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of 1 Shropshire CCG Primary Care Commissioning Committee Meeting – Agenda 13 June 2018

William Farr House

Mytton Oak Road Shrewsbury Shropshire

SY3 8XL Tel: 01743 277580

E-mail: [email protected]

A G E N D A

Meeting Title

Primary Care Commissioning Committee

Date Wednesday 13 June 2018

Chair

Mr Keith Timmis Time 9.00 am

Minute Taker

Mrs Chris Billingham Venue / Location

Room K2, William Farr House, Mytton Oak Road, Shrewsbury SY3 8XL

Reference

Agenda Item Presenter Time Paper

PCCC-2018-6.108 Apologies Councillor Lee Chapman Dr Julian Povey Dr Simon Freeman Mr William Hutton Dr Colin Stanford

Keith Timmis 9.00 Verbal

PCCC-2018-6.109 Members’ Declaration of Interests


PCCC-2018-6.110 Minutes/Actions of Previous Meeting and Action Log held on 2 May 2018

Keith Timmis 9.05 Enclosure 1

PCCC-2018-6.111 Matters Arising


PCCC-2018-6.112 GP Forward View

Phil Morgan 9.25 Enclosure 2

PCCC-2018-6.113 Extended Access Steve Ellis 9.35 Enclosure 3

PCCC-2018-6.114

Finance Update

Claire Skidmore 9.45 Enclosure 4

PCCC-2018.6.115 Primary Care Risk Register Nicky Wilde 9.55 Enclosure 5

PCCC-2018-6.116 Primary Care Priorities 2018/19 Nicky Wilde 10.05 Enclosure 6

PCCC-2018-6.117 NHS England Update

Rebecca Woods 10.15 Verbal

PCCC-2018-6.118 PCCC-2018-6.119

Items for information only:

PCCC Cycle of Work

Primary Care Working Group (PCWG) Update

10.25

Enclosure 7 Enclosure 8

PCCC-2018-6.120 Any Other Business Keith Timmis 10.50 Verbal

PCCC-2018-6.121

Date of Next Meeting Wednesday 4 July 2018, 9.00 am, Room K2, William Farr House, Mytton Oak Road, Shrewsbury SY3 8XL

mailto:[email protected]

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Agenda Item PCCC-2018-6.110 Enclosure Number 1

Shropshire Clinical Commissioning Group

MINUTES OF THE PRIMARY CARE COMMISSIONING COMMITTEE (PCCC) HELD IN ROOM K2, WILLIAM FARR HOUSE, SHREWSBURY AT 9.00 AM ON

WEDNESDAY 2 MAY 2018

Present Mr Keith Timmis Lay Member, Performance (Chair) Mrs Nicky Wilde Director of Primary Care Ms Dawn Clarke Director of Nursing, Quality, Safety & Patient Experience Mrs Sam Tilley Director of Corporate Affairs Dr Ed Rysdale Secondary Care Consultant Dr Steve James GP Member Dr Finola Lynch GP Member Mr William Hutton Lay Member Mr Meredith Vivian Lay Member Mrs Sarah Porter Lay Member Dr Julian Povey CCG Chair & GP Member Mrs Jane Randall-Smith Chief Executive, Health Watch Mr Tony Uttley Deputy Chief Finance Officer Dr Colin Stanford External GP Member Mrs Amanda Alamanos Primary Care Lead for Shropshire & Telford, NHS England In Attendance Mrs Tracy Eggby-Jones Corporate Services Manager, Minute Taker Mr Phil Morgan Primary Care Manager (agenda item PCCC-2018-5.089) Mr Charles Millar Head of Planning, Performance & Contracting (agenda item PCCC-2018-5.092) Mr Phil Brenner Project Manager, Whitchurch Development (agenda item PCCC-

2018-5.093) Ms Sue Holding Business Case Development (agenda item PCCC-2018-5.093) Mr Adrian Johnson Community and Care Co-ordinator Manager (agenda item PCCC-2018-5.095) Mr Tom Brettell South - Locality Manager (agenda item PCCC-2018-5.095) Apologies Mrs Claire Skidmore Chief Finance Officer Dr Deborah Shepherd GP Member, Locality Chair Mr Kevin Morris Practice Board Member Mrs Rebecca Woods Head of Primary Care for Shropshire & Staffordshire, NHS England PCCC-2018-5.083 - Apologies 1.1 Mr Timmis welcomed Members and attendees to the Primary Care Commissioning

Committee (PCCC), in particular Mr Uttley who was in attendance representing Mrs Skidmore.

PCCC-2018-5.084 - Members’ Declaration of Interests 2.1 There were no declarations of interests raised. Mr Timmis reminded Members to declare

any conflicts if they arose during discussions. Dr Povey expressed a potential conflict in that his wife, Dr Jane Povey, was involved with the Council regarding Social Prescribing.

PCCC-2018-5.085 - Minutes/Actions of Previous Meeting and Action Log held on 4 April 2018 3.1 The Minutes of the meeting held on 4 April 2018 were agreed to be a true and accurate

record. 3.2 An update on the actions from the previous meeting were noted as follows:

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PCCC-2018-1.005 - PCCC Terms of Reference 3.3 Mr Timmis noted this had been delayed as the Terms of Reference needed to be agreed by

the Executive Team prior to being circulated to PCCC members. Mr Timmis advised that Mrs Tilley had asked all Committee Chairs to consider the effectiveness and operation of their relevant committee, any changes would be considered and reported back to the July meeting.

ACTION: Mr Timmis to feedback outcome of the review of the effectiveness and operation of

the CCG’s committees to the July PCCC meeting. 3.4 Mr Timmis asked for any observations from members of the public on the effectiveness of

the PCCC, which he would be happy to receive these verbally or in writing via email. Dr Stanford arrived at this point. PCCC-2018-3.047 - Social Prescribing Data/Care Co-ordinator Update 3.4 It was agreed that as Councillor Chapman was absent, this item would be deferred to the

next meeting. ACTION: Councillor Chapman to chase the relevant department regarding data sharing

agreements and present update to next PCCC meeting. PCCC-2018-4.065 - PCCC Cycle of Work 3.5 Noted that as no comments had been received the Cycle of Work was accepted. PCCC-2018-4.066 - GP Forward View 3.6 It was noted a meeting was being held later that day with Mr Timmis, Mrs Wilde and Dr

Stanford to discuss any soft intelligence and an update would be presented to the June meeting.

PCCC-2018-4.068 - Finance Update 3.7 Noted the final finance budget, including the Long Term Financial Model (FLTM), would be

presented to the July PCCC meeting. ACTION: Mrs Skidmore to present the final finance budget, including the Long Term

Financial Model (FLTM), to July PCCC meeting. PCCC-2018-4.069 - Primary Care Working Group (PCWG) Update 3.8 It was confirmed that the Committee did have sight of the Quality Report, for information

purposes, and it was agreed that Mrs Wilde would check to ascertain whether Mrs Gittins’ comments raised had been noted on the action tracker. A broader discussion was required about how quality issues were going to be addressed over the next few months and how this would be merged with performance.

ACTION: Mrs Wilde to check that Mrs Gittins’ comments had been raised on the PCCC

action tracker. PCCC-2018-4.070 – Memorandum of Understanding 3.9 It was noted that Mr Timmis was due to meet with Mrs Woods the following week to discuss

governance around this.

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PCCC-2018-4.072 – Communications and Engagement Plan for Primary Care 3.10 It was noted that the action for Mrs Harper to review the plan, to either include engagement

in the plan, or in a separate plan, was still outstanding. ACTION: Mrs Harper to review the Communications & Engagement Plan for Primary Care, to

either include engagement in the plan, or in a separate plan and present the plan to a future PCCC meeting.

PCCC-2018-5.086 - Matters Arising 4.1 There were no matters arising that were not on the agenda. 4.2 Mr Timmis apologised for the delay in circulating the Terms of Reference and confirmed that

these were still under review and would be presented as soon as possible. PCCC-2018-5.087 - PCCC Cycle of Work 5.1 The Committee noted the cycle of work. PCCC-2018-5.088 - Quality Update 6.1 Ms Clarke presented a briefing paper that outlined the activity undertaken in Primary Care by

the Nursing and Quality team for assurance purposes. 6.2 Ms Clarke confirmed that the largest piece of work related to the end to end process/incident

reporting from GP practices, either those issues raised within their practice, or from other providers. Ms Clarke advised that practices were encouraged to report incidents so that the CCG could see what the trends and themes were and could work with providers and ensure that problems were being addressed. It was noted that the number of incidents coming in were a lot, but it was how the CCG dealt with these effectively and in a timely manner was important.

6.3 Ms Clarke noted that the team was small and that they had agreed with all providers that

there would be a single point of contact. Rather than sending individual incidents through, they would get them weekly or monthly which would make it easier to get a proper response out. This work had been done in conjunction with practices looking at what they needed and what they expected from the CCG. Feedback would be proved to practices via regular newsletters.

6.4 Ms Clarke highlighted the importance of feedback and reported that an end to end feedback

response letter to practices had been compiled. It was noted that some of the issues related to discharges and medication, but there had been some positive changes, particularly in radiology processes in Shrewsbury & Telford Hospital NHS Trust (SATH) to improve response times for patients.

6.5 It was noted that in order for the CCG’s Safeguarding Team to provide assurance to the

Safeguarding Board, a safeguarding audit was issued to each of the practices in 2017 in order not only to identify good practice but to ensure that the appropriate action was taken to address problems identified. A summary of the outcome of the audit was included in the report.

6.6 Ms Clarke reported that primary care played a vital role in improving health and well-being

for Looked After Children (LAC) working in conjunction with local authorities and other health providers. Currently Shropshire had over 300 LAC and up to 500 from out of county by other Local Authorities, therefore, it was noted that the responsibilities for LAC was integral to the safeguarding audit being undertaken.

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6.7 Ms Clarke drew Members’ attention to page 9 of the report which outlined the Care Quality Commission (CQC) ratings for all practices and noted that all practices were rated good with areas of outstanding care.

6.8 Mrs Porter noted that only 27 practices had participated in the audit. Ms Clarke explained

that although the audit was not mandatory practices were being encouraged to participate. 6.9 Dr Povey referred to section 5 of the report where it stated that one of the CCG actions was

to ‘promote E-CINS with GP practices and for some GPs to become champions of the system to encourage others practices to join’ and sought clarity as to what this entailed. Ms Clarke explained that this related to sharing of child protection data.

6.10 Dr Povey noted that some of the incidents reported via Datix related to secondary care

quality issues and not primary care and thought that the PCCC may not be the most relevant committee to receive the information. Mr Timmis felt that it was useful background information for the committee, however, felt that a primary care dashboard needed to be developed and also include quality, resilience and performance data. Ms Clarke confirmed that the Quality Committee did receive and consider all incidents from both secondary and primary care and that there were a small number of internal primary care issues raised. Details of these would be presented going forward.

6.11 Mr Timmis noted that only moderate harm was being reported and questioned what criteria

this was based on and what the difference was between significant, moderate and low harm. Ms Clarke advised that all incidents were measure against national criteria and that as a rule significant harm related to death, debilitating injury or major outbreaks, was as moderate harm related to fractures etc and low harm to near misses or avoided incidents.

6.12 Mrs Alamanos asked if a representative from Shropshire CCG attended NHS England’s

Primary Care Quality Committee. Ms Clarke confirmed that members of the Quality Team attend when they were able. Mrs Wilde suggested that trends from across the region be included in the CCG’s quality report. Mrs Alamanos agreed to ensure that Mrs Wilde was included on the distribution list for future agenda papers/minutes.

6.13 Mrs Alamanos also highlighted that a series of workshops had been planned on the future of

patient safety, investigation, serious incident and review, which will look at reviewing the framework for incidents. CCG representatives were encouraged to attend.

6.14 Dr Lynch reported that a greater focus had been given on quality in primary care at the

recent Local Medical Committee (LMC) meeting and felt that the recently developed primary care quality newsletter would be well received by practices. It was suggested that this be included with the both the CCG’s primary care and practice managers newsletters.

6.15 Mr Timmis noted that feedback from Healthwatch would also be included in future reports.

Mrs Randall-Smith advised that it had been agreed to include this information on a quarterly basis.

RESOLVE THE PCCC RECEIVED AND NOTED the activity undertaken in Primary Care by

the Nursing and Quality team. THE PCCC ALSO NOTED the milestones that had been agreed as part of the

Quality Strategy Delivery Plan for 2018-2019, which was monitored by the Quality Committee.

ACTION: Mrs Alamanos to ensure that Mrs Wilde was included on the distribution list for

agenda papers/minutes for NHS England’s Primary Care Quality Committee. Ms Clarke to look at including trends from the regional Primary Care Qulaity

Committee meetings in future Quality reports presented to the PCCC. Ms Clarke to take forward the issuing of the primary care quality newsletter with

the CCG’s primary care and practice managers newsletters.

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Ms Clarke to ensure that feedback from Healthwatch was also included the

primary care quality report going forward. PCCC-2018-5.089 - GP Forward View 7.1 Mr Morgan was in attendance and presented the Committee with an update on the GP

Forward View (GPFV), which included:

Overall delivery against the GPFV

Current plans and progress in Workforce

Plans to deliver the Extended Access project

Progress against the GPFV Delivery Plans 7.2 Mr Morgan noted that the main change to the report was contained within page 6 which

related to the GPFV Delivery Plans. 7.3 Mr Morgan highlighted that the main, local planning and monitoring mechanism for the GPFV

was a series of milestones and targets designed to assess overall delivery at a CCG and, in some cases, on a STP footprint. Progress against these milestones and targets were captured in a report submitted to the NHS England North Midlands GPFV Umbrella Group and was attached as Appendix 1 to the report. It was noted that this was produced on an STP footprint and showed the position as at 24 April 2018.

7.4 Mr Morgan drew Members’ attention to paragraph 58, page 12, of the report which outlined

the next steps in delivering the key milestones for the next two months in the work areas. These included:

Developing Workforce Plans for each of the eight GPFV delivery groups

Developing the role of the lead GP for Workforce

Analysing the results of the Extended Access patient survey

Developing and delivering Extended Access pilot schemes across the county

The GPFV Delivery Groups had been asked to complete their refreshed plans by the end of May 2018 following which payment of the £1.50 per head would be made.

The main addition to the 2018/19 template was the requirement on practices to identify success measures to enable progress against milestones to be measured more accurately next year

7.5 It was noted that the CCG had advertised for a lead GP to support the Primary Team with

delivery of the workforce plan and the two Practice Nurse Facilitators were now being hosted by Shropshire CCG.

7.6 The CCG was continuing to develop plans to deliver against the NHS England target to ensure that, by 1 October 2018, 100% of the population had access to GP appointments Monday to Friday 8am to 8pm and weekends subject to local need. The CCG had secured interest from a number of groups of practices for delivering local extended access pilots and would be reviewing the groups’ plans with a view to securing funding from NHS England. Mr Morgan reported that the patient survey was now live and encouraged patients and the public to complete it. The outcomes would be reported to a future PCCC meeting.

7.7 The CCG had collected information from practices on the actions they have taken to deliver against the GPFV Delivery Plans since funding was released last year. There had been some significant achievements, particularly around the practice collaborations, the10 High Impact Actions and workforce initiatives, however it was noted that further work was needed to accelerate delivery this year.

7.8 Mr Timmis acknowledged the work undertaken to date in getting systems set up for the

delivery of the GPFV, but now felt it was moving in to the delivery stage where evidence against the key milestones in the delivery plan would need to be seen, along with the impact

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and benefits for patients. Mr Morgan advised that following the refresh of the plans feedback from GP practices would be sought on their robustness, which will include success measures, prior to the payment of £1.50 being made.

7.9 Mrs Porter noted that there had been a delay in the NHSE Demand and Capacity Tool which had hindered progress around practices’ ability to significantly look at this element of the GPFV and asked if there was any update in this regard. Mr Morgan advised that this was out of the CCG’s control and no further update had been received. Mrs Wilde agreed to raise this at the next regional GPFV meeting.

7.10 Mrs Porter also raised concern in relation to the delay with Wifi implementation. Mr Morgan noted the frustration of GP practices and gave assurance that it had been raised with the supplier (Redcentric) and an implementation plan was being agreed to ensure that VoiP/WiFi was implemented in all practices over coming months.

7.11 Mrs Wilde advised that the CCG had recognised the importance of IT/digital within primary care and as a result has advertised for a Primary Care IT post, which should be recruited to over the next few weeks.

7.12 Mr Timmis asked if greater clarification could be given to why some of the RAG ratings were Amber or Red and what mitigating actions were in place to move them to Green. Mr Morgan agreed to update this for future reports.

7.13 Mr Timmis also asked if the GPFV Delivery Plan would be presented to the PCCC in future and what the role of the Committee would be in ensuring its implementation. Mrs Wilde explained that monthly meetings were held with NHS England to seek assurance on the delivery of the GPFV, which included benchmarking the CCG’s performance against other CCGs. Mrs Wilde noted that Shropshire CCG did lag behind in relation to workforce, but reported that significant work had taken place over the past few months and performance had now improved.

7.14 Mrs Randall-Smith advised that she had been involved in the GPFV umbrella group, but felt that there needed to be greater emphasis on the impact to patients of the GPFV. Mrs Wilde advised that the remit of the group had been reviewed and attendees revised to ensure it was more relevant to the issues locally. Mrs Randall-Smith agreed to pick this up with Mr Morgan outside the meeting.

7.15 Mrs Wilde wished to record her thanks to the Primary Care Team and GP practices for their joint working in taking forward the delivery of the GPFV. Mrs Wilde noted that greater links would need to be made with the out of hospital transformation programme (now known as the Shropshire Care Closer to Home transformation programme).

RESOLVE THE PCCC RECEIVED AND NOTED the progress report on the GP Forward View

(GPFV) and ACCEPTED that the monitoring of the delivery against the GPFV contained in the report and Appendix 1 provided sufficient assurance to demonstrate progress towards delivery.

ACTION: Mr Morgan to ensure refreshed plans include evidence against delivery of key

milestones and impact/benefits to patients. Mrs Wilde to raise the issue of delay in the NHSE Demand and Capacity Tool at

the next regional GPFV meeting and feedback to next PCCC meeting. Mr Morgan to include explanation/rationale why RAG ratings were Amber or Red

and what mitigating actions were in place to move them to Green. Mrs Randall-Smith to speak to Mr Morgan in relation to ensuring there was

greater emphasis on patient impact/benefits of the GPFV.

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PCCC-2018-5.090 - Primary Care Working Group (PCWG) Update 8.1 Mr Ellis presented a summary paper which provided Members with an update on discussions

held at the Primary Care Working Group (PCWG) meeting in April 2018. This included:

GP Reports of Primary Care/Secondary Care issues

Medicines Management

GP Forward View

Extended Access

Serious Incidents 8.2 Mr Ellis noted that a lot of the issues had also been covered in the Quality update. 8.3 Dr Povey noted that not all GP practices had purchased GPTeamNet, which was being used

as a central log for issues and responses. Mr Ellis reported that there were 4/5 practices that had not yet purchased it but were being encouraged to use the system so that it would then be accessible for all. Dr James and Mrs Wilde advised that it had been raised within the CCG and that Locality Managers were also obtaining logins.

8.4 Mr Ellis reported that the PCWG Terms of Reference (TOR) would be reviewed once the

PCCC TOR had been confirmed. Mr Ellis advised that the role and remit of the PCWG would need to be considered to ensure the right issues were being discussed and comprised the right membership, and that it was emphasised that practice representatives were there to represent their locality not their individual practice.

RESOLVE THE PCCC RECEIVED AND NOTED the summary report from the Primary Care

Working Group (PCWG) meeting held in April 2018. PCCC-2018-5.091 - Finance Update

9.1 Mr Uttley, on behalf of Mrs Skidmore, presented the Month 12 (31 March 2018) financial

position of the Delegated Co-Commissioning Primary Care services and reported that the Co Commissioning spend for 2017/18 was within the budget allocation received, with a small underspend of £170k being reported in the unaudited figures.

9.2 Mr Uttley reported that the year-end position had also been finalised for the CCG as a whole. 9.3 Mr Timmis acknowledged the significant work undertaken by the finance and primary care

team in reaching the year-end position. Mr Timmis noted that although he was not anticipating any material change to the position, there had been some prudent assessments made which enabled there to be a level of underspend that should cover any potential issues identified during the auditing of the accounts.

9.4 Mr Timmis advised that Price Waterhouse Coopers (PWC) had undertaken a broad financial

review of the CCG and noted that any issues relating to the primary care budget should be reflected in future finance reports presented to the Committee. In particular Mr Timmis felt that the specific allocation of reserves should be included in the report.

9.5 Mr Uttley reported that the CCG had developed a detailed action plan as a result of the PWC

review and advised that he would feedback Mr Timmis’s comments. RESOLVE THE PCCC RECEIVED AND NOTED the Month 12 (31 March 2018) financial

position of the Delegated Co-Commissioning Primary Care services. ACTION: Mr Uttley to ensure Mr Timmis’s comments are fed back as part of the CCG’s

action plan following PWC’s review of the CCG’s financial systems.

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PCCC-2018-5.092 - Performance Report 10.1 Mr Millar was in attendance and presented a Performance Report on Primary Care Services

It was noted that the object of the report was to provide assurance to the Committee around Primary Care Services and to inform the Committee on the development of a dashboard for use by CCG Primary Care staff.

10.2 Mr Millar highlighted the key points from the report as follows:

There was a variation within and between localities in the number of metrics shown in the report, in particular the age structure of nurses.

Some variation was explainable but other may require deeper analysis

Primary Care staff within the CCG would have access to the dashboard of the data which would help inform scheduled practice visits.

10.3 Mr Millar advised that the report was a first draft and that it was intended to bring a refresh of

it to the Committee on a quarterly basis. Therefore, Mr Millar noted that it was an evolving process and sought feedback on its contents and asked if there was any additional information required.

10.4 Mr Timmis explained that the intention of having the report was to enhance the Committee’s

focus on quality and performance and that consideration would need to be given how it linked with other reports and data. Mr Timmis particularly referred to public health data and deprivation. Mr Millar advised that a lot more information could be included in relation to disease prevalence and life expectancy etc. Mr Timmis welcomed the inclusion of life expectancy data, as he noted that it had been suggested that life expectancy had decreased following the publication of a national report.

10.5 Mr Timmis noted that there were significant variations in some of the metrics and that this

was likely to be due to comparisons being made between small and large practices. 10.6 Mrs Wilde advised that the referral information was presented to practices to ensure

appropriate feedback was received. Also that Locality Managers had access to the public health data. Mrs Wilde reported that it was the intention to include more detailed narrative in future iterations of the report so that progress could be monitored and although she advised that it may be combined as one quality and performance report in the future, she felt it was appropriate to keep it separate at the moment.

10.7 Mrs Wilde also noted that NHS England had a particular system which looked at primary

care performance and felt that it would be good to include this in future reports. 10.8 Ms Clarke concurred with Mrs Wilde’s comments but was mindful that duplication was not

made in the reports as capacity within the teams was limited. Ms Clarke welcomed the inclusion of public health data and noted that this should also encompass immunisation data, as well as the ‘Fingertip’ data available from NHS England.

10.9 Dr Povey felt that the data in the workforce graphs could be presented better showing both

Shropshire and locality data and that the data could be colour coded for ease of reference. Dr Povey also felt that an un-anonymised version should be presented to the confidential part of the meeting. Mr Millar acknowledged that the presentation of the data would be developed going forward.

10.10 Dr Stanford recognised the difficulty in presenting data and felt that there needed to be

greater narrative explaining some of the variances. 10.11 Mrs Wilde also suggested that deep dives could be conducted in specific specialities where

concerns may have been identified, but noted that this may have to be presented to the confidential session due to potential sensitivities and validity of data.

10.12 Mr Hutton referred to the Care Quality Commission (CQC) ratings and noted there was a

difference in the rating for a particular practice compared to the Quality report presented

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earlier. Ms Clarke noted that this was due to a timing issue and that both reports would need to be aligned going forward.

10.13 Mr Timmis welcomed the performance report and noted that it was a first draft which would

be developed going forward. RESOLVE THE PCCC RECEIVED AND NOTED the Primary Care Services Performance

Report. ACTION: Mr Millar to ensure feedback received from Members was included in the next

iteration of the Primary Care Services Performance Report presented to the Committee.

PCCC-2018-5.093 - Whitchurch Outline Business Case (OBC) 11.1 Mr Brenner and Ms Holding were in attendance to present the Outline Business Case (OBC)

for a new Primary Care Centre in Whitchurch. 11.2 Members were specifically asked to note the impact this would have on the CCG’s finances

from 2020, but noted that the recurrent costs detailed in the business case sat within the financial envelope available to the CCG.

11.3 Ms Holding reported on the comments made by Shropshire Council in relation to the OBC

and noted that the project was an outline and would still need to follow due process and be presented to the Council’s Cabinet meeting schedule for 23 May 2018. Furthermore, Ms Holding reported that although the OBC was primarily for the new primary care centre, Shropshire Council saw it as part of a wider regeneration scheme, integrated with community and social care, which would benefit the health and wellbeing of the Whitchurch population as a whole, and therefore the Council saw their investment in this light.

11.4 Ms Holding reported that the rental value outlined in the OBC (page 52) was incorrect and

should read £232,500 not £234,500 as stated. It was noted that the figure was correct in the Executive Summary.

11.5 Ms Holding advised that work was underway in terms of mitigating the risks to GPs in

relation to becoming lease holders and the British Medical Association (BMA) template for lease holders had been shared with the team. It was noted that consideration would also have to be given to the length of the GPs’ GMC contract.

11.6 Mr Timmis welcomed the OBC and noted the benefits for the wider population of Whitchuch,

but highlighted that the primary care centre was the key focus for the CCG. Mr Timmis also asked if there were any financial sustainability issues the CCG would need to consider as a result of the project. It was noted that Mrs Skidmore had previously indicated that the business case sat within the CCG’s financial envelope. Mr Uttley advised that the 2018/19 primary care budgets were in the process of being finalised and they would be presented to a future Committee meeting.

11.7 Mrs Alamanos advised that as it was an OBC the figures contained within it were indicative

at this stage and that discussions were still underway in relation to the layout, terms of the loan and what other services would also occupy the centre. Therefore, she felt assured by the figures quoted in the OBC and noted that these would be firmed up at the Full Business Case stage.

11.8 Mrs Wilde noted that the figures quoted in the OBC were not as significant as originally

thought and was also assured they were within the current cost envelope. 11.9 Dr Povey felt that having clarity on the lease and associated costs of the OBC was positive 11.10 There were no questions or concerns raised by Clinical Members in relation to the OBC.

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RESOLVE THE PCCC:

RECEIVED the Outline Business Case for a new Primary Care Centre in Whitchurch and NOTED that further updates and a Full Business Case would be presented to future meetings.

APPROVED the expected revenue costs of the development, subject to

further details provided in the Full Business Case.

AUTHORISED NHS England and CCG Primary Care Teams to approve the

final Medical Centre layout (ie floor plans)with the Practices.

PCCC-2018-5.094 - Social Prescribing Data 12.1 In the absence of Councillor Chapman the report on Social Prescribing in Shropshire was

noted for information. 12.2 Mr Timmis advised that he would speak to Councillor Chapman to see if this needed to be

rescheduled for a future meeting. RESOLVE THE PCCC RECEIVED AND NOTED the report on Social Prescribing in

Shropshire. ACTION: Mr Timmis to check with Councillor Chapman if his report on Social Prescribing

in Shropshire needed to be rescheduled for a future meeting. PCCC-2018-5.095 - Care Co-ordinator Report 13.1 Mr Adrian Johnson and Mr Tom Brettell were in attendance to present the Committee with an

update on the Community and Care Coordinator (C&CC) project 13.2 Mr Brettell advised that the C&CC roles were supporting delivery of the GP Forward View

around care navigation and sign posting and that the project was continuing to have a valuable impact on patients, their carers, general practice and the wider health and care economy.

13.3 The initial C&CC Project started as a pilot back in 2012 and the aim of the C&CC Project

was to enable primary care services to refer patients with social, emotional or practical needs

to a range of non-clinical services. It was noted that currently 40 of the 41 practices had their

own C&CC and that referrals to the service had increased year on year, as had the number

of C&CCs and their skill levels. The vast majority (85%) of referrals received were for

patients over 65yrs, however, there had been an increase in referrals from the younger

patient populations (41 – 65yrs 11%, 20 – 40yrs 3% and under 20yrs 1%.). Mr Johnson felt

that this demonstrated that the C&CCs approach was beneficial to the whole of the patient

population with unmet social care needs.

13.4 Mr Johnson emphasised that the skill levels of the workforce had also increased over the 5

years the project had been in existence and highlighted that it had been nationally

recognised as an excellent service and a valuable resource locally.

13.5 Mr Johnson also reported that an independent evaluation of the C&CC project was carried

out in 2016 and found that the C&CC approach saved the system between £1.54 - £2.22 for

every £1 spent on funding the C&CCs which equated to between £533,600 - £754,800. It

was noted that this calculation was thought to conservative as it was based purely on

savings made on patients with complex needs, a cohort that only accounted for 14% of total

number of referrals. No calculation was made for the remaining 86% of referrals, nor further

savings in other areas that may have been achieved with the 14% of the most complex

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referrals, but it was felt that it was not unreasonable to assume that the associated savings

would have increased due to the significant increase in referrals.

13.6 Mr Johnson noted that the project had been funded by the CCG since its inception as a pilot

and that contracts with Practices were in place until March 2019 and, although this did not

come under the remit of PCCC, a decision would be required into the future of the project by

the 31 October 2018.

13.7 It was felt that there was a significant opportunity to develop an integrated care model for Shropshire that brought together the range of care navigation services that currently were disparate and were failing to maximise benefit on patients or the health and care system. This included Social Prescribing and Healthy Lives.

13.8 Dr Lynch also recognised the value of the C&CC project and the links it had with other non-

clinical services (ie Social Prescribing and Healthy Living) and advised that she would be championing the resource with Jo Robins. Dr Lynch reported that as part of the national framework the impact on GPs and practices was being measured.

13.9 Dr Povey welcomed the role of the C&CC in general practice, but noted that there was

inconsistency across some practices in terms of what they did and felt that perhaps they should be embedded within the practice, although recognised the potential risks of employing the C&CCs directly.

13.10 Mrs Wilde reminded Members that the report was being presented as a result of discussion

around the 10 High Impact Changes and showed how the CCG was meeting these requirements. Mrs Wilde noted that the project would need to be linked with the Shropshire Care Close to Home Transformation Programme, but the decision on the future of the C&CC project was not for the PCCC but the wider CCG.

13.11 Mrs Randall-Smith advised that from a Healthwatch perspective patients were signpostd to

their services and were valued. 13.12 Mr Timmis felt that the value of the C&CCs needed to be captured but that the CCG needed

to be mindful of the links with the local authority around social prescribing to ensure there was no duplication.

RESOLVE THE PCCC RECEIVED AND NOTED the contents of the paper and how the

Community and Care Coordinators (C&CCs) were currently supporting the delivery of elements of the GP Forward View.

PCCC-2018-5-096 - NHS England Update 14.1 No report was received from NHS England. PCCC-2018-5-097 - Any Other Business 15.1 There was no other business raised. 15.2 Mr Timmis opened the meeting to questions and comments from members of the public.

These were noted as follows:

Councillor Karen Calder Councillor Calder referred to the various items being discussed and developed across both the CCG and local authority and noted that behaviour change would be fundamental to achieving this. In particular, Councillor Calder referred to the GPFV and the extended access survey, where she thought the behaviour of patients would need to change

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Mr Timmis took on board Councillor Calder’s comments and advised that the GP extended service had been nationally mandated and that in Shropshire it had been agreed to undertake a patient survey in order to understand patient need. Mrs Wilde clarified that it was mandated that the GP extended service be open 8am-8pm weekdays, but local arrangements could be made at weekends depending on the level of need, which was why the patient survey was being undertaken. Dr Povey noted that the GPFV was indirectly about patients, but that its main focus was to support general practice and redefine services and skill mix etc. Councillor Calder reflected on the development of a new primary care centre in Whitchurch and noted that the remit of the PCCC was to focus on the medical centre, but highlighted the CCG’s involvement in the Health & Wellbeing Board and its aim to address the wider determinants of health and wellbeing, including cohesion, social inclusion. Mr Timmis acknowledged the wider benefits to the Whitchurch population of the new primary care centre and the CCG’s involvement in this. However, Mr Timmis advised that he wanted to ensure the Committee focused discussion on the legalities of the OBC given it had delegated responsibility from NHS England. Councillor Calder noted that the out of hospital programme was now called Shropshire Care Closer to Home transformation programme and was concerned that greater focus was being given to the name rather than developing the programme. Dr Lynch acknowledged that there had been significant debate about the name of the programme, as it was felt that out of hospital did not encompass the whole remit of the project. Dr Lynch gave assurance that the programme had not been held back as a result.

Councillor Madge Sheinton Councillor Sheinton was pleased to note that the needs of Shropshire residents were

being considered in the areas of work currently being undertaken by the CCG. Furthermore, Councillor Sheinton welcomed the training and development of GP practice staff.

Councillor Sheinton referred to the integration of services and felt that consideration

should be given to access to transport not just access to services. PCCC-2018-5-098 - Date of Next Meeting 16.1 The next meeting was due to be held on Wednesday 13 June 2018, 9.00 am, in Meeting

Room K2, William Farr House, Mytton Oak Road, Shrewsbury SY3 8XL.

1

Agenda item: PCCC2018-6.112 Enclosure Number: 2

Shropshire CCG Primary Care Committee meeting: 13th June 2018

Title of the report:

General Practice Forward View – Progress Report

Responsible Director:

Nicky Wilde – Director of Primary Care

Authors of the report:

Steve Ellis – Head of Primary Care Phil Morgan – Primary Care Manager

Presenter:

Phil Morgan – Primary Care Manager

Purpose of the report: To provide a formal report to Primary Care Commissioning Committee on:

Overall delivery against the GP Forward View (GPFV)


The impact of the 2017/18 Resilience Fund

Key issues or points to note:

The General Practice Forward View (GPFV) sets out the resilience and sustainability plan for GP Practices and aligns to the main Five Year Forward View Plan. Primary Care Commissioning Committee (PCCC) has received regular update papers on the planning for local delivery of the GPFV in Shropshire.

The main, local planning and monitoring mechanism for the GPFV is a series of milestones and targets designed to assess overall delivery at a CCG and, in some cases, an STP footprint.

Progress against these milestones and targets are captured in a report submitted to the NHS England North Midlands GPFV Umbrella Group. This report (attached at Appendix 1) is produced on an STP footprint and shows the position as at 29th May 2018. The report contains summaries of the progress being made in the key GPFV workstreams.

The CCG is progressing well against most of the targets; where there has been a delay, further information is provided below.

The CCG continues to monitor the detailed milestones contained on the spreadsheet that has previously been provided to the Committee. Detailed plans, designed to support the high-level milestones, are being developed with the first of these, for workforce, completed.

The NHS England Staffordshire and Shropshire workforce project manager, Julie Downie, is continuing to meet with the GPFV Delivery Groups with a view to producing a series of local workforce plans which will link up to the STP Primary Care Workforce Plan.

2

Progress is being made in a number of the workforce projects including the provision of training and development for nurses and HCAs. The CCG is developing plans to bid into the recently announced NHS England Local General Practitioners Retention Fund.

The CCG’s GP international recruitment bid is still awaiting a decision.

Good progress is being made in improving joint working between practices in each locality, as a result of the funding provided by the 2017/18 Resilience Fund.

Actions required by Governing Body Members: Primary Care Commissioning Committee are asked to:

Accept that the monitoring of the delivery against the GPFV contained in Appendix 1 and in the content of this paper provides sufficient assurance to demonstrate progress towards delivery.

3

Monitoring form Agenda Item: Enclosure Number

Does this report and its recommendations have implications and impact with regard to the following:

1 Additional staffing or financial resource implications No

2 Health inequalities Yes All of the schemes and initiatives listed in this report, particularly

the larger ones, will need an Equality Impact Assessment to ensure that improvements to services reduce health inequalities or, at worst, do not worsen them.

3 Human Rights, equality and diversity requirements Yes All of the schemes and initiatives listed in this report, particularly

the larger ones, will need an Equality Impact Assessment to ensure that improvements to services are accessible to all.

4 Clinical engagement Yes Many of the schemes need clinical engagement, particular the plan

to extend access to GP appointments and many of the workforce initiatives – such engagement is being developed.

5 Patient and public engagement Yes Many of the schemes need patient and public engagement,

particular the plan to extend access to GP appointments. 6 Risk to financial and clinical sustainability No

If yes how will this be mitigated

4

NHS Shropshire CCG Primary Care Commissioning Committee

GP Forward View Progress Report – June 2018 Steve Ellis – Head of Primary Care

Phil Morgan – Primary Care Manager Introduction 1 The General Practice Forward View (GPFV) was published by NHSE in April

2016. The purpose of the document was to identify key actions which GP practices should take to secure delivery of Primary Care Services in the future.

2 Primary Care Commissioning Committee and CCG Board have previously

received papers on the CCG plans for delivery including the development of GPFV Milestones which are monitored by an NHSE “Umbrella” Group which monitors assurance across all the CCGs in Staffordshire, Shropshire, Derbyshire and Nottinghamshire.

3 In addition, the Committee has been previously informed of:

the development of the STP Primary Care Workforce Plan

the successful bids, made by each locality, to the 2017/18 NHS England Resilience Fund

4 The purpose of this paper is to provide a progress report to Primary Care

Commissioning Committee on:

Overall delivery against the GP Forward View (GPFV)


The impact of the 2017/18 Resilience Fund

Key messages: Overall delivery against the GPFV 5 Progress against the milestones and targets that are monitored via the joint

Shropshire CCG and Telford & Wrekin CCG spreadsheet is captured in a report that is submitted to the NHS England North Midlands GPFV Umbrella Group. This report, which is attached as Appendix 1, shows the position as at 29th May 2018. Each of the workstreams in the Umbrella Report are RAG rated and, this month, the ratings (along with commentary) are as follows:

Access: Amber – good progress is being made to develop pilots across the county, but more confirmation is needed on funding and timescales for delivery of the pilots. Further information is provided in a separate report to this committee

Workload/Resilience: Green – good progress is being made in delivering against the Resilience Fund and 10 High Impact Actions a series of case studies has been produced by the three localities,

showing how the 2017/18 Resilience Fund money was spent – see below for more detail on this.

the localities have also been asked to develop bids against the 2018/19 Resilience Fund which will be announced shortly by NHS England – see below for more detail on this.

Workforce: Amber – a robust delivery plan has been developed against the 15 projects in the Workforce Plan but more work is needed to complete the local Workforce Plans. Further information is provided on this below

5

ETTF: Amber – All of the projects are moving forward but previous delays have meant that delivery dates have been pushed back. E-consultation: The CCGs’ IT Forum has reviewed the specification of

a number of possible software applications. Practice staff (clinical and managerial) will be able to view the two main applications (EMIS and E-Consult) at a meeting on June 27th.

VoiP/WiFi: following discussions with the Midlands and Lancashire CSU and the supplier (Redcentric) an implementation plan has been agreed enabling VoiP/WiFi to be installed in all practices between June and September 2018.

Whitchurch Premises: following the appointment of a project board and project steering group further work will continue on the business case with a view to an FBC going to PCCC by May 2019

Shifnal new premises: further work will continue on the business case with a view to an OBC going to July PCCC

Models of care: Amber – Progress has been made in developing high-level plans around working at scale, but more engagement and operational detail is needed. Practices have been encouraged and enabled to work at scale in a

number of ways including the production of localised workforce plans, localised Practice Manager training plans and the development of pilots to deliver the extended access scheme on a localised footing.

The CCG continues to ensure that the scoping of its Shropshire Closer to Home programme is linked with the work on developing at-scale primary care.

Finance: Green – GPFV finances are being managed across all workstreams. all payments were made to practices for 2017/18 GPFV funds before

the end of the financial year. Funding for 2018/19 is likely to be released in June following approval of the practices’ GPFV delivery plans.

Key messages – Workforce 6 The NHS England Staffordshire and Shropshire workforce project manager, Julie

Downie, is continuing to meet with the GPFV Delivery Groups. Her work to date has been well-received by practices and has helped them in developing their local workforce plans which will link up to the STP Primary Care Workforce Plan. These plans are due to be produced by July 31st 2018 and will indicate, among other things, how the practices, in groups, are planning to develop and diversify their workforce.

7 Among the positive developments, as a result of these visits, is the identification of interest from some practices in the GP International Recruitment programme, possible bids to the NHS England Clinical Pharmacist programme and some interest in the recruitment of Physician Associates. A full report on this work will be provided to a future PCCC meeting, along with proposals for ongoing support from NHS England on workforce development.

8 The Workforce working group (a cross-CCG group) has been liaising with the STP Workforce Group and colleagues from HEE to both report on plans to spend funding allocations from 2017/18 and to develop bids for funding for 2018/19. The three main areas of funding from 2017/18, for which project plans have been agreed, are the funding of a GP workforce lead (the CCG has re-advertised this

6

role), fellowships for ST3s and/or recently qualified GPs and training and development for nurses.

9 Potential bids for 2018/19 funding include the development of a training scheme for Physician Associates, support/training for Clinical Pharmacists, further training for nurses/HCAs and funding for marketing and recruitment campaigns for general practice clinicians.

10 NHS England published, on 29th May, details of its new Local General Practitioners Retention Fund. The fund, which totals £7m, is allocated across the five regions with the Midlands and East region allocated £2.1m. Although there are no specific allocations for individual STPs the CCG is working with colleagues in Telford & Wrekin CCG, and NHS England, to develop a bid against this fund by the deadline of 29th June.

11 The guidance indicates that the fund should be used to “facilitate the establishment of local schemes and initiatives that enable local GPs to stay in the workforce, through promoting new ways of working”. The guidance identifies three, broad categories of GPs which could be assisted by the fund:

those who are newly qualified or within the first five years of practice

those who are seriously considering leaving general practice or are considering changing their role or working hours, and

those who are no longer clinically practicing by remain on the national performers list.

An update on this issue will be provided at the July PCCC meeting.

Key messages – Resilience Fund 12 The CCG was successful in bidding against the NHS England 2017/18 Resilience

Fund with a total of around £37k being secured, via individual bids from the three localities.

13 The funding was used, in all three localities, for the purchase and installation of GPTeamnet which has largely been achieved, with only a small number of practices not yet using this platform.

14 Feedback from practices on the positive impact that the use of GPTeamnet has had can be summarized as follows:

Communication, both internal and external has been improved

Many smaller, rural practices feel less isolated

The system encourages and enables collaborative working by ensuring that all practices have the same tools and information on key projects

Document sharing is made easier by the use of the central library with a bespoke search tool

Sharing policies and procedures amongst groups of practices facilitates joint working

Improved business continuity

The system frees up Practice Manager time

The shared calendar function assists in workforce collaboration

Shared learning from significant events is made easier

The system helps with preparation for CQC inspections and facilitates a consistent approach to the collation of evidence for the on-site visits

7

15 Although the installation of GPTeamnet is providing benefits to practices there

are a number of ongoing challenges identified by the practices:

Achieving 100% coverage for GPTeamnet installation across practices

Providing training to practice staff to enable them to use the system effectively

Greater use of functionality e.g. coaching and supervision, developing new models of care

Linking up with CCG use of GPTeamnet

Integrating with similar systems run by key stakeholders – e.g. the local authority

Building on work to date around sharing policies and protocols across groups of practices

16 Following the announcement by NHS England of the details of the 2018/19

Resilience fund in early May the CCG invited the seven GPFV delivery groups to develop bids against the fund. As with the 2017/18 fund, NHS England has not allocated specific amounts of funding to individual CCGs but it is anticipated that Shropshire CCG should receive around the same amount of funding as last year.

17 The GPFV delivery groups are developing bids that are aimed at delivering improved at-scale working, in line with the requirement on the CCG to encourage practices to form “primary care networks” of around 30,000 to 50,000 patients.

18 The outcome of the bidding process (which will be decided at an NHS England panel in July) will be provided to PCCC in a future GPFV update report.

Next Steps 19 The key milestones for the next two months in the work areas described above

are:

Developing Workforce Plans for each of the seven GPFV delivery groups

Submission of workforce funding bids to the STP Workforce Group

Developing the role of the lead GP for Workforce

Submission of Resilience Fund bids to NHS England

Roll-out of the implementation plan for VoIP and Wi-Fi

Support for practices in identifying suitable e-consultation products

Summary and Conclusion 20 Going forward, ongoing monitoring and reporting of progress against all aspects

of the GPFV will be provided to the Committee on both a CCG-wide footprint and in relation to the joint work across the STP footprint.

21 These reports will provide more detail about the effect GPFV is having on GPs

and Patients and how work to implement GPFV is linked to work around new models of care and Shropshire Care Closer to Home.

Recommendations Primary Care Commissioning Committee are asked to:

Accept that the monitoring of the delivery against the GPFV contained in Appendix 1 and in the content of this paper provides sufficient assurance to demonstrate progress towards delivery.

8

Appendix 1 – Shropshire STP report to the NHS England NM GPFV Umbrella Group

Purpose of this Report Bundle This report bundle provides a concise update on the overall position of each work stream and specific progress made in the last period. It sets out priorities for action in the next period and any new risks or issues identified and requiring the attention of the STP governance group(s) The bundle includes individual papers as follows:

1. Access Phil Morgan and Darren Francis

2. Workload including Resilience Funding Phil Morgan and Berni Williams

3. Workforce including Practice Manager funding Phil Morgan and Jane Sullivan

4. Nursing Workforce Helen Bayley

5. Infrastructure: Estates and Technology Transformation Fund (ETTF) and Digital

Nigel Crew, Antony Armstrong, Steve Ellis and Darren Francis

6. Models of Care Phil Morgan and Rebecca Thornley

7. Finance Roger Eades and David Court

Update Bundle: June 7th

2018

North Midlands DCO GPFV: Shropshire STP Report

9

Progress Status Key On schedule Behind schedule with

mitigating actions in place

Behind schedule

Abbreviation Key

GPFV General Practice Forward View

STP Sustainability and Transformation Plan

PM Practice Manager

ETTF Estates and Technology Transformation Fund

DCO Director of Commissioning Organisation

CEPN Community Education Provider Network

SRO Senior Responsible Officer

Risk Scoring Key

Probability

1. Rare The event may only occur in exceptional circumstances (<1%)

2. Unlikely The event could occur at some time (1-5%)

3. Possible Reasonable chance of occurring at some time (6-20%)

4. Likely The event will occur in most circumstances (21-50%)

5. Almost certain More likely to occur than not (>50%)

Impact

1. Insignificant No impact on GPFV outcomes, insignificant cost or financial loss, no media interest

2. Minor Limited impact on GPFV, moderate financial loss, potential local short-term media interest

3. Moderate Moderate impact on GPFV outcomes, moderate loss of reputation, moderate business interruption, high financial loss, potential local long-term media interest

4. Major Significant impact on GPFV, major loss of reputation, major business interruption, major financial loss, potential national media interest

5. Severe Severe impact on patient outcomes, far reaching environmental implications, permanent loss of service or facility, catastrophic loss of reputation, multiple claims, parliamentary questions, prosecutions, highly significant financial loss

IMP

AC

T

5 5 10 15 20 25

4 4 8 12 16 20

3 3 6 9 12 15

2 2 4 6 8 10

1 1 2 3 4 5

1 2 3 4 5

Probability

10

Work Stream Access Month covered

May 2018

Author Phil Morgan and Darren Francis Status

Summary Status:

The two CCGs (Shropshire and Telford & Wrekin) are working on the delivery of the national target (100% of the population to access pre-bookable and on-the-day GP appointments by 1

st October 2018).

Progress is being made in developing plans including engaging with key stakeholders and the development of pilot schemes to be launched ahead of the 1

st October deadline.

Ongoing support and advice will be sought, where needed, from regional and national colleagues.

A key piece of information that is needed from NHS England is confirmation of the funding arrangements for both 2018/19 and for future years.

Activities and Updates from the Last Period

1. Shropshire CCG practices have been asked to submit at-scale plans to set up pilots to deliver extended

access prior to the national deadline of October 1st 2018. Two such plans have been submitted, with

anticipated start dates of July/August 2018. Other plans are being worked up for an October start date. 2. For Telford & Wrekin a series of locality meetings has taken place to discuss plans for implementing the new

services from 1st October. Practices have been asked to submit plans to the CCG by the end of May 2018. It

is anticipated that there will be a good response to this request. 3. The patient survey has been rolled-out during May 2018. Approximately 1,500 responses, across both

CCGs, have been received. Key, clear messages include no appetite for Sunday appointments, limited interest in bank-holiday appointments and a good level of interest in using technology as an alternative to face-to-face consultations.

4. The GPAF scheme (provided by Shropdoc) has been extended and is now covering 100% of the population (for Shropshire CCG practices) with around 90 additional appointments per week. For Telford & Wrekin CCG coverage continues at 54%.

5. Further clarification has been sought from NHS England over the funding arrangements for both 2018-19 and 2019-20 onwards.

6. Further clarification has also been requested from NHS England on the weighting system to be used to calculate the funding and the gaps that result (approx. 10,000 patients for Telford & Wrekin and approx. 25,000 patients for Shropshire).

Actions Planned for Next Period

1. Subject to confirmation of funding, submission to NHS England of the detail of pilot schemes and subsequent

agreement of funding to enable these schemes to be launched ahead of the national deadline of October 1st.

2. Further meetings with groups of GPs and Practice Managers will be held during June to discuss further pilots 3. The results of the patient survey will be analysed with key messages reported to relevant stakeholders. 4. Information on the funding arrangements for 2018/19 from NHS England is needed by the end of June – i.e.

confirmation of funding gap due to weighting system being used and recurrence of funding after 2020.

Recommendations for the Umbrella Group

1. NHS England to provide clarity, in writing, around the funding for Extended Access in 2018/19 onwards and confirmation on the weighting system and funding gap that results. In the absence of this information there will be a risk to delivery in 2018/19.

New risks and issues that need input from the Umbrella Group – what do we need the Umbrella Group to do to help mitigate risks?

No. New Risk / Issue Risk Rating

Mitigation Support Requested

1.

Delays in NHS England providing clear information on 2018/19 funding will adversely affect the ability of the CCGs to plan for the new service.

16 Clear, prompt information on all aspects of the funding for the Extended Access scheme

2.

The possibility of the current GPAF provider not being able to provide the service to the end of the contract (30

th

September) following the award of the OOH contract in mid-July.

15 Increased focus on developing and delivering pilots in July/August

11

Work Stream Workload including Resilience Funding

Month covered

May 2018

Author Phil Morgan and Berni Williams Status

Summary Status:

The two CCGs are monitoring the spend and impact of the funds provided to practices from the 2017/18 Resilience Fund – this will be reported to relevant committees in the first quarter of 2018/19.

Practices have been developing at-scale bids against the 2018/19 Resilience Fund

The CCGs are liaising with the National Team to coordinate ongoing support for practices around the 10 High Impact Actions


1. Shropshire CCG has worked with the lead practices for its GPFV Delivery Plans, to monitor and report

impact and progress against the 2017/18 Resilience Fund. This has resulted in the production of a number of case studies showing how the money has been spent.

2. Both CCGs are working with their practices to develop bids against the 2018/19 Resilience Fund. 3. Following the 10 High Impact Actions event, run by the NHS England Time for Care team in February 2018,

the CCGs are working with the National and Team and other stakeholders to identify specific, ongoing training and development needs within the practices. A number of practices, and groups of practices, are in conversation with the national team with a view to including locally developed projects in programmes of work.

4. Telford and Wrekin CCG and the NHS England Time for Care Team are shaping an engagement programme to support further resilience.

5. Both CCGs have revised the milestones for the 10 High Impact actions to ensure that clear outcomes, where possible, are measured.


1. Progress against the 2017/18 Resilience Fund, including the case studies referred to above, will be reported

to Shropshire CCG’s June Primary Care Commissioning Committee (PCCC). 2. Telford and Wrekin CCG practices will complete a self-assessment on progress for the 10 High Impact

Actions. Progress will be reported to the CCG’s PCCC. 3. Further support will be provided to practices to assist them in developing their plans for working with the

national Time for Care team. 4. Bids will be submitted for the 2018/19 Resilience Fund. 5. Detailed actions will be developed to enable delivery of the 10 High Impact Action milestones

Recommendations for Umbrella Group

1. None




1. None

12

Work Stream Workforce including Practice Manager funding

Month covered

May 2018

Author Phil Morgan, Jane Sullivan and Rebecca Thornley

Status

Summary Status:

The NHS England Workforce Project Officer is working with practices, at scale, to develop local solutions to the recruitment and retention targets.

Project plans are being developed to ensure that individual funding pots, including for GP Fellowships, are accessed and used.


1. The NHS England Workforce Project Officer is working with practices, at scale, to develop local solutions to

the recruitment and retention targets. Interest in a number of schemes, including GPIR, Clinical Pharmacists and Physician Associates, has already been identified.

2. Practices in Oswestry, Shrewsbury and Telford are being asked to express interest in hosting healthcare support worker apprentices.

3. The cross-CCG workforce working group is developing project plans to ensure that individual funding pots are utilised. These pots relate to GP Fellowships (£40k) and an amount originally earmarked for UCP training (£12k). Given that there are no UCPs currently operating in Shropshire this funding will be used to support the development of clinical leadership for the projects in the workforce plan.

4. Shropshire CCG is making good progress in appointing a GP lead for workforce – this role will involve providing a strategic, clinical lead on all workforce issues and attending key local and regional meetings.

5. Practices, within groups and localities, are developing Practice Manager training plans. 6. Key projects within the workforce plan, including Physician Associates, have been discussed at the STP

Workforce Group. 7. Draft bids against the HEE/LWAB funds have been developed.


1. The NHS England Workforce Project Officer will continue to work with practices. In Shropshire CCG this will

result in the production of localised workforce plans, aligned to the STP Primary Care Workforce Plan. In Telford the Project Officer will engage with locality groups to understand current and future workforce needs and plans for recruitment and retention

2. A decision is expected on the GPIR bid – further actions will be discussed and agreed following this decision 3. The Shropshire CCG GP workforce lead will be recruited and start to engage with practices and other

stakeholders 4. Discussions about a possible PA scheme in Shropshire will be discussed at the June STP workforce meeting 5. Following the success of the CP bid in Shrewsbury, a series of next steps will be discussed and agreed 6. A project plan for the allocation of the GP Fellowships funding will be agreed 7. Plans to bid against the upcoming GP Retention scheme will be developed and agreed 8. Clarity on the status of the CEPN/Training Hub, associated funding and KPIs, will be provided by HEE


1. None




1. The IR application is approved but with lower numbers that originally planned

9 Review and amend the remaining targets in the Plan

13

Work Stream Nursing Workforce Month covered

May 2018

Author Helen Bayley and Rebecca Thornley Status

Summary Status:

The Shropshire STP GP Workforce Plan, which was re-submitted to NHS England in February, contains two specific project delivery plans relating to Nursing

These plans contain a number of milestones, designed to deliver against the specific recruitment and retention targets in the Workforce Plan.

Following the resolution of the employment status of the Practice Nurse Facilitators work is in hand to develop activities and projects designed to implement the 10 point action plan across both CCGs.


1. The Shropshire STP GP Workforce Plan, which was re-submitted to NHS England in February, contains two

specific project delivery plans relating to Nursing – one covers the National 10 Point Nursing Plan and the other is specifically focused on up-skilling HCAs

2. A number of milestones have been identified for both of these plans, designed to deliver both the additional Nurses that need to be recruited, and the upskilling and development work needed to ensure the retention of the current group of HCAs

3. The employment status, and ongoing roles, of the two Practice Nurse Facilitators who have previously worked for the CEPN has been resolved. The two members of staff are employed by Shropshire CCG but will work across both CCGs.

4. A project has been developed to use the nurse development fund (£40k) on prescribing training 5. Information has been provided to nurses, and other non-doctor clinicians, about HEE’s ACT funding proposal


1. The two project delivery plans will continue to be refined, with relevant detail added including timescales 2. Places on the prescribing course for nurses (funded via the £40k development fund) will be confirmed 3. The CCGs will be working with the DCO project manager to support the implementation of the GPN 10 point

plan. We are in the process of arranging meetings to further shape plans and clarify local need.


1. None




1

As this project delivery plan is new there has not yet been any risk assessment carried out. This will take place during June.

14

Work Stream ETTF Month covered

May 2018

Author Nigel Crew, Steve Ellis, Antony Armstrong and Darren Francis

Status

Summary Status:

All of the IT projects, funded through the ETTF, are now progressing following a lack of clarity over NHS England funding which contributed to delays in agreeing project plans. There have also been regional issues around procurement and delivery of some of the schemes.

Progress is also being made on the estates projects


1. Shropshire CCG’s IT Forum has reviewed the specification of a number of possible e-consultation software

applications. 2. An implementation plan for VoIP and Wi-Fi has been provided by the supplier of the WiFi and VoiP system

(Redcentric) 3. Shawbirch new premises: revised business case being finalised in advance of submission to PCCC in June

2018. 4. Whitchurch new premises: a project board and project steering group have been appointed and an outline

business case has been developed 5. Shifnal new premises: ongoing work on the outline business case continuing


1. The CCG will enable practices to view potential e-consultation products and then agreeing final timescales

for interested practices to choose suitable products. 2. The roll-out of VoiP/WiFi, in line with the implementation plan, will continue between June and September

2018 3. Whitchurch new premises: further work will continue on the business case with a view to an FBC going to

PCCC by March 2019 4. Shifnal new premises: further work will continue on the business case with a view to an OBC going to July

PCCC 5. Shawbirch: further work will continue on the business case with a view to an OBC going to June PCCC


1. None




15

Work Stream Models of Care Month covered

May 2018

Author Phil Morgan and Rebecca Thornley Status

Summary Status:

The CCGs are working with NHS England to develop actions that will assist both CCGs in identifying next steps around developing new models of primary care.

Both CCGs have begun the process of encouraging and enabling practices to work at-scale but it has been recognised that more work is needed to identify key issues around cultural change and organisational development.


1. The CCGs are working with the GPFV PMO on a local approach to developing working at scale within

practices, with particular emphasis on workforce. 2. The CCGs have produced a position statement on at-scale working and transformation that has been shared

with NHS England

Telford and Wrekin: 1. The four neighbourhoods continue to work at pace to develop at scale working. Service pilots are already

being designed and delivered with plans to deliver enhanced services at scale to ensure universal coverage together with extended access. The alliance contract has been drafted to support governance arrangements and is in the process of being reviewed.

2. Practices are being encouraged to broaden plans for back office collaboration in a number of areas which will again support at scale working – practices already share a DPO for GDPR.

3. Two functioning MDTs are now in place which enables the full vision of at scale working – bringing in community and local authority.

Shropshire: 1. Practices have been encouraged and enabled to work at scale in a number of ways including the production

of localised workforce plans, localised Practice Manager training plans and the development of pilots to deliver the extended access scheme on a localised footing.

2. The CCG continues to ensure that the scoping of its Shropshire Closer to Home programme is linked with the work on developing at-scale primary care


1. The CCGs will continue to work with the GPFV PMO on a local approach to developing working at scale

within practices and with the DCO on OD and Transformation plans.

Telford and Wrekin: 1. Currently planning T&W community needs workshop linked to estates enabling at scale working 2. Workshop to design an evaluation strategy with logic model to measure the progress of neighbourhood

working 3. Formalising a structure and mechanisms for full risk stratification and associated interventions across T&W

by the end of May – which will again support new models of care.

Shropshire: 1. Further engagement on the Shropshire Closer to Home programme will take place with practices 2. Development of milestones to reflect General Practice at scale plans


1. None




1 Lack of alignment between the at-scale primary care plans and the Shropshire Closer to Home programme

12 Involvement in the Out of Hospital Programme Board by the Director of Primary Care.

16

Work Stream Finance Month covered

May 2018

Author Roger Eades (Shropshire) Status

Summary Status:

This report provides an update on allocations and sources of funding and ETTF Risk.


1. All GPFV funding for 2017/18 has been made to practices


1. Shropshire CCG will be paying the 2018/19 transformation money to practices (£1.50 per head)

during the first quarter of 2018/19 2. Details of the arrangements for the 2018/19 extended access funding to be confirmed with NHS

England – this is needed to inform the planning for this project including the development of pilots during the period April to September

3. The CCG is in the process of receiving additional funding in respect of ETTF approved bids for telehealth and Skype.

4. Bids are in the process of being submitted by both CCGs for 2018/19 resilience funding.


1. None




1.

Lack of clarity over funding for Extended Access pilots from NHS England will delay the development of plan.

16 Prompt, clear information on funding from NHS England

1

Agenda item: PCCC-2018-6.113 Enclosure Number 3

Shropshire CCG Primary Care Committee meeting: 13th June 2018


Extended Access Planning


Nicky Wilde – Director of Primary Care

Authors of the report:

Steve Ellis – Head of Primary Care

Presenter:

Steve Ellis – Head of Primary Care

Purpose of the report: To provide a formal report to Primary Care Commissioning Committee on:

Current provision of extended access

Results of patient engagement

Planned pilot schemes

Planned rollout specification


The NHS planning guidance for 2018/19 has revised the national target to achieve 100% of population coverage of GP Extended Access from 1st April 2019 to 1st October 2018.

There are Seven core requirements that the Extended Access Service should adhere to, 4 of these apply in October, with the rest applying from April 2019.

The current GP Access Fund (GPAF) scheme, provided by Shropdoc across Shropshire, Telford & Wrekin and Staffordshire ends on 20 September 2018.

Two Practice led pilot schemes will begin in July, with an aim of running at full capacity by 1st September 2018. These schemes are based in Shrewsbury (provided by Darwin Health) and in Oswestry (provided by a consortium of the 3 Oswestry based practices)

Discussions are ongoing with practices in the North and South of the county to encourage groups of practices to provide this service.

Significant Patient Engagement has taken place through an engagement event in March and a patient survey held during May.

Funding has been centrally allocated based on population figures, though we are waiting on

2

final confirmed figures

A draft service specification has been produced

Provision has been made in the new Out of Hours contract for the new contract holder to provide 25 appointments per day at weekends and on Bank Holidays.

Actions required by Committee Members: Primary Care Commissioning Committee are asked to:

Note the contents of this report

Agree the service specification as set out in Appendix B

Agree the funding proposal as set out in Paragraphs 41 - 48

3




2 Health inequalities Yes The Extended Access Programme will need an Equality Impact

Assessment to ensure that improvements to services reduce health inequalities or, at worst, do not worsen them.

3 Human Rights, equality and diversity requirements Yes The Extended Access Programme will need an Equality Impact

Assessment to ensure that improvements to services are accessible to all.

4 Clinical engagement Yes Clinical Engagement is ongoing

5 Patient and public engagement Yes Results of patient and public engagement are detailed in this

report, there will be a need for further engagement work. 6 Risk to financial and clinical sustainability No

If yes how will this be mitigated

4

NHS Shropshire CCG

Primary Care Commissioning Committee – June 2018

Extended Access in Primary Care

Steve Ellis, Head of Primary Care

Background

2 The NHS Planning Guidance 2018/19 revised the national target to achieve 100%

population coverage of GP Extended Access from 1st April 2019 to 1st October 2018.

This October deadline is to be delivered without exception across all CCGs.

3 The trajectories submitted for all CCGs across the DCO currently show a significant

step change on 1st October (rather than a gradual increase in delivery month on

month). This has led to some nervousness that the target may not be delivered and

to mitigate this risk, Stuart Poynor, Director of Commissioning Operations (North

Midlands) has requested assurance from all CCG AOs that their CCG will deliver for

1st October 2018.

4 To provide some additional assurance, an interim target has been introduced and

CCGs will be performance managed on delivery. All CCGs will now be RAG rated

based on plans to deliver 80% population coverage by 1st September 2018.

Green More than 80% coverage by 1st September

Amber 50 – 8-% coverage by 1st September

Red Less than 50% coverage by 1st September

5 This paper provides details of the current actions and delivery outcomes the Primary

Care Team will deliver which will enable the targets to be delivered.

6 There are 7 core criteria which the extended access service should ultimately deliver,

however it is nationally and regionally recognised that not all will be deliverable by 1st

October. The minimum acceptable is delivery of 4 of the core standards as below:

Delivery of extended hours - Commission weekday provision of access to general practice services in evenings (after 6:30pm) – to provide an additional 1.5 hours a day, Commission weekend provision on both Saturdays and Sundays to meet local population needs

Capacity - Commission a minimum additional 30 minutes consultation capacity per 1000 population

Bookable appointments - pre-bookable and same day appointments

Advertisement of service – ensure services are advertised to patients,

including notification on practice websites, notices in local urgent care

services and publicity into the community, so that it is clear to patients how

they can access these appointments and associated service, patients should

be offered a choice of evening or weekend appointments on an equal footing

to core hours appointments.

Enclosure Agenda Item –

5

Current position:

7 The CCG has been part of an extended access pilot (GPAF), commissioned through

NHSE which is provided across Shropshire, Telford and Wrekin and Stafford and

Surrounds CCGs. The provider of the GPAF pilot is Shropdoc.

8 Originally there were 17 Shropshire practices who signed up for the GPAF scheme

(circa. 145,000 patients).

9 Shropshire CCG became aware of some unutilised funding as part of the GPAF

project and asked if the scheme could be expanded to cover all practices in

Shropshire CCG.

10 Shropdoc agreed to this and all practices in the CCG are now signed up to the

scheme through Data Sharing Agreements enabling the whole population to access

Extended Access appointments. The service is delivered from 8 locations across the

CCG, however does not meet the required 30min for 1000 population as the NHSE

target demands.

11 The NHS England contract with Shropdoc expires at the end of September and to

explore other delivery options, Primary Care Commissioning Committee agreed that

new demonstrator sites should be set up before longer term procurement could be

considered.

12 The Primary Care Team have been worked on the new commissioning model which

is detailed in this paper for approval.

13 For information the national Directed Enhanced Service (DES) for extended hours, is

a separately commissioned service and not connected to this new initiative, therefore

the hours provided under the DES are not included in this paper. The CCG is waiting

for further information from NHS England around the future of the DES.

Demonstrator sites / Pilots to commence by 1st September

14 By 1st September, there is a requirement to have over 50% of the population covered

by extended access in line with point 4 above. This will result in an Amber rating,

however Shropshire CCG would be aiming to secure over 80% by 1st September,

which will achieve a Green rating.

15 The allocation of funding will be based on the same methodology used in 2017-18.

Allocation populations have been calculated using the CCG primary medical care

allocations weighted populations. These weighted populations are predicted until

2020-21 using ONS projections. The CCG primary medical care allocations weighted

populations are not the same as the sum of the Carr-Hill formula weighted practice

populations in the CCG as they use different weighting methodologies.

16 The CCG primary medical care allocations weighted population for the extended

access programme for Shropshire is 300,109 which compares to a Carr-Hill Formula

population of 328,732 and an actual population of 309,098 (Q4 2017/18).

6

17 To ensure delivery of the 80% target, the Primary Care Team have contacted groups

of practices to establish the appetite to deliver early implementation of the extended

access by 1st September. These early implementers will be funded by NHS England.

These schemes would continue until the end of March 2020 which is when the

current financial allocation from NHSE ends.

18 Two groups of practices have so far shown an interest in early implementation.

19 Oswestry Pilot – The 3 practices in Oswestry Caxton, Cambrian and Plas Ffynon,

have put together a plan to cover 35,613 weighted patient population. This

represents 10.8 % of the overall CCG weighted population.

20 The scheme will initially deliver Monday – Friday, 6.30pm – 8.00pm and will enable

clinicians to view and edit patient records from all the practices provided that patients

agree to have their record shared.

21 The planned pilot will begin in July 2018 and will reach full capacity (30 mins per

1000) by the end of August 2018. For the purposes of the pilot, each practice in

Oswestry will operate as the hub location on different weeks. This element of the

service will require evaluation to ascertain patient satisfaction, as opposed to a more

regular pattern of hub locations.

22 The Oswestry pilot will affect the overall CCG position as follows:-

Scheme Number of Practices

Weighted population covered

Population (Weighted) mins/1000

% overall CCG population (weighted) at 30mins/1000

GPAF 38 293,119 13 mins

GPAF (@ 30mins/1000)

124,000* 30 mins 37.7%

Oswestry pilot 3 35,613 30mins 10.8%

Total 41 328,732 48.5%

23 Shrewsbury pilot - The 11 Shrewsbury practices operating as Darwin Health have

submitted a plan covering their 89,111 weighted patients.

24 This plan identifies fixed hubs operating on regular days of the week apart from a

Friday which is planned to rotate around practices. All practices will be able to

directly book their patients into the extended access appointments via Emis.

25 The plan provides appointments Mon – Friday, 6.30 – 8.00pm plus Saturday and Sunday mornings and will enable clinicians to view and edit patient records from all the practices provided that patients agree to have their record shared. This delivery plan will also reach full capacity by the end of August and affect the position as below:

7

26 As at 31st August, and if all pilots progress as planned the coverage of the CCGs

weighted population for the core standards identified in 4 above is 75.6%.

27 However, 100% of patients will still have access to the GPAF scheme and this is

identified by the * figure in the table above. These patients however will not meet the

4 core requirements and therefore are not included in the delivery trajectory.

28 To enable these pilots to be successful there are IT requirements to be secured and

discussions are ongoing with supplies around lead in times for these:

EMIS Community Services Hub – Ordered for the Pilots

Remote Consultations – Ordered for the Pilots

Early implementation of Docman 10 – Priority list given to Docman

Cloud version of the dictation software, Speechwrite to be enabled – Awaiting

further details from Speechwrite.

Additional IT Support provision until 8pm and at weekends – awaiting costs

from MLCSU.

Current gap in provision

29 The plans above show 75.6% coverage by 1st September.

30 Due to the current GPAF pilot ceasing from 1st October, practices not covered by one

of the new pilots identified above will no longer be part of an extended access

scheme. The CCG therefore needs to secure coverage of these 27 practices as well

as the pilots already identified.

31 Representatives from the South Locality (including OHP Practices) met in early May

to discuss providing Extended Access appointments as a group. This would involve a

number of practices operating as hubs with the other practices able to directly book

appointments for their patients. There is a further meeting on 14 June to develop this

model further. It is anticipated that they will be in a position to begin delivering

appointments by 1st October 2019.

32 The primary care team have a planned meeting, on 25 June, with interested

practices in the North of the county to work through potential models of delivery.

Scheme Number of Practices

Weighted population covered

Population (Weighted) mins/1000

% overall CCG population (weighted) at 30mins/1000

GPAF 27 204,008* 18 mins

GPAF (@ 30mins/1000)

27 124,000 30 mins 37.7%

Oswestry pilot 3 35,613 30mins 10.8%

Shrewsbury pilot 11 89,111 30 mins 27.1%

Total 41 328,732 75.6%

8

33 Knockin Medical Practice are currently in discussion with the Oswestry practices

around the possibility of joining their scheme by 1st October.

34 There are a number of rural practices in ‘Outer Shrewsbury’ that do not have an

obvious hub, and transport links align them more closely to Shrewsbury than one of

the other hubs. The potential solution will be clearer following the planned meeting on

25 June.

35 The proposed hub model to provide 100% coverage from 1st October will be

confirmed at a future PCCC meeting, once further work has been undertaken with

Practices.

36 To provide additional coverage for pre-bookable appointments over weekend and

bank holidays, and as an additional mitigation, capacity has also been included in the

out of hours tender. The outcome of the tender will be known in July 2018. The

contract requires the contract holder to provide 25 appointments per day on

Saturdays, Sundays and Bank Holidays. Further information will be provided upon

award of the tender.

Patient Involvement

37 The CCG has a duty to involve patients in the planning of services. Together with

Telford and Wrekin CCG, a patient survey has been undertaken to identify the patient

need specifically for weekend and bank holiday cover.

38 The survey has now closed, and 1758 responses have been received across

Shropshire and Telford and Wrekin CCGs. 86% (1513) responses have been

received from Shropshire CCG patients.

39 Whilst there are still approximately 100 hard copy forms to be formally recorded a

summary of the outcomes is provided below:

12% of respondents state that they would not give permission to have their

medical details shared and therefore would not be able to access extended

hours.

82% are able to attend appointments between 8.30am and 6pm.

33% prefer to see a GP in the evenings

36% prefer Saturday mornings and only 1.5% would prefer a Sunday.

48% said that they could attend anytime over the weekend.

Interestingly 22% would request an appointment on a bank holiday

There is a mixed response to whether people would be prepared to go to a

different GP practice in the evening or at the weekend – 36% Yes, 36% Maybe,

28% No.

42% are prepared to travel up to 5 miles and 46% are prepared to travel up to 10

miles to get to a different practice to access the service.

There is a good level of interest in different consultation types – 51% telephone,

17% email and 19% video/Skype

9

40 There is very little variance around these figures when they are split by locality, the

statistical validity of the results is affected when looking at groups much lower than

10 practices.

41 The full report is attached at appendix 1

Funding

42 NHSE have indicated that they will fund the new early implementer pilot schemes

with £108,105, though we are still awaiting final written confirmation. This funding

would be passed directly to the pilot practices that are delivering the service and

work with the CCG to address any delivery issues before full coverage on 1st

October.

43 For the 6 months October 2018 to March 2019 funding is £3.34/patient and for the

financial year 2019/20 - £6/patient.

44 The CCG has not been made aware of any funding commitment from NHSE from

April 2020 and therefore can only commit to commissioning the service up to this

date. When long term funding is allocated, the CCG will commission the full service.

45 The available funding is detailed above and the CCG has benchmarked the use of

this funding across all CCGs in the DCO. This has revealed a wide variance in how

the £6 per patent is being used from giving practices the full £6 per patient to only

£4.50. The amount paid is directly related to slight differences in services

specifications and the activity and reporting required from providers.

46 Shropshire CCG will use some of the allocated funding centrally for IT costs, project

management costs and to fund the additional weekend and bank holiday

requirements by the new Out of Hours provider.

Grand Total

Estimated Population 300,109

£6/patient £ 1,800,000.00

IT Costs £ 108,000.00

OOH Contract £ 100,000.00

Project Management £ 32,000.00

£6 less costs £ 1,560,000.00

£5.20/pt £ 1,560,566.80

Hours/week (provided by Practices) 137.5

Hours Provided by OOH/week 12.5

10

47 Bank Holiday appointments are also commissioned via the OOH provider and are in

addition to the 12.5 hours noted in the table above.

48 The NHSE England guidance states that although the initial requirement is for 30

minutes/1000 this will increase to 45 minutes/1000 in the future, with no additional

funding being forthcoming.

49 Given the above, we would propose paying providers £5.20/pt with £3.50 being

recurring and £1.70 being for year one only to support implementation costs of

providers. This would then enable the CCG to formally offer the additional £1.70 to

increase capacity to 45 minutes/1000 when requested by NHS England.

50 NHSE have verbally offered £163,995 additional funding to mitigate for the difference

in population weighting noted in paragraphs 14 & 15. This sum is not included in the

table above as we have not yet received written confirmation.

Service Specification

51 The service specification offered to practices contained the elements required by

NHSE, although the actual specification is not a nationally agreed specification. The

draft is attached at Appendix 2 for approval.

Assurance level

52 By 1st September and based on the actions identified above and the level of

engagement with practices so far, we anticipate that RAG rating for 1st September

will be at least Amber at 75.6% - the Primary Care Team will continue to work with

practices to increase this to 80%.

53 The assurance of delivery by 1st October for 100% coverage is to be delivered

without exception. The Primary Care Team will be able to provide assurance of this

within the next month, however are confident that the 100% target will be achievable.

Recommendations

54 PCCC is asked to


Agree the service specification as set out in Appendix B

Agree the funding proposal as set out in Paragraphs 41 - 48

Enclosure 3a -Appendix 1. Extended Access Survey Data Report – Summary

The survey was available both on-line and in hard copies between 30/04/18 and 25/05/18.

In total, there were 1,513 responses

71% of the respondents were female

49% of the respondents were aged 56 and over

12% of respondents state that they would not give permission to have their medical details

shared (the following data includes these respondents – however, there is very little difference

with the results if these 12% are excluded from the data).


39% have difficulty in getting an appointment when they need one

48% prefer to see a GP in the morning, 19% in the afternoon and 33% in the evenings

In terms of weekends, most (45%) would prefer any of the slots, and 36% prefer Saturday

mornings – only 4% want Saturday afternoons, 1 % Sunday mornings and 0.5% Sunday afternoons.

There is a mixed response to whether people would be prepared to go to a different GP practice

in the evening or at the weekend – 36% Yes, 36% Maybe, 28% No.

42% are prepared to travel up to 5 miles and 46% are prepared to travel up to 10 miles to get to a

different practice

51% would be interested in a telephone consultation, 17% via email and 19% via video/Skype

22% would request an appointment on a bank holiday if one were available.

Oswestry Pilot Area (Cambrian, Caxton, Plas Ffynnon and Knockin)

The following are the key points as at 4th May, with 113 responses (61% female, 55% aged 56 and over):

8% of respondents state that they would not give permission to have their medical details shared.




In terms of weekends, most (48%) would prefer Saturday mornings, 31% would prefer any of the

slots, only 4% want Saturday afternoons, 1 % Sunday mornings and 1% Sunday afternoons.




different practice

There is good interest in other consultation types – 50% telephone, 11% email and 15%

video/Skype

19% would request an appointment on a bank holiday.

Darwin Pilot Area (Belvidere, Claremont Bank, Marden, Marysville, Mytton Oak, Radbrook Green,

Riverside, Severnfields, South Hermitage, The Beeches, Worthen)

The following are the key points as at 4th May, with 278 responses (68% female, 41% aged 56 and over):

13% of respondents state that they would not give permission to have their medical details

shared.




In terms of weekends, most (41%) would prefer Saturday mornings, 35% would prefer any of the

slots, only 4% want Saturday afternoons, 1 % Sunday mornings and 1% Sunday afternoons.




different practice

There is good interest in other consultation types – 54% telephone, 19% email and 19%

video/Skype

20% would request an appointment on a bank holiday.

Detailed Assessment

1. Response Rate

In total there were 1,513 responses from Shropshire CCG registered patients.

The response rated varied between practices with eight practices having fewer than 10 patient responses

each, whereas other practices had many more, with the highest return being 349 responses. It is clear that

there is a correlation between those practices with high numbers of responses and their marketing of the

survey via their website, local media and training for practice staff.

2. Breakdown of Respondents

Gender – the overwhelming majority (71%) of respondents were female

Age – just under three quarters (73%) of the respondents were of normal, working age

Disability – most respondents (83.7%) don’t consider themselves to have a disability

Ethnicity – the overwhelming majority (96.4%) of respondents were British

3. Permission to share medical details – the vast majority (87.7%) of respondents said that they would

agree to sharing their medical details

4. Attending normal surgery appointments – most respondents (82.4%) said that they could attend

appointments during normal opening hours

5. Access to normal practice appointments – over half of respondents (61%) don’t have difficulty in

getting an appointment when they need one, but 39% do have a problem with this.

6. Reasons for difficulty in attending during normal working hours – for most people who said they had

a problem attending during normal opening hours, this was because no appointments were available

7. Times of appointments with a GP or other health professional from Monday to Friday – just under

half of respondents (48.3%) preferred a morning appointment, but just under a third (32.6%) would

prefer an evening appointment (this rose to 47% for people of normal, working age).

8. Weekend appointments – most respondents (44.7%) would prefer any weekend slot and 36% would

prefer a Saturday morning appointment. Less than 2% would prefer a Sunday appointment.

9. Going to a different GP practice for a routine appointment in the evening or at the weekend – most

people (72%) would definitely, or probably, go to a different GP practices for a routine evening or

weekend appointment

10. Travelling distance for appointments at a different GP practice, in the evening or at a weekend –

most people (89%) would be prepared to travel, with nearly half saying they would travel up to 10

miles.

11. Transport to evening or weekend appointments in a different practice – the vast majority of people

(89%) would use their own vehicle to get to an evening or weekend appointment at a different

practice

12. Different types of appointment for evening and weekend appointments – although most people

prefer face-to-face appointments, over half (51%) would choose a telephone appointment, 17.3% an

electronic appointment and 19% a video/skype consultation.

13. Routine (non-emergency) appointments on Bank Holidays – the vast majority of respondents (78%)

would not request a normal, routine appointment on a bank holiday.

Free-text responses

The broad categories of comments were as follows:

Suitability of evening and weekend appointments

A large number of responses referred to the importance of enabling people who normally worked

9 – 5 Mon – Fri to access appointments at evenings and weekends

Similar comments were made for people who work shifts, parents with dependent children who

wanted to attend on their own without their children and people who work away from the area

Within the many positive comments about weekend and evening (predominantly Saturday)

appointment were many suggestions about trying reserve/prioritise these appointments to

specific groups of patients – i.e. those working full time, people with one-off queries/problems

etc.

Concerns over the impact of extended access

Many patients were concerned around the clinical safety of requiring clinicians to work longer

hours and of them having to see more patients whom they had not previously seen

A large number of responses expressed concerns around the problems there would increasingly

be around recruitment of GPs and retaining existing GPs if they were being required to work

longer hours – the GP work/life balance is seen as important

Other concerns were expressed about the impact that extended access appointments would have

on the availability and number of core hours appointments

Cost effectiveness

Some patients questioned the cost-effectiveness of an extended access service if payments to

clinicians were high and potential take-up was low

Notwithstanding this, some patients thought that, if there was new funding, it should be kept

within the practices

Linked services

Concerns were expressed around patients’ ability to access a pharmacy if they were attending

evening appointments, especially where the practice was not near a large supermarket

Some patients thought that linking the service to existing pharmacy services might take some of

the strain off GPs

There were also concerns around access to test results

Links to A&E and OOH

Some patients queried why the Out of Hours service shouldn’t be providing evening and weekend

appointments

Others thought that an extended access service might have a positive impact on A&E attendance

Benefits of evening and weekend appointments

Many commented that such appointments were good for one-off, specific medical issues, rather

than for discussion of ongoing conditions

Concerns over travel

Many responses emphasised the need to ensure that public transport links should be considered

in the design of the extended access service

Others commented on the potential longer distances that people would have to travel to access

extended hours appointments

Concerns over continuity of care

This was a major theme of the comments with many respondents raising the issue of the

importance of continuity of care and the negative impact the extended access scheme would have

on this

Patients were concerned about the ability of GPs/other clinicians to properly assess and deal with

ongoing conditions where medical histories were complex and detailed

Using technology

The comments reflected the survey findings that some patients are keen to utilise technology

(Skype and on-line consultations) to reduce the need to physically attend practices

Other patients thought that email queries/consultations would be a useful way of managing

demand

Bank Holidays

The comments relating to bank holidays were overwhelmingly negative – i.e. saying that there is

no need for bank holiday appointments

Practicalities of the Service

A plea from many respondents was the new service should be easy to book, both on-line and by

phone and should be well-publicised

A few comments made the point that the service should be accessible to people with disabilities,

including those people with hearing difficulties

1


Shropshire CCG P.C. Committee meeting:


Primary Care Committee Finance Report


Claire Skidmore

Author of the report:

Roger Eades

Presenter:

Claire Skidmore

Purpose of the report: To inform the Primary Care Committee of the financial position of the Delegated Co-Commissioning Primary Care services to month 1, April 2018.


The Co Commissioning budget for 2018/19 has been uploaded to the finance system.

The spend for 18/19 is within the budget allocation received for month 1.

The CCG & NHSE finance team continues to scrutinise all areas of the delegated budgets.

Actions required by Governing Body Members:

Note the position reported at month 1.

2



1 Additional staffing or financial resource implications No If yes, please provide details of additional resources required

2 Health inequalities No If yes, please provide details of the effect upon health inequalities

3 Human Rights, equality and diversity requirements No If yes, please provide details of the effect upon these requirements

4 Clinical engagement No If yes, please provide details of the clinical engagement

5 Patient and public engagement No If yes, please provide details of the patient and public engagement

6 Risk to financial and clinical sustainability No If yes how will this be mitigated

3

Introduction: The 18/19 budget has now been uploaded to the finance system as detailed in the analysis below. Reports on actual and forecast expenditure are not produced at month 1. Current Position: With the team being involved in the production of the 2017/18 year end accounts, in line with other parts of the NHS, no formal financial position was recorded for month 1.This report therefore confirms the 18/19 budget for PCCC as approved at a previous meeting. The usual monthly format of summary and detailed analysis will be presented in the month 2 report.

Budget Notes Local Reserves The local reserve represents the projected overspend when the budget was agreed in March 18, with regards to expenditure against the budget envelope. It is anticipated that savings during the year can be achieved to generate the projected break-even position, however the management team recognise that we do have a number of significant challenges to meet during the year. Budgetary Cost Pressures Since the committee signed off the 18/19 budget and the last finance report in April, the CCG has continued to review expected spend and an additional pressure relating to the consolidation of the Whitchurch practices has been identified. This will have an additional £120k impact on the position which will not be covered by central funding Five Year Plan The team are currently working on a five year plan that will presented as part of the papers submitted to the Committee with the June 18 finance position in July. This work includes looking at the impact of changes in a number of areas over the coming five years; particularly with regards to premises costs both prior commitments and also future ones already agreed by the Committee as well as other cost pressures within the subjective descriptions noted above. It is hoped this plan can assist in making future decisions to improve Primary Care within our agreed budget allocation.

Month 1 Financial Position

Month 1 April 18

Subjective Description

Annual

BudgetYTD Budget YTD Actual

YTD Variance Forecast M1

(£) (£) (£) (£) (£)

Premises Costs Reimbursements 5,115,317 426,276 426,276 0 4,968,256

General Practice GMS 27,638,396 2,303,200 2,303,200 0 27,638,396

Enhanced Services 946,224 78,852 78,852 0 946,224

QOF 4,515,204 376,267 376,267 0 4,515,204

Dispensing & Prescribing 2,324,509 193,709 193,709 0 2,324,509

General Practice PMS 367,234 30,603 30,603 0 367,234

General Practice APMS 1,199,120 99,927 99,927 0 1,199,120

Other GP Services 1,132,317 94,360 94,360 0 1,132,317

Reserves 0.50 Contingency 216,740 18,062 18,062 0 216,740

Local Reserves (147,061) (12,255) (12,255) 0 0

TOTAL 43,308,000 3,609,000 3,609,000 0 43,308,000

* For further information on the contents of the subjective descriptions above,see Appendix 1

1

Agenda Item PCCC-2018.6.115 Enclosure Number 5

Shropshire CCG Primary Care Commissioning Committee – Part 1: 13 June 2018


Primary Care Committee Risk Register


Nicky Wilde, Director of Primary Care



Presenter:


Purpose of the report: To provide Primary Care Committee with an update to the Risk Register for approval


There are currently 7 identified risks, 4 rated as Red and 3 as Amber

Details on the risks are contained in the report and in Appendix 1

Actions required by Primary Care Commissioning Committee Members: Primary Care Commissioning Committee are asked to:

consider and agree the risks identified in Appendix 1.

2

Monitoring form



2 Health inequalities No

3 Human Rights, equality and diversity requirements No

4 Clinical engagement No

5 Patient and public engagement No

6 Risk to financial and clinical sustainability No

3

NHS Shropshire CCG

Primary Care Commissioning Committee March 2018


Nicky Wilde, Director of Commissioning

Executive Summary

1. To ensure that all the risks identified by Primary Care Commissioning Committee (PCCC) are recorded and mitigated appropriately, a PCCC Risk Register has been produced.

2. The risk register currently consists of 7 risks, 4 are rated as Red, 3 as Amber.

3. Primary Care Committee is asked to consider and agreed the risks identified in Appendix 1

Introduction

4. A risk register is an important component of the overall risk management framework and records all identified risks of a project or programme of work.

5. There are currently 7 risks highlighted on the PCCC Risk Register which have

identified control, levels of assurance and key actions to provide mitigation.

Key Points to note

6. Out of the 7 risks highlighted on the PCCC Risk Register, many have been on-going for some time.

7. The risks which are highlighted as Amber are those where actions are actively being

delivered to provide the required mitigation with the anticipation that these will be removed in the next 3 months, when it is anticipated that a request will be made to Committee to remove these risk from the Register. However, these risks remain amber since the last register was reported to Primary Care Committee.

8. There are 3 actions which currently attract an amber risk rating for Primary Care Commissioning Committee:

9/14 - Quality Assurance of Primary Care Medical Services

10/14 – Risk of communication and engagement with the wider CCG team, CCG members and the public is insufficient – a draft Communications Plan was presented to PCCC in April and we are currently awaiting a final plan which will further mitigate this risk.

11/14 – Risks associated with premises developments affecting several practices in Shropshire. Progress has been made on these premises developments but we are not yet in a position to move the risk to low.

9. There are 4 actions currently logged as red, and the ratings have not changed since the last risk register was reported to Committee:

4

3/14 - Avoidance of underspend against primary care budget

5/14 - Failure to recruit and retain GPs and nurses in Shropshire which is mirrored nationally.

6/14 - Risk of not meeting 7 day target to offer extended access across primary care by 2019/20.

7/14 - Failure to develop neighbourhood working/integrated models of care across Shropshire

10. At March 2018 PCCC, Risk 3/14 was left at red until the new financial year and the

CCG had a complete view of finances.

11. Risk 5/14 has been mitigated with the approval of the Primary Care Workforce plan and the subsequent work done on locality workforce plans. The focus now is on completion of the locality plans and the delivery of those plans. Once that phase has started, there will be an opportunity to review and possibly reduce the risk.

12. Risk 6/14 is part of the GP Forward View, however is specifically related to the 7 day working in Primary Care. Significant progress has been made in planning this, including patient engagement, the set-up of pilot sites and the engagement of practices. NHSE has the CCG rated as ‘Amber’ following the development of those plans and this risk could be reduced to Amber in the next risk register report due September 2018.

13. Risk 7/14 is highlighting a risk around neighbourhood working and integration of models of care across Shropshire. This risk should remain red until the CCG has agreed the Out of Hospital Model and the new model for Primary Care is agreed. Actions will then be agreed to enable this risk to be removed from the Register.

Recommendations

14. PCCC are requested to consider and agree the risks identified in Appendix 1.

Principle Risk Key Controls

'What controls / systems are in place to manage the risk'

Source of Assurance

Where can we gain evidence (internal or external)

that our controls / systems

on which we are placing our

reliance are effective?

Assessme

nt of risk

level - Low

/ Medium /

High /

Extreme

Risk

Action / Lead Name /

Timescale

‘Action to be taken’

Assessme

nt of risk

level - Low

/ Medium /

High /

Extreme

Risk

L I Rating L I Rating

PCCC 3/14

There is a risk that underspend against

primary care budget will fail to deliver

financial balance for delegated primary care

Regular and formal meetings between CCG finance and

Director of Primary Care undertaking a deep dive of the

budget reports and supporting information

Reformatting PCCC finance report

Regular meetings with CCG and NHSE finance and

contracting team are ongoing

Formal reporting to Primary Care Committee 3 3 9 High Left at Red following March

PCCC - due to be reviewed

in Q1 2018/19

2 2 4 Medium

PCCC 5/14

Failure to recruit and retain GPs and nurses

in Shropshire which is mirrored nationally.

This will impact on local GP workload and

the delivery of transformational primary care

in Shropshire.

Primary Care workforce plan has been written, there is a

regular internal Workforce group meeting and a wider

delivery group planned.

Practice grouplevel Workforce delivery plans due at end of

July.

Primary Care Committee

NHSE Programme Management Office

3 4 12 High Regular workforce

meetings now being held

and detailed plans are

being developed. A clinical

workforce lead is being

recruited - Lead Helen

Bailey/Phil Morgan

3 3 9 High

PCCC 6/14

Risk of not meeting 7 day target to offer

extended access across primary care by

October 2018.

Part of the GPFV programme of work and plans submitted

and approved by NHSE

High level target dates and actions in place

Head of Primary Care and Primary Care Manager

appointed to lead on implementation



3 3 9 High Pilot sites due to go live in

July/August (Shrewsbury &

Oswestry). Lead Steve Ellis

2 3 6 Medium

PCCC 7/14

Failure to develop neighbourhood

working/integrated models of care across

Shropshire will affect delivery of new

services following the Out of Hospital

services review.

Part of GPFV programme and also connected with the STP

out of hospital programme



STP programme

3 4 12 High Formal plan needs to be

agreed once the out of

hospital framework is

approved locally - Lead

Steve Ellis

2 3 6 Medium

PCCC 9/14

A lack of Quality Assurance of primary care

medical services could lead to the CCG

being unaware that practices may be failing

to deliver services correctly

Maintain and build relationships with GP practices to

monitor quality standards. Update quality dashboard

regularly.

21-08-2017 Lead Nursing and Quality lead for primary care

identified who will work to align activity undertaken by

medicines optimisation team, infection prevention and

control team, safeguarding teams, CQC and others to

ensure the quality dashboard reflects the patient safety,

patient experience and patient outcome indicators

accurately

CQC reports and regular meetings with CQC.

Regular liaison with NHSe. Quality dashboard

updated and presented with PCWG and PCCC

quarterly. Annual practice Support/quality visits to

be scheduled. Regular reporting to Quality and Audit

Committee on risks and achievements

2 2 4 Medium Lead is Dawn Clarke 1 2 2 Low

PCCC 10/14

Risk of communication and engagement

with the wider CCG team, CCG members

and the public is insufficient to understand

the needs and preferences of the practices

and patient population when develoing new

services.

Primary Care work plan and CCG priorities to be

communicated to members regularly.

Communication and Engagement plan to be agreed. First

draft was presented to Primary Care Commissioning

Committee April 2018

Regular reporting to GPFV PMO lead at NHSe and to

CCC and Gov Body. Regular reporting to PCCC and

locality boards. GP newsletters.

2 2 4 Medium Lead is Sam Tilley/Andrea

Harper, working closely

with the Primary Care

Team

1 2 2 Low

PCCC 11 /14

Risks associated with premises

development affecting several practices in

Shropshire for various reasons (the

individual practices are not named in this

register). If appropriate premises are not

secured, there is a risk that the affected

practices may hand back their GMS

contracts

Conversations are ongoing with practices, NHSE and

NHSPS. Premises meeting with key stakeholders June

2017.

Routine reporting to Primary Care Commissioning

Committee

Improvement Grant process approved by Primary Care

Commissioning Committee in August 2017


NHS England

2 2 4 Medium Lead is Steve Ellis. next

actions are to continue to

take forward the indiviudal

practice schemes with

regular reporting to PCCC.

2 2 4 Medium

Appendix 1 - Primary Care Risk Register

Current Assessment

L= Likelihood

I = Impact

Residual Target Risk Score (after

actions completed)

1


Shropshire CCG Primary Care Commissioning Committee – June 2018


Delegated Primary Care Priorities 2018/19





Presenter:


Purpose of the report: Primary Care Commissioning Committee (PCCC) is the corporate decision-making body for the management of the Primary Care delegated functions. This paper asks PCCC to approve the 7 delegated Primary Care Priorities to be delivered in 2018/19.

Key issues or points to note: There are 7 priorities for Delivery:-

GP Extended Access 8am – 8pm 7 days a week, evidenced by local need. A Primary Care Workforce plan addressing recruitment and retention issues in Primary

Care and introducing a wider clinical workforce to support GPs. Development of Primary Care Hubs to support “at scale” working, resilience and

sustainable Primary Care Detailed review of Primary Care estate finances An assurance level of Significant from internal audit All 10 high impact actions as outlined in the GPFV delivered by all practices within the

CCG A balanced financial plan

Actions required by Primary Care Commissioning Committee Members: Primary Care Commissioning Committee are asked to:

Agree the delegated Primary Care Priorities for 2018/19 and the associated reporting schedule.

2




Achieving financial balance and supporting the Primary Care Workforce are included in the Recommended priorities.


Not specifically, however individual projects will ensure any related health inequalities are addressed


Not specifically, however individual projects will ensure any related issues are addressed

4 Clinical engagement Yes

The CCG works closely with all the GP Practices to ensure clinical engagement of the delivery of the priorities

5 Patient and public engagement Yes

There is a Primary Care Communications plan in place and an engagement plan is currently being developed.

6 Risk to financial and clinical sustainability Yes

Achieving financial balance and supporting the Primary Care Workforce are included in the Recommended priorities.

3

NHS Shropshire CCG




Executive Summary

2 Primary Care Commissioning Committee (PCCC) is the corporate decision-making body for the management of the Primary Care delegated functions.

3 This paper asks PCCC to approve the 7 delegated Primary Care Priorities to be delivered

in 2018/19.

4 Papers providing detailed progress reports will be submitted to PCCC as the projects progress and a formal assurance report against the 7 priorities presented to Committee quarterly commencing September 2018.

5 Upon approval of this paper, the PCCC cycle of work will be updated to include these quarterly updates.


6 The delegated Primary Care Priorities for 2018/19 are mainly founded from the GP Forward View which is a document published by NHSE indicating the deliverables for Primary Care.

7 There are 7 priorities for Delivery:-

GP Extended Access 8am – 8pm 7 days a week, evidenced by local need. A Primary Care Workforce plan addressing recruitment and retention issues

in Primary Care and introducing a wider clinical workforce to support GPs. Development of Primary Care Hubs to support “at scale” working, resilience

and sustainable Primary Care Detailed review of Primary Care estate finances An assurance level of Significant from internal audit All 10 high impact actions as outlined in the GPFV delivered by all practices

within the CCG A balanced financial plan

Recommendations

8 PCCC are asked to agree the delegated Primary Care Priorities for 2018/19 and the associated reporting schedule.

Enclosure Agenda Item –

1

NHS Shropshire CCG


Primary Care Commissioning Committee Cycle of Business


Executive Summary

1 The CCG Primary Care Commissioning Committee (PCCC) is the corporate decision-making body for the management of the Primary Care delegated functions.

2 To ensure that the functions are monitored and delivered, a cycle of routine business reporting

has been developed. Actions Required 3 PCCC are asked to agree that the cycle of reporting will provide the level of assurance required

to ensure that the delegated functions are carried out with due diligence. Introduction

4 The CCG Primary Care Commissioning Committee (PCCC) is the corporate decision-making body for the management of the delegated functions. The Committee has been established to enable the members to make collective decisions on the review, planning and procurement of primary care services in the Shropshire CCG area under delegated authority from NHS England.

5 PCCC has a duty for the following:

To promote the NHS Constitution (section 14P);

To exercise its functions effectively, efficiently and economically (section 14Q);

To improve in quality of services (section 14R);

In relation to quality of primary medical services (section 14S);

To reduce inequalities (section 14T);

To promote the involvement of each patient (section 14U);

To patient choice (section 14V);

To promote integration (section 14Z1);

For public involvement and consultation (section 14Z2)

6 The functions of the Committee should be undertaken in the context of a desire to promote commissioning of primary care services to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

Purpose of Report

7 The purpose of this report is to provide PCCC with a cycle of business which will enable Committee to provide assurance that it is delivering its primary function of Delegated Commissioning.

Agenda Item: PCCC-2018-6.118

Enclosure Number 7

2

8 Appendix 1 provides the detail of the reporting for the main cycle of business.

9 There will be additional papers where PCCC requests further information from the main papers or when “ad hoc” issues are to be reported e.g. a practice merger or details of new programmes of work from NHS England.

Recommendations

10 PCCC are asked to:-

Agree the cycle of reporting provides the level of assurance required to ensure that the delegated functions are carried out with due diligence.

3

PRIMARY CARE COMMISSIONING COMMITTEE CYCLE OF BUSINESS Appendix 1

Month June 2018 July 2018 August 2018 September 2018 October 2018 November 2018

Standing Items

Apologies Apologies Apologies Apologies Apologies Apologies

Members declaration of interest






Minutes of the previous meeting






Matters arising from previous meeting






Cycle of Business for PCCC






Assurance

GPFV progress report GPFV progress report GPFV progress report GPFV progress report GPFV progress report GPFV progress report

Finance Report Finance Report Finance Report Finance Report Finance Report Finance Report

Primary Care Working Group







Quarterly Assurance for NHSE

Quality / resilience / sustainability Report


Quarterly Assurance for NHSE

Quality / resilience /sustainability Reports

Extended Access Primary Care Workforce Extended Access Primary Care Workforce Extended Access Primary Care Workforce

At Scale working Primary Care Estates At Scale working Primary Care Estates Communications Plan

Communications update Internal Audit update Internal Audit report

Strategy

NHS England Update NHS England Update NHS England Update NHS England Update NHS England Update

Primary Care Priorities 2018/19

Primary Care Budget sign off

1

Shropshire CCG Primary Care Commissioning Committee – Part 1 : 13 June 2018


PCCC Primary Care Working Group





Presenter:

For Information Only

Purpose of the report: To provide Primary Care Committee with a summary of the Primary Care Working Group held in May 2018.


Discussions took place regarding:-

Supporting Change in General Practice

Medicines Management

Implications of GDPR

GP Forward View

Workforce

Extended Access

Actions required by Primary Care Commissioning Committee Members:

Primary Care Commissioning Committee are asked to:


Agenda Item: PCCC-2018-6.119 Enclosure Number 8

2

Monitoring form





4 Clinical engagement No

5 Patient and public engagement No

6 Risk to financial and clinical sustainability No

3

Primary Care Commissioning Committee June 2018

Primary Care Working Group Report


Introduction

1. Primary Care Committee agreed for regular written updates from Primary Care Working Group to be received. This is the written summary of the Primary Care Working Group which took place in May 2018.

Key discussion areas

2. The meeting was chaired by Mr Steve Ellis, Head of Primary Care, and had representation from GP Practices, CCG Locality Managers, Locality GPs, CCG Board Members, NHSE and the CCG Primary Care and Quality Teams.

3. There was a useful presentation from Dr Steve Bradder and his Supporting Change

in General Practice team around the support that they provide and the progress that has been made.

4. Much of their work links very closely with the 10 High Impact Actions that are part of our GPFV targets for 2018/19

5. Liz Walker, Head of Medicines Management, addressed some practice concerns around the implementation of the Self-care agenda and updated the meeting on the ongoing concerns around likely flu delivery dates.

6. Liz also informed the meeting that the Minor Ailments Scheme is expected to be withdrawn following the implementation of the self-care strategy.

7. Liz Griffiths, IG Support Oficer with the CSU, gave an overview of the support available from the CSU around the implementation of the new General Data Protection Regulations (GDPR). A briefing note comprising the details of the CSU support and FAQs on GDPR was sent to practices following the meeting.

8. There was an update on progress made in implementing the GP Forward View in

practices. This included:-

Details of the bidding process for this year’s resilience fund.

A reminder of deadlines for various practice plans (PM Training; Workforce; GPFV Delivery)

A welcome update on the new delivery plans for VoIP and Wi-Fi into practices..

9. Julie Downie, Workforce Project Lead at NHSE, attended to provide an update on the work that she has been doing with practices/practice groups. She reported on some of the issues that she has met and the progress that is ongoing to address those concerns. Workforce plans for practices/practice groups are due to be completed at the end of July

10. There is increasing focus on the need to commission extended access to 100% of the population by 1st October 2018. Pilot schemes are confirmed in Shrewsbury and Oswestry, beginning in July. The patient survey was live and practices were reminded to encourage participation.

4

11. Ruth Bolderston, Assistant Contracts Manager, NHS England, reminded practices of

the complaints data collection that closes on 8th June at 5pm. Practices were also reminded to check acceptance of Friends & Family Test on CQRS as there were initially some issues with the original message going out to practices.

12. The next meeting will take place on 19 June.

Recommendations

13. Primary Care Commissioning Committee are asked to:


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