being an appetite amongst existing groups and individuals to form up into a neighbourhood arrangement. Support from the existing PPGs/PNGs who have self-organised into the Patient Network will be of value in enabling this to happen.  Look at using new approaches and techniques (and pilot where appropriate) – e.g. Citizens Juries, Public Consultation Hearings, and ethnographic research.  PEN summit. One off summit using the market place approach providing an opportunity for PNGs, HealthWatch, Action Together, The Bureau and a range of groups to showcase their work, network with others, share learning.  Building back better summit. Single issue thematic summit to be delivered in the last quarter of 2020 following the virtual events and other activity over the next couple of months.  PEN network bespoke group training on building skills as a community leader (open to all individuals and groups on PEN database). The Peer Leadership Academy work being developed by NHS England provides an opportunity, alongside other local ideas.  Ad-hoc asset / strengths based training (like Dementia Friends). Topics to be determined based on what is available. Open to all on PEN database.  Strengthen the ‘You said we did’ feedback loop to include insight from both project leads and those being engaged to maximise the learning and better influence future service redesign.

4.0 ENGAGEMENT ON COVID-19

4.1 To start discussion and take away learning from Covid-19, four virtual engagement sessions took place in July and August. Attended by over 50 PEN members, the sessions were a way for members of the network to learn from one another and to recommence Covid-19 safe PEN activity. The themes for each of the sessions were:

 How do we get services back open safely?  What has been the impact of Covid-19 on the most vulnerable?  Living with Covid-19 and preventing outbreaks/spikes  How do we do things differently in the future based on experiences of Covid- 19?

A fifth virtual workshop session was undertaken with young people and their representatives to better understand their experiences during the pandemic and to obtain their views on how we can do things differently in the future. The session was attended by 14 people.

4.2 Each of the virtual engagement sessions invited participants to share their experiences, both as individuals or speaking on behalf of their organisation where appropriate. Despite there being a distinct topic for each of the workshops, there were clear themes that arose from each of the sessions. The general consensus from individuals and professionals is summarised below:

Page 15  Communication – clear, consistent public communications was said to be vital to reopening services safely, restoring public confidence and trust, encouraging people to follow the rules and vital to preventing future spikes. There was consensus on the need for a local communications strategy that reaches all communities (including the disabled, learning/physical; people for whom English isn’t their first language) that is more specific to the local area.  Mental health/isolation – has caused notable fallout during the pandemic. The mental health of the shielded/isolated, those who have lost work or income and children in particular. Future service planning will need to ensure that mental health needs can be met and met virtually where appropriate.  Digital services – there are many concerns about digital exclusion of vulnerable people. Where services have been delivered virtually during the lockdown, face-to-face services should resume for those who need it – older people, people with mental health problems, disabilities. A mix of digital and face-to-face should be explored as the default.  Vaccination – for Covid-19 and flu vaccine extension. Plenty of planning and consideration should be given to this in order to take us through the winter and prevent serious strain on services and serious ill health. Public communications need to dispel misinformation and build public trust.  Role of VCFSE – has been vital during the pandemic. Volunteers and community/mutual aid groups should be harnessed as a resource for any future spikes or in the event of a second wave.  Impact of Covid-19 on people from a Black, Asian & Minority Ethnic background (in particular Muslim community, people for whom English is not their first language, BAME staff in health services) – BAME communities have had disproportionate experiences of the pandemic – higher cases, more severe illness and/or death, Muslim community reported they are more likely to be at the receiving end of abuse relating to implementation of local lockdown restrictions.

The young person’s engagement session took place on Monday 17 August, which provided an insight into the experiences of our younger residents during the pandemic. Key themes arising from this session were as follows:

 Concerns about school work – difficulty accessing due to no internet connection or access to a device; poor motivation and concentration and; some young people have other issues in their lives that have prevented them from doing any work, for example caring duties.  Exam concerns – Participants spoke of stress owing to the cancellation of exams, missing a huge part of their education for GCSEs and A-Levels and worries about having to catch up for next year. Young people also feel they have missed out on the opportunity to celebrate the milestone due to the way results are calculated.  Mental health – also a common theme across the other PEN sessions, young people said that their mental health should be a priority for the future. Mental health of children and young people has deteriorated during the lockdown and many more young children have struggled. There needs to be more support available to help.  Isolation – the impact of being unable to visit people outside the home has been deeply felt by young people. For example being separated from parents, siblings and friends has been a big difficulty. Digital contact does not replace human contact, and many have had to ‘re-form’ relationships.  Other comments – included: children and young people have not been part of the decision-making process throughout the pandemic. Many children will have

Page 16 undergone major life experiences without the usual services, support and social contact with others, so this should be considered for future. Digital poverty deepens the issues caused by the lockdown for many young people – particularly those leaving care. Positive comments were also made in terms of some children feeling they had learnt more during lockdown and the provision of digital equipment had assisted with this.

The full report detailing the findings from the virtual PEN engagement sessions can be found at Appendix 2.

4.3 A survey on the Impact of COVID-19 / Building Back Better was hosted through July and August by the Strategic Commission via the Big Conversation pages on the Council and CCG websites. The survey aimed to understand how the pandemic has impacted the lives of people who live, work or spend time in Tameside & Glossop. We also wanted to gather views on how we can better live with, and recover from, COVID- 19. As challenging as the COVID-19 pandemic has been, it also presents a range of opportunities to do things differently in Tameside & Glossop. We wanted to understand resident’s priorities for the way we recover and for the future of the area. In total 455 responses to the survey were submitted. Some of the key themes emerging from the survey are drawn out below with the more detailed findings included in Appendix 2.

What do you think the impacts of coronavirus have been on the most vulnerable members of our community? How can we best learn from this in the future?

Theme No. % Loneliness and isolation 178 39.1 Mental health 51 11.2 Fear and anxiety about Covid-19 35 7.7 More/better services supporting vulnerable people 34 7.5 Access to technology/digital services 27 5.9 Reduced access to healthcare/other services 24 5.3 Financial difficulties 24 5.3 Access to food 20 4.4 Better communication/engagement 16 3.5

How do you think we can best prevent future outbreaks of COVID-19 in Tameside & Glossop? What does our local community need to be able to do to support this?

Theme No. % Following social distancing and hygiene guidelines 89 19.6 Stronger enforcement of lockdown measures 80 17.6 Effective and clear communication 59 13.0 Education of residents 28 6.2 More cleaning/hygiene 28 6.2 Local based approach 25 5.5 More/better testing 22 4.8 More effective track and trace 20 4.4 Support for people isolating/quarantining 18 4.0

Page 17

What are your thoughts on how we can re-open services safely in Tameside & Glossop?

Theme No. % Follow social distancing guidelines (e.g. facemasks) 101 22.2 Reopen services slowly/cautiously 32 7.0 Ensure effective communication 32 7.0 Enforce lockdown measures 31 6.8 Lift lockdown quickly/immediately 28 6.2 Cleanliness/hygiene 23 5.1 Reopen services only when safe 19 4.2

Based on your experiences during COVID-19, how do you think we can do things differently in the future?

Theme No. % Tighter enforcement of social distancing and hygiene 83 18.0 guidelines Better flow of information 56 12.0 Focus on vulnerable people and shielded/isolated 26 5.7 residents More use of digital services 21 4.6 Raising issues with national government 20 4.0 More use of community volunteers or resources 17 3.7 More local input into decision making 16 3.5 (residents/community groups)

4.4 Additional engagement work around the impacts of COVID-19 has also been undertaken via other forums – specifically the Children in Care Council and via the Council’s two Scrutiny Panels. The engagement work undertaken with the Children in Care Council consisted of two questionnaires circulated via children’s social workers. These contained statements about mental wellbeing and how well children felt they had been supported during lockdown.

The first survey was sent out to children aged 8-16 involved with the duty, safeguarding and Looked After Children teams. Key findings included:

 Over three quarters (77%) agreed that they were generally in a good mood  91% said they had felt supported during the lockdown (none disagreed with this statement)  80% said that they felt like their rights were respected  Over nine in ten (94%) felt they were able to share their worries or opinions  When asked what they worried about, children mostly indicated that the future and how their family and friends were doing were the main concerns  When asked what helped them during lockdown, it was family, friends, pets, activities and residential staff  Generally, children understood the changes and reasons why

Page 18  When asked if there was anything they wished they could do but couldn’t because of restrictions, children said seeing family and friends, social activities and holidays

The second survey was sent to young people involved with the leaving care team, aged 16-25.

 Over a third (37%) said that generally they were in a good mood  Two-thirds said they felt supported during lockdown  75% said they felt able to share their worries or opinions  When asked about what worried them, how their family were doing, the future, mental health and finances were the biggest issues for those who responded

4.5 Engagement with residents and communities was reported via Elected Members on the council’s Scrutiny Panels. Scrutiny Panel members are well placed to report on feedback from residents in their wards, and so it was requested that they take time to note experiences, impacts and the response to Covid-19 in Tameside. These are summarised as follows:

 Responding to Covid-19 – The crisis has helped generate a resurgence of a sense of community. There were positive outcomes such as online support groups. Agencies have responded well with regards to food and medication provision.  Health systems – there are a number of concerns linked to the impact of Covid-19 and the lockdown on physical and mental health. Assessing and supporting mental health need must remain a priority. Concerns about avoidance of primary care during lockdown. Work is required to understand the impact on certain groups, for example Black, Asian and Minority Ethnic people.  Economy – Residents have concerns about uncertainty connected with lockdown measures, particularly in the insecurity of employment, housing, financial support and debt.  Children and families – There has been a positive response from local schools, but there are concerns about children returning to school. There is need for consistency in the messages relayed from schools.  Vulnerabilities (elderly/shielded, BAME, homelessness, domestic abuse) – To review the need for a collaborative approach to assess and remove any potential barriers (physical or psychological), in supporting our elderly, shielded and vulnerable residents to become more socially mobile as lockdown restrictions start to ease further.  Future consideration – A need to plan for the challenges we are likely to face going forward and particularly how we work to mitigate the problems that lockdown has imposed. For example, getting people back to work, future financial hardships and feasibility of foodbanks.

5.0 PARTNERSHIP ENGAGEMENT NETWORK (PEN) UPDATE

5.1 Since its inception in 2017 there have been eight Tameside and Glossop Partnership Engagement Network (PEN) large scale conferences, participated in 3 large scale summits and supported over 50 pieces of thematic engagement or consultation work. Feedback from the conferences is positive with 9 out 10 delegates rating them as very good or good overall, and 9 out of 10 delegates saying they were given enough opportunity to express their opinions.

Page 19 5.2 The table below summarises the topics discussed at the conferences that have taken place since start of 2019 to current date.

Conference Presentations Workshops February  Corporate Plan  Living Life Well (All Attendees) 2019  Living Life Well  PEN Development Session (All Attendees)  Loneliness (Over 70  Greater Manchester Moving Local delegates) Delivery Pilot  Corporate Plan  Building a Social Movement around Community Wellbeing  Social Prescribing and Asset Based Community Development

June 2019  Greater Manchester  Active Neighbourhoods, Greater Clean Air Plan Manchester Get Moving  Tackling Dementia in Campaign (Over 80 Tameside and  Personalised Care Planning at delegates) Glossop the End of Life  Tackling Dementia in Tameside and Glossop  New Ways to Access General Practice  Tameside and Glossop Lung Health Checks  Tameside and Glossop Bereavement Booklet

October  Health Inequalities /  ICFT Health Inequalities – 2019 Mayors Challenge Closing the Gap Fund  Active Parks (Over 70  Advanced Care  ICFT Patient Experience & delegates) Planning – You Said, Service User Engagement We Did Strategy  ICFT Volunteer Strategy  Co-operative Councils  SAMMIE (Smoking, Alcohol, Mobility, Mental Health, Isolation and Elderly) campaign.

February  Estates Strategy  Primary Care Networks 2020  NWAS Public/Patient  The Future of Personalised Care Panel in Tameside & Glossop (Over 60  Evaluation of Tameside & delegates) Glossop Transformation of Integrated Care  The Bureau, Glossop – Communications and Engagement Strategy  Bee Network Proposals

Page 20 Conference Presentations Workshops  Tameside Sexual Health Services  NWAS (North West Ambulance Service) Experience

5.3 Full feedback reports available for the conferences are posted on the Partnership Engagement Network (PEN) pages of both the council and CCG website. Similarly, for all thematic engagement and consultation activity a short feedback report is posted on the Big Conversation pages of the Tameside Council website (with links also included on the CCG website).

5.4 Since the beginning of 2019, two large scale stakeholder ‘summits’ have been held on key themes. These bring together a range of public service leaders, members of voluntary, community, faith and social enterprise (VCFSE) groups and public and patient representatives to discuss and guide future planning in those areas. The two events are the Neighbourhood Summit (January 2019) and the Co-operative Summit (October 2019).

6.0 OTHER ENGAGEMENT WORK

6.1 This section provides an update on other key pieces of engagement work that has, or was due to, take place recently. It also details some upcoming key pieces of strategic consultation and engagement activity for the Strategic Commission.

 What Matters to You - ‘What Matters to You’ is a national campaign led by NHS England each year that encourages and supports more conversations between those who commission health and social care and those who receive it. From 6 June to 31 July 2019, Tameside and Glossop Strategic Commission jointly promoted and facilitated the ‘What Matters to You’ campaign. The findings were then shared with senior leaders for their use to inform future service improvement. Due to COVID-19 the campaign was not undertaken in the same way in 2020. We will look to return to promoting the ‘What Matters to You’ campaign in Tameside & Glossop should it be reinstated in 2021.

 NHS Oversight Framework: Patient and Community Engagement Indicator - Each year NHSE undertake an Oversight Framework (formerly the Improvement and Assessment Framework (IAF)) with a focus on public and patient engagement for every clinical commissioning group. For the last two years – 2017/18 and 2018/19 – NHS Tameside and Glossop Clinical Commissioning Group achieved the top score of Green Star. For the 2018/19 assessment Tameside and Glossop Clinical Commissioning Group was awarded the top rating – Green Star (with the highest possible score of 15 out of 15) for patient and community engagement. Only 35 out of 195 areas in the country have received Green Star, and Tameside and Glossop is one of only 13 out of 195 go achieve the highest possible sore of 15 out of 15. Our submission for 2019/20 was made to NHSE in February 2020 with results originally expected in June 2020. Results for the 2019/20 assessment been delayed due to COVID-19 – confirmation is currently awaited from NHSE as to when these will be announced.

 GP Patient Survey – The national GP Patient Survey results for Tameside & Glossop CCG were released in July this year. In Tameside & Glossop, 14,196

Page 21 questionnaires were sent out and 3,993 were completed. This represents a response rate of 28%. Results from the survey will be used by Primary Care as part of their routine oversight of practices and is one of a range of data sources to help our understanding of practices.

 Listening Framework – earlier this year Children’s Commissioning worked with children and young people to develop a listening framework / co- production pledge that enshrines their involvement in the development of services that affect their future. Due to COVID-19 the implementation of the framework has been delayed. The Listening Framework will be taken through governance over the coming months to launch and embed across all services.

 SEND Offer - Tameside SEND strategic partnership are looking to improve the experience of and outcomes for the young people and families using their Integrated Service for Children with Additional Needs (ISCAN). The core aim and objectives of this work is:

- To assist Tameside and Glossop SEND strategic partners to develop an integrated vision for a 0-25 years disability service

- To assist identification of the necessary stepping stones to achieve the vision.

- To build a service based on the lived experience and preferences of young people and families in order to improve agreed outcomes

A series of consultation exercises will be undertaken across the SEND stakeholder network with particular reference to parents, carers and young people in order to establish views, experiences and suggestions for a local integrated 0-25 disability service.

 Primary Care Digital Strategy – we need to ensure Tameside and Glossop’s diverse population is considered when reviewing the ever changing demand for the way in which we deliver services. The NHS Long Term Plan is heavily linked to the adoption of digital provision for access to health services. Work is currently underway to deliver these national requirements across our own locality focusing on the implementation of online and video consultations, and the impact this may have in relation to access. In order for us to measure the impact of these nationally driven requirements, we need to ensure we engage effectively with the people that access primary care services. We need to establish how, moving to digitally enhanced services, may affect them in terms of their future healthcare. It has been proposed that a period of engagement will be undertaken to inform the work of the Primary Care Digital Strategy. The engagement process will take into account other surveys implemented locally including recent Covid related surveys (Strategic Commission and Healthwatch Tameside) to ensure questions are not duplicated.

 Budget Conversation 2021/22 – the third joint budget conversation for Tameside Council and Tameside & Glossop CCG is due to launch this autumn. It is important that we understand the priorities of the public – local residents, businesses, patients and service users. Plans are in place to engage with the public in autumn 2020 on their priorities for spending within the context of the financial challenges facing public services – particularly in light of the impact of COVID-19. It is proposed that this year’s engagement will take the form of a

Page 22 conversation with the public on providing sustainable public services for the future; encouraging residents to see themselves as citizens, not just consumers of services. The conversation will take place through existing meetings/forums (virtually if necessary) supported by an extensive communications campaign. The public will be provided with the opportunity to leave comments and feedback through the Big Conversation including ideas and suggestions for saving money and improving services.

 GM Consultations - Three separate but aligned consultations are planned to take place within GM in autumn 2020. These three consultations are:

- Greater Manchester Spatial Framework (GMSF) - Greater Manchester Clean Air Plan (GMCAP) - GM Minimum Licensing Standards for taxis and private hire vehicles (MLS)

GM Leaders have agreed to bring these consultations together under one narrative as all have a significant impact on the future of GM and its recovery. The joint narrative will reflect Greater Manchester’s commitment to build back better and support economic growth. Locally we will need to devote resource and time to the local engagement activity required to ensure local residents are fully engaged and input into these key strategic consultation pieces.

7.0 RECOMMENDATIONS

7.1 As set out on the front of the report.

Page 23 APPPENDIX 1

The table below summarises engagement and consultation activity in the last two years.

Ref Topic Lead 1 The Big Alcohol Conversation GMHSCP/GMCA Items which should not routinely be prescribed in primary 2 care: an update and a consultation on further guidance for NHSE CCGs MEC SCN Children and Young People Increasing 3 GMEC confidence Survey Strategy for our veterans: UK government consultation 4 Ministry of Defence paper 5 Budget Conversation 2019-20 TMBC 6 Housing Assistance Policy TMBC 7 Council Tax Charge on Long Term Empty Dwellings TMBC Department for 8 Williams Rail Review Transport Ministry of Housing, Planning reform: supporting the high street and increasing 9 Communities, and the delivery of new homes Local Government 10 Regulating Basic Digital Skills Qualifications Ofqual Commission for 11 Extremism in England and Wales: call for evidence Countering Terrorism Developing a Drug and Alcohol Strategy for Greater 12 GMCA Manchester Department for 13 Improving Adult Basic Digital Skills Edcuation 14 Gambling Policy Consultation TMBC 15 Physical Activity: LGBTQ Questionnaire TMBC 16 Greater Manchester Spatial Framework GMCA 17 Police Funding 2019/20 GMCA Ministry of Housing, Improving access to social housing for members of the 18 Communities, and Armed Forces Local Government 19 Single Handed Care TMBC 20 Suicide prevention campaign consultation GMHSCP 21 Greater Sport Physical Activity Survey GreaterSport Implementing the NHS Long Term Plan - Proposals for 22 NHS England possible changes to legislation Consultation on consistency in household and business 23 DEFRA recycling collections in England 24 Introducing a Deposit Return Scheme for Drinks Containers DEFRA Healthwatch 25 Healthwatch Tameside NHS Long Term Plan Tameside 26 Plastic waste and recycling in Greater Manchester GMCA Department of Introducing further advertising restrictions of products high 27 Health and Social in fat, sugar and salt (HFSS) on TV and online Care Ministry of Housing, 28 Tackling Homelessness Communities, and Local Government

Page 24 Ref Topic Lead 29 Tameside Food Survey TMBC Greater Manchester Fire & Rescue Service - Programme of 30 GMCA/GMFRS Change Serious violence: new legal duty to support multi-agency 31 Home Office action 32 Tameside Parenting Support Survey TMBC 33 Deferred Payment Scheme Consultation TMBC Recycle for Greater 34 Recycle for Greater Manchester Campaign Feedback Manchester 35 Our Pass Opportunities GMCA Regulator of Social 36 Consultation on a new Rent Standard from 2020 Housing 37 GM Clean Air Clean Air GM 38 GM Vascular Services Survey GMHSCP Department for 39 Children not in school Education 40 Wheelchair Survey GMHSCP Department for 41 Adding folic acid to flour Health and Social Care 42 What Matters to You? (2019) CCG 43 Tameside Museums and Galleries: Planning for the Future TMBC 44 Consultation on Proposed PSPO for Moorland TMBC 45 Local Studies and Archives Forward Plan TMBC 46 Shining a Light on Suicide GMHSCP Department for 47 Higher technical education consultation Education 48 Changing Places Toilets MHCLG Support for victims of domestic abuse in safe 49 MHCLG accommodation 50 Greater Manchester High Rise Residents Survey GMCA Redress for purchasers of new build homes and the new 51 MHCLG homes Ombudsman Department for 52 Restraint in mainstream settings and alternative provision Education 53 Tenancy deposit reform: a call for evidence MHCLG Digital-first Primary Care: Policy consultation on patient 54 NHSE registration, funding and contracting rules Supporting victims and witnesses every step of the way: 55 GMP experiences of police, court and support services Medicines and How should we engage and involve patients and the public 56 Healthcare in our work Products Agency GM VCSE 57 VCSE in Greater Manchester - the next 10 years Devolution Reference Group A new deal for renting: resetting the balance of rights and 58 MHCLG responsibilities between landlords and tenants 59 Rogue Landlord Database Forum MHCLG Department for 60 Advancing our health: prevention in the 2020s Health and Social Care

Page 25 Ref Topic Lead 61 Co-operative Councils' Innovation Network Proposals TMBC 62 Improving Specialist Care: GM Cardiology GMHSCP 63 Transport and the Night Time Economy GMCA 64 Measures to reduce personal water use DEFRA Electric vehicle chargepoints in residential and non- Department for 65 residential buildings Transport Department for 66 Home to school travel and transport: statutory guidance Education Ministry for Sprinklers and other fire safety measures in new high-rise Housing, 67 blocks of flats Community, and Local Government 68 LGBT Foundation Trans and NB People affected by cancer LGBT Foundation 69 Doing Buses Differently TfGM 70 Tameside Health Improvement TMBC 71 Greater Manchester Hate Crime Plan GMCA 72 The Ignition Project GMCA 73 Health Improvement Stakeholder Engagement TMBC 74 EDS2 Event Dec 2019 Feedback TMBC 75 Budget Conversation 2020/21 TMBC/CCG Healthwatch 76 Healthwatch - Home Care Survey Tameside Healthwatch 77 Healthwatch - Residential Care Survey Tameside Healthwatch 78 Healthwatch - Carers Survey Tameside Department for 79 Ofsted inspection: removal of outstanding exemption Education Greater Manchester review of paediatric medicine hospital 80 GMHSCP services 81 Appointee and Deputyship Consultation TMBC 82 Future of PEN Survey TMBC 83 Tameside Sexual Health Services Survey TMBC 84 Chadwick Dam Bee Network Scheme TMBC 85 Hill St to Trafalgar Sq, Bee Network Scheme TMBC 86 Stamford Drive Bee Network Scheme TMBC 87 Clarendon Rd Bee Network Scheme TMBC 88 Rayner Lane Bee Network Scheme TMBC 89 Ross Lave Lane Bee Network Scheme TMBC 90 A57 Crown Point Bee Network Scheme TMBC 91 Ashton Streetscape Bee Network Scheme TMBC 92 Ashton Town Centre South Bee Network Scheme TMBC 93 Manchester Road Link Bridge Bee Network Scheme TMBC 94 A57 Denton to Hyde Bee Network Scheme TMBC 95 Council Off-Street Parking Review TMBC 96 Future Health and Care Services in Hattersley TMBC 97 First Homes MHCLG Reforms to unregulated provision for children in care and Department for 98 care leavers Education Review of the ban on the use of combustible materials in 99 MHCLG and on the external walls of buildings

Page 26 Ref Topic Lead Manchester's Gay Village - What it means to those who use 100 GMCA it 101 Tameside Council's Statutory Budget Consultation 2020/21 TMBC 102 Hyde Town Centre Consultation TMBC Integrating Care for Trans Adults Open University, LGBT Foundation, 103 and Yorkshire MESMAC Changes to Ofsted’s post-inspection processes and 104 Ofsted complaints handling: proposed improvements 105 NHS Net Zero - Call for evidence NHS Healthwatch Tameside Young people’s health & care Healthwatch 106 Survey 2020 Tameside Healthwatch Tameside General survey 2020 Healthwatch 107 Tameside Understanding the impact of the Coronavirus on voluntary, 108 GMCA community and social enterprise organisations (VCSE) Understanding the impact of Coronavirus on food banks, 109 GMCA clubs, pantries and other food providers 110 Protecting places of worship consultation Home Office Low Pay Commission consultation Low Pay 111 Commission 112 NHS: Your current experience of coronavirus NHS 113 LGBT People: Share How Coronavirus Has Affected You LGBT Foundation 114 Physical Activity in Covid-19 Greater Sport Greater Manchester Big Disability Survey - Covid 19 Special / 115 GMCA Greater Manchester Big Disability Survey about Covid 19 - Easy Version Covid-19 Survey Healthwatch 116 Tameside 117 COVID-19 in the Caribbean and African Community GMCA 118 Manchester Pride Online Consultation Manchester Pride New walking & cycling measures to allow safe social 119 TMBC distancing 120 Future Travel Survey TfGM Greater Manchester, Ethnic Minority Experiences of Caring: Wraparound Your Voice Matters Partnership/Greater 121 Manchester Health and Social Care Partnership 122 Survey for Foster Carers in Tameside TMBC 123 LGBTQI+ sport and physical activity Pride Sports 124 Greater Moments COVID -19 Greater Moments 125 National Health Data Consent Survey The CLIMB Project Children’s Food Campaign and Food Active Survey Children’s Food 126 Campaign 127 LGBT Homes Survey LGBT Foundation Consultation on proposed changes to the assessment of 128 Ofqual GCSEs, AS and A levels in 2021

Page 27 Ref Topic Lead Save the Children Tameside Youth 129 Council/Save the Children 130 Developing a Race Equality Panel GMCA 131 Impact of COVID-19 and Building Back Better TMBC / CCG 132 Reopening the high street safely TMBC 133 Tameside & Glossop Young People Wellbeing Survey Worth-it Greater Manchester State of the VCSE Sector Evaluation 10GM/University of 134 2020 Salford 135 Local Offer Survey TMBC (T&G – 50; GM/NW – 39; National – 46)

Page 28 Partnership Engagement Network (PEN)

Report of Engagement during the Covid-19 Pandemic

Background

Tameside & Glossop Strategic Commission (Tameside Council and Tameside & Glossop Clinical Commissioning Group) has engaged with residents, patients, service users and other stakeholders on the impacts of Covid-19 and their experiences during the pandemic in a number of ways to date. This includes virtual engagement sessions with members of the Tameside & Glossop Partnership Engagement Network, a locality-wide survey on the impacts of the pandemic and learning for the future, engagement with children and young people and with Elected Members via Scrutiny.

Key messages from the engagement that has taken place are:

Key messages

 Communication – participants spoke of the need for clear, effective and locally tailored communications to support the safe return to normality

 Mental health was a key concern, particularly for young, older, vulnerable people, and people facing hardship of the pandemic

 Isolation/fear experienced by most vulnerable was said to be a key impact of the pandemic

 Digital methods of delivering services & concerns – respondents spoke of the positives of how services have adapted to digital methods but this risks excluding vulnerable people and poorer outcomes

 Ability to access to GP services/primary care services was a focus for future planning

 Vaccinations – both for winter flu and a possible Covid-19 vaccine featured in discussion about priorities for the future

 The role that the VCFSE sector has played in the pandemic was discussed, including how it could be harnessed in the future

 Positive experiences and outcomes from the pandemic, such as less travel by car or improved delivery of public services

 The disproportionate impact that Covid-19 has had on BAME members of our community - with particular emphasis on our Muslim community and people for whom English is not their first language

 Young people also raised issues in relation to completing school work (difficulty for some in terms of accessibility / digital exclusion and motivation levels), exam concerns (including the feeling of missing out on key life milestones) and the importance of including young people in decision making processes

Page 29 Virtual Engagement Sessions

Between 31 July and 17 August 2020, members of the public, stakeholders, partners, and voluntary, community and faith sectors, alongside representatives from Tameside Council, NHS Tameside and Glossop Clinical Commissioning Group and Tameside and Glossop Integrated Care NHS Foundation Trust met virtually for the first virtual Partnership Engagement Network engagement sessions of 2020. These are the first sessions to have taken place since the Covid-19 outbreak and resulting social distancing restrictions. There were over 55 participants in total.

The sessions were intended to be predominantly listening exercises – building on attendees’ experiences during the pandemic, both as individuals and professionals/part of an organisation. In addition to this, the fifth session held with young people across the local area was held so that the perspective of children was captured.

Each session was facilitated by local leaders who led the discussions:  How do we get services back open safely? Facilitated by Jane McCall, Chair of Tameside & Glossop ICFT and Karen Huntley, CCG Governing Body Lay Member  What have been the impacts on the most vulnerable members of our community/ what is the learning for the future in terms of inequalities? Facilitated by Councillor Brenda Warrington, Executive Leader of Tameside Council and Liz Windsor-Welsh, CEO of Action Together  Living with Covid-19 and preventing future outbreaks / spikes – what does the community need to be able to do this? Facilitated by Dr Asad Ali, Co-Chair of the CCG and Jody Smith, Policy & Strategy Service Manager  How do we do things differently in the future based on our experiences of COVID-19? Facilitated by Councillor Brenda Warrington and Karen Huntley.  A bespoke young person’s engagement session focusing on their experiences of Covid-19 and how we can do things differently in the future. Facilitated by Councillor Bill Fairfoull, Executive Deputy Leader of Tameside Council, Councillor Leanne Feeley, Executive Member - Lifelong Learning, Equalities, Culture and Heritage and Karen Huntley.

Participants were invited to have their say on the topic of the session, drawing on their personal experiences of the pandemic in their capacity as a local resident, patients, service user or other stakeholder.

Prominent key themes emerged from across all five virtual engagement sessions. The discussions and feedback captured during these sessions will be used to provide data, information, evidence and insight to the development of public services in Tameside and Glossop in light of the pandemic and to help us build back better.

Messages from the engagement sessions in full:

Communication

 Communication was notably the most prominent theme across all five discussions. There was a general consensus of how essential communication has been to the

Page 30 pandemic, and how it continues to be of vital importance to a number of factors – keeping the public informed regarding lockdown rules, information about the virus, what services are available and how they can be accessed,  Communication on a national scale (for example government communications) has been a cause for concern as new restriction measures are increasingly being implemented and communicated at a pace that is very fast and difficult to understand for many, in particular those who are more vulnerable.  Comments echoed the need for strong local communication that will combat any confusion about national guidance. For example the national message encouraging the public to go out and support local businesses versus the localised lockdown measures in Greater Manchester and beyond shows how there needs to be a local strategy for communications. Another example is how well local public services are communicated – health, social care and other public services are open for business, however the fear caused by lockdown measures means that many vulnerable people still believe it is not safe to go and seek help or that services are still ‘closed’.  Communication also needs to be inclusive of people who may struggle to understand or for whom communication by digital methods is harder to access. For example – communication adapted for partially sighted/blind people; for people whose first language is not English.

Mental health

 Mental health also featured heavily – many participants reported either through individual experiences or their experience of working with people that mental health has worsened significantly as a direct result of the lockdown restrictions. Particularly for those who have had to shield as a result, or those who were already socially isolated.  Some services that have been delivered digitally will need to return to face-to-face, particularly if their remit is to combat social isolation – this cannot be done through screens. For example social groups at the Grafton Centre.  The mental health or emotional needs of those who have had severe symptoms of Covid-19 or who have lost a loved one to the virus and have been unable to grieve properly due to social restrictions – will need to have their needs met.  Anxiety is a problem for those people who have been shielding, now that the official shielding period has ended. Many are still too afraid to leave their house, and many have not left their house at all or very little throughout the pandemic.  Mental health of children requires much consideration and planning – children have missed key life events during lockdown, have anxiety relating to school and exams missed.

Digital services/digital exclusion

 The discussion in each of the sessions largely found that there were two sides to the way that public and health services have been delivered virtually (Zoom, Teams, social media or other). Many reported personal experience of having better quality, more frequent contact with a doctor for example, and reported that as professionals there has been more time to deliver services because they have been able to do this virtually. However on the other hand, many people risk being digitally excluded from these new

Page 31 methods, particularly older people, people with no access to digital methods (financial reasons or other), and people who require additional support in such services – such as people who require a chaperone to advocate or family member who can translate.  It was agreed that some services are best delivered in person, for example counselling or any sort of mental or emotional support that requires human contact to work well.  As a result, there were suggestions that going forward there are many who will benefit from a return to face-to-face services – such as health appointments or social activities.  Finally where digital methods have benefited a public service provider or charity, these methods should be retained where possible with learning from the pandemic to be incorporated.  Those who may be affected by domestic abuse may feel safer and get the help they need by attending a setting as opposed to digital methods

Access to GP/Primary Care Services

 Many participants reported a disconnect between patients and GPs or Primary Care providers as a result of the lockdown measures. There were comments that now that the country is slowly beginning to open up, the relationship between patients and the NHS must be ‘repaired’ to encourage people to begin to seek help for whatever their need is once again.  Many participants noted a variance between GP practices and communications about the services patients can access and how; the quality and frequency of communications is inconsistent across practices.  Patients need to be reassured that they can and should ask to be seen at their GP practice in order to repair fear and anxiety about going into healthcare settings. There is a general sentiment that patients feel their practice is ‘closed’.

Vaccinations

 When asked about how to do things differently in the future, some participants raised the issue of future vaccination programmes, for example the Covid-19 vaccine if it becomes available; the flu vaccine in light of eligibility being expanded to all those over 50; and finally those who have missed vaccines while the pandemic has been going on.  Another point regarding the flu vaccine was how to manage its supply and distribution in terms of availability, learning from past shortages of the vaccine itself.  Comments raised concerns over fear and misinformation being spread about a possible Covid-19 vaccine; and how suspicion is not limited to certain social groups but across age groups and social demographics. Future communications need to be able to counteract misinformation.

Impact of the pandemic on BAME people (emphasis on Muslim community and those whose first language is not English)

 Some residents accessing support through the Humanitarian Hub set up to support local residents experienced some language barriers with call handlers  For those whose first language is not English or who do not speak English, the impact of having to attend appointments (in hospital or elsewhere) has caused issue for those

Page 32 who would normally bring a family member of friend to translate on their behalf. This acts as a further barrier to accessing primary and secondary care, and other services.  Closure of Mosques – formerly strong community hubs for Muslims in Tameside & Glossop. Their closure posed problems to many during the pandemic who would rely on them for support. However now that they are open again they are useful for getting message out to Muslim community about the pandemic.  There have been some reports of incidences of discrimination towards black and minority ethnic communities from others in public places / outside local Mosque. This appears to have been further compounded by the emergency lockdown measures announced the day before Eid.

The role of the VCSE sector

Discussion across the sessions highlighted the work of voluntary, community and social enterprise sector in providing for vulnerable people during the pandemic.

 Many charitable organisations continued throughout the pandemic to ensure that their vital support continued to those who needed it. Some have adapted to deliver services digitally/over the phone, which will need to continue to ensure those who are still vulnerable can access.  Charities may struggle to continue working again in the event of a second wave.  Volunteers require protection such as PPE and emotional wellbeing support  There is a need for recognition of the impact that volunteers have had on people during the pandemic  Volunteers and VCSE organisations must be harnessed as a vital resource in the event of a second wave or second lockdown

Positive outcomes of the pandemic

Participants from a range of individual and professional backgrounds wanted to share some of the positive outcomes they have experienced as a result of the Covid-19 outbreak:

 The role that local Mosques have played in dissemination of information, vital support to the vulnerable and coordination of volunteers  The positive role that the community has played in supporting the most vulnerable, particularly volunteers – either from charities or those that have been furloughed and offered their time to help others – has been immeasurable  The use of technology to deliver services has been positive for some service users and staff for a multitude of reasons – has resulted in greater flexibility and quality  Comments that communications from the Council and CCG have been positive and had a good impact

Other comments:

 Comments about the difficulty of isolating for 14 days if there is a chance someone may have been in contact with a Covid positive person. Many do not have the financial option to do this and rely on going out to work.  Track & trace has been inadequate – discussion of other local areas that have developed their own systems

Page 33  Better Covid-19 patient follow-up or aftercare is needed, particularly for those with severe symptoms who experience difficulty after being discharged  Concerns about some treatments provided, for example Vitamin B12

The engagement session for young people was held on Monday 17 August. In addition to the key themes outlined above a number of distinct themes arose from this session as follows:

Concerns relating to school

 Participants of different ages voiced their worries about the amount of time and learning that they have missed due to school closures since March. The concerns are largely around the prospect of having to catch up with all of their work.  A number of participants reported difficulty with completing online work at home for a number of reasons – no access to internet, limited or no access to a device in the household that will allow them to do their work and lack of motivation.  Some young people such as young carers will have had further difficulty doing school work because of other responsibilities that have to come first

Concerns about exams

 Participants talked about stress owing to the cancellation of exams for a number of reasons including the varying information they were given about what was going to happen at the beginning of lockdown.  The prospect of catching up on all the lost learning is more stressful for those in Year 10 or 12, who will have either GCSEs or A-levels next year.  The way exam results are calculated has left young people feeling as though they cannot celebrate.

Mental health

 A key theme for the discussion was that the mental health of children and young people had deteriorated during the pandemic, affecting younger children as well. This notably includes children who had no prior mental health issues.  There is a strong need for support networks for young people whose mental health is suffering as a result of the pandemic. Young people need to be made aware of what is available to them.  For some young people, existing mental health problems were exacerbated and coping mechanisms or ways to alleviate this weren’t accessible to them because of limited social contact.

Isolation

 Many participants spoke of the isolation felt due to being unable to see close family and friends. One word used to describe this was ‘strange’.  Children have been separated from parents and siblings due to lockdown and social distancing restrictions which has been very difficult. Having contact over the phone with family is no real consolation for the in-person connection that is needed.  The lack of contact with friends has also impacted young people’s lockdown experience, which was said to be ‘boring and repetitive’.

Page 34  For some young people leaving care, digital access has rendered them even more isolated with phones and internet access being the main contact with the outside world.  Young people have been left with no space to interact with others during the lockdown, and this has led to scapegoating about young people spending time on the streets with friends.  The redciution of youth services has meant that young people have not had the space outside the home to enjoy themselves – either as part of youth groups or support groups for young carers

Other comments:

 Some feel that children and young people have been left out of the decision-making process during the course of the pandemic  Many children will have gone through major life experiences since the beginning of the pandemic and may experience greater struggles associated with lockdown  Some children have adapted well, particularly with learning and bonding with siblings  Family bereavement is difficult for children because of funeral restrictions meaning family members cannot attend  No internet access puts young people in a very difficult position in terms of completing school work, talking to friends and accessing support  Positive comments were also made in terms of some children feeling they had learnt more during lockdown and the provision of digital equipment had assisted with this

Impact of Covid-19 and Building Back Better: Survey Feedback

A survey on the Impact of COVID-19 / Building Back Better was hosted by the Strategic Commission via the Big Conversation pages on the Council and CCG websites. The survey aimed to understand how the pandemic has impacted the lives of people who live, work or spend time in Tameside & Glossop. We also wanted to gather views on how we can better live with, and recover from, COVID-19. As challenging as the COVID-19 pandemic has been, it also presents a range of opportunities to do things differently in Tameside & Glossop. We wanted to understand resident’s priorities for the way we recover and for the future of the area.

The survey was open from 31 July and closed on 1 September. In total 455 responses were received and analysed.

Table 1 details the achieved sample from the survey by postcode sector compared to the Tameside & Glossop population. The achieved sample figures are based on the 62% of respondents who provided a valid Tameside & Glossop postcode sector in response to the question “What is your postcode?”

Table 1: Achieved Sample by Postcode Sector

Postcode Sector Tameside & Glossop Achieved sample Households1 (%) (%) M34 – Denton / Audenshaw 18.5 13.2

1 Figures are based on the number of households in each postcode sector area.

Page 35 M43 – Droylsden 9.0 6.1 OL5 – Mossley 4.6 2.8 OL6 – Ashton (Hurst / St. Michaels) 11.6 11.0 OL7 – Ashton (Waterloo / St. Peters) 6.6 4.6 SK14 – Hyde 18.2 28.1 SK15 – Stalybridge 10.9 7.8 SK16 - Dukinfield 7.7 13.9 SK13 - Glossop 12.7 7.1 Other (outsideTameside & Glossop) - 5.0

Weighting the data to account for over and under-sampling of particular sections of the population is not necessary, given that the survey was available via the Big Conversation web pages on both the Council and CCG websites. It was open to all residents / members of the public and was not a fixed/controlled sample. No personal identifying data was collected as part of the consultation process.

A total of 451 respondents also stated their interest in the consultation (Question 1). 393 of respondents (87.1%) were a resident of the area. Responses are detailed in table 2. Responses were not exclusive: a respondent could select as many or as few options as they wanted.

Table 2: Respondent’s interest in consultation

Interest in Issue % I work in Tameside & Glossop 42.6 I live in Tameside & Glossop 87.1 I spend leisure time in Tameside & Glossop 37.9 Other 3.8

The 42.6% of respondents who indicated that they worked in Tameside & Glossop were asked which sector they work in. Responses are detailed in table 3.

Table 3: Employment sector of respondents

Employment sector % Public sector 64.9 Private sector 16.8 Voluntary sector 15.2 Other 3.1

All respondents were asked to select their top three priorities when thinking about living with Covid-19. The most commonly selected options are presented in table 4.

Table 4: Priorities when thinking about living with Covid-19

Priorities for living with Covid-19 % My / my family’s physical health 65.0

Page 36 My / my family’s emotional wellbeing and mental health 62.3 Staying in touch with friends / family 27.5 Access to health and care services 21.6 Capacity of health and care services to cope with coronavirus 17.9

Respondents were then asked to select their top three priorities for the future beyond Covid- 19. The most commonly selected options are presented in table 5.

Table 5: Priorities for the future beyond Covid-19

Priorities for the future beyond Covid-19 % My / my family’s emotional wellbeing and mental health 59.6 My / my family’s physical health 59.4 Staying in touch with friends / family 28.8 Access to health and care services 26.7 Managing household income and finances 13.4

Respondents were asked to indicate if they would do anything differently in the future by selecting as many options as appropriate. The most commonly selected options are presented in table 6.

Table 6: what would you do differently in the future?

What would you do differently in the future % Spend more time with family 60.9 Support local businesses more 59.6 Holiday more in the UK 40.1 Spend more time at home 39.8 Work from home more 36.7

In addition to the quantitative questions presented above, the Building Back Better survey asked five key open-ended questions. These align with those questions asked during the virtual PEN engagement sessions:

 What do you think the impacts of coronavirus have been on the most vulnerable members of our community? How can we best learn from this in the future?  How do you think we can best prevent future outbreaks of COVID-19 in Tameside & Glossop? What does our local community need to be able to do to support this?  What are your thoughts on how we can re-open services safely in Tameside & Glossop?  Based on your experiences during COVID-19, how do you think we can do things differently in the future?  Do you have any other comments you wish to make?

The key themes arising from each of the open-ended questions are outlined in Tables 7-11.

Page 37

Table 7: What do you think the impacts of coronavirus have been on the most vulnerable members of our community? How can we best learn from this in the future?

Theme No. % Loneliness and isolation 178 39.1 Mental health 51 11.2 Fear and anxiety about Covid-19 35 7.7 More/better services supporting vulnerable people 34 7.5 Access to technology/digital services 27 5.9 Reduced access to healthcare/other services 24 5.3 Financial difficulties 24 5.3 Access to food 20 4.4 Better communication/engagement 16 3.5

Table 8: How do you think we can best prevent future outbreaks of COVID-19 in Tameside & Glossop? What does our local community need to be able to do to support this?

Theme No. % Following social distancing and hygiene guidelines 89 19.6 Stronger enforcement of lockdown measures 80 17.6 Effective and clear communication 59 13.0 Education of residents 28 6.2 More cleaning/hygiene 28 6.2 Local based approach 25 5.5 More/better testing 22 4.8 More effective track and trace 20 4.4 Support for people isolating/quarantining 18 4.0

Table 9: What are your thoughts on how we can re-open services safely in Tameside & Glossop?

Theme No. % Follow social distancing guidelines (e.g. facemasks) 101 22.2 Reopen services slowly/cautiously 32 7.0 Ensure effective communication 32 7.0 Enforce lockdown measures 31 6.8 Lift lockdown quickly/immediately 28 6.2 Cleanliness/hygiene 23 5.1 Reopen services only when safe 19 4.2

Table 10: Based on your experiences during COVID-19, how do you think we can do things differently in the future?

Theme No. %

Page 38 Tighter enforcement of social distancing and hygiene 83 18.0 guidelines Better flow of information 56 12.0 Focus on vulnerable people and shielded/isolated 26 5.7 residents More use of digital services 21 4.6 Raising issues with national government 20 4.0 More use of community volunteers or resources 17 3.7 More local input into decision making 16 3.5 (residents/community groups)

Table 11: Do you have any other comments you wish to make?

Theme No. % Better flow of information 24 5.3 Tighter enforcement of social distancing/hygiene 24 5.3 guidelines Praise for pandemic response 14 3.1 More local input into decision making 12 2.6 (residents/community groups) Disappointed by response to pandemic 12 2.6 Support town centre and local economies/businesses 11 2.4 Support vulnerable, disabled and shielded residents 11 2.4

Cross tabulation of results by demographic group has not been undertaken due to small numbers by individual category, making meaningful analysis not possible.

The achieved survey sample compared to the Tameside & Glossop population is presented in table 12.

Table 12: achieved survey sample compared to the Tameside & Glossop population

Demographic Group Tameside & Glossop Achieved Sample (%) Population (%) Sex Male 49.1 31.9 Female 50.9 64.5 Prefer to self-describe Not available 0.3 Prefer not to say 3.3 Age2 Under 18 21.9 0.7 18 – 29 14.5 5.2 30 – 49 26.3 37.4 50 - 64 19.8 34.6 65+ 17.5 22.0 Ethnicity White 91.8 93.0 BME 8.2 7.0

2 Based on those respondents who provided an exact age to enable categorisation

Page 39 Religion No Religion 24.0 42.1 Christian (including Church 64.2 55.1 of England, Catholic, Protestant and all other Christian denominations) Buddhist 0.2 0.7 Jewish 0.0 0.0 Sikh 0.0 0.0 Hindu 1.3 0.4 Muslim 3.9 1.8 Any other religion N/A 4.9 Sexual Orientation Heterosexual / straight Not available 82.3 Gay/lesbian 4.8 Bisexual 1.7 Prefer not to say 8.2 Prefer to self-describe 1.4 Disability Yes 20.5 30.9 No 79.5 69.1 Carer Yes 10.9 35.7 No 89.1 64.3 Armed Forces Member / Ex-Member Yes Not available 5.3 No 91.3 Prefer not to say 3.3 Marital Status Single 34.8 18.0 Married / Civil Partnership 44.4 62.7 Divorced 13.2 8.7 Widowed 7.5 3.0 Prefer not to say Not available 7.7

OTHER FEEDBACK METHODS

In addition to feedback received through the 455 survey responses, some comments were also made directly via social media posts on the Strategic Commission social media sites.

In total, 9 posts promoting the Covid-19 Impact and Building Back Better survey were made across Tameside & Glossop Strategic Commission social media channels (Twitter and Facebook) during the engagement period. Information detailing responses to these posts is outlined in table 13.

Table 13: Social media – number of posts and performance

Social Media No. of Posts Shares Replies Likes Platform Facebook 1 7 11 6

Page 40 Twitter 8 5 1 3

These social media responses were analysed to draw out any key themes. Table 14 details these key themes. Percentages are not provided due to low number of responses.

Table 14: Key themes from social media responses

Theme Focus on other towns (not Ashton) Redevelop old/disused buildings Listen to residents Crime/anti-social behaviour

Other Sources

Additional engagement work around the impacts of COVID-19 has also been undertaken via the Children in Care Council. The engagement work undertaken with the Children in Care Council consisted of two questionnaires circulated via children’s social workers. These contained statements about mental wellbeing and how well children felt they had been supported during lockdown. The young people who responded were Tameside children aged between 8 all the way up to age 25, involved with either the safeguarding, Looked After or Leaving Care social work teams. Children and young people were asked about their lockdown experiences, general wellbeing and their priorities or concerns for the future.

The first survey was sent out to children aged 8-16 involved with the duty, safeguarding and Looked After Children teams. Key findings included:

 Over three quarters (77%) agreed that they were generally in a good mood.  91% said they had felt supported during the lockdown (none disagreed with this statement).  80% said that they felt like their rights were respected  Over nine in ten (94%) felt they were able to share their worries or opinions.  When asked what they worried about, children mostly indicated that the future and how their family and friends were doing were the main concerns.  When asked what helped them during lockdown, it was family, friends, pets, activities and residential staff.  Generally, children understood the changes and reasons why.  When asked if there was anything they wished they could do but couldn’t because of restrictions, children said seeing family and friends, social activities and holidays.

The second survey was sent to young people involved with the leaving care team, aged 16- 25.

 Over a third (37%) said that generally they were in a good mood  Two-thirds said they felt supported during lockdown  75% said they felt able to share their worries or opinions

Page 41  When asked about what worried them, how their family were doing, the future, mental health and finances were the biggest issues for those who responded.

Engagement with residents and communities was also reported via Elected Members on the council’s Scrutiny Panels. Scrutiny Panel members are well placed to report on feedback from residents in their local wards, and so it was requested that they take time to note experiences, impacts and the response to Covid-19 in Tameside. These key messages from this work was as follows:

 Responding to Covid-19 – The crisis has helped generate a resurgence of a sense of community. There were positive outcomes such as online support groups. Agencies have responded well with regards to food and medication provision.  Health systems – there are a number of concerns linked to the impact of Covid-19 and the lockdown on physical and mental health. Assessing and supporting mental health need must remain a priority. Concerns about avoidance of primary care during lockdown. Work is required to understand the impact on certain groups, for example Black, Asian and Minority Ethnic people.  Economy – Residents have concerns about uncertainty connected with lockdown measures, particularly in the insecurity of employment, housing, financial support and debt.  Children and families – There has been a positive response from local schools, but there are concerns about children returning to school. There is need for consistency in the messages relayed from schools.  Vulnerabilities (elderly/shielded, BAME, homelessness, domestic abuse) – To review the need for a collaborative approach to assess and remove any potential barriers (physical or psychological), in supporting our elderly, shielded and vulnerable residents to become more socially mobile as lockdown restrictions start to ease further.  Future consideration – A need to plan for the challenges we are likely to face going forward and particularly how we work to mitigate the problems that lockdown has imposed. For example, getting people back to work, future financial hardships and feasibility of foodbanks.

Page 42 Agenda Item 5

PRIMARY CARE COMMITTEE

Title of Subject: Enhanced Health in Care Home Funding

Date of paper: 7th October 2020

Prepared By: Tori O’Hare

History of paper: A paper on the delivery and funding of the Enhanced Health in Care Homes Network Specification was presented to September Primary Care Committee. It was requested this be brought back for further consideration in the October meeting.

Executive Summary: In 2020/21 the Primary Care Network (PCN) Contract DES introduces three Network Specifications for PCN delivery, one of which is the Enhanced Health in Care Homes Network specification.

This specification sets out the provision which must be in place across the locality, reflecting the delivery of this is by a range of partners, for care home patients. These patients remain registered with general practice and therefore all the existing funding for those patients remains. A recurrent Care Home Premium payment of £120 per year per care home bed is also introduced from 1 October 2020, in line with the start date of the Network specification.

This paper considers the investment into practices for these patients for consideration by Primary Care Committee. Recommendations Primary Care Committee is asked to: required of the Committee (for 1. note the question raised in relation to recurrent increased funding Discussion and for this Network specification above the existing contract values; Decision): 2. agree the existing breadth of investment in general practice through core contract, LCS, Additional Roles Reimbursement Scheme and Care Home Premium, 3. noting the aligned investment in other partners and the importance of total system working, recommend no further funding into PCNs or general practice is made; 4. support future consideration of this decision, if required, as an output of the Enhanced Health in Care Homes Task and Finish group. Principles addressed National Policy by proposal (QIPP, national/regional policy etc): Direct questions to: Tori O’Hare

Page 43 1. INTRODUCTION

1.1 The Primary Care Network (PCN) Contract DES introduces from 2020/21 Network Specifications for PCN delivery. In 2020/21 this brings in three specifications, one of which is the Enhanced Health in Care Homes Network specification.

1.2 This specification sets out the provision which must be in place across the locality, reflecting the delivery by a range of partners, for care home patients. These patients remain registered with general practice and therefore all the existing funding for those patients remains.

1.3 A Care Home Premium, a recurrent payment of £120 per year per care home bed is also introduced from 1 October 2020, in line with the start date of the Network specification.

1.4 As part of the Covid pandemic response, aspects of this Network specification were introduced early, detailed in a NHS England letter of 1 May. The subsequent finance letter of 4 August confirmed funding arrangements for this period.

1.5 This paper articulates the question raised by PCNs regarding the recurrent funding for this specification for Primary Care Committee consideration. This paper focusses on the recurrent position for the total delivery of the full Network specification from 1st October.

2. ENHANCED HEALTH IN CARE HOME NETWORK SPECIFICATION

2.1 The Enhanced Health in Care Homes Network specification sets out a clear ambition to move away from “traditional reactive models of care delivery towards proactive care that is centred on the needs of individual residents, their families and care home staff.” It is recognised that “such care can only be achieved through a whole-system, collaborative approach”.

2.2 The full specification document is included at appendix A however an extract, showing the care elements is shown below. This table highlights the breadth of providers across the system required to achieve full delivery of the specification.

Care element Sub-element Each care home aligned to a named PCN, which leads a weekly multidisciplinary ‘home round’ Enhanced primary care Medicine reviews support Hydration and nutrition support Oral health care Access to out-of-hours/urgent care when needed Expert advice and care for those with the most complex needs Multi-disciplinary team Continence promotion and management (MDT) support including Flu prevention and management coordinated health and Wound care – leg and foot ulcers social care Helping professionals, carers, and individuals with needs navigate the health and care system Falls prevention, Rehabilitation/reablement services reablement, and Falls, strength, and balance

Page 44 rehabilitation including Developing community assets to support resilience strength and balance and independence High quality palliative and Palliative and end-of-life care end-of-life care, Mental Mental health care health, and dementia care Dementia care Co-production with providers and networked care Joined-up commissioning homes and collaboration between Shared contractual mechanisms to promote health and social care integration (including Continuing Healthcare) Access to appropriate housing options Training and development for social care provider Workforce development staff Joint workforce planning across all sectors Linked health and social care data sets Data, IT and technology Access to the care record and secure email Better use of technology in care homes

2.3 Requirements for the delivery of Enhanced Health in Care Homes by PCNs are included in the PCN DES for 2020/21. Complementary requirements for relevant providers of community physical and mental health services have been included in the NHS Standard Contract. This supports the NHS Long Term Plan goal of "dissolving the historic divide" between primary care and community healthcare services and sets a minimum standard for NHS support to people living in care homes.

2.4 The guidance is clear this can only be achieved through system working across the locality, with delivery by a range of partners. There is significant investment across the locality through these services.

2.5 A system wide Enhanced Health in Care Homes Task and Finish group is in place to lead the oversight of the specification across the system. This group will co-ordinate the efficiency and effective use of the existing investment across those partners to maximise the personalised care offer to these patients. A lead PCN Clinical Director, to represent PCNs at this group, is in place.

3. CARE HOME PATIENT FUNDING

3.1 There is a range of funding within the GP Contract and in local contracting arrangements attributed to each registered patient on a practice list, this includes:

 Global Sum (Core contractual payment)  QOF  Directed Enhanced Services  Locally Commissioned Services

In addition, the Care Home Premium has been introduced from 2020/21 in line with the introduction of the Enhanced Health in Care Homes Network specification. This is recurrent funding of £120 per care home bed per year.

3.2 Our refreshed LCS specifications, new in 2019/20, introduced many aspects of this Enhanced Health in Care Homes Network specification. Multidisciplinary Team meetings, Advanced Care Planning for example are covered in the Identification and Management of Long Term Conditions and the Palliative, End of Life and Frailty LCS bundles.

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3.3 A separate workstream is in place, through the LCS working group, to review the investment through that framework and ensure continued support to these patients.

3.4 All PCNs have access to, and have appointed PCN Clinical Pharmacists under, the Additional Roles Reimbursement Scheme. This will support the delivery of the medicine reviews requirements of the specification, as part of the locality Care Home Pharmacy Hub.

3.5 There is an aligned digital project has introduced an app which collates information on care home patients to give practices a ‘dashboard’ overview of their patients. It will support decision making on risk stratification of patient s for the weekly care home ward rounds and will support the allocation of face to face and remote consultations.

3.6 All PCNs put forward funding requests through the Partnership LCS bundle to support the early delivery of aspects of this specification. The level of funding of these proposals exceeds the Care Home Premium funding level however we supported in recognition of the accelerated introduction, and pace of implementation, of those aspects of the Network specification. These LCS proposals were supported until 30 September, recognising the introduction of the Care Home Premium from 1 October 2020.

3.7 The learning from those Partnership LCS projects will be taken forward through PCN meetings and through the Enhanced Health in Care Homes Task and Finish group as part of the recurrent delivery model development.

3.8 Although this paper summarises some of the key workstreams, Primary Care Committee can be assured the Enhanced Health in Care Homes Task and Finish will oversee the joined up system working to ensure the effective delivery for this population.

4. RECOMMENDATIONS

4.1 Primary Care Committee is asked to:

1. note the question raised in relation to recurrent increased funding for this Network specification above the existing contract values; 2. agree the existing breadth of investment in general practice through core contract, LCS, Additional Roles Reimbursement Scheme and Care Home Premium 3. noting the aligned investment in other partners and the importance of total system working, recommend no further funding into PCNs or general practice is made; 4. support future consideration of this decision, if required, as an output of the Enhanced Health in Care Homes Task and Finish group.

Page 46 Agenda Item 6

PRIMARY CARE COMMITTEE

Title of Subject: GP Contract Changes – Update Briefing

Date of paper: 7th October 2020

Prepared By: Tori O’Hare

History of paper: This is one of a series of GP Contract changes papers brought to Primary Care Committee as required following national changes to the General Practice contract.

Executive Summary: This is an update paper to PCC on the latest GP Contract Reform guidance published by NHS England in September 2020.

This paper sets out an overview of key changes and highlights the financial impact of those changes to the CCG.

This paper also gives an update on the work programme of the Primary Care Living with Covid Group and the support guidance to practices and patients overseen by that group.

Recommendations Primary Care Committee is asked: required of the Committee (for 1. to note the changes set out in this contract changes Discussion and briefing, Decision): 2. to support the ongoing support guidance to our practices led by the Primary Care Living with Covid Task Group.

Principles addressed by National Policy proposal (QIPP, national/regional policy etc): Direct questions to: Tori O’Hare

Page 47 1. INTRODUCTION

1.1 In September 2020 a number of changes to the GP Contract were announced, these include changes designed to support the Covid pandemic response by practices. A presentation overview of these changes is included as appendix A to this report. The detail of these changes and any associated financial impact are set out in turn below.

1.2 This paper also gives an update on the work programme of the Primary Care Living with Covid Group.

2. QUALITY AND OUTCOMES FRAMEWORK

2.1 Further to the Update to GP Contract letter detail announced by NHS England in the 9 July letter, the detail of the Quality and Outcomes Framework (QOF) changes for 2020/21 have now been published.

2.2 A separate paper to Primary Care Committee this month covers the detail of these changes, including the aspects income protected, the eligibility requirements for income protection and the areas of prioritisation for 2020/21.

2.3 The total points remain the same and therefore funding forecast for the year is in line with our financial planning in February.

3. CHANGES TO THE GP CONTRACT

3.1 The September publication of changes also introduces a number of changes to the GP Contract from 1 October 2020; these include:

 a continuation of the temporary increase in the number of appointment slots that practices must make available for direct booking by 111 to 1 slot per 500 patients per day. GP practices are asked to make sufficient slots available for NHS 111 to refer into; they should assess the use of the slots each day and adjust the number to meet demand. This could be fewer than 1 in 500.  a requirement for practices to participate in the Appointments General Practice data collection  a requirement for practices to participate in monthly updates regarding the NHS Digital Workforce Census. This move from quarterly reporting aims to better understand the workforce pressures in primary care.  a requirement for practices to support NHS England to fulfil its statutory duties to maintain an accurate and up-to-date list of patients, including by responding to reasonable requests to correct and update inaccurate patient data held on clinical systems  an amendment to allow onward sub-contracting of clinical services provided under the Network Contract DES.

These changes will improve the data available to support planning, though noting these datasets cannot be used in isolation.

3.2 The ability to draw comparisons for example from the appointment data will depend on the level of detail in the data collection. Not all appointments will be the same length, the same complexity and the appointment measure does not reflect the breadth of work which will sit behind this. This will include but not be limited to care planning, proactive contact of patients, weekly ward rounds in care homes, referral to and follow up from other providers and multi-disciplinary team (MDT) meetings.

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3.3 There is no financial impact expected in year as a result of these changes; no change to the global sum rate of the core contract has been indicated.

4. PCN NETWORK DES CHANGES

4.1 There a three key changes to the PCN Network DES; these changes are effective from 1st October 2020.  the Investment and Impact Fund commences – this is a QOF style achievement scheme for PCNs. This was indicated in the PCN contract from 1st April however delayed until 1st October as a result of the Covid pandemic. The funding for the first six months was protected and made available to PCNs as a pandemic resilience fund.  nursing associates and trainee nursing associates are added to the Additional Roles Reimbursement Scheme. This addition will provide further options for PCNs as part of the impetus to increase the primary care workforce.  providing flexibility, by exception and with the agreement of CCGs, for the care homes clinical lead to be a non-GP and instead be another clinician with appropriate experience.

4.2 There is no financial impact expected in year as a result of these changes, the Investment and Impact Fund and the Additional Roles Reimbursement Scheme were known at the time of budget setting however, as new or significantly increased in value respectively, were not in our spend in 2019/20. The financial planning arrangements for the latter part of 2020/21 are being discussed as a separate agenda item.

5. OTHER CONTRACT CHANGES

5.1 There are a number of other contract changes introduced in the update to the GP contract agreement published in September 2020, these are summarised below.

5.2 Individuals become eligible for routine vaccination against shingles when they become 70 years of age and for those in the catch-up cohort, as they become 78 or 79 years of age. All eligible individuals retain eligibility to receive the shingles vaccine until they become 80 years of age. Some individuals who were eligible for the shingles (catch- up) vaccination programme may have turned 80 years during the pandemic and missed the opportunity to be vaccinated. This cohort of individuals can still be offered shingles vaccine unless contraindicated, up to the 31 December 2020. This temporary offer applies only to those who were eligible and who missed shingles vaccination because of lockdown or shielding was recommended.

5.3 As part of the workforce strategy and the skill mixing of roles by practices, workforce support resources are available in relation to the recruitment and supervision support programme requirements for practice considering employing a Physician Associate for the first time. This is available for a limited time however at no cost to the practice. A First Contact Practitioner workforce modelling tool is available. This can be used to identify the workforce capacity at a system level, including potential gaps and areas of opportunity. A General Practice Fellowship Programme and Supporting Mentors scheme have been launched, forming part of a suite of interlocking GP recruitment and retention initiatives.

5.4 To support primary care in delivering video consultations, two new resources have been published. These are visual resources, intended to support patients and staff in the use of video technology when conducting appointments.

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5.5 There are no financial impact of these changes, the immunisation programme costs and budget are held by GM HSCP.

6. PRIMARY CARE LIVING WITH COVID TASK GROUP UPDATE

6.1 The Primary Care Living with Covid Task Group has focussed on providing guidance to practices to support the resumption of activity, prioritisation and management of capacity and demand pressure. This work has been overseen by the Primary Care Ambition and Recovery Group.

6.2 A number of guides are available to practices, these are distributed to all practices and also made available on the intranet and internet as appropriate. The ‘unlocking guidance’ provides guidance on models of delivery, particularly around long term condition management, self care resources are also documented to be shared with patients for whom these are appropriate.

6.3 Recognising capacity and demand pressures, local infection rates and priorities set out in QOF changes and the phase 3 letter, a prioritisation letter has also been shared. Flu vaccination programme, childhood immunisations, cervical screening. 8 week baby checks and 6-8 week post-natal check for new mothers, high risk drug monitoring (DMARDS, warfarin etc), LD and SMI healthchecks, pneumococcal and shingles vaccination programme are listed. In addition, proactive contact of potential COPD exacerbations to ensure medications are in place if required is noted.

6.4 This group, along with Primary Care Delivery and Improvement Group, will continue to monitor the resumption of activity in line with phase three but noting the need to reflect local infection rates, workforce resilience and risk assessment and patient confidence and support needs to access care.

6.5 There is a programme of work, in conjunction with the Strategic Commission Communications Team to support this with a campaign to reinforce the messaging of general practice being open, a blended model of access, which includes face to face appointments at all practices however that continued adjustments to delivery remain essential.

7. RECOMMENDATION

7.1 Primary Care Committee is asked to:

1. to note the changes set out in this contract changes briefing, and 2. to support the ongoing support guidance to our practices led by the Primary Care Living with Covid Task Group.

Page 50 Update on recent developments

Page 51 Page Dr Nikita Kanani, Medical Director for Primary Care Ed Waller, Director of Primary Care

3 September 2020 QOF update

• As part of the revised requirements practices are being asked to: • Focus on flu vaccinations and restoration of cervical screening services. To support this the number of points associated with these indicators have been doubled. Page 52 Page Achievement against these indicators will be paid based on recorded achievement at year end as usual. • Registers and eight prescribing indicators will also be paid on an achievement basis. • The QI module requirements have been refocused on key actions which practices are being asked to implement to assist in restoring services in the topic areas of early cancer diagnosis and care of people with a learning disability. • The remaining 310 points will be subject to income protection with practices being credited with points based upon historical achievement.

5 | QI actions: early cancer diagnosis

1. Continue to focus on restoring the cervical screening programme; 2. Proactively engage with patients, families and carers to build confidence in primary care and take action to offer reassurance that services can be accessed safely; Page 53 Page 3. Monitor suspected cancer referral rates, reflect and identify where improvements could be made in relation to: 1. The quality of referrals and alignment with NICE guidance 2. Awareness of referral and testing pathways and how these might have changed as part of the pandemic response 4. Ensure a robust and consistent system for safety netting of patients on urgent referral pathways, those who have been downgraded and those who were not referred

6 | QI actions: care of people with a learning disability

1. Review and update registers of people with a learning disability to ensure accuracy; 2. Restore full operation of annual health checks; Page 54 Page 3. Develop and implement a plan to improve the delivery of flu vaccinations to this patient group; 4. Record the need for and type of reasonable adjustments; 5. Review all DNACPR decisions made in respect of any patient on the learning disability register to confirm that were determined appropriately and continue to be clinically indicated with records updated where necessary.

7 | Conditions of income protection

• To be eligible for income protection practices will need to: • Agree a plan for QOF population stratification with their commissioner to include the identification and prioritisation of the highest risk patients for practice review including: • Those vulnerable to harm from Covid-19 including patients from BAME groups and those from the 20% most deprived neighbourhoods nationally; Page 55 Page • Those at risk of harm from poorly controlled long-term condition parameters; • Those with a history of missing reviews.

• Commit to making referrals to existing and new weight management programmes where this is identified as a key health and wellbeing intervention as part of any review.

• Practices will be asked to confirm their approach to population stratification via the eDEC in October/November 2020.

8 | Standard Operating Procedure (SOP) for general practice The latest version of the GP Standard Operating Procedure, which contains current information and guidance in the context of COVID-19 is available on our website.

Key 56 Page recent changes include: • Updates to reflect latest position on people who are extremely clinically vulnerable • Links to advice on the use of face masks by patients in general practice • Addition of a new section on health inequalities https://www.england.nhs.uk/coronavirus/wp- content/uploads/sites/52/2020/03/CO485_guidance-and-standard-operating-procedures- general-practice-covid-19.pdf

9 | Changes to the GP contract legislation On 1 October 2020, further amendments will be made to the GP contract regulations in line with agreements reached in last year’s GP contract deal. We will write to practices soon outlining the full set of changes, but the key changes include: • A new requirement for practices to participate in the Appointments in General Practice data collection. Practices will be required to record appointments in their appointments book in line with guidance we jointly published with the BMA in August: https://www.england.nhs.uk/wp- Page 57 Page content/uploads/2020/08/gpad-guidance.pdf • A requirement for practices to participate in monthly updates regarding the NHS Digital Workforce Census • A requirement for practices to support NHS England to fulfil its statutory duties to maintain an accurate and up-to-date list of patients including by responding to reasonable requests to correct and update inaccurate patient data held on clinical systems • An amendment to allow onward sub contracting of clinical services provided under the Network Contract DES The SFE will also be updated to reflect the revised approach to QOF and DSQS in 2020/21 which we have previously announced. 10 | Primary Care Networks – forthcoming amended DES

We will shortly be publishing an amended Network Contract DES for 2020/21, taking effect from 1 October. The amended DES will include three main changes:

1. Establishing the Investment and Impact Fund (IIF). The IIF is the QOF-style incentive scheme for PCNs. We will add £24.25m to the DES, focussing on a small number of indicators (including flu

Page 58 Page vaccination for over 65s and learning disability health checks) which are key to recovery from the Covid pandemic. 2. Introducing nursing associates (and trainee nursing associates) into the Additional Roles Reimbursement Scheme. This addition will provide further options for PCNs as part of the impetus to increase the primary care workforce. 3. Providing flexibility – by exception and with the agreement of CCGs – for the care homes clinical lead to be a non-GP. As communicated earlier in the year, the clinical lead may be another clinician with appropriate experience.

The 99% of practices already signed up to the DES (and their PCNs) will be auto-enrolled into the amended DES, but there will be a one month window to opt out of the DES if practices no longer wish to participate.

11 | Shingles vaccination programme for those who missed it during lockdown or were shielding

Individuals become eligible for routine vaccination against shingles when they become 70 years of age and for those in the catch-up cohort, as they become 78 or 79 years of age. All eligible individuals retain eligibility to receive the shingles vaccine until they become 80

Page 59 Page years of age. As lockdown and shielding measures are easing, this a reminder that the shingles vaccine can be offered opportunistically to the cohorts of individuals outlined above. Some individuals who were eligible for the shingles (catch-up) vaccination programme may have turned 80 years during the pandemic and missed the opportunity to be vaccinated. This cohort of individuals can still be offered shingles vaccine unless contraindicated, up to the 31 December 2020. This temporary offer applies only to those who were eligible and who missed shingles vaccination because of lockdown or shielding was recommended.

12 | Physician Associate (PA) supervision support programme for GPs

Health Education England has commissioned a Physician Associate (PA) recruitment and supervision support programme for any practices thinking of employing a PA for the first time. Page 60 Page It is available for a limited time, at no cost to your practice. Through the programme experts will support: • understanding the role, scope and benefits of employing a PA; • making sure your PA is seeing patients confidently, effectively, safely and efficiently; • understanding how services to patients can develop; • developing the PA role to benefit you in the long term. For more information please email [email protected]

13 | First Contact Practitioner workforce modelling tool

First Contact Practitioners (FCPs) provide increased capacity to general practice by offering patients with musculoskeletal (MSK) conditions direct access to advice, assessment and self-management options across the MSK pathway. FCPs also help reduce unwarranted variation in secondary care referrals and imaging requests. Page 61 Page The NHS Long Term Plan sets out a commitment to ensure all patients have direct access to FCPs by 2022/23. To deliver this ambition, and support systems with their mobilisation planning, the South, Central and West Commissioning Support Unit has developed a FCP workforce modelling tool. Primary care networks (PCNs) can use this tool to identify FCP workforce capacity at a system level, including potential gaps and areas of opportunity. For more information on FCPs or the workforce modelling tool, please contact [email protected].

14 | Presentation title Registering patients prior to their release from the secure residential estate

GP practices are asked to ensure that processes are in place to support registration of patients prior to their release from the secure residential estate.

Page 62 Page Further information on how to do this can be found via the link belowFurther information on how to do this can be found via the link below: https://www.england.nhs.uk/publication/process-for-registering-patients-prior-to- their-release-from-prison/

Plans are also progressing to enable patients to register with a GP in their place of detention in the same way as they register with a community GP. This will be rolled out next year in a phased approach across England.

15 | Video consultations – new resources

To support primary care in delivering video consultations, two new resources have been published. These are visual resources, intended to support patients and staff in the use of video technology when conducting appointments. Video consulting with your NHS is a quick step-by-step guide for patients which explains the benefits of a video consultation and provides practical guidance on how Page 63 Page to start, have and finish a video consultation. https://www.england.nhs.uk/coronavirus/wp- content/uploads/sites/52/2020/08/C0638-nhs-vc-patient-quick-guide-a4.pdf A similar quick step-by-step guide aimed at NHS staff is also available and covers practical tips on running a video consultation. https://www.england.nhs.uk/coronavirus/wp- content/uploads/sites/52/2020/08/C0638-nhs-vc-nhs-staff-quick-guide-a4.pdf

16 | General Practice Fellowship Programme and Supporting Mentors scheme launched Guidance and information on two schemes which were announced in the update to the GP Contract agreement 2020/21–2023/24 are now available, forming part of a suite of interlocking GP recruitment and retention initiatives.

The 64 Page General Practice Fellowship programme - https://www.england.nhs.uk/gp/the- best-place-to-work/gp-fellowship-programme/ - is a two year programme of support, available to all newly-qualified GPs and nurses working substantively in general practice, with a focus on working in a Primary Care Network (PCN). The programme supports nurses and GPs to take up substantive roles, understand the context they are working in and become embedded in the PCN. The Supporting Mentors Scheme - https://www.england.nhs.uk/gp/the-best-place-to- work/supporting-mentors-scheme/ - is designed to upskill experienced GPs and provide a portfolio working opportunity. The vision is for systems to develop and access a cohort of locally based and highly experienced doctors to support their own more junior doctors.

17 | Cervical Screening Administration Service

Following the successful Phase 1 transfer of the Cervical Screening Administration Service (CSAS) back to the NHS in August 2019, Phase 2 involves the allocation of a new telephone number, the staff relocation to NHS run buildings, and the move to working on NHS systems. Page 65 Page From 19 August 2020, the new telephone number for CSAS will be 0300 124 0248; the postal address will remain as PO Box 572, Darlington DL1 9AG. As part of this second phase, CSAS will also be deleting all old email addresses on 31 August 2020 which link to Capita / PCSE. The quickest and most efficient way of contacting CSAS is by completing an online form available via this link - https://www.csas.nhs.uk/contact-us/

18 | This page is intentionally left blank Agenda Item 7

PRIMARY CARE COMMITTEE

Title of Subject: Primary Care Risks on CCG Risk Register

Date of paper: 7 October 2020

Prepared By: Christopher Martin

History of paper: This is the first update on primary care risks on the CCG risk register since the COVID-19 global pandemic.

Executive Summary: This paper summarises the primary care risks on the CCG risk register and highlights the mitigations that have been out in place.

Recommendations For information, comment and noting the primary care risks on the required of the risk register, including the mitigations established to control these Committee (for risks and reduce them. Discussion and Decision): Principles addressed by Patient experience proposal (QIPP, national/regional policy etc):

Direct questions to: Christopher Martin

Page 67 1. INTRODUCTION

1.1 There are four primary care risks on the CCG risk register:

1.1.1 The risk of inadequate general practice provision; 1.1.2 That the Primary Care Workforce does not have the required capacity or capability to help to deliver the Tameside and Glossop locality plan; 1.1.3 The risk of potential harm to patients from having no central reporting of serious incidents within primary care and therefore not always sharing learning; 1.1.4 The risk of the discontinuation in April 21 of Priadel (a brand of lithium) by the manufacturers Essential Pharma.

1.2 This paper will briefly summarise these risks and the mitigations in place to lessen the risk.

2. INADEQUATE GENERAL PRACTICE PROVISION RISK

2.1 Primary care general practice is delivered, in Tameside and Glossop, by 37 individual contractor partnerships Each partnership may face a number of issues from the following areas; workforce issues and increased demand, financial and partnership stability, structural and procedural demands that place pressure on small organisations, estates issues that limit growth of services and income, and the CQC inspection regime that may result in practices losing their CQC registration resulting in their not being able to provide primary care general practice to patients.

2.2 The COVID-19 global pandemic is also be a huge contributor to the risk of inadequate general practice. This hasn’t proven to be the case so far as the mitigating factors put in place have enabled primary care to continue to function. These mitigations included general practice moving to a digital triage first model, re-evaluating how services are delivered, pandemic resilience teams being put in place, strengthening ties between and within Primary Care Networks, putting in place IT solutions to support primary care. This support has continued as we have moved in to the “living with covid” phase 3 and as we move into a period of increased infections. There has been a huge amount of learning taken from the initial phase that will help us should the situation develop to be similar to the initial phase.

2.3 Some of the pressures faced by general practice lie outside the control of the CCG – especially related to partnerships. However, there is support for practices to build resilience from the Greater Manchester GP Excellence programme which includes support for partnership development / relationships.

2.4 Where the risk of inadequate provision may relate to safety and quality issues, routine quality monitoring is in place to understand which practices may need support. This may be provided by the CCG or from the Greater Manchester GP Excellence programme. We have provided extensive support to all practices that have received poor CQC reports, which has been successful and will be replicated should it be needed again.

2.5 This risk has been updated to reflect the risks from the global pandemic.

2.6 Individual practice business continuity plans will play an important part in mitigating this risk. Prior to the global pandemic a gap in the robustness of practice business continuity plans was identified that was to be supported by additional training and guidance, including a

Page 68 workshop session. This session was postponed during the crisis management phase of COVID-19. However, the work undertaken by practices within Tameside and Glossop during the last six months and during the crisis management, while exceptional and requiring support and solutions to some extent outside existing business continuity plans, has shown the resilience of general practice and its willingness to adapt when circumstances require.

2.7 The learning taken from the response COVID-19 will be used as part of a revised business continuity session when it is reasonable to do so.

3. PRIMARY CARE WORKFORCE RISK

3.1 This articulates the risk that the existing Primary Care Workforce does not have the required capacity or capability to help to deliver the Tameside and Glossop locality plan. The mitigations around this risk have been to support the primary care workforce by expanding upon it and helping to make it more resilient. These include recruiting clinical pharmacists, care navigators and medical assistant roles into primary care, alongside additional practice nursing development in the form of including non-medical prescribing training and Multi- professional Support of Learning and Assessment in Practice (Mentorship) and the GM General Practice Nurse collaborative providing support for nursing workforce to ensure ongoing training and education is provided in an accessible way. There is also the development of the Tameside and Glossop Training Academy, which has been developed by the Primary Care Workforce, Training and Education Group in place (sub-group of Locality Workforce Transformation Group).

3.2 Peer support forums have been established for practice nurses, health care assistants, advanced clinical practitioners and pharmacists. These provide support and learning opportunities to these colleagues within general practice. Additional work has been undertaken to understand what further knowledge and skills are needed in primary care to support individual career progression, which further shows how valued the primary care workforce is and helps with retention. More detailed work is planned to be carried in conjunction with local population data analysis on determinants of health, to ensure staff are able to provide the specialist care required for their local population. There is also a group for GP’s that are in their first five years of general practice which provides education and peer support.

3.3 The above responses to this risk have been to mitigate it by forward planning. However, the need to respond to the COVID-19 pandemic has necessitated a more immediate response by rapidly implementing local and GM banks of clinical staff to support any potential clinical staff shortages caused by COVID-19 related absences and reducing the impact on delivery of primary care, alongside ensuing the provision of PPE for primary care providers.

3.4 A big challenge over the coming six months will be retention due to the challenges primary care faces in responding to COVID-19. As infection rates increase, despite all the learning that has already been gathered, primary care staff will be placed under increased pressure which may affect resilience. To mitigate this various activities are addressing especially around investing in staff, support and resilience which will be key through the next six months to support retention.

4. NO CENTRAL REPORTING OF SERIOUS INCIDENTS IN PRIMARY CARE RISK

4.1 The relationship between commissioner and contractor is defined and governed by the contract between the parties. Primary care medical services contracts do not include any requirements for practices to share incidents any wider than within the practice. This tends to deprive the rest of our practices from benefitting from that learning that could prevent future harm to patients.

Page 69

4.2 Discussions on how this can be mitigated have taken place in the past on the best way to address this. We have looked at encouraging practices to use the National Reporting and Learning System (NRLS) to report serious incidents in primary care and have considered scaling up the reporting of Special Patient Notes incidents to incidents wider than those related to Special Patient Notes. To be successful and encourage uptake this would need financial support in the form of a locally commissioned service or other investment circle. Ultimately, clinical guidance has been that hard levers such as this would not necessarily be helpful in sharing learning, so we explored human factors training as a way of reducing serious incidents taking place in the first place. This proved to be a prohibitively expensive approach both in terms of financially for the CCG and in terms of time for practices.

4.3 However, the lack of hard levers should not detract from the soft levers the CCG has at its disposal to encourage the sharing of learning. The most important soft lever at our disposal is to create a supportive environment for practices to convince them that the CCG is supportive on matters of learning and quality improvement, so that they feel confident in sharing incidents with us, knowing we will be supportive and take a collaborative, system wide approach to resolving the issue and putting in place any quality improvements to prevent things happening again in the future.

4.4 This approach informs our support to practices with poor CQC outcomes, responses to Regulation 28 prevention of future death reports, poor General Practice Patient Survey results, serious system wide incidents that cross primary care, secondary care, community health services and ambulance services. Taking this approach has encouraged our practices to be open with us, which is a major contributor to reducing patient harm.

5. DISCONTINUATION OF PRIADEL RISK

5.1 Priadel is a brand of lithium carbonate tablets that was withdrawn from sale by its producer from6 April 2021. Lithium carbonate is prescribed for patients with severe mental illness and as such these patients should be considered a vulnerable group. There are also no direct alternatives to switching patients as outlined in a recent DHSC letter. The letter advises prescribers to switch patients to one of the available brands at the nearest equivalent dose.

5.2 Lithium has a narrow therapeutic index meaning to avoid sub-therapeutic or toxic plasma levels effective monitoring and control of dose is required. In order to safely switch patients from Priadel to Camcolit, blood testing will be required approximately one week after a change in formulation. For some patients there will be a need for further dose adjustment and blood testing. Switching may be complicated for some patients by there being no combination of alternative tablets that would deliver the same dose.

5.3 Managing this switch will be complicated and time consuming. Clinic and lab time will need to be identified to cover the specialist review and additional monitoring required. Patient and HCP communications will be developed. Current discussions are aimed at clarifying what primary care and secondary care are each responsible for and how each will support the other to manage this process. Tameside and Glossop are providing GP input to help shape regional deliberations.

5.4 Despite these efforts and costs, there remains the likelihood of instability in a number of patients. This leaves a clinical risk of harm, loss of symptom control, admission to in patient care or in the worst case scenario, loss of life.

Page 70 5.5 Data was extracted from ePACT2 on 27th August has identified 207 Tameside and Glossop patients who will be impacted. These are unique patients identified by the system within the 3 months to June 2020

5.6 As well as the potential risk to patient’s health there will also be an ongoing financial pressure to Tameside and Glossop, calculated as £56 000 per annum. At GM level this is £600k per annum drugs budget pressure.

5.7 Due to the significant current capacity issues in both mental health services and general practice, GM is currently debating whether a GM commissioned service with dedicated psychiatrist oversight and hand on nursing and pharmacy staff is necessary to ensure support safe switching activity. This is likely to cost £250K. Additional phlebotomy and lab tests will be an additional £50K. Extrapolating these costs to national level equates to a non-recurrent cost of approximately £16 million and a recurrent £10 million impact across for England.

5.8 To mitigate this a GM response is being developed that will attempt to prevent the withdrawal of Priadel – including writing to the Secretary of State for Health and Social Care, recommending a Competition and Markets Authority review, while encouraging MPs to campaign against the manufacturers decision – while planning for its discontinuation by working with primary and secondary care colleagues to make the switch in brands as least harmful as possible for patients.

6. RECOMMENDATIONS

6.1 As set out at the front of the report.

Page 71 This page is intentionally left blank Agenda Item 8

PRIMARY CARE COMMITTEE

Title of Subject: QOF 20/21 Update and QOF 19/20 Achievement

Date of paper: 7 October 2020

Prepared By: Christopher Martin

History of paper: QOF 19/20 has been discussed previously at PCC in the context of payment approach.

Executive Summary: This paper summarises the recent 20/21 QOF changes and guidance and its focus on inequalities for those most at risk of adverse effects from COVID-19. It also highlights individual 18/19 QOF achievement and recommends an approach to using QOF data, amongst a range of other information to improve and reduce health inequalities in Tameside and Glossop, while recognising that with the changes to QOF and the need to support quality improvement in a COVID safe way, our response must necessarily be different. Recommendations For information, comment and noting the work programme required of the overseen by PCDIG and PCC. Committee (for Discussion and Decision): Principles addressed by Patient experience proposal (QIPP, national/regional policy etc):

Direct questions to: Christopher Martin

Page 73 1. INTRODUCTION

1.1 Changes to 20/21 QOF were published in September 2020. These detailed the changes to QOF for 20/21, which have been made to free up capacity within general practice for their response to COVID-19 recovery and to support reprioritisation of care not related to COVID- 19. 1.2 The aim is to direct practices to focus their efforts upon the identification and prioritisation of people at risk of poor health and those who suffer health inequalities for proactive review.

1.3 19/20 QOF achievement data was published in August 2020. BI have been analysing this data, which was available in September 2020. This paper highlights the key themes from that analysis and details the support to be provided to practices in the context of the changes to 20/21 QOF.

2. QOF 20/21 CHANGES

2.1 Total points for QOF 20/21 remain at 567. 310 points are income protected and will not be paid according to performance. 257 points are paid subject to practice performance.

2.2 Where areas of care are linked to practice performance some of the points have been increased to provide additional encouragement to practices to achieve. These are cervical smears, flu vaccinations for patients with coronary heart disease, COPD, stroke/TIA and diabetes, register indicators and eight indicators related to optimal prescribing of medications to manage long term conditions.

2.3 The cohort of patients practices are asked to focus on includes the following: 2.3.1 Those most vulnerable to harm from COVID-19; evidence suggests that this includes patients from BAME groups and those from the 20% most deprived neighbourhoods nationally 2.3.2 Those at risk of harm from poorly controlled long-term condition parameters. 2.3.3 Those with a history of missing annual reviews.

2.4 The Quality Improvement (QI) indicators retain the same areas – early cancer diagnosis and care of people with learning difficulties, though they have been refocussed with practices asked to achieve the following: 2.4.1 Early Diagnosis of Cancer  Be proactive - encourage patients with cancer symptoms to make contact  Monitor referral, including the quality of referrals  Self-assess referrals and pathways to find an improvement objective and improve it (via Plan Do Study Act - PDSA)  Self-assess systems for safety-netting and if needed improve it (via PDSA)  Share learning from QI work with PCN (minimum of two meetings)

2.4.2 Care of People with Learning Disability  Review and update register  Restore full annual LD health checks  Ensure LD patients have their flu jab  Assess what ‘reasonable adjustments’ are needed for person to access care, implement and record  Review any DNACPR instructions that have been applied to people with LD – confirm they are clinically appropriate and continue to be clinically indicated

Page 74  Share learning from QI work with PCN (minimum of two meetings)

2.5 To be eligible for income protection practice are asked to:

2.6 Agree a plan for QOF population stratification with the CCG by the time practices need to submit their eDEC. The plan should include the identification and prioritisation of the highest risk patients for proactive review including: 2.6.1 those most vulnerable to harm from COVID-19; evidence suggests that this includes patients from BAME groups and those from the 20% most deprived neighbourhoods nationally (LSOAs); 2.6.2 those at risk of harm from poorly controlled long-term condition parameters; 2.6.3 those with a history of missing reviews.

2.7 The aim of this plan is for practices to identify and focus proactive care delivery on patients identified as having a high risk from COVID-19 if infected.

2.8 Commit to making referrals to existing and any new weight management programmes and support offers commissioned during the year where this is identified as a key health and wellbeing intervention in these discussions.

2.9 The plan needs to be submitted via the annual eDEC, which will be published between October and November 2020. It needs to be shared with the CCG at the same time.

2.10 Work is being undertaken to support practices in the stratification of their populations to reduce the administrative burden.

3. QOF 19/20 ACHIEVEMENT

3.1 The final month of QOF 19.20 was affected by COVID0-19. This affected delivery and practice achievement. NHS England / Improvement guaranteed payment to practices, to support financial resilience, which stated: 3.1.1 If 19/20 points are higher than 18/19 points, payment will be at the higher number of points; 3.1.2 If 19/20 points are 30 or less than 18/19 points the payment will be pay protected at the 18/19 rate; 3.1.3 If 19/20 points are more than 30 below 18/19 points it will require local consideration.

3.2 Tameside and Glossop had three practices with 30 points lower than 18/19 which was discussed at Primary Care Committee in June 2020.

3.3 Appendix one contains the 19/20 achievement by points with a year on year comparison of 18/19 achievement versus 19/20 achievement.

3.4 The CCG average achievement dipped from 539.82 in 18/19 to 532.86 in 19/20. While this is disappointing it is perhaps reflective of March 2020 being the month the COVID-19 pandemic struck and the focus on managing that saw the suspension of the link between payment for QOF and the work carried out.

3.5 26 practices saw a year on year decrease. Again this is not surprising when considering the COVID-19 pandemic and is indicative that 19/20 is an exceptional year for QOF achievement and should be treated as such.

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3.6 Notwithstanding the reduction in the CCG’s average achievement, there were some welcome achievements. 11 practices saw year on year increases while Ashton Medical Group, Awburn House, Howard Medical Practice, St Andrews House, The Brooke Surgery and Waterloo Medical Centre saw double digit increases – some of which are significant.

3.7 Appendix two shows a heat map of achievement. Individual practice analysis based upon the outliers in the heat map has shown the CCG’s areas for quality improvement for the practices with a larger number of red markers on the lies mainly with COPD and diabetes. There is a level of commonality amongst these practices in terms of the indicators with lower than average achievement.

3.8 As detailed in the first section of this paper, guidance on 20/21 QOF has been received with many indicators income protected and those indicators where payment is protected having a focus on COVID-19 recovery or management. In the usual course of events, we would use QOF as the framework to support improvements. This is not going be possible for this financial year. However, a large contributing factor to adverse effects from COVID-19 arises from inequalities – whether of race, deprivation, education and those with long term conditions – and we can use QOF data, along with a range of other indicators to focus on managing COVID-19 but also addressing inequalities.

3.9 Primary Care Networks are currently identifying inequalities leads and we will work with these leads to help support their work to reduce inequalities, by referring to the full range of data available to us, including QOF and the population stratification data to support PCNs and practices to drive improvements aligned to the national request to help reduce the risks to those who become COVID-19 positive, while concurrently supporting Tameside and Glossop’s goal to reduce the health inequalities of its population.

4. RECOMMENDATIONS

4.1 As set out at the front of the report.

Page 76 APPENDIX ONE

Practice 18/19 19/20 Points Practice Code Points Points Difference

ALBION MEDICAL P89003 559 551.29 554.16 2.87 PRACTICE ASHTON GP Y02586 559 528.65 521.83 -6.82 SERVICE ASHTON P89008 559 500.89 556.54 55.65 MEDICAL GROUP P89004 AWBURN HOUSE 559 510.33 521.5 11.17 CLARENDON P89012 559 549.12 540.55 -8.57 MEDICAL CENTRE COTTAGE LANE C81615 559 554.8 554.12 -0.68 SURGERY DENTON P89018 MEDICAL 559 558.06 541.25 -16.81 PRACTICE DONNEYBROOK P89016 559 546.91 513.01 -33.9 MEDICAL CENTRE DROYLSDEN Y02663 MEDICAL 559 524.74 522.72 -2.02 PRACTICE DUCKINFIELD P89021 MEDICAL 559 559 545.72 -13.28 PRACTICE GORDON STREET P89011 559 487.99 436.96 -51.03 MEDICAL CENTRE GROSVENOR P89026 559 558.1 535.26 -22.84 MEDICAL CENTRE GUIDE BRIDGE Y02713 MEDICAL 559 534.63 541.98 7.35 PRACTICE HADFIELD C81660 559 556.47 540.58 -15.89 MEDICAL CENTRE HATTERSLEY P89013 559 533.54 505.83 -27.71 GROUP PRACTICE HAUGHTON P89014 THORNLEY 559 559 534.41 -24.59 MEDICAL CENTRE HOWARD STREET C81077 MEDICAL 559 541.57 554.25 12.68 PRACTICE P89020 HT PRACTICE 559 547.96 531.41 -16.55 KING STREET P89022 559 537.69 519.67 -18.02 MEDICAL CENTRE

Page 77 LAMBGATES C81106 559 559 555.61 -3.39 HEALTH CENTRE LOCKSIDE P89005 559 559 553.11 -5.89 MEDICAL CENTRE MANOR HOUSE C81081 559 558.65 539.27 -19.38 SURGERY MARKET STREET P89029 MEDICAL 559 559 471.51 -87.49 PRACTICE MEDLOCK VALE P89010 MEDICAL 559 545.95 529.11 -16.84 PRACTICE MILLBROOK Y02936 MEDICAL 559 542.72 538.43 -4.29 PRACTICE MILLGATE P89015 HEALTHCARE 559 557.23 555.59 -1.64 PARTNERSHIP MOSSLEY P89612 MEDICAL 559 540.54 524 -16.54 PRACTICE PIKE MEDICAL P89618 559 553 559 6 CENTRE SIMMONDLEY C81640 MEDICAL 559 559 547.94 -11.06 PRACTICE ST ANDREWS P89023 559 499.99 534.67 34.68 HOUSE STAMFORD P89609 559 558.67 548.15 -10.52 HOUSE STAVELEIGH P89007 559 557.84 558.66 0.82 MEDICAL CENTRE THE BROOKE P89002 559 515.42 550.74 35.32 SURGERY P89602 THE SMITHY 559 538.26 541.28 3.02 TOWN HALL P89025 559 519.24 503.52 -15.72 SURGERY WATERLOO P89613 559 473.21 523.12 49.91 MEDICAL CENTRE WEST END P89030 MEDICAL 559 535.99 510.46 -25.53 PRACTICE Average 539.82 532.86

Page 78 APPENDIX TWO

% Patients Receiving Intervention

Asthma

Cancer

Smoking

Dementia

Depression

Heart failure Heart

Hypertension

Mental health Mental

Blood pressure Blood

Atrial fibrillation Atrial

ischaemic attack ischaemic

Diabetes mellitus Diabetes

pulmonary disease pulmonary

primary prevention primary Cervical screening Cervical

Chronic obstructive obstructive Chronic

Rheumatoid arthritis Rheumatoid

Stroke and transient transient and Stroke

coronary heart disease heart coronary

Secondary prevention of of prevention Secondary

Cardiovascular disease – – disease Cardiovascular Ashton PCN 90.7% 81.3% 62.7% 85.6% 92.1% 89.3% 88.1% 73.0% 66.7% 73.7% 76.1% 27.7% 75.4% 71.8% 66.3% 52.0% 57.0% 78.8% 89.8% 71.3% 77.2% 63.3% 79.1% 62.8% 54.2% 81.4% 77.6% 87.3% 63.5% 79.4% 71.2% 74.8% 62.5% 78.2% 74.3% 83.4% 74.0% 92.1% 94.3% 96.4% 92.2% 72.3% 82.0% 92.1% 70.7% Albion Medical Practice 96.7% 77.8% 57.4% 83.6% 88.6% 90.5% 100.0% 75.0% 66.5% 71.9% 78.7% 19.5% 79.4% 71.7% 56.3% 42.0% 51.9% 81.6% 92.8% 79.5% 77.4% 71.9% 82.9% 70.7% 61.8% 72.4% 85.3% 88.2% 63.4% 75.2% 87.2% 80.8% 74.4% 22.7% 72.9% 84.0% 77.3% 92.4% 96.8% 95.8% 93.6% 79.7% 82.4% 93.3% 76.2% Ashton Gp Service 91.0% 94.1% 66.0% 92.9% 100.0% 93.8% 100.0% 100.0% 57.8% 73.1% 67.6% 59.1% 75.0% 78.8% 68.8% 50.6% 71.9% 75.0% 93.2% 64.4% 69.2% 67.3% 37.5% 62.4% 51.3% 100.0% 100.0% 88.9% 56.5% 88.9% 72.5% 82.5% 72.5% 100.0% 79.7% 90.0% 71.6% 89.2% 89.9% 98.6% 91.6% 84.2% 75.0% 90.0% 56.5% Ashton Medical Group 90.9% 77.0% 61.3% 87.3% 94.7% 88.7% 92.9% 66.7% 67.4% 74.1% 71.7% 7.7% 73.0% 69.8% 70.3% 61.7% 56.9% 80.1% 87.7% 67.0% 86.7% 62.9% 78.7% 62.4% 54.5% 81.1% 71.2% 84.7% 65.4% 82.8% 81.1% 63.8% 47.2% 92.0% 75.9% 85.9% 71.7% 95.5% 99.7% 99.0% 89.6% 72.5% 84.9% 94.8% 66.9% Gordon Street Medical Centre 81.0% 79.2% 62.8% 83.8% 88.9% 92.7% 37.5% 75.0% 62.7% 75.5% 75.5% 1.9% 58.7% 72.0% 33.3% 46.1% 28.6% 76.8% 87.7% 70.7% 80.0% 36.0% 100.0% 54.0% 53.3% 100.0% 77.8% 84.0% 56.8% 75.3% 19.4% 72.2% 44.4% 77.8% 69.7% 80.0% 74.7% 93.8% 93.6% 98.3% 92.9% 64.0% 78.6% 97.6% 78.1% Ht Practice 84.8% 79.3% 67.3% 78.8% 97.4% 85.8% 94.4% 50.0% 65.8% 70.9% 81.0% 59.1% 83.9% 62.2% 87.3% 45.5% 91.3% 79.2% 88.4% 65.1% 69.2% 74.6% 66.7% 54.1% 48.8% 100.0% 60.0% 87.5% 56.9% 71.0% 77.6% 82.1% 76.1% 95.4% 69.6% 72.9% 65.1% 87.0% 99.4% 96.3% 94.4% 59.6% 75.0% 90.3% 63.3% Stamford House 95.8% 83.3% 60.1% 78.9% 91.3% 90.6% 93.3% 100.0% 73.3% 78.9% 84.3% 47.4% 78.5% 80.4% 55.6% 51.7% 44.4% 79.1% 94.3% 79.3% 78.8% 74.9% 100.0% 63.6% 63.0% 100.0% 100.0% 87.0% 60.7% 80.6% 48.9% 85.1% 66.0% 83.3% 69.6% 76.0% 79.6% 88.3% 99.3% 98.4% 95.1% 75.5% 85.7% 82.1% 84.1% Waterloo Medical Centre 83.0% 92.9% 64.4% 85.3% 66.7% 91.2% 100.0% 66.7% 68.9% 77.9% 54.3% 5.3% 72.6% 75.8% 83.3% 50.4% 48.5% 95.0% 98.4% 77.7% 100.0% 58.5% 83.0% 70.7% 56.4% 83.3% 100.0% 90.9% 73.7% 88.7% 69.2% 84.6% 76.9% 95.0% 89.7% 95.7% 83.2% 91.1% 80.6% 96.8% 93.0% 72.0% 77.8% 100.0% 76.5% West End Medical Centre 99.1% 86.7% 73.3% 98.5% 92.9% 87.3% 92.3% 0.0% 71.8% 72.0% 85.0% 32.7% 78.2% 84.5% 70.6% 63.6% 37.5% 64.5% 86.4% 77.1% 71.1% 48.6% 100.0% 73.0% 40.9% 60.0% 100.0% 100.0% 74.0% 85.9% 70.3% 64.9% 62.2% 91.3% 76.1% 92.9% 82.0% 90.2% 65.6% 82.7% 93.2% 76.4% 81.8% 73.0% 74.2% Denton PCN 92.6% 76.0% 62.6% 89.7% 92.5% 90.4% 87.4% 80.0% 75.8% 76.8% 78.8% 28.9% 79.7% 79.8% 65.2% 63.2% 52.8% 74.5% 85.4% 74.9% 75.6% 72.9% 85.5% 72.4% 58.7% 83.5% 83.1% 87.3% 69.2% 83.4% 81.2% 84.8% 77.9% 80.3% 78.6% 85.2% 79.6% 92.6% 89.7% 96.9% 93.8% 76.1% 88.5% 91.8% 74.8% Denton Medical Practice 90.4% 77.1% 71.4% 91.9% 79.4% 93.2% 87.5% 100.0% 73.0% 73.0% 81.5% 34.1% 72.2% 78.0% 67.5% 54.8% 68.2% 82.1% 89.9% 78.2% 76.3% 75.6% 94.1% 73.6% 65.7% 88.9% 78.3% 85.9% 69.3% 87.8% 70.9% 90.9% 83.6% 85.1% 79.8% 88.9% 79.2% 94.7% 92.4% 96.8% 95.3% 74.8% 93.1% 93.4% 76.3% Droylsden Medical Practice 100.0% 86.4% 70.3% 94.3% 100.0% 95.3% 100.0% 100.0% 79.4% 83.0% 84.6% 8.3% 82.9% 86.7% 70.8% 82.4% 57.1% 66.3% 93.2% 68.2% 78.9% 75.4% 92.3% 46.5% 48.8% 66.7% 85.7% 90.5% 58.3% 81.3% 85.7% 85.7% 100.0% 76.5% 78.7% 81.0% 82.3% 88.5% 90.8% 98.6% 95.1% 67.3% 86.7% 90.2% 71.9% Guide Bridge Medical Practice 94.9% 92.3% 61.4% 81.4% 100.0% 93.6% 100.0% 100.0% 80.4% 83.6% 85.9% 39.3% 83.8% 73.7% 91.3% 68.0% 66.7% 82.4% 87.8% 73.0% 83.9% 75.0% 93.9% 57.9% 58.4% 100.0% 71.4% 96.2% 66.9% 89.5% 82.5% 92.5% 67.5% 90.0% 81.2% 90.9% 74.8% 94.3% 90.9% 97.6% 93.1% 79.5% 100.0% 92.3% 66.7% Market Street Medical Practice 91.6% 72.7% 62.8% 89.1% 94.6% 89.6% 60.0% 66.7% 73.2% 79.5% 75.0% 25.0% 81.5% 80.5% 36.2% 47.3% 55.6% 66.1% 83.8% 74.9% 69.2% 61.0% 80.6% 70.7% 55.3% 81.8% 100.0% 86.1% 54.4% 79.8% 52.7% 72.7% 56.4% 35.7% 68.2% 80.0% 80.8% 90.0% 95.6% 98.4% 90.5% 64.9% 82.9% 86.8% 75.0% Page 79 Page Medlock Vale Medical Practice 90.4% 88.0% 66.8% 87.8% 93.9% 86.7% 97.4% 80.0% 72.3% 72.1% 84.6% 32.4% 86.4% 77.9% 73.0% 58.3% 80.0% 71.9% 87.9% 72.3% 79.7% 42.0% 82.9% 62.9% 46.2% 85.0% 87.0% 86.8% 65.7% 76.9% 88.7% 82.3% 75.8% 95.3% 75.0% 83.7% 73.9% 94.4% 90.6% 99.4% 92.1% 74.2% 88.7% 96.4% 72.0% Millgate Healthcare Partnership 92.3% 65.2% 55.8% 90.2% 95.3% 90.1% 83.0% 69.2% 76.7% 77.4% 74.3% 29.8% 78.3% 80.9% 66.7% 67.7% 37.3% 73.9% 82.1% 75.9% 71.3% 87.6% 89.6% 79.5% 60.8% 81.7% 83.2% 86.9% 78.1% 85.1% 93.0% 86.0% 85.3% 88.8% 81.3% 85.5% 81.8% 92.1% 85.9% 95.2% 94.8% 79.5% 87.2% 90.8% 76.5% Glossop PCN 94.3% 78.4% 73.5% 86.3% 95.5% 90.7% 95.6% 73.9% 81.3% 80.3% 84.2% 39.7% 79.4% 83.7% 81.3% 68.1% 63.3% 70.3% 83.5% 80.3% 82.1% 76.8% 92.3% 74.6% 62.3% 81.0% 81.8% 94.3% 66.4% 84.3% 82.1% 88.8% 81.7% 83.7% 81.0% 88.4% 83.3% 92.7% 94.4% 98.1% 95.3% 76.6% 86.4% 91.1% 81.4% Cottage Lane Surgery 83.9% 100.0% 81.7% 86.4% 100.0% 94.2% 100.0% 100.0% 78.8% 82.6% 79.6% 59.3% 93.7% 92.8% 96.8% 75.6% 83.3% 80.6% 92.0% 90.4% 75.0% 83.8% 95.6% 73.6% 51.6% 100.0% 100.0% 94.4% 79.6% 94.0% 91.3% 91.3% 87.0% 92.3% 90.5% 92.9% 92.0% 97.7% 90.3% 97.9% 96.2% 85.3% 86.7% 100.0% 85.7% Hadfield Medical Centre 96.9% 63.6% 81.3% 92.6% 96.3% 88.9% 100.0% 100.0% 83.9% 78.8% 90.5% 8.6% 77.2% 83.2% 85.0% 78.3% 42.9% 67.4% 87.3% 82.0% 71.4% 64.5% 92.9% 72.2% 63.9% 100.0% 94.1% 94.7% 58.3% 86.1% 83.3% 88.9% 88.9% 77.8% 84.3% 91.2% 83.1% 91.5% 89.1% 99.2% 95.3% 75.3% 96.8% 80.7% 82.7% Howard Street Medical Practice 95.2% 100.0% 78.7% 83.1% 95.8% 90.9% 95.5% 50.0% 81.0% 80.2% 65.5% 76.3% 89.2% 87.1% 84.8% 57.3% 85.7% 78.7% 84.9% 81.6% 100.0% 83.2% 90.9% 80.6% 62.9% 83.3% 75.0% 100.0% 72.3% 92.4% 77.8% 88.9% 88.9% 96.2% 85.0% 97.6% 85.1% 93.6% 93.2% 98.7% 98.0% 93.5% 92.6% 96.3% 72.6% Lambgates Health Centre 93.7% 77.4% 77.7% 83.1% 97.8% 93.7% 100.0% 100.0% 80.1% 80.3% 87.1% 30.0% 87.6% 82.1% 87.7% 68.3% 79.4% 76.4% 87.4% 78.2% 88.0% 91.1% 92.7% 69.8% 60.9% 88.9% 90.0% 92.9% 73.6% 90.7% 78.8% 94.2% 88.5% 82.5% 82.5% 93.2% 83.4% 93.7% 96.2% 97.1% 97.0% 76.3% 97.1% 90.0% 82.0% Manor House Surgery 95.8% 75.7% 67.0% 85.5% 92.4% 89.2% 91.4% 63.6% 80.0% 77.9% 86.2% 24.5% 68.9% 81.2% 71.9% 68.8% 41.2% 67.2% 78.7% 78.0% 80.6% 67.7% 86.7% 74.2% 62.9% 75.4% 78.4% 94.5% 58.9% 77.2% 82.1% 87.4% 74.7% 79.8% 75.3% 85.0% 80.9% 91.9% 97.4% 99.2% 93.3% 72.1% 81.3% 90.3% 81.2% Simmondley Medical Practice 96.7% 90.9% 73.4% 92.5% 100.0% 91.2% 100.0% 0.0% 88.0% 89.8% 80.7% 23.1% 90.7% 86.7% 90.0% 68.0% 20.0% 63.9% 85.7% 82.7% 75.0% 86.2% 85.7% 80.4% 65.1% 100.0% 100.0% 86.7% 73.5% 89.2% 81.3% 75.0% 68.8% 87.0% 85.3% 78.6% 85.4% 90.2% 90.3% 93.2% 96.5% 86.1% 81.0% 97.1% 86.0% Hyde PCN 94.0% 74.0% 67.1% 86.6% 96.6% 90.6% 91.3% 67.4% 74.0% 75.6% 79.8% 33.5% 74.1% 75.2% 73.0% 65.6% 71.5% 75.2% 86.2% 71.2% 85.5% 74.6% 83.0% 68.9% 56.2% 84.5% 80.7% 87.9% 63.8% 83.7% 79.2% 80.8% 69.9% 79.6% 77.2% 88.3% 75.0% 89.8% 91.8% 96.7% 94.2% 73.1% 87.5% 91.0% 70.8% Awburn House Medical Practice 94.7% 83.3% 60.1% 88.2% 97.9% 93.0% 82.0% 100.0% 83.4% 81.6% 89.9% 27.5% 55.9% 81.8% 73.5% 47.1% 97.3% 71.0% 81.3% 76.6% 83.3% 86.1% 75.5% 86.6% 49.5% 100.0% 80.0% 86.3% 72.2% 93.4% 77.3% 93.2% 77.3% 87.3% 74.7% 86.8% 75.4% 83.9% 96.3% 91.7% 93.3% 77.7% 97.8% 86.9% 73.4% Clarendon Medical Centre 94.4% 72.1% 65.5% 84.6% 93.6% 91.5% 91.9% 75.0% 71.2% 70.3% 79.3% 5.3% 78.0% 72.6% 66.3% 49.6% 87.5% 71.3% 84.9% 70.1% 90.0% 77.1% 100.0% 68.2% 56.6% 87.2% 85.5% 89.0% 63.0% 80.8% 87.9% 90.9% 72.7% 86.4% 76.4% 85.7% 70.6% 91.9% 99.7% 100.0% 94.2% 71.3% 87.5% 85.2% 65.7% Donneybrook Medical Centre 94.9% 64.4% 61.7% 81.1% 95.4% 87.4% 89.4% 16.7% 69.6% 70.5% 81.2% 22.1% 65.5% 72.5% 75.3% 71.2% 84.0% 82.6% 89.8% 72.5% 88.5% 64.9% 90.5% 62.8% 62.9% 82.5% 74.1% 81.6% 55.6% 78.1% 66.3% 78.9% 55.8% 75.9% 71.7% 88.5% 78.2% 85.0% 79.3% 92.8% 92.9% 71.0% 81.8% 88.8% 68.5% Dukinfield Medical Practice 90.9% 80.7% 65.3% 91.1% 91.5% 91.6% 95.2% 60.0% 76.7% 79.5% 80.3% 51.4% 72.5% 81.0% 80.6% 65.5% 89.5% 74.7% 83.5% 75.8% 64.4% 82.0% 95.3% 73.1% 58.9% 87.0% 71.9% 88.9% 66.7% 85.1% 79.4% 82.5% 74.6% 90.2% 75.6% 88.7% 77.7% 90.9% 98.5% 98.1% 94.8% 74.7% 84.9% 94.3% 75.3% Hattersley Group Practice 98.5% 85.0% 70.4% 85.1% 97.4% 88.2% 91.7% 50.0% 70.6% 69.1% 71.9% 41.1% 87.0% 76.0% 45.7% 69.0% 38.9% 76.4% 89.8% 71.5% 85.4% 71.3% 80.5% 52.3% 57.4% 72.7% 100.0% 85.2% 58.5% 78.8% 62.0% 68.0% 74.0% 70.3% 70.7% 93.6% 77.5% 96.1% 90.2% 96.6% 90.1% 65.9% 83.9% 95.4% 69.8% Haughton/Thornley Medical Centres 95.8% 69.1% 66.0% 88.5% 100.0% 92.4% 93.5% 85.7% 74.6% 78.3% 85.6% 62.7% 81.9% 72.1% 70.7% 73.0% 75.0% 72.0% 85.0% 64.0% 89.9% 71.3% 79.6% 72.7% 42.7% 86.7% 88.2% 89.0% 61.7% 82.7% 82.2% 70.3% 62.7% 68.3% 78.9% 88.8% 69.9% 94.2% 90.5% 98.0% 96.3% 77.4% 89.0% 96.2% 64.1% The Brooke Surgery 91.4% 69.0% 75.5% 87.9% 94.8% 90.9% 96.2% 75.0% 72.1% 76.9% 67.4% 24.4% 68.5% 71.3% 77.5% 71.9% 34.3% 74.3% 84.9% 70.3% 68.0% 77.3% 88.4% 69.7% 55.5% 88.4% 82.7% 87.1% 69.0% 86.6% 87.2% 84.9% 80.2% 80.3% 86.2% 89.8% 72.2% 88.1% 91.7% 97.1% 95.3% 73.4% 92.5% 89.5% 73.9% The Smithy Surgery 92.4% 100.0% 73.2% 82.1% 100.0% 86.8% 91.7% 75.0% 75.2% 71.1% 82.8% 40.0% 87.6% 83.8% 76.0% 61.8% 52.4% 69.4% 93.9% 77.1% 85.7% 75.8% 79.5% 65.1% 66.1% 54.5% 68.8% 97.1% 63.2% 86.7% 94.1% 82.4% 82.4% 79.2% 82.1% 85.4% 86.7% 90.3% 90.5% 97.8% 93.4% 67.1% 72.0% 89.6% 80.6% Stalybridge PCN 95.1% 85.7% 72.2% 86.0% 93.2% 91.8% 95.7% 75.0% 77.0% 78.4% 82.3% 41.2% 82.6% 79.9% 78.6% 73.5% 69.4% 75.3% 86.8% 78.2% 77.4% 77.4% 88.7% 72.5% 57.6% 81.6% 80.6% 94.7% 70.6% 84.7% 81.9% 86.5% 81.6% 85.6% 82.2% 86.8% 81.6% 93.1% 89.3% 97.0% 96.9% 79.4% 86.5% 93.2% 80.0% Grosvenor Medical Centre 99.6% 68.8% 75.4% 85.1% 97.5% 91.9% 96.7% 100.0% 78.3% 78.4% 77.2% 31.7% 75.9% 80.6% 68.1% 67.9% 25.0% 71.2% 84.4% 73.3% 76.9% 72.8% 75.0% 76.7% 58.3% 75.8% 82.5% 97.1% 74.7% 82.5% 70.8% 87.5% 79.2% 58.0% 82.9% 81.8% 77.5% 92.9% 87.0% 96.4% 97.2% 73.5% 96.0% 94.7% 70.7% King Street Medical Centre 83.1% 100.0% 68.7% 84.8% 66.7% 90.2% 100.0% 100.0% 69.8% 74.9% 78.6% 38.5% 89.3% 58.3% 100.0% 61.9% 90.0% 54.5% 88.7% 56.3% 75.0% 71.0% 100.0% 53.1% 46.9% 100.0% 75.0% 100.0% 46.2% 68.8% 95.8% 87.5% 87.5% 96.3% 61.6% 76.5% 59.4% 96.2% 93.5% 97.8% 97.1% 66.7% 75.0% 94.4% 54.7% Lockside Medical Centre 96.8% 76.7% 73.2% 91.5% 100.0% 91.3% 94.4% 75.0% 79.4% 80.4% 81.5% 66.7% 76.4% 84.9% 76.1% 85.5% 88.9% 87.3% 89.9% 84.5% 88.5% 80.8% 89.2% 75.6% 57.9% 76.5% 94.4% 93.0% 76.6% 90.0% 88.4% 81.4% 72.1% 92.1% 85.8% 88.1% 86.7% 94.7% 97.4% 99.0% 98.7% 90.5% 92.7% 95.0% 88.4% Millbrook Medical Practice 92.0% 92.9% 65.1% 81.8% 93.8% 96.6% 100.0% 100.0% 79.6% 82.3% 88.1% 62.5% 67.3% 69.2% 65.0% 75.8% 85.7% 70.0% 86.2% 73.9% 63.6% 66.4% 81.8% 66.7% 48.0% 100.0% 33.3% 91.7% 68.8% 88.6% 79.2% 70.8% 83.3% 90.9% 82.9% 93.3% 84.0% 94.0% 96.0% 96.0% 95.3% 77.8% 62.5% 91.7% 74.3% Mossley Medical Practice 87.9% 100.0% 73.2% 67.7% 100.0% 91.6% 50.0% 100.0% 80.3% 83.5% 75.8% 42.1% 81.0% 91.4% 50.0% 76.9% 71.4% 72.3% 83.3% 87.4% 75.0% 62.2% 95.0% 60.6% 59.6% 100.0% 50.0% 92.9% 64.5% 77.5% 92.3% 76.9% 100.0% 82.4% 75.0% 92.3% 86.8% 92.5% 96.7% 98.9% 96.7% 77.8% 100.0% 90.9% 77.1% Pike Medical Practice 93.9% 83.3% 77.2% 80.0% 100.0% 95.4% 100.0% 100.0% 84.2% 80.5% 84.2% 68.8% 89.7% 82.8% 100.0% 71.0% 77.8% 86.0% 87.5% 82.3% 93.8% 86.9% 87.8% 87.6% 62.9% 100.0% 88.9% 89.5% 83.5% 97.4% 95.2% 100.0% 100.0% 100.0% 96.4% 100.0% 87.1% 90.0% 98.6% 100.0% 99.5% 94.1% 100.0% 100.0% 86.4% St. Andrew's House Surgery 93.7% 86.4% 72.4% 80.8% 88.5% 91.4% 95.0% 100.0% 73.1% 76.4% 92.6% 5.3% 91.1% 80.0% 70.4% 73.8% 71.4% 71.5% 85.4% 82.2% 90.9% 85.5% 100.0% 74.0% 60.6% 100.0% 100.0% 96.4% 61.2% 87.0% 80.0% 87.5% 72.5% 90.5% 83.5% 89.1% 85.1% 91.9% 77.5% 93.7% 96.4% 72.4% 79.2% 87.0% 82.2% Staveleigh Medical Centre 97.8% 100.0% 73.2% 90.0% 88.3% 91.1% 100.0% 57.1% 77.1% 77.6% 83.5% 45.9% 90.1% 81.3% 89.1% 56.3% 83.0% 83.9% 89.1% 81.9% 73.9% 90.8% 86.7% 78.1% 63.5% 86.7% 71.4% 91.5% 77.6% 88.8% 90.5% 92.9% 88.1% 91.5% 85.7% 89.0% 85.9% 92.2% 89.8% 98.7% 95.3% 80.9% 95.3% 96.7% 89.1% Town Hall Surgery 92.9% 76.9% 64.1% 93.5% 93.8% 90.5% 100.0% 66.7% 71.3% 74.5% 68.5% 15.9% 77.4% 80.6% 79.4% 76.6% 88.2% 73.4% 81.4% 81.7% 50.0% 55.9% 66.7% 68.4% 54.1% 50.0% 80.0% 95.0% 67.0% 75.2% 55.6% 88.9% 74.1% 93.5% 80.0% 84.2% 81.3% 92.7% 68.6% 92.8% 96.0% 83.9% 69.6% 83.9% 79.6% Grand Total 93.3% 78.1% 67.1% 87.0% 94.2% 90.5% 91.4% 73.3% 74.1% 76.6% 79.8% 32.9% 77.5% 77.3% 72.2% 63.1% 63.0% 75.6% 86.6% 74.0% 80.1% 72.1% 84.4% 69.2% 57.0% 82.7% 81.1% 89.8% 66.3% 83.0% 78.5% 82.0% 72.9% 81.0% 78.1% 86.4% 77.9% 91.8% 91.9% 96.9% 94.3% 75.1% 86.4% 91.7% 74.7%

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PRIMARY CARE COMMITTEE

Title of Subject: Provision of Personal Protective Equipment in General Practice

Date of paper: 7 October 2020

Prepared By: Martin Ashton, Associate Director of Commissioning – Living Well

History of paper: First Paper

Executive Summary: The purpose of this paper is to:

 Update on the current position in relation to PPE in General Practice  Provide options for consideration by the committee on the approach in relation to the provision of COVID-19 PPE to General Practice.

Recommendations PCC is asked to: required of the Committee (for  Note the contents of this report. Discussion and  Note the benefits and challenges associated with each Decision): option.  Support the proposal for General Practice to manage the ordering of COVID-19 PPE with additional emergency resilience provided by T&G Strategic Commission.

Principles addressed by National strategy: proposal (QIPP, national/regional policy  To support delivery of Health and Social Care services to etc): during the COVID-19 pandemic

Local strategies:

 To maintain service provision in line with the Total Triage Blueprint.

Direct questions to: Martin Ashton – [email protected]

Page 81 1. BACKGROUND

1.1 In response to the current pandemic Public Health England (PHE) issued recommendations around Personal Protective Equipment (PPE) for all health and social care services. The CCG has worked with all Providers to ensure that they have access to the recommended PPE in order that services can be delivered safely and effectively.

2. LOCAL RESPONSE

2.1 In response to COVID-19 and following requests from General Practice for support to enable the continuation of services, the CCG offered to manage the process of monitoring, purchasing and distribution of PPE for Tameside and Glossop CCG practices from a central point. It was agreed that the additional PPE requirements in General Practice would be supported by additional COVID-19 funding provided to the CCG as long as it met PHE guidance. Practice demand for PPE is managed through the daily reporting by practices to the GM Primary Care SITREP; during the pandemic this reporting requirement has replaced the daily reporting requirement of the Access Locally Commissioned Services bundle.

2.2 To provide the necessary support to General Practices, team members from the CCG commissioning directorate alongside a CCG appointed PPE GP Clinical Lead developed a streamlined PPE administration process. This included working with TMBC colleagues to support centralised ordering and local VCSE agencies to support the distribution of stock to practices via volunteers.

2.3 To ensure that the CCG moved to a more proactive process for ordering of PPE, General Practices were asked to perform an exercise to calculate an average consumption rate of PPE use across the locality in the form of a one-off exercise utilising a ‘Burn Rate Calculator’. Unfortunately the level of engagement with the exercise was not significant enough to make estimates on required stock levels and impacted upon the ability of the CCG to proactively order PPE and increase local resilience.

2.4 Other commissioned services were contacted by the CCG team to understand their position in relation to PPE requirements. Following this exercise it was found that the Providers were managing their own PPE ordering and funding processes and the CCG has not routinely ordered PPE for any Providers other than General Practice.

3. NATIONAL PPE PORTAL (DEPARTMENT OF HEALTH & SOCIAL CARE)

3.1 Eligible health and social care providers can order PPE through the national portal to meet the increased need that has arisen as a result of the COVID-19 pandemic. The portal can be used by: . GPs . Residential social care providers . Domiciliary social care providers . Pharmacies . Dentists . Orthodontists . Optometrists . Children’s care homes and secure homes . Children’s residential special schools

3.2 General Practice can use the portal to meet the extra need for PPE that has arisen as a direct result of the COVID-19 pandemic. It should not be used to order PPE for non-COVID-19 requirements; though practice feedback is that non-COVID-19 PPE utilisation is minimal.

Page 82 Every practice can order directly using the portal and the PPE is delivered directly to the practice, this eliminates the need for central receipt and distribution by the CCG.

3.3 The national PPE portal is centrally funded and initially provided limited access to PPE which was required to be topped-up by the CCG. Following an announcement on 24 September 2020 the Department of Health and Social Care confirmed that ordering limits were increasing and that COVID-19 PPE would be free of charge via the portal until 31 March 2021. This includes Type II masks, type IIT masks, aprons, gloves, hand hygiene and visors.

4. FINANCIAL CONSIDERATIONS

4.1 NHSE established a COVID-19 investment fund utilising ‘command and control’ processes in March 2020. This enabled practices to submit claims for reimbursement for additional COVID-19 related expenses which included expenses for PPE. A national letter in relation to COVID-19 funding support for general practice, dated 4 August, indicates practices may claim for COVID-19 related expenses, pay and non-pay, for the period to 31 July. In September, PCC agreed to fund COVID-19 support costs until the end of September, bringing this in line with other providers.

4.2 CCG Primary Care PPE spend from March to July was circa £7,000 per month. Since the introduction of the national PPE Portal this has reduced demand to between £4,000- £5,000 per month. If COVID-19 funding to CCGs is not extended this creates a significant avoidable cost pressure to the CCG if this model is maintained.

4.3 The national PPE portal is centrally funded, if each practice could place a weekly order this would significantly reduce the cost pressure on the CCG. The CCG could continue to top-up via the local SITREP if additional PPE is required.

5. OPTIONS AVAILABLE TO THE CCG

5.1 The Strategic Commission recognises the challenges that ordering, delivering and funding provides to General Practice, wider Providers, the CCG and the Local Authority. The CCG is in a position where the level of support to General Practice to manage this process from a financial or operational perspective is difficult to sustain at the current level.

5.2 Any PPE provision by the CCG is to support core GMS activity only; practices who provide independent services will need to procure additional PPE for this activity as appropriate.

5.3 The following three options have been considered:

Option 1: The CCG will continue to fund and support the process for provision of PPE in General Practice.

Benefits Efficient ordering process x 1 per week Avoidable monthly cost of c.£7k, for which there is no available budget.

Challenges Weekly order must be received by a CCG staff member diverted from another role. Weekly order must be sorted into 37 packages. 37 deliveries required from central point of receipt.

Option 2: The CCG will continue to fund and support the process until the end of September 2020. Following this practices will be asked to order via the national PPE portal and manage

Page 83 all PPE requirements. The strategic commission could order PPE only in extreme servcies to provide resilience.

Funded centrally, no cost to T&G CCG or General Practice. Benefits Direct delivery to practices. No central sorting required. 37 separate orders required (opportunity to work together Challenges across a PCN)

5.4 It is proposed that Option 2 is the most efficient and effective PPE administration process that reduces avoidable cost and administration procedures.

6. RISKS

6.1 As the pandemic progresses the national and regional policy and PPE guidelines are constantly evolving. This paper recognises the current situation which is subject to change.

7. RECOMMENDATIONS

7.1 As set out at the front of the report.

Page 84 Agenda Item 10B

PRIMARY CARE COMMITTEE

Title of Subject: Primary Medical Care Commissioning and Contracting: Primary Care Finance Report 2020/21 Date of paper: 7th October 2020

Prepared By: Liz Sabel

History of paper: Third internal audit for Primary Medical Care commissioning and contracting. This audit reviewed Primary Care Finance functions.

Executive Summary: The Primary Care Internal Audit, Primary Medical Care Commissioning and Contracting: Internal Audit Framework for delegated Clinical Commissioning Groups, was presented to Primary Care Committee in October 2018. The paper provides Primary Care Committee with the final report, prepared by Mersey Internal Audit Agency, on the third audit under the programme.

The report gives an overall assurance rating of Full Assurance with no recommendations for CCG action.

Recommendations Primary Care Committee is asked to accept the report provided required of the Committee (for Discussion and Decision): Principles addressed by proposal (QIPP, national/regional policy etc): Direct questions to: Liz Sabel [email protected]

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Primary Medical Care Commissioning: Primary Care Finance DRAFT Report 2020/21

Page 87 Page NHS Tameside and Glossop Clinical Commissioning Group

QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

Contents

1. Introduction and Background

2. Objective

3. Executive Summary Page 88 Page 4. Findings, Recommendations and Action Plan

Appendix A: Terms of Reference Appendix B: Assurance Definitions and Risk Classifications Appendix C: Report Distribution

P a g e | 1 QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

1. Introduction and Background NHS England (NHSE) became responsible for the direct commissioning of primary medical care services on 1 April 2013. Since then, following changes set out in the NHS Five Year Forward View, primary care co-commissioning has seen the Clinical Commissioning Groups (CCGs) invited to take on greater responsibility for general practice commissioning, including full responsibility under delegated commissioning arrangements. From 1st April 2019, 96% of CCGs have fully delegated commissioning arrangements. From 2018/19 there was a requirement by NHSE that there should be an internal audit of delegated CCGs’ primary medical care commissioning arrangements. The purpose of this was to provide information to CCGs that they are discharging NHSE’s statutory primary medical care functions effectively, and in turn to provide aggregate assurance to NHSE and facilitate NHSE’s engagement with CCGs to support improvement. In order to support this, the Primary Medical Care Commissioning and Contracting Internal Audit Framework for Delegated CCGs was issued in August 2018. This was to be delivered as a 3-4 year programme of work and was to focus on the following areas: Page 89 Page  Commissioning and procurement of services  Contract Oversight and Management Functions  Primary Care Finance  Governance (common to each of the above areas) For 2020, the review of Primary Care Finance has been undertaken. The remaining review of commissioning and procurement of services will be incorporated into the planning cycle for the internal audit plan.

2. Objective The overall objective was to evaluate the effectiveness of the arrangements put in place by the CCG to exercise the primary care medical care commissioning function (Primary Care Finance) of NHS England as set out in the Delegation Agreement.

P a g e | 2 QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

3. Executive Summary The controls in place adequately address the risks to the successful achievement of objectives and the controls tested are operating effectively. The overall assurance rating is provided as per the NHSE guidance. A comparison of NHSE and MIAA assurance ratings is at Appendix B.

Full Assurance

Overall the review identified that the arrangements in place in relation to the financial management of delegated funds were effective. The following provides a summary of the key themes.

Elements Key Themes Page 90 Page Overall management and reporting of delegated funds The memorandum of understanding in place with Greater Manchester Health – processes for forecasting, monitoring and reporting and Social Care Partnership (GMH&SCP) had started to be reviewed in February 2020 however this was paused due to the ongoing COVID-19 pandemic. The 2019/20 arrangements have been rolled forward with the intention to include this on the next Delegated Management Oversight Group agenda. Roles and responsibilities are clearly defined within the Task and Function List and include forecasting, approving, monitoring and reporting arrangements. Decisions around delegated funds are transparently managed by the Primary Care Committee (PCC) in accordance with NHSE Statutory Duties. A position report is presented to the PCC monthly.

Financial controls and processes for approving The CCG has arrangements in place to ensure that roles to authorise and payments to practice; and submit payments are correctly allocated and are aligned with the processes outlined by GMH&SCP. Our review of a sample of payments (including Processes to approve and decisions regarding discretionary payments) confirmed that these had been appropriately ‘discretionary’ payments (e.g. Section 96 funding authorised in line with the scheme of delegation. arrangements, Local Incentive Schemes) Decisions in relation to the Directed Enhanced Services and Quality Outcomes Framework (QOF), including the validation processes, are

P a g e | 3 QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

Elements Key Themes managed by GMH&SCP. The locally commissioned services payments are managed by the CCG and the 2020/21 weighted list size based payments were approved by the Primary Care Committee at the May 2020 meeting. Our sample included locally commissioned services payments which are entered on a schedule to be processed by GMSS, authorisation for payment is via email and supporting evidence is retained by GMSS.

Compliance with coding guidance on a sample basis The CCG work closely with GMH&SCP to ensure financial coding errors are corrected and identify these as part of month end processes. Some transactions are consistently miscoded due to limitations on CQRS/ Exeter, however these are amended by the GMH&SCP team each month. All journals are approved by CCG officers as was confirmed from review of a

Page 91 Page sample of recoding journals. Controls within the system also ensure journals are appropriately authorised.

Implementation of the Premises Costs Directions Premises Costs Directions enable GP contractors to request financial assistance from the Commissioner towards premises running costs and service charges that are not reimbursable elsewhere under the Directions. The CCG premises costs are implemented through GMH&SCP with practice reimbursements included within the monthly payment file. Responsibilities in relation to rent review process are also clearly set out in the MOU. The CCG has an adequate process in place to ensure the correct payments are made and any queries are raised with the GMH&SCP primary care team.

4. Findings, Recommendations and Action Plan The review findings are provided on a prioritised, exception basis, identifying the management responses to address issues raised through the review. To aid management focus in respect of addressing findings and related recommendations, the classifications provided in Appendix B have been applied. The table below summarises the prioritisation of recommendations in respect of this review.

P a g e | 4 QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

Core Elements Critical High Medium Low Total Overall management and the reporting of delegated funds – processes for 0 0 0 0 0 forecasting, monitoring and reporting Review of financial controls and processes for approving payments to 0 0 0 0 0 practice Review of compliance with coding guidance on a sample basis 0 0 0 0 0 Processes to approve and decisions regarding ‘discretionary’ payments 0 0 0 0 0 (e.g. Section 96 funding arrangements, Local Incentive Schemes) Implementation of the Premises Costs Directions 0 0 0 0 0 Total 0 0 0 0 0 Page 92 Page

P a g e | 5 QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

Appendix A: Terms of Reference The overall objective was to evaluate the effectiveness of the arrangements put in place by the CCG to exercise the primary care medical care commissioning function (Primary Care Finance) of NHS England as set out in the Delegation Agreement.

Limitations inherent to the internal auditor’s work We have undertaken the review subject to the following limitations. Internal control Internal control, no matter how well designed and operated, can provide only reasonable and not absolute assurance regarding achievement of an organisation's objectives. The likelihood of achievement is affected by limitations inherent in all internal control systems. These include the possibility of poor judgement in decision-making, human error, control processes being deliberately

Page 93 Page circumvented by employees and others, management overriding controls and the occurrence of unforeseeable circumstances. Future periods The assessment is that at July 2020. Historic evaluation of effectiveness is not always relevant to future periods due to the risk that: The design of controls may become inadequate because of changes in the operating environment, law, regulation or other; or The degree of compliance with policies and procedures may deteriorate.

Responsibilities of management and internal auditors It is management’s responsibility to develop and maintain sound systems of risk management, internal control and governance and for the prevention and detection of irregularities and fraud. Internal audit work should not be seen as a substitute for management’s responsibilities for the design and operation of these systems. We shall endeavour to plan our work so that we have a reasonable expectation of detecting significant control weaknesses and, if detected, we shall carry out additional work directed towards identification of consequent fraud or other irregularities. However, internal audit procedures alone, even when carried out with due professional care, do not guarantee that fraud will be detected. The organisation’s Local Counter Fraud Officer should provide support for these processes.

A p p e n d i x A | 1 QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

Appendix B: Assurance Definitions and Risk Classifications

MIAA Definitions NHSE Definitions

Level of Level of Description Description Assurance Assurance

High There is a strong system of internal control which has Full The controls in place adequately address the risks to the been effectively designed to meet the system objectives, successful achievement of objectives; and, and that controls are consistently applied in all areas The controls tested are operating effectively. reviewed.

Substantial There is a good system of internal control designed to Substantial The controls in place do not adequately address one or

Page 94 Page meet the system objectives, and that controls are more risks to the successful achievement of objectives; and generally being applied consistently. / or, One or more controls tested are not operating effectively, Moderate There is an adequate system of internal control, however, resulting in unnecessary exposure to risk. in some areas weaknesses in design and/or inconsistent application of controls puts the achievement of some aspects of the system objectives at risk.

Limited There is a compromised system of internal control as Limited The controls in place do not adequately address multiple weaknesses in the design and/or inconsistent application significant risks to the successful achievement of of controls puts the achievement of the system objectives objectives; and / or, at risk. A number of controls tested are not operating effectively, resulting in exposure to a high level of risk.

No There is an inadequate system of internal control as No The controls in place do not adequately address several weaknesses in control, and/or consistent non-compliance significant risks leaving the system open to significant error with controls could/has resulted in failure to achieve the or abuse; and / or, system objectives. The controls tested are wholly ineffective, resulting in an unacceptably high level of risk to the successful achievement of objectives.

A p p e n d i x B | 1 QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

Risk Rating Assessment Rationale

Critical Control weakness that could have a significant impact upon, not only the system, function or process objectives but also the achievement of the organisation’s objectives in relation to:  the efficient and effective use of resources  the safeguarding of assets  the preparation of reliable financial and operational information  compliance with laws and regulations.

High Control weakness that has or could have a significant impact upon the achievement of key system, function or process objectives. This weakness, whilst high impact for the system, function or process does not have a significant impact on the achievement of the overall organisation objectives.

Page 95 Page Medium Control weakness that:  has a low impact on the achievement of the key system, function or process objectives;  has exposed the system, function or process to a key risk, however the likelihood of this risk occurring is low.

Low Control weakness that does not impact upon the achievement of key system, function or process objectives; however implementation of the recommendation would improve overall control.

A p p e n d i x B | 2 QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

Appendix C: Report Distribution

Name Title Report Distribution

Kathy Roe Director of Finance, Tameside Metropolitan Borough Council Final (TMBC) and Chief Finance Officer, NHS Tameside and Glossop Clinical Commissioning Group

Jessica Williams Director of Commissioning Draft/Final

Carol Prowse Governing Body Lay Member for Commissioning Final

Tracey Simpson Deputy Chief Finance Officer Draft/Final Page 96 Page

David Milner Assistant Chief Finance Officer Draft/Final

Tori O’Hare Head of Primary Care Draft/Final

Liz Sabel Finance Business Partner Draft/Final

Judith Stevens Finance Business Partner Draft/Final

David Swift Audit Committee Chair & Conflicts of Interest Guardian Final

Review prepared on behalf of MIAA by

Name Zainab Patel Name Ruth Parker

Title Principal Auditor Title Senior Internal Audit Manager

 07551 131067  0772 1237349 A p p e n d i x C | 1 QD-5 Rev 1 Primary Medical Care Commissioning – Primary Care Finance NHS Tameside and Glossop CCG 536_TGCCG2021_011

 [email protected]  [email protected]

Acknowledgement and Further Information MIAA would like to thank all staff for their co-operation and assistance in completing this review. This report has been prepared as commissioned by the organisation, and is for your sole use. If you have any queries regarding this review please contact the Audit Manager. To discuss any other issues then please contact the Director. MIAA would be grateful if you could complete a short survey using the link below to provide us with valuable feedback to support us in continuing to provide the best service to you. https://www.surveymonkey.com/r/MIAA_Client_Feedback_Survey

Page 97 Page

A p p e n d i x C | 2 QD-5 Rev 1 This page is intentionally left blank Agenda Item 11

PRIMARY CARE COMMITTEE

Title of Subject: Safeguarding Children and Vulnerable Adults: General Practice reporting

Date of paper: 7th October 2020

Prepared By: Tori O’Hare

History of paper: First Paper

Executive Summary: In 2019 NHS England wrote to CCG Safeguarding Leads in relation to the reporting by general practice, on request of Local Authorities as part of safeguarding arrangements for children and vulnerable adults.

The sharing of information by general practice on request from local authorities is not resourced under national NHS contracts. Statutory and professional duties apply on individual GPs to share information in a timely fashion, but GP practices are nevertheless entitled to seek payment for this local authority requested work. In Tameside & Glossop the CCG does not fund this information requests.

Such payment arrangements vary and we have asked Greater Manchester Health and Social Care Partnership to co-ordinate an overview of arrangements across GM CCGs.

A small working group, reflecting both the Safeguarding and Primary Care teams has been convened and will take this discussion forward and report again to Primary Care Committee with an options paper for consideration.

Recommendations Primary Care Committee is asked to note the NHS England letter, required of the the current position across Tameside and Glossop and the work Committee (for programme in place. Discussion and Decision):

Principles addressed by National policy proposal (QIPP, national/regional policy etc): Direct questions to: Tori O’Hare

Page 99 1. INTRODUCTION

1.1 In 2019 NHS England wrote to CCG Safeguarding Leads in relation to the reporting by general practice, on request of Local Authorities as part of safeguarding arrangements for children and vulnerable adults. The full letter is included for information as an appendix to this paper.

1.2 The sharing of information by general practice on request from local authorities is not resourced under national NHS contracts. Statutory and professional duties apply on individual GPs to share information in a timely fashion, but GP practices are nevertheless entitled to seek payment for this local authority requested work.

1.3 With increasing requests for reports due to welcome improvements in education there is a need to review how general practice is supported.

2. GREATER MANCHESTER POSITION

2.1 Payment arrangements vary across CCGs and we have asked Greater Manchester Health and Social Care Partnership (GM HSCP) to co-ordinate an overview of arrangements across GM CCGs.

2.2 The output of this will form part of the assessment and review of local arrangements and recommendation for the future.

3. LOCAL POSITION

3.1 The response by practices to information requests for safeguarding meetings varies, although it should be noted the lead time for requests can also vary, therefore making a comprehensive response unfeasible.

3.2 The CCG does not directly fund these information requests. Early knowledge of GM position reflects a varied position with some funding this on a case by case basis as required, some funding via a locally commissioned service and others not providing additional funding.

3.3 The time commitment, requiring clinical and non-clinical capacity from the practice, can vary depending on the case however these can be up to 3 to 4 hours for a full report.

4. NEXT STEPS

4.1 A small working group, reflecting both the Safeguarding and Primary Care teams has been convened and will take this discussion forward and report again to Primary Care Committee with an options paper for consideration. This will include the feedback from GM CCGs and will quantify this in terms of numbers of requests to our practices, based on current safeguarding caseload.

5. RECOMMENDATIONS

5.1 Primary Care Committee is asked to note the NHS England letter, the current position across Tameside and Glossop and the work programme in place.

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To: CCG Accountable Officers Primary Care and System Transformation Operations and Information NHS England and NHS Improvement Copy: STP Leads Quarry House, CCG Named GPs for Safeguarding Quarry Hill CCG Designated Nurses for Safeguarding Leeds LS2 7UE. [email protected]

11 July 2019

Publishing Approval Reference: 000565

Dear Colleagues,

Safeguarding Children and Vulnerable adults: general practice reporting I am writing, with the support of NHS England’s Regional Directors of Nursing for Professional and System Development, to request action from local systems to ensure children and vulnerable adults are effectively safeguarded. Issue The sharing of information by general practice on request from local authorities is not resourced under national NHS contracts. Statutory and professional duties apply on individual GPs to share information in a timely fashion, but GP practices are nevertheless entitled1 to seek payment for this local authority requested work. Such payment arrangements have always varied locally2 but with increasing requests for reports due to welcome improvements in education there is a need to review how general practice is supported. With the new placed based system arrangements set out in the NHS Long Term Plan there is an opportunity to embrace shared local responsibility for these arrangements. Further, new statutory guidance3 ‘Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children’ requires from September 2019 local system leaders to collaborate to lead, implement and deliver local child safeguarding processes in order to protect the paramountcy of the child. All three safeguarding partners (local authority, health and police) have equal and joint responsibility for local safeguarding arrangements. Action required System Transformation Partnerships – effectively Clinical Commissioning Groups working together in this collaboration along with local GP provider representatives – should review their local arrangements in 2019/20 and where necessary implement

1 National GMS contract expressly enables GP practices to demand or request a fee in respect of any activity requested by a statutory body in exercise of its function 2 Payments to GP practice variably made: sometimes through the NHS as core contract holder , sometimes through the local authority as the statutory body requesting the activity; and, sometimes no arrangement w here activity w as never anything more than exceptional 3 https://w ww.gov.uk/government/publications/w orking-together-to-safeguard-children--2 NHS England and NHS Improvement Page 103 changes. The outcome we want to achieve is to assure safeguarding activity in general practice is supported to contribute efficiently and effectively to local decision making on ensuring the safety of children and vulnerable adults. Local examples of work that have been successfully implemented to improve reporting and the quality of reports include: • Direct payments to a practice by the CCG under long standing “Collaborative arrangements” • Introducing a Safeguarding Local Enhanced Service

For full details of these examples, please see Annex 1. For further background on professional, regulatory and contractual duties as apply to GPs and General Practices, see Annex 2. At this juncture, 11 local systems (Annex 3) are also prototyping new ways of working together, including shared values, collaborative behaviours and resolving local conflicts. Current focus for CCG are: 1. Managing the change of Child Death Overview Panels, (as per Chapter 5 of the new statutory guidance) Reforms, to establish a larger, more integrated care footprint 2. Managing the process of data sharing (as per Chapter 4), to ensure GPs and other health providers actively contribute contemporaneously to case reviews 3. Facilitating a local MOU for sustainable partnership funding.

All annexes can be found here: https://www.england.nhs.uk/primary-care/primary-care-commissioning/primary-care- resources/

Monitoring NHS England and NHS Improvement expects local system reviews for supporting (including resourcing) general practice reporting activity to completed and implemented by the end of October 2019. NHS England and NHS Improvement will work with CCGs named GP safeguarding leads to obtain assurances that local systems are supporting effective safeguarding arrangements in general practice from 1 November 2019. Thank you for your action in support but should you need any further advice or guidance please contact [email protected]. Best wishes

Dr David Geddes Director, Primary Care Commissioning GMC no. 3253722 Page 104 Agenda Item 12

PRIMARY CARE COMMITTEE

Title of Subject: Special Allocation Service Contracts (SAS) Options Paper

Date of paper: 7 October 2020

Prepared By: Christopher Martin

History of paper: The SAS has been discussed previously at Primary Care Committee but not in terms of the expiration of the current contracts.

Executive Summary: The SAS service contracts with Ashton GP Service and West End Medical Centre are due to expire on 31 March 2021. There is no provision to extend within the current contracts.

This paper presents three options for contracts going forward:

1. Retain the status quo and re-contract with both current providers for a further year with an extension of an additional year – this does not involve a procurement exercise 2. Retain two providers but re-contracting with Ashton GP Service and undertaking a procurement exercise for the services delivered West End Medical Centre, recognising Ashton GP Service’s requirement under its APMS contract to deliver the SAS. 3. Consolidate the service under one provider – Ashton GP Service recognising its requirement under its APMS contract to deliver the SAS. Recommendations Taking into account the current environment for general practice required of the and the vulnerability and challenging nature of these patients, Committee (for option 1 is the preferred option for retaining stability for patients and Discussion and of providers. Decision): Principles addressed by National Policy proposal (QIPP, national/regional policy etc):

Direct questions to: Christopher Martin

Page 105 1. INTRODUCTION

1.1 The Special Allocation Service (SAS) is a primary care service for patients who have been removed from a practice patient list and can continue to access healthcare services at an alternative, specific GP practice. NHS England / delegated commissioners have a responsibility to ensure that all patients can access good quality GP services and that patients are not refused healthcare following incidents that are reported to the police. It is usually delivered by existing primary care general practice contractors. In Tameside and Glossop these contractors are Ashton GP Service (AGPS) and West End Medical Centre (WEMC).

1.2 The contracts for these providers end on 31 March 2021. These contracts have already been extended once and cannot be extended again. Tameside and Glossop needs a provider in place to deliver the SAS, so a decision needs to be made on re-procurement.

1.3 This paper advises on the options available and asks Primary Care Committee to agree an approach for the contracts ending.

2. CURRENT SPECIAL ALLOCATION SERVICE CONTRACTS

2.1 Both AGPS and WEMC provide the SAS under a separate contract to their primary medical services contract, via the NHS standard contract. AGPS provides general medical services under an Alternative Primary Medical Services (APMS) contract while WEMC provides general medical services under a General Medical Services Contract.

2.2 In total in Tameside and Glossop currently has 43 patients on the SAS scheme, AGPS has 14 patients while WEMC has 29 patients on the service.

2.3 It was a requirement of the tender process that whichever provider won the contract to provide primary medical services via the Ashton GP Services APMS contract should also provide the SAS.

2.4 The current contracts have a notice period of six months. While contracts can end by expiration of the contract on the end date, it is common practice within the NHS for commissioners to advise providers of their intentions with regard to the contract within the notice period. This means, as a courtesy, notice and the CCGs intentions should have been communicated to the two providers on 30 September 2020. However, as this courtesy has no legal force, communication of the CCG’s intentions is pending the outcome of Primary Care Committee’s decision.

2.5 There is no provision in the contracts to extend the existing contracts, which means that a procurement exercise should be undertaken. Ordinarily this would be by utilising STAR contracts but as this service is part of primary care delegated services this may mean that any procurement is undertaken by North of England Commissioning Support Unit (NECS). Procurement advice and clarification will be sought on this if required.

2.6 Due to the structuring of the APMS contract re-procurement of the service provided by AGPS will be considered at the time of re-procuring the APMS contracts, which means the only contract that may change is that with WEMC. Again, procurement advice and clarification will be sought on this.

Page 106 3. OPTIONS FOR RE-PROCUREMENT

Option Option Advantages Disadvantages Number 1 Retain the status quo Maintains stability for this May be outside – re-contract with both vulnerable and procurement rules. providers, for a further challenging cohort of Doesn’t open to the year, without a patients. service to being provided procurement exercise Reduces time taken to re- by new and innovative procure at a time when providers. capacity is an issue in general practice and the CCG. 2 Retain two providers Retains the two provider The time taken to run a and re-procure the structure, which has procurement exercise service currently always given flexibility for when general practice delivered by West this vulnerable and may be in a challenging End, while re- challenging cohort of environment. contracting with patients. A lack of providers Ashton GP Service interested in delivering (recognising it is an the service, which could APMS requirement for negate a procurement AGPS) while alienating WEMC. 3 Consolidate the Places the service with Moving 29 vulnerable service with one one provider, and challenging patients provider – AGPS consolidating economies to a different provider. (recognising AGPSs of scale and support for AGPS may not have the requirements under its patients. capacity for 29 of APMS contract to Managing the contract additional patients, who provide this service) – becomes easier and can add considerably to a without a procurement costs can better be practice’s workload. exercise reviewed. The flexibility of having two providers is lost and the ability to move patients between the two providers, which may increase the need for bespoke primary care. May alienate WEMC, with whom good commissioner- provider relations should be maintained. May be outside procurement rules.

3.1 Patients are allocated to the SAS and cannot chose to register with another primary medical services provider until their SAS GP feels they can access mainstream primary care. This results in patient experiences not always being positive as they are not with the provider of their own volition. This observation is made based on the appeals received when patients are placed on the SAS and also from interactions with existing patients on the scheme.

3.2 However, the difficulty of engaging with this group should not prevent us from trying to understand their feelings about the service and how the providers are performing from the patient perspective. Regardless of the option recommended by Primary Care Committee, we will endeavour to engage with patients during this process.

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4. RECOMMENDATIONS

4.1 Option 1 is the preferred option. We are seeing an increase in COVID-19 infections with no indication of them starting to reduce. General practice is at the forefront of the response to COVID-19 and will need to focus on that in the coming months. Undertaking a procurement exercise for a service for some of our most vulnerable and challenging patients’ risks reducing that focus on the response to COVID-19 while continuing to deliver core general practice.

Page 108 Agenda Item 13

PRIMARY CARE COMMITTEE

Title of Subject: Partnership Oversight Group report

Date of paper: 7th October 2020

Prepared By: Lyndsey Whitwam

History of paper: Primary Care Committee agreed in March 2020 the establishment of a Partnership Oversight Group to oversee the proposals from PCNs under the Partnership LCS bundle. Partnership Oversight Group is a task group of Primary Care Committee.

Executive Summary: This report provides a summary of the fifth meeting of the group with recommendations progressed by the group for decision by Primary Care Committee.

The resubmitted proposal put forward by Hyde PCN shows increased engagement and co-design around Mental Health with both the commissioning team and Pennine Care FT.

The second discussion at this meeting of POG was from Glossop PCN and a request for consideration of early approval and funding confirmation for 2021/22 to enable them to expand the Ageing Well team and retain the existing staff beyond March 2021.

Recommendations Primary Care Committee is asked to: required of the Committee (for 1. support the proposals put forward by the Partnership Discussion and Oversight Group for approval of the Hyde PCN proposal, and Decision): 2. discuss/provide advice on the position regarding continuation of funding to ensure continuity of service provision as sought by Glossop PCN but for feedback to all PCNs.

Principles addressed by n/a proposal (QIPP, national/regional policy etc): Direct questions to: Lyndsey Whitwam

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1. PARTNERSHIP OVERSIGHT GROUP SUMMARY

1.1 The table below details the proposal considered and supported for onward recommendation for approval by Primary Care Committee following the Partnership Oversight Group meeting on 23rd September 2020.

Proposal POG Feedback Outline & Funding Hyde PCN – 1. At its meeting on 23rd September POG supported the Mental proposal for Access to Mental Health Support via a Primary Health Care Mental health Practitioner (PCMHP) for the Hyde Support via neighbourhood patients through the employment by the Primary Healthy Hyde Team of an Adult MH worker and a Childrens Care Mental MH worker, planned and recruited in conjunction with Health Pennine Care FT. Practitioners £133,303 2. POG was content with the two posts being planned and recruited in conjunction with Pennine Care, but did raise concerns as to how easily the posts would be to recruit to as Pennine Care have in previous months been unable to fill posts - the suggestion of a secondment was raised as a possible way to overcome this but with the need to ensure destabilisation did not occur in another part of the service as a result. The timing of this recruitment and the non-recurrent position of this funding at this time, pending the easing of command and control arrangement and the allocation detail for 21/22, was also raised and the suggestion that a temporary secondment may also align with this funding position.

3. The group asked for clarity as to what in practice “formally connected into the Neighbourhood M H team” meant in terms of governance and line management of the post holders.

4. POG supported this proposal and funding request of £133,303 with caveats particularly around sharpening the outcomes and ensuring they are patient focused to aid retrospective evaluation.

2. 2021/22 LOCALLY COMMISSIONED SERVICES

2.1 Glossop PCN put forward a proposal for the Expansion of the Ageing Well Team into 2021/22, this was discussed by the group with emphasis on the early consideration from the PCN of this proposal to maintain and grow the existing service whilst noting the commissioning arrangements for the Partnership bundle are in place until 31st March 2021.

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2.2 POG recognised the importance of retention of staff and the continuation of the good work by teams employed under this funding stream and, will take this forward now that national command and control arrangements are being lifted and detail regarding funding for the latter part of this year and future years is starting to emerge. POG will stay close to this discussion and keep PCNs informed.

2.3 Glossop PCN was advised that POG recognised the delays in initial recruitment and would be keen to see detail of the outcomes against the existing service, workforce stories from employees illustrating how they feel in the team and the difference the roles are making in the community would be a welcome qualitative aspect of this evaluation.

2.4 The feeling was that this early ask showed commitment to this model of working and the ambition to grow and expand into the next financial year was generally supported although great caution and uncertainty remains with the financial position of the CCG and therefore no current confirmation can be given.

3. RECOMMENDATIONS

3.1 Primary Care Committee is asked to:

1. support the proposal put forward by the Partnership Oversight Group for approval of the Hyde PCN Mental Health offer, 2. discuss/provide advice on the position regarding continuation of funding to ensure continuity of service provision as sought by Glossop PCN but for feedback to all PCNs.

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PRIMARY CARE COMMITTEE

Title of Subject: Update on Primary Care Network Additional Roles Reimbursement Scheme 2020/21 Local Intentions

Date of paper: 7th October 2020

Prepared By: Lyndsey Whitwam

History of paper: This is a further update paper on the Additional Roles Reimbursement Scheme which forms part of the Primary Care Network DES. Plans previously approved are in italics at Appendix 1, whilst Wave 4 applications for Hyde are shown in standard font for approval.

Executive Summary: The five year framework for GP Contract Reform to implement the NHS Long Term Plan included the need to address the workforce shortfall recognising a range of factors which have, and continue, to contribute to this.

The Additional Roles Reimbursement Scheme provides financial support to Primary Care Networks (PCNs). The initial reimbursable roles included within the scheme were clinical pharmacists, social prescribing link workers, physician associates, first contact physiotherapists and first contact community paramedics. From April 2020 the list has been added to include pharmacy technicians, care co- ordinators, health coaches, dietitians, podiatrists and occupational therapists. PCNs can now choose from this expanded this the roles to make up the workforce they need from their identified resource.

This paper provides an update of the Wave 4 applications for Hyde PCN.

Recommendations Primary Care Committee is asked to: required of the Committee (for 1. Approve Wave 4 application against the Additional Roles Discussion and Reimbursement Scheme by Hyde PCN as shown at Appendix Decision): 1 in standard font. Principles addressed National Policy by proposal (QIPP, national/regional policy etc): Direct questions to: Lyndsey Whitwam, [email protected]

Page 113

Appendix 1 - updated as at September

maximum Additional Roles Reimbursement reimbursable £ (12 Total Funding PCN plans Scheme month including on available costs) Ashton 3 x Clinical Pharmacists £55,670 £167,010 1 x First Contact Physiotherapists £55,670 £55,670 1 x Social Prescribing Link Worker £35,389 £35,389 2 x Physician Associate £53,724 £107,448 £365,517 £438,444 Hyde 2 x Clinical Pharmacists £55,670 £111,340 1 x First Contact Physiotherapist £55,670 £55,670 1 x Social Prescribing Link Worker £35,389 £35,389 1 x Wellbeing Co-ordinator £35,389 £35,389 2 x Care Coordinator £29,135 £58,270 1 x Wellbeing Co-ordinator £35,389 £35,389 1 x Clinical Pharmacists £55,670 £55,670 2 x Physician Associate £53,724 £107,448 £494,565 £536,567 Glossop 0.8 x Clinical Pharmacists £55,670 £44,536 0.8 x First Contact Physio £55,670 £44,536 1 x Social Prescribing Link Worker £35,389 £30,711 1 x Physician Associate £53,724 £38,991 1 x Clinical Pharmacists £55,670 £51,737 £210,511 £228,947 Denton 4 x Clinical Pharmacists £55,670 £222,680 1 x Social Prescribing Link Worker £35,389 £35,389 1x Wellbeing Co-ordinator £35,389 £35,389 1 x Care Coordinator £29,135 £29,135 1 x First Contact Physiotherapist £55,670 £55,670 £378,263 £380,575 Stalybridge 1 x Clinical Pharmacists £55,670 £55,670 1 x Social Prescribing Link Worker £35,389 £35,389 3.5 x Care Coordinator £29,135 £101,973 1 x Pharmacy Technician £35,389 £35,389 1 x First Contact Physiotherapist £55,670 £55,670 £284,091 £303,083 Total £1,732,947 £1,887,616

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