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Meeting Agenda (Public Session)

Primary Care Commissioning Committee

Wednesday 22 April 2020 9.00-9.30

Teleconference

Time Item Presenter Reference

TBC Introductory Items

1. Welcome, Introductions and apologies Eleri de Gilbert PCC/20/052

2. Confirmation of quoracy Eleri de Gilbert PCC/20/053

3. Declarations of interest for any item on the agenda Eleri de Gilbert PCC/20/054

4. Management of any real or perceived conflicts of interest Eleri de Gilbert PCC/20/055

5. Questions from the public Eleri de Gilbert PCC/20/056 EdG PCC 20/044

6. Shared minutes from the predecessor CCGs’ meetings held in common held on: 25 March 2020

Eleri de Gilbert PCC/20/057

EdG PCC 20/045

7. Action log and matters arising from the from the predecessor CCGs’ meetings held in common on:25 March 2020

Eleri de Gilbert PCC/20/058 EdG PCC 20/046

8. Actions arising from the Governing Body Eleri de Gilbert PCC/20/059 EdG PCC 20/047

TBC For Approval

9. Primary Care Transformation Monies 2020/2021 - Proposal for Allocation of Funding

Helen Griffiths PCC/20/060

TBC To Note

10. Primary Care Response to the Covid-19 pandemic - Update

Lucy Dadge PCC/20/061 - verbal

11. Overview of GP Practice Additional Expenses in Relation to COVID-19

Lynette Daws PCC/20/062

Risk Management

12. Risk Report Sian Gascoigne PCC/20/063

TBC Closing Items

13. Any other business Eleri de Gilbert PCC/20/064

14. Risk identified during the course of the meeting Eleri de Gilbert PCC/20/065

15. Key messages to escalate to the Governing Body Eleri de Gilbert PCC/20/066

Chair: Eleri de Gilbert

Enquiries to: ncccg.notts - [email protected]

Agenda

1 of 3422 April, 9.00-9.30 virtual meeting-22/04/20

mailto:ncccg.notts%20-%[email protected]

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Time Item Presenter Reference

16. Date of next meeting:

20/05/2020

Teleconference

Eleri de Gilbert PCC/20/068

Agenda

2 of 34 22 April, 9.00-9.30 virtual meeting-22/04/20

Name Current position (s)

held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

inan

cia

l

Pro

fessio

nal In

tere

sts

No

n-f

inan

cia

l P

ers

on

al

Inte

rests

Ind

irect

Inte

rest

Date

Fro

m:

Date

To

:

Action taken to mitigate risk

BEEBE, Shaun Non-Executive Director Eastwood Primary Care Centre Family members are registered patients

-

01/03/2020 Interest expired - no action required

BEEBE, Shaun Non-Executive Director University of Nottingham Senior manager with the University of Nottingham

-

Present This interest will be kept under review and specific

actions determined as required.

BEEBE, Shaun Non-Executive Director Nottingham University Hospitals NHS Trust Patient in Ophthalmology

-



CAWLEY, Michael Operational Director of Finance Castle Healthcare Practice Registered Patient

-


actions determined as required - as a general guide, the

individual should be able to participate in discussions

relating to this practice but be excluded from decision-

making.

DADGE, Lucy Chief Commissioning Officer Mid Nottinghamshire and Greater

Nottingham Lift Co (public sector)

Director 01/10/2017 Present This interest will be kept under review and specific


DADGE, Lucy Chief Commissioning Officer Pelham Homes Ltd – Housing provider

subsidiary of Nottinghamshire Community

Housing Association



DADGE, Lucy Chief Commissioning Officer 3Sixty Care Ltd – GP Federation,

Northamptonshire

Chair 01/01/2017 Present This interest will be kept under review and specific


DADGE, Lucy Chief Commissioning Officer First for Wellbeing Community Interest

Company (Health and Wellbeing

Company)



DADGE, Lucy Chief Commissioning Officer Valley Road Surgery Registered Patient 19/06/1905 Present This interest will be kept under review and specific




making.

DADGE, Lucy Chief Commissioning Officer Nottingham Schools Trust Chair and Trustee 01/11/2017 Present This interest will be kept under review and specific


DAWS, Lynette Head of Primary Care Rivergreen Medical Centre Family members are registered patient

-

Present Involvement in commissioning work relevant to this

practice will be kept under review and specific actions

determined as required.

DE GILBERT, Eleri Non-Executive Director Middleton Lodge Surgery Husband registered patient

-Present This interest will be kept under review and specific


Register of Declared Interests - Primary Care Commissioning Committee (as at April 2020)

• As required by section 14O of the NHS Act 2006 (as amended), the CCG has made arrangements to manage conflicts and potential conflicts of interest to ensure

that decisions made by the CCG will be taken and seen to be taken without being unduly influenced by external or private interests.

• This document is extracted, for the purposes of this meeting, from the CCG’s full Register of Declared Interests (which is publically available on the CCG’s website).

• The register is reviewed in advance of the meeting to ensure the consideration of any known interests in relation to the meeting agenda. Where necessary

(for example, where there is a direct financial interest), members may be fully excluded from participating in an item and this will include them not receiving

the paper(s) in advance of the meeting.

• Members are reminded that they can raise an interest at the beginning of, or during discussion of, an item if they realise that they do have a potential interest

that hasn’t already been declared.

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

Declarations of interest for any item

on the agenda

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pril, 9.00-9.30 virtual meeting-22/04/20


held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

inan

cia

l

Pro

fessio

nal In

tere

sts

No

n-f

inan

cia

l P

ers

on

al

Inte

rests

Ind

irect

Inte

rest

Date

Fro

m:

Date

To

:


DE GILBERT, Eleri Non-Executive Director Middleton Lodge Surgery Registered Patient -



DE GILBERT, Eleri Non-Executive Director Middleton Lodge Surgery Son registered patient

-18/10/2019 This interest will be kept under review and specific


DE GILBERT, Eleri Non-Executive Director Rise Park Practice Son and Daughter in Law registered patients 18/10/2019 Present This interest will be kept under review and specific


DE GILBERT, Eleri Non-Executive Director Nottingham Bench Justice of the Peace

-Present This interest will be kept under review and specific


DE GILBERT, Eleri Non-Executive Director Sherwood and Newark Citizens Advice

Bureau

Trustee on the board 01/03/2016 07/02/2020 This interest will be kept under review and specific


DE GILBERT, Eleri Non-Executive Director Major Oak Medical Practice, Edwinstowe Son, daughter in law and grandchild registered patient

-



GASKILL, Esther Head of Quality Intelligence Mapperley and Victoria Practice Registered Patient

-





making.

GRIFFITHS, Helen Associate Director of Primary

Care Networks

Musters Medical Practice Registered Patient 01/04/2013 Present Involvement in commissioning work relevant to this




Care Networks

Castle Healthcare Practice (Rushcliffe

Practice)

Spouse is GP Partner 01/10/2015 Present Participate in discussion or service redesign as clinical

expert if organisation is potential provider, withdraw from

voting unless otherwise agreed by the meeting chair


Care Networks

Embankment Primary Care Centre Spouse is Director 01/10/2015 Present Withdraw from all discussion and voting if organisation is

potential provider unless otherwise agreed by the

meeting chair


Care Networks

NEMS Healthcare Ltd Spouse is shareholder 01/04/2013 Present Withdraw from all discussion and voting if organisation is

potential provider unless otherwise agreed by the

meeting chair


Care Networks

Partners Health LLP Spouse is a member 01/10/2015 Present Participate in discussion or service redesign as clinical




Care Networks

Principia Multi-specialty Community

Provider

Spouse is a member 01/10/2015 Present Participate in discussion or service redesign as clinical




Care Networks

Nottingham Forest Football Club Spouse is a Doctor for club 01/04/2013 Present This interest will be kept under review and specific


LUNN, Joe Interim Associate Director of

Primary Care

Kirkby Community Primary Care Centre Registered Patient

-





making.

SIMMONDS, Joanne Head of Corporate Governance Elmswood Surgery Registered Patient

- Present

This interest will be kept under review and specific


SULLIVAN, Amanda Accountable Officer Hillview Surgery Registered Patient 2013 Present This interest will be kept under review and specific




making.

STRATTON, Dr Richard Governing Body GP

Representative

Belvoir Health Group GP Partner 01/08/2012 Present To be excluded from all commissioning decisions

(including procurement activities and contract

management arrangements) relating to services that are

currently, or could be, provided by GP Practices.


on the agenda

4 of 3422 A



held in the CCGs

Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

inan

cia

l

Pro

fessio

nal In

tere

sts

No

n-f

inan

cia

l P

ers

on

al

Inte

rests

Ind

irect

Inte

rest

Date

Fro

m:

Date

To

:


STRATTON, Dr Richard Governing Body GP

Representative

PartnersHealth LLP GP member 01/11/2015 Present To be excluded from all commissioning decisions

(including procurement activities and contract

management arrangements) in relation to services

currently provided by Partners Health LLP; and Services

where it is believed that Partners Health LLP could be an

interested bidder.

SUNDERLAND, Sue Non-Executive Director Joint Audit Risk Assurance Committee,

Police and Crime Commissioner (JARAC)

for Derbyshire / Derbyshire Constabulary

Chair 01/04/2018 Present This interest will be kept under review and specific


SUNDERLAND, Sue Non-Executive Director NHS Bassetlaw CCG Governing Body Lay Member 16/12/2015 Present This interest will be kept under review and specific


SUNDERLAND, Sue Non-Executive Director Inclusion Healthcare Social Enterprise CIC

(Leicester City)

Non-Executive Director 16/12/2015 Present This interest will be kept under review and specific


TRIMBLE, Dr Ian Independent GP Advisor Occasional consultancy work for other

CCGs

Occasional consultancy work for other CCGs 01/10/2016 Present This interest will be kept under review and specific


TRIMBLE, Dr Ian Independent GP Advisor Unity Surgery, Mapperley Registered Patient

-

Present Involvement in commissioning work relevant to this



TRIMBLE, Dr Ian Independent GP Advisor National Advisory Committee for Resource

Allocation

Independent GP Advisor 01/04/2013 Present Participate in discussion or service redesign as clinical



WADDINGHAM, Rosa Chief Nurse No relevant interests declared Not applicable - - Not applicable

WRIGHT, Michael LMC Representative, CEO Practice Support Services Limited -

Nottinghamshire

Support service as for profit subsidiary of LMC 01/04/2016 Present Withdraw from a specified activity or relevant parts of

meetings during which relevant subjects are discussed

and not to take part in any related vote

WRIGHT, Michael LMC Representative, CEO LMC Buying Groups Federation Manager 01/04/2016 Present Withdraw from a specified activity or relevant parts of



WRIGHT, Michael LMC Representative, CEO GP-S coaching and mentoring Support service as for profit subsidiary of LMC 01/04/2016 Present Withdraw from a specified activity or relevant parts of



WRIGHT, Michael LMC Representative, CEO Nottinghamshire GP Phoenix Programme Manager 01/04/2016 Present Withdraw from a specified activity or relevant parts of



WRIGHT, Michael LMC Representative, CEO Castle Healthcare Practice Registered Patient 30/09/2016 Present Involvement in commissioning work relevant to this



WRIGHT, Michael LMC Representative, CEO Notspar and Trent Valley Surgery Special

Allocation Schemes (violent patient

schemes)

Chair 01/04/2016 Present Withdraw from a specified activity or relevant parts of




on the agenda

5 of 3422 A


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Managing Conflicts of Interest at Meetings

1. A “conflict of interest” is defined as a “set of circumstances by which a reasonable person

would consider that an individual’s ability to apply judgement or act, in the context of

delivering commissioning, or assuring taxpayer funded health and care services is, or could

be, impaired or influenced by another interest they hold”.

2. An individual does not need to exploit their position or obtain an actual benefit, financial or

otherwise, for a conflict of interest to occur. In fact, a perception of wrongdoing, impaired

judgement, or undue influence can be as detrimental as any of them actually occurring. It is

important to manage these perceived conflicts in order to maintain public trust.

3. Conflicts of interest include:

Financial interests: where an individual may get direct financial benefits from the

consequences of a commissioning decision.

Non-financial professional interests: where an individual may obtain a non-financial

professional benefit from the consequences of a commissioning decision, such as

increasing their reputation or status or promoting their professional career.

Non-financial personal interests: where an individual may benefit personally in ways

which are not directly linked to their professional career and do not give rise to a direct

financial benefit.

Indirect interests: where an individual has a close association with an individual who has

a financial interest, a non-financial professional interest or a non-financial personal

interest in a commissioning decision.

The above categories are not exhaustive and each situation must be considered on a case

by case basis.

4. In advance of any meeting of the Committee, consideration will be given as to whether

conflicts of interest are likely to arise in relation to any agenda item and how they should be

managed. This may include steps to be taken prior to the meeting, such as ensuring that

supporting papers for a particular agenda item are not sent to conflicted individuals.

5. At the beginning of each formal meeting, Committee members and co-opted advisors will be

required to declare any interests that relate specifically to a particular issue under

consideration. If the existence of an interest becomes apparent during a meeting, then this

must be declared at the point at which it arises. Any such declaration will be formally

recorded in the minutes for the meeting.

Management of any real or perceived conflicts of interest


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6. The Chair of the Committee (or Deputy Chair in their absence, or where the Chair of the

Committee is conflicted) will determine how declared interests should be managed, which is

likely to involve one the following actions:

Requiring the individual to withdraw from the meeting for that part of the discussion if the

conflict could be seen as detrimental to the Committee’s decision-making arrangements.

Allowing the individual to participate in the discussion, but not the decision-making

process.

Allowing full participation in discussion and the decision-making process, as the potential

conflict is not perceived to be material or detrimental to the Committee’s decision-making

arrangements.

Management of any real or perceived conflicts of interest


of 6

Meetings in common of the

NHS Mansfield and Ashfield CCG Primary Care Commissioning Committee

NHS Newark and Sherwood CCG Primary Care Commissioning Committee

NHS Nottingham City CCG Primary Care Commissioning Committee

NHS Nottingham North and East CCG Primary Care Commissioning Committee

NHS Nottingham West CCG Primary Care Commissioning Committee

NHS Rushcliffe CCG Primary Care Commissioning Committee

Public Session

Unratified minutes of the meetings held in common on

25/03/2020, 09:00 – 9.30

Teleconference

Organisation

NH

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an

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field

CC

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NH

S N

ew

ark

an

d S

herw

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CG

NH

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ott

ing

ham

Cit

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CG

NH

S N

ott

ing

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No

rth

an

d E

ast

CC

G

NH

S N

ott

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ham

West

CC

G

NH

S R

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cli

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CG

Members present:

Eleri de Gilbert Lay Member, Quality and

Performance (Chair)

Shaun Beebe Lay Member, Financial

Management

Lucy Dadge Chief Commissioning Officer

Joe Lunn Interim Associate Director of

Primary Care

Dr Nigel Marshall Independent GP Advisor

Amanda Sullivan Accountable Officer

Sue Sunderland Lay Member – Audit and

Governance

Dr Ian Trimble Independent GP Advisor

Rosa Waddingham

Interim Chief Nurse

Shared minutes from the predecessor CCGs’ meetings held in common held on: 25 March 2020


of 6

In attendance:

Lynette Daws Head of Primary Care

Esther Gaskill Head of Quality Intelligence

Helen Griffiths Associate Director of Primary Care

Networks

Sue Wass Corporate Governance Officer

(minute taker)

Michael Wright Chief Executive, Local Medical

Committee (LMC)

Apologies:

Michael Cawley Operational Director of Finance

Andrew Morton Operational Director of Finance

Sharon Pickett Associate Director of Primary Care

Commissioning

Cumulative Record of Members Attendance (2019/20)1

Name Possible Actual Name Possible Actual

Eleri de Gilbert 10 9 Michael Cawley 10 8

Shaun Beebe 10 8 Lucy Dadge 10 10

David Heathcote2 6 6 Andrew Morton 10 5

Dr Nigel Marshall 10 9 Sharon Pickett 10 2

Dr Ian Trimble 10 8 Amanda Sullivan 10 2

Rosa Waddingham 10 7 Sue Sunderland3 5 5

Joe Lunn4 1 1

1 From commencement of new aligned governance arrangements

2 Membership ceased October 2019

3 Membership commenced November 2019

4 Membership commenced March 2020

ITEM

Introductory Items

PCC 20/040 Welcome and Apologies for Absence

Eleri de Gilbert welcomed everyone to the public meeting in common of the Primary

Care Commissioning Committees of NHS Nottingham City CCG, NHS Mansfield and

Ashfield CCG, NHS Newark and Sherwood CCG, NHS Nottingham West CCG, NHS

Rushcliffe CCG and NHS Nottingham North and East CCG (hereafter referred to

collectively as “the Committees” unless the item being discussed pertains to an

individual CCG (or CCGs)).

The Chair noted formally that the Committees were meeting virtually with a much

shorter agenda due to the current mobilization around the NHS’ response to the

COVID-19 virus. A log of deferred reports would be kept to ensure that key issues

were not overlooked.



of 6

ITEM

The Chair wished to put on record her thanks to the CCG Primary Care Teams for their

hard work to ensure the sustainability of General Practice during the emergency

response to COVID-19.

PCC 20/041 Confirmation of Quoracy

It was confirmed that each Committee was quorate for the meeting.

PCC 20/042 Declaration of interest for any item on the shared agenda

No interests were declared in relation to any item on the agenda. The Chair reminded

members of their responsibility to highlight any interests should they transpire as a

result of discussions during the meeting.

PCC 20/043 Management of any real or perceived conflicts of interest

As no conflicts of interest had been identified, this item was not necessary for the

meeting.

PCC 20/044 Questions from the Public

There were no questions from the public.

PCC 20/045 Shared Minutes from previous meetings in common held on 19 February 2020

It was agreed that the minutes were an accurate record of the meeting.

PCC 20/046 Action log and matters arising from the meetings in common held on 19 February

2020

Members discussed the actions that were in progress and highlighted the following key

points:

PCC 20/024 Contract Management Update Report

It had been agreed that a joint piece of work detailing the local recruitment of GP

Partners and issues around the GP estate be brought to the Committees for discussion

at its March meeting. It was noted this issue would be kept on the action log for

discussion at a future meeting yet to be determined.

PCC 20/026 Primary Care Quality Group’s Terms of Reference and Quality

Reporting

A report to be produced detailing how ‘lessons learnt’ have informed the CCGs' quality

monitoring systems and processes. This item was not yet due.

PCC 20/048 Millview Surgery – Six Month List Closure Review



of 6

ITEM

Objective criteria for all list closures was due to be drafted and agreed by the

Committees. This item had been due to be discussed at this meeting; however due to

the current response to COVID-19 the item would be discussed at a future meeting yet

to be determined. It was agreed that the report would be circulated for comment ahead

of any formal agreement.

ACTION:

Sue Wass to circulate the draft objective decision making criteria for list

closure applications to the Committees for comment.

PCC 20/047 Actions arising from the Governing Bodies

No actions for the Primary Care Commissioning Committees were identified at the

March 2020 Governing Bodies meeting.

Contract Management and Applications

PCC 20/048 Leen View Surgery: Boundary Reduction

Joe Lunn presented this item to NHS Nottingham City CCG’s Primary Care

Commissioning Committee and highlighted the following key points:

(a) In September 2019, NHS Nottingham City CCG’s Primary Care Commissioning

Committee agreed a temporary nine month boundary reduction for Leen View

Surgery, with the caveat that the practices within the Primary Care Network (PCN)

and neighbouring Nottingham West PCN worked together to find a longer

term solution for the provision of services to two care homes affected by this

boundary change. This temporary boundary reduction was due to expire on 18 June

2020.

(b) The purpose of this paper was to provide the Committee with the requested update

on the impact of the boundary change and progress with the management of the

two care homes.

(c) In February 2020 NHS England published final service specifications for the PCN

Directed Enhanced Service, which would come into effect from the 30 September

2020 and it was expected that this would support the practices to agree a shared

approach to managing these homes.

(d) In light of this new PCN specification the recommendation was to extend the

temporary boundary reduction to 30 September 2020 to align with the start of the

new specification and provide additional time for the agreement of the approach to

care homes.

The following points were made in discussion:

(e) Members noted the potential confusion any changes made now would cause if the

new specifications were due to commence in September, alongside the need for a

consistent approach.

(f) Dr Trimble noted the importance of the specification for care homes to start in



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ITEM

September.

(g) Members discussed the increased pressure placed on care homes during this time

and requested that a progress report be brought to the July Committee meeting on

progress with implementation of the proposed DES and the implications in particular

for this practice and its neighbours.

NHS Nottingham City CCG’s Primary Care Commissioning Committee:

NOTED the update provided in this paper

APPROVED the extension of the temporary boundary reduction to 30

September 2020

AGREED to RECEIVE a progress update in July 2020 for a decision on

whether the boundary reduction should be made permanent after September.

Action:

Sue Wass to add to the Committee’s workplan an update on the PCN DES for

care homes in July

PCC 20/049 Deer Park Family Medical Practice: List Closure

Joe Lunn presented this item to NHS Nottingham City CCG’s Primary Care

Commissioning Committee and highlighted the following key points:

(a) The Deer Park Family Medical Practice had applied to close their list for a period of

12 months. The practice operated from the Wollaton Vale Health Centre which was

owned by NHS Property Services.

(b) The practice had previously submitted an application back in June 2016. The

Primary Care Commissioning Committee considered the application on the 7th July

2016 and approved the closure for a period of 6 months. The practice was advised

to use the closure period to recruit an additional GP and to explore options

regarding the estates and premises issues.

(c) Since this time another practice that was a co-located practice, Wollaton Vale

Health Centre, closed in February 2107 and the list was dispersed.

(d) The practice was now requesting a further list closure due to the growing list size

which was impacting on the current workforce. The practice noted in the application

that the list closure could be mitigated if the premises issues were resolved. These

issues have been ongoing since the previous list closure application.

(e) NHS Property Services and the CCG Estates team have been trying to resolve the

space issues since 2016 and have been working through options to utilise vacant

space from the previous practice closure.

(f) Prior to the emergency measures implemented to respond to COVID-19, the

Primary Care Teams were supportive of a further closure, but only for a period of six

months. However at the current time, the proposal was not to agree to the list

closure due to potential impact on other practices in current circumstances.

The following points were made in discussion:

(g) Members noted that neighbouring practices had not responded to the consultation



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ITEM

and they would be reluctant to agree to any closure without the other practices’

views.

(h) Members noted that the pressure being faced by the practice was primarily a

premises issue, rather than a growing list size issue, as this had been stable for

some time, and noted continuing work to resolve the premises constraints.

Members did not feel that there was a compelling case from the practice to support

a list closure at this stage

(i) Members discussed the broader issue of practice resilience and sustainability

during the response to COVID-19 and the possible impact a list closure may have

on other practices.

(j) It was also noted that the objective decision-making criteria for making such a

decision had not yet been discussed or agreed. It was agreed that in principle

under the current circumstances that list closures would not be encouraged at this

time but every effort made to work with practices to ensure sustainability

throughout the COVID-19 response period.

NHS Nottingham City CCG’s Primary Care Commissioning Committee:

RECEIVED the application from Deer Park Family Medical Practice to close the

patient list

CONSIDERED the application to close the patient list for 12 months

DISCUSSED the closure of the patient list for a period of 12 months

Closing Items

PCC 20/050 Any other business

The chair noted that this was the last meeting of the Primary Care Commissioning

Committees of the six CCGs and thanked members for their input over the last ten

months.

PCC 20/051 Key messages to escalate to the Governing Bodies

Approval of the extension of the temporary boundary reduction for Leen View Surgery to 30 September 2020.

Not to approve the application to close the patient list for Deer Park Family Medical Practice in current circumstances.

During the COVID-19 response period the focus should be on sustainability of practices through support and not unilateral list closures

Confidential Motion

The Primary Care Commissioning Committees will resolve that representatives of the

press and other members of the public be excluded from the remainder of this meeting,

having regard to the confidential nature of the business to be transacted, publicity on

which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission

to Meetings] Act 1960)



of 2

Primary Care Commissioning Committees in Common OPEN ACTION LOG from the meetings in common on 25 March 2020

MEETING

DATE

CCG AGENDA

REFERENCE

AGENDA ITEM ACTION LEAD DATE TO BE

COMPLETED

COMMENT

ACTIONS OUTSTANDING

No actions outstanding

ACTIONS ONGOING/NOT YET DUE

19/02/2020 All PCC 20/024 Contract

Management Update

Report

It was agreed that a joint piece of work

detailing the local recruitment of GP

Partners and issues around the GP

estate be brought to the Committees

for discussion at a future meeting.

Andrea

Brown/Lynne

Sharp/Lucy

Dadge

20/05/20 Date for completion to be

agreed and added to the

Committee’s workplan for

2020/21.

19/02/2020 All PCC 20/026 Primary Care Quality

Group’s Terms of

Reference and

Quality Reporting

A report to be produced detailing how

‘lessons learnt’ have informed the

CCGs' quality monitoring systems and

processes.

Esther

Gaskill/Rosa

Waddingham

20/05/20 This has been included on the

forward work programme

2020/021 for presentation to

the Committee in May 2020.

21/08/2019 All PCC 19/048 Millview Surgery –

Six Month List

Closure Review

Michael Wright to share with Lucy

Dadge a set of objective criteria the

Committees could use when

considering patient list closure

applications. This will be reviewed and

Lucy Dadge 20/05/20 The objective criteria has been

discussed, revised and

updated. The final version was

due to be included on the

March agenda for approval; but

Action log and m

atters arising from the from

the predecessor CC

Gs’ m

eetings held in comm

on on:25 March 2020

14 of 3422 A


of 2

MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

updated for approval at the September

2019 meeting.

has now been deferred to the

May meeting.

20/11/2019 Nottingham

City

PCC 19/115 Welbeck Surgery

Patient List Closure

To bring an outline PCN/CCG plan,

with proposed timescales (supported

by the effected practices) to the

Committees demonstrating that work is

in progress to alleviate pressure on

neighbouring practices caused by

recent practice closures.

Lynette Daws 20/05/20 The plan was due to be

included on the agenda for

assurance; but has now been

deferred to the May meeting.

ACTIONS COMPLETED

25/03/2020 All PCC 20/046 Action from Previous

Meetings

To circulate the draft objective decision

making criteria for list closure

applications to the Committees for

comment.

Sue Wass circulated 12 April

25/03/2020 Nottingham

City

PCC 20/048 Leen View Surgery:

Boundary Reduction

To add to the Committee’s workplan

an update on the PCN DES for care

homes in July

Sue Wass Added to workplan

Action log and m

atters arising from the from

the predecessor CC

Gs’ m

eetings held in comm

on on:25 March 2020

15 of 3422 A


of 1

Primary Care Commissioning Committees in Common OPEN ACTION LOG from the Governing Body on 8 April 2020

MEETING

DATE

CCG AGENDA

REFERENCE


COMPLETED

COMMENT

ACTIONS OUTSTANDING

No actions outstanding

ACTIONS ONGOING/NOT DUE

No actions ongoing/not due

Actions arising from

the Governing B

odies

16 of 3422 A


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Meeting Title: Primary Care Commissioning Committee (Open Session)

Date: 22 April 2020

Paper Title: Primary Care Transformation Monies 2020/2021 - Proposal for Allocation of Funding

Paper Reference: PCC 20 060

Sponsor:

Presenter:

Lucy Dadge – Chief Commissioning Officer

Attachments/ Appendices:

N/A

Helen Griffiths – Associate Director of Primary Care Networks

Purpose: Approve ☒ Endorse ☐ Review ☐ Receive/Note for:

∑ Assurance∑ Information

☒

Executive Summary

This paper outlines the discussions and work to date to determine the allocation of the Primary Care Transformation Monies available for 2020/2021.

The paper summarises the NHSE guidance on the use of the money, as well as the agreed local principles on how the money might be best utilised. The paper also outlines the proposed interim approach to determine the immediate use of a proportion of the Primary Care Network (PCN) Support Fund, given the current response to COVID-19.

A paper was presented at the ICS Board on 16 January 2020, where the available funding to support primary care transformation was considered and discussed. The same paper was also taken to the ICS Primary Care Programme Board on 6 February 2020 for discussion and update following the ICS Board meeting.

The purpose of this paper is for the CCG Primary Care Commissioning Committee to note the progress and work to date to consider the future use of the primary care transformation funds, as well as approve an initial commitment of the PCN Support Fund for 2020/2021 - to support an uplift in payments to the PCN CDs for their time and commitment to develop and lead the PCNs,

Relevant CCG priorities/objectives:

Compliance with Statutory Duties ☐ Wider system architecture development (e.g. ICP, PCN development)

☒

Financial Management ☒ Cultural and/or Organisational Development

☐

Performance Management ☐ Procurement and/or Contract Management ☐

Primary Care Transformation Monies 2020/2021 - Proposal for Allocation of Funding


of 3

Strategic Planning ☐

Conflicts of Interest:

☐ No conflict identified

☐ Conflict noted, conflicted party can participate in discussion and decision

☒ Conflict noted, conflicted party can participate in discussion, but not decision

☐ Conflict noted, conflicted party can remain, but not participate in discussion or decision

☐ Conflict noted, conflicted party to be excluded from meeting

Dr Richard Stratton, as a member of the South Locality PCN is conflicted

Completion of Impact Assessments:

Equality / Quality Impact Assessment (EQIA)

Yes ☐ No ☐ N/A☒

Risk(s):

The risk to approving the proposed PCN CD uplift of 0.4 WTE would take up to 60% of the PCN Support Fund for 2020/21. This would therefore reduce the amount of funds available for the other transformational proposals to support progress and development of the NHSE PCN Matrix.

The overall risks of delivering a transformation programme in primary care with the primary care transformation monies can be summarised as:

The major risk to delivery of the programme of work is the fragility of general practice and the capacity to deliver a significant change programme over and above operational delivery and growing demand. Despite the funding being made available to drive this forward it will require leadership and capacity from the newly formed PCNs, the appointed Clinical Directors, and the on-going support and engagement of all system partners.

NHSE’s requirements to evolve the PCNs at pace, for example, the additional five PCN service specifications which are due to commence from October 2020/21.

The availability of wider workforce in primary care also remains a risk. Without a stable and permanent workforce, right-sized to cope with increasing demand, primary care will be unable to deliver the changes needed to support the wider system.

The facilitation, implementation and delivery of this transformation programme is reliant on a small cohort of staff within the CCGs. Competing pressures and lack of resilience may lead to slippage in implementation and expected deliverables.

Confidentiality:

☒No

☐Yes (please indicate why it is confidential by ticking the relevant box below)

☐The document contains Personal information

☐The CCGs are in commercial negotiations or about to enter into a procurement exercise

☐The document includes commercial in confidence information about a third party

☐The document contains information which has been provided to the CCG in confidence by a third party

☐The discussion relates to policy development not yet formalised by the organisation

☐The document has been produced by another public body

☐The document is in draft form

Recommendation(s):



of 3

1. NOTE that the use of the Primary Care Transformation Funds has been considered by both the ICS Board and ICS Primary Care Programme Board, and an agreement reached on the approach and principles to be applied. On this basis, discussions have commenced with primary care clinical leads to determine its use for 2020/21.

2. NOTE the agreed principles for the allocation of the primary care transformation funds.

3. APPROVE the funding for PCN CDs to uplift their time to support PCN delivery and development to 0.4 WTE for full year effect until 31st March 2021.



Primary Care Transformation Monies 2020/2021

Proposal for Allocation of Funding

1. Introduction

This paper outlines the discussions and work to date to determine the allocation of the Primary Care Transformation Monies available for 2020/2021.

The paper summarises the NHSE guidance on the use of the money, as well as the agreed local principles on how the money might be best utilised. The paper also outlines the proposed interim approach to determine the immediate use of a proportion of the Primary Care Network (PCN) Support Fund, given the current response to COVID-19.

A paper was presented at the ICS Board on 16 January 2020, where the availablefunding to support primary care transformation was considered and discussed. Thesame paper was also taken to the ICS Primary Care Programme Board on 6 February 2020 for discussion and update following the ICS Board meeting.

The purpose of this paper is for the CCG Primary Care Commissioning Committee to note the progress and work to date to consider the future use of the primary care transformation funds, as well as approve an initial commitment of the PCN Support Fund for 2020/2021 - to support an uplift in payments to the PCN CDs for their time and commitment to develop and lead the PCNs,

2. Background and Context on the Primary Care Transformation Funds

In 2019/20 the ICS received £2.9m of ‘fair shares’ funding to support the development of primary care across a number of programme areas, including improving access, PCN development and workforce training.

NHSE/I have since provided allocations over a 5-year period to provide certainty of funding availability and the ability to implement on a recurrent basis.

The General Practice Forward View (GPFV), published in April 2016, sought to improve patient care and access, and invest in new ways of providing primary care. This wasfurther supported through the NHS Long Term Plan which indicated £2.3 billion be invested in primary care from 2019/20 to 2023/24 across a number of programme

areas. NHSE also allocated £181k for 2019/20 to support workforce and the development of training hubs, and in Q3 of 2019/20 allocated £791k to support the development of PCNs,

The following table provides a summary of primary medical funding received by the Nottinghamshire ICS in 2019/20. Note that these funds are in addition to expenditure made from core and delegated CCG budgets – e.g. GMS/PMS contracts with GP practices and allocations for GP extended access:



Primary Care Strategic Plan Funding - £'000 Annual Budget

Primary Care Investment Programme 2,196of which:Practice Resilience 145Reception and Clerical 182Online Consultation 297PCN Development 791Workforce Training Hubs 181GP Retention 229Fellowships - Core Offer 163

Fellowships - Aspiring Leaders 208

3. Engagement with Primary Care Clinical Leads

A meeting was held on 25 February 2020 with primary care clinical leads to discuss and determine their views on how the primary care transformation funds should be best used and allocated to benefit primary care across Nottingham and Nottinghamshire. Representatives and input into the meeting included: PCN Clinical Directors (CD) or their deputy; Nottingham City GP Alliance; Primary Integrated Community Services; Partners Health; CCG Clinical Chairs; ICS Clinical Lead; ICP Clinical Leads; the CCGs Independent GP, and the LMC. The meeting was also supported by the three CCG Officers who support the relevant funding streams: AD for Primary Care; AD for PCN Development; AD for Strategic Planning and Workforce Transformation.

4. Local Principles on use of Primary Care Transformation Funds

Through local discussions with primary care clinical leads the agreed principles for the allocation of the primary care transformation funds has been determined as:

∑ Consideration to be given to proposals for 2020/21 to support primary care transformation, innovation and delivery of the ICS Long Term Plan.

∑ Proposals must demonstrate they meet an immediate need and will have impact longer term during this GP contract 2023/24.

∑ Equity of allocation across the system is key, which supports all Primary Care Networks to strive to progress to develop in line with the domains in the NHSE PCN Maturity Matrix.

∑ Use of funds will only be supported where it is clear there is no current or existing provision for delivery or future system resource.

∑ Use of the funds will be applied to maximise impact and economies of scale. This may be at an individual practice, individual PCN, each ICP or ICS level. This will be to support developing a ‘Network of Networks’, and operate at scale, to support ICP and ICS priorities.

∑ A designated sum will be allocated at an individual PCN level for local determination of use in line with delivery of agreed primary care transformation outcomes.

∑ Any allocation for a proposal at system level will be considered to support all PCNs unless there is sufficient evidence to support local or targeted developments.



∑ Any local schemes agreed must be able to be replicated at a system level where indicated.

∑ Schemes must deliver with a view to becoming ‘business as usual’, where recurrent monies are required.

∑ Spend against the allocation must be evidenced, and evaluated, being considered in terms of impact and return for the purposes of future NHSE returns.

5. Primary Care Transformation Funds

At the Primary Care Transformation Funds meeting, held on 25 February 2020, there was extensive and constructive discussion to reflect ideas and considerations for future use of the monies. There was agreement that the money would be best used if considered collectively as a ‘single pot’ of transformation funds. There was also a general consensus and recognition that the money needed to be allocated/split in different ways to best support the system; this included: at an individual GP practice level, as well as a PCN level, and where indicated at an ICP and ICS level to support creating a ‘Network of Networks’. It was felt this approach would support delivering economies of scale for both staffing resources, as well as costs. It was also highlighted that where possible the funds should be considered in line with the PCN Investment and Improvement Fund and the PCN Maturity Matrix, as further detail becomes available from NHSE/I.

A key priority which was raised for ongoing use of the funds was to match fund the PCN Clinical Director (CD) payment for the requested leadership time felt to be required. NHSEcurrently fund PCN CD time at 0.25 WTE; in 2019/20 it was locally agreed to uplift the PCN CD time to 0.4WTE to assist in the CD’s being able to support and lead the delivery of the initial set-up of the PCNs.

The meeting concluded that the attendees would feedback and further discuss the priorities for the use of the money with their colleagues and gain proposals for priorities for spend. Asummary matrix would be developed by the CCG Officers to reflect all suggestions for investment of the schemes, and furthermore, the costings to support PCN CDs being paid at 0.4WTE would be calculated to demonstrate the level of commitment of funds that might be required.

Unfortunately the follow up meeting scheduled for 24th March had to be cancelled due to the demands on primary care in preparing for the COVID-19 response. It was recognised that this created a timing issue for PCNs, as the current increased payments to PCN CD was due to finish 31 March 2020. An email was therefore sent to all primary care clinical leads to ask for their feedback by return on the proposed PCN CD uplift to 0.4WTE.

The appendix shows the breakdown of the associated costs of supporting the PCN CDs payment at 0.4WTE

The email correspondence made it clear that the proposed PCN CD uplift of 0.4 WTE would take up to 60% of the PCN Support Fund for 2020/21 stating that this would therefore reduce the amount available for the other transformational proposals to support progress and development of the NHSE PCN Matrix.

The responses from the email all supported the commitment to funding 0.4WTE for 2020/21.



Replies were received from PCNs in Mid Notts, City and South Notts, with a general consensus which can be summarised as follows:

∑ Payments should be uplifted from the nationally funded 0.25WTE to 0.4WTE for the next financial year

∑ PCN CD time of 0.4 WTE should be equalised across all PCNs ∑ Support for the CD role was felt to be critical, especially given the current need for

the COVID-19 response∑ Ongoing support for learning and development for the CDs was felt to be important in

the future

It was also noted in the email that the remaining primary care transformation funds which were still to be determined and allocated would be discussed and determined later in the financial year, when colleagues would have time to give a more considered response to the best use of the funds to support the future emerging model of general practice, post Covid-19.

6. Risks

The risks of delivering a transformation programme in primary care with the primary care transformation monies was identified as part of the original ICS Board paper (January 2020), and can be summarised as:

∑ The major risk to delivery of the programme of work is the fragility of general practice and the capacity to deliver a significant change programme over and above operational delivery and growing demand. Despite the funding being made available to drive this forward it will require leadership and capacity from the newly formed PCNs, the appointed Clinical Directors, and the on-going support and engagement of all system partners.

∑ NHSE’s requirements to evolve the PCNs at pace, for example, the additional five PCN service specifications which are due to commence from October 2020/21.

∑ The availability of wider workforce in primary care also remains a risk. Without a stable and permanent workforce, right-sized to cope with increasing demand, primary care will be unable to deliver the changes needed to support the wider system.

∑ The facilitation, implementation and delivery of this transformation programme is reliant on a small cohort of staff within the CCGs. Competing pressures and lack of resilience may lead to slippage in implementation and expected deliverables.

7. Next Steps

The primary care clinical leads will reconvene in the recovery phase of COVID-19 to continue to consider the investment and allocations of the remaining primary care transformation monies, in light of where the system is in light following the pandemic.



8. The Primary Care Commissioning Committee is requested to:

∑ NOTE that the use of the Primary Care Transformation Funds has been considered by both the ICS Board and ICS Primary Care Programme Board, and an agreement reached on the approach and principles to be applied. On this basis, discussions have commenced with primary care clinical leads to determine its use for 2020/21.

∑ NOTE the agreed principles for the allocation of the primary care transformation funds.

∑ APPROVE the funding for PCN CDs to uplift their time to support PCN delivery and development to 0.4 WTE for full year effect until 31st March 2021.



Appendix

PCN Clinical Director Uplift Calculations

Raw list Raw sessions

Raw CD entitlement

Uplifted session to 0.4wte

Uplifted £ to 0.4wte

Variance TOTAL VARIANCE 1yr

South NottsByron PCN 36930 0.18 £26,677 0.30 £42,683 £16,006Arnold and Calverton 33605 0.17 £24,275 0.27 £38,840 £14,565Arrow Health 41591 0.21 £30,044 0.33 £48,071 £18,026Synergy Health 29750 0.15 £21,490 0.24 £34,385 £12,894

141876 0.71 £102,487 1.14 £163,979 Total £61,492

Nottingham West 106394 0.53 £76,856 0.85 £122,969 Total £46,113

Rushcliffe 129825 0.65 £93,782 1.04 £150,051 Total £56,269

City Bulwell & Top Valley PCN 44987 0.22 £32,497 0.36 £51,996 £19,498BACHS 54229 0.27 £39,173 0.43 £62,677 £23,504Radford & Mary Potter PCN

59340 0.30 £42,865 0.47 £68,585 £25,719

Bestwood & Sherwood PCN

50679 0.25 £36,609 0.41 £58,574 £21,965

City South 50939 0.25 £36,797 0.41 £58,875 £22,078Nottingham City East 66350 0.33 £47,929 0.53 £76,687 £28,758Clifton & Meadows PCN 37089 0.19 £26,792 0.30 £42,867 £16,075Unity (Nottingham) PCN (PCN U)

32011 0.16 £23,124 0.26 £36,998 £13,874

395624 1.98 £285,787 3.16 £457,259 Total £171,472Mid-Notts Raw list Ashfield North 51568 0.26 £37,251 0.41 £59,602 £22,351Ashfield South 39337 0.20 £28,416 0.31 £45,465 £17,050Mansfield North 58830 0.29 £42,497 0.47 £67,995 £25,498Rosewood 47115 0.24 £34,034 0.38 £54,455 £20,421Newark 76595 0.38 £55,330 0.61 £88,528 £33,198Sherwood 60334 0.30 £43,583 0.48 £69,733 £26,150

333779 1.67 £241,112 2.67 £385,779 Total £144,667Grand total £480,014



of 4

Meeting Title: Primary Care Commissioning Committee

(Open Session) Date: 22 April 2020

Paper Title: Overview of GP Practice Additional

Expenses in Relation to COVID-19 Paper Reference: PCC 20 062

Sponsor:

Presenter:

Joe Lunn, Associate Director of Primary Care

Attachments/ Appendices:

N/A

Lynette Daws, Head of Primary Care

Purpose: Approve ☐ Endorse ☐ Review

☐ Receive/Note for:

Assurance

Information

☐

Executive Summary

This paper is in line with delegated function 3; Management of the delegated funds.

On 3 April 2020, information was distributed to practices informing them of a process to claim back additional expenses incurred directly due to COVID-19 pressures. This paper provides an overview of the cost for March, the process undertaken and summary of spend areas.


Compliance with Statutory Duties ☐ Wider system architecture development (e.g. ICP, PCN development)

☐

Financial Management ☒ Cultural and/or Organisational Development

☐

Performance Management ☐ Procurement and/or Contract Management ☒



☐ No conflict identified


☒ Conflict noted, conflicted party can participate in discussion, but not decision



Dr Richard Stratton is conflicted as a practicing GP, however the paper is not for a decision



Yes ☐ No ☐ N/A ☒

Risk(s):

Overview of GP Practice Additional Expenses in Relation to COVID-19


of 4

No risks identified

Confidentiality:

☒No


Recommendation(s):

To NOTE the information for assurance purposes.



of 4

GP Practice Additional Expenses due to Covid-19 Pressures

Since the COVID-19 outbreak, additional pressures and costs have been placed on General Practice in order for them to respond to the needs of patients whilst maintaining a safe environment for their staff and patients. On the 3 April 2020, a message was distributed to practices via TeamNet, outlining a process for which practices could claim back additional expenses from the CCG in relation to costs incurred due to COVID-19. Practice managers were also emailed on the 6th April to ensure the message was received by all.

Practices can claim for additional expense incurred due to COVID-19 pressures such as; staff overtime costs, locum support for ill or self-isolating GPs, additional PPE or additional cleaning items. However, in order to be accepted under the reimbursement arrangement, the costs have to be additional to the practice’s regular orders and outgoings and items must be appropriate and necessary in dealing with the COVID-19 outbreak.

The CCG is currently supporting additional costs as a result of COVID-19 at risk. The CCG will seek to reclaim expenditure from NHS England but need to be able to evidence and demonstrate to NHS England that all costs are appropriate and will satisfy their processes.

Overview of Claims Submitted in March

Practices were asked to submit their March expenses by 10 April 2020 in order to receive timely payment, only claims which related to the month of March would be accepted for this submission and practices had to submit backing rationale and evidence of the spend with their claim. Practices that did not send evidence and rationale for spend were followed up and reminded to send this information for their claim to be reviewed and processed.

84 individual claims were submitted

The total cost of the claims submitted was £181,983.39

An initial review of the claims identified a number of queries that required further investigated

A further review of the claims resulted in this figure reducing to a final payment sum for March of £73,347.00

The final payment figure was reduced significantly due to the exclusion of items for the following reasons: o No backing evidence of spend was provided o Practices did not submit forms correctly o Practices did not provide appropriate rationale for the claim o The CCG are awaiting further supporting evidence to allow a review of clinical need for appropriate

medical equipment to be undertaken o Following clinical review the item may or may not be deemed as appropriate or necessary in relation

to COVID-19

Individual practices will be contacted where full payment has not been made to outline the reasons why. Where further claim evidence can be provided and the claim deemed reasonable, payment will be provided in May alongside payment for April claims.

A breakdown of the spend in each claim category is listed below:

PPE Scrubs Medical Equip-ment

Cleaning Resources

Telephones and Mobiles

Staff Costs Letters/ Postage Costs

Miscellaneous Equipment (non-medical)

£10,414.23 £10,525.77 £805.15 £14,902.25 £4,119.62 £19,309.95 £2,107.79 £11,698.40

The above figures include an additional £536.16 that was identified on further review of the March claims. This will be communicated and paid to the affected practices in May.



of 4

Future submission and payment dates are as follows:

April 2020 Claim - Submit by 8th May - Paid by 22nd May

May 2020 Claim - Submit by 12th Jun - Paid by 26th Jun

Summary

The total paid to practices for March COVID-19 expenses was, £73,347.00. A further £536.16, identified following a further review of spend will be paid to practices in May 2020.

On-going contact is taking place with practices where deductions from their original claims were made. If practices are able to provide further information and evidence, deeming the claim payable, this will be paid in May 2020. The maximum amount which could be paid to practices for March 2020 claims is £181,983.39.



of 2

Meeting Title: Primary Care Commissioning Committee (Open Session)

Date: 22 April 2020

Paper Title: Risk Report Paper Reference:

PCC 20 063

Sponsor: N/A Attachments/ Appendices:

Risk Report

Risk Register (Extract) - Appendix A

Presenter: Siân Gascoigne,Head of Corporate Assurance

Summary Purpose:

Approve ☒ Endorse ☐ Review ☐ Receive/Note for:

∑ Assurance∑ Information

☐

Executive Summary

The purpose of this paper is to present the Primary Care Commissioning Committee with risks relating to the Committee’s responsibilities. The paper provides assurance that primary care risks are being systematically captured across the Nottingham and Nottinghamshire CCG and sufficient mitigating actions are in place and being actively progressed.


Compliance with Statutory Duties ☒ Wider system architecture development (e.g. ICP, PCN development)

☐

Financial Management ☐ Cultural and/or Organisational Development ☐

Performance Management ☐ Procurement and/or Contract Management ☐



☒ No conflict identified


☐ Conflict noted, conflicted party can participate in discussion, but not decision





Yes ☐ No ☐ N/A☒ None required for this paper.

Risk(s):

Report contains all risks from the CCG’s Corporate Risk Register which fall under the remit of the Primary

Risk Report


of 2

Commissioning Committee.

Confidentiality: (please indicate whether the information contained within the paper is confidential)

☒No


Recommendation(s):

1. APPROVE the archiving of risk RR 089;

2. COMMENT on the risks shown within the paper (including the high/red risk) and those at Appendix A; and

3. HIGHLIGHT any risks identified during the course of the meeting for inclusion within the Corporate Risk Register.

Risk Report


1

Primary Care Commissioning Committee

Monthly Risk Report

1. Introduction

A full review of the Corporate Risk Register is currently ongoing to ensure that the ‘live’ risks recorded

continue to be relevant to the single CCG and that the controls and mitigating actions listed are up-to-

date and accurate.

A further exercise is being undertaken to determine whether any risks listed need to be marked as

‘inactive’ during the current Covid-19 incident response period. These may relate to business as

usual activities which are paused; meaning that the CCG is not currently exposed to the associated

risk.

The purpose of this paper is to present the Primary Care Commissioning Committee with risks relating

to the Committee’s responsibilities. It provides assurance that primary care risks are being

systematically captured across the Nottingham and Nottinghamshire CCG and sufficient mitigating

actions are in place and being actively progressed.

2. Risk Profile

There are currently five risks pertaining to the

Committee’s responsibilities (as detailed in

Appendix A). Since the last meeting, risks

have been reviewed by the Head of

Corporate Assurance.

The table to the right shows the current risk

profile of the five risks. There is one high /

red risk in the Committee’s remit as outlined

below.

Risk

Reference Risk Narrative

Current Risk

Score

RR 032

Reducing workforce capacity within General Practice may impact

the sustainability of some GP Practices. In responding to these

challenges, Practices should consider adapting their workforce

models to enable the sustained delivery of core services, whilst

also ensuring sufficient capacity to deliver/contribute to system

and transformation requirements.

Lack of pace of change may present a risk that the CCG's

population access needs are not met, adversely impacting patient

experience and/or outcomes.

Overall Score

16: Red

(I4 x L4)

Risk Matrix

Imp

act

5 - Very High

4 – High 1 1

3 – Medium 1 2

2 – Low

1- Very low

1 -

Rare

2 -

unlik

ely

3 -

Po

ssib

le

4 -

Lik

ely

5 -

Alm

ost

Cert

ain

Likelihood

Risk Report


2

3. Risk Identification

There have been no new risks added since the last meeting.

4. Archiving of Risks

The score for risk RR 089 (which relates to the primary care financial position for 2019/20) has been

reduced in line with the proposed 2019/20 year-end reporting positions for the Mid Nottinghamshire

CCGs.

Given that the risk score is now below the threshold for inclusion in the Corporate Risk Register, it is

proposed that risk RR 089 is archived.

Risk Reference

Risk Narrative Current Risk

Score

RR 089

There is a risk associated with the loss of financial flexibility for

the CCGs as a result of:

National funding adjustments, which reduced primary care

allocations (£1.4 million for Mid Notts); and

Updated guidance on the cost of the new GP contract (£0.4

million cost increase for Mid Notts).

The impact of the above is that the primary care financial

position is more sensitive to the impact of unforeseen pressures

that could occur during 2019/20.

This presents a risk that there is an additional £1.8 million risk to

deliver the CCG's overall financial target.

Overall Score 3:

Amber/Green

(I3 x L1)

5. Amendments to Risk Score/Narrative

There have been no amendments to risk score or risk narrative since the last meeting.

6. Recommendations

The Committee is asked to:

APPROVE the archiving of risk RR 089;

COMMENT on the risks shown within this paper (including the high/red risk) and those at

Appendix A; and

HIGHLIGHT any risks identified during the course of the meeting for inclusion within the

Corporate Risk Register.

Siân Gascoigne

Head of Corporate Assurance

April 2020

Risk Report


Risk Ref Oversight Committee Directorate Date Risk

Identified Risk Description Risk Category Existing Controls Mitigating Actions Mitigating Actions Progress Update:

Last Review

Date

(Relevant committee in

the CCG's governance

structure responsible for

monitoring risks relating

to their delegated duties)

(as per April 2020

CCG structure)

(Date risk

originally

identified)

(These are operational risks, which are by-products of day-to-day business delivery.

They arise from definite events or circumstances and have the potential to impact

negatively on the organisation and its objectives.) Imp

act

Like

liho

od

Sco

re (The measures in place to control risks and reduce the likelihood of

them occurring).

(Actions required to manage / mitigate the identified

risk. Actions should support achievement of target risk

score and be SMART (e.g. Specific, Measurable,

Assignable, Realistic and Time-bound). Imp

act

Like

liho

od

Sco

re

(To provide detailed updates on progress being made against any mitigating actions

identified. Actions taken should bring risk to level which can be tolerated by the

organisation).

RR022 Primary Care

Commissioning

Committee / Quality and

Performance Committee

Commissioning Jul-19 Failure to address unwarranted clinical variations, across primary and secondary care,

may not be achieved across Nottingham and Nottinghamshire. This, in turn, may

present a risk in terms of the quality of care provided and value for money.

Commissioning

Lucy

Dad

ge

Loca

lity

Dir

ecto

rs

4 3 12 • Role and remit of the Primary Care Commissioning Committee (and

supporting governance structures - e.g. primary care quality /

contracting teams)

• Activity monitoring via e-Health Scope tool.

• GP Practice Quality Visits programme

• Locality Teams' roles and remits (across all 3 ICPs)

• Financial Recovery Plan and associated governance arrangements

(including review of demand management).

Action: To continue with relevant actions within the

CCG's Financial Recovery Plan (FRP).

Action: To ensure Local Enhanced Services review is

rolled-out across all GP practices.

3 3 9 March 2020: It was highlighted that unwarranted clinical variation continues to be a key

focus at the CCGs' Financial Recovery Group (FRG) meetings.

Demand management continues to be an area of priority across primary and secondary care

provision. Action being taken includes, but is not limited to, Local Enhanced Services, PLTs,

referral management, GN RSS, MN referral support and PCN support and development. A full

review of the provision of LESs has now concluded.

10/03/2020

RR023 Primary Care

Commissioning

Committee

Commissioning Jul-19 As practices have seen an increase in charges for non-reimbursable costs for premises

from Property Services and from CHP (Community Health Partnerships), there is a risk

that (for some practices) this may impact viability of providing primary care services

from their current location.

This may, in turn, lead to service disruption, inability to invest and/or risks to patient

access to primary care services.

Finance

Lucy

Dad

ge

Lyn

ne

Shar

p

3 3 9 • CCG meetings with NHS Property Services and Community Health

Partnerships (quarterly).

• Engagement with NHS England Primary Care national and local teams

• LMC support to Practices.

Action: To continue to work with local GP practices, the

LMC and property companies (NHSPS and CHP) to

ensure management plans are in place.

Action: To escalate larger GP practice debts to NHSE/I

for further national support.

3 3 9 March 2020: CCG primary care staff are supporting GP Practices in identifying solutions to

their premises cost issues, with areas of most concern (e.g. largest debt) being prioritised.

Clear advice has been given by the CCG (and LMC) to Practices to pay reimbursable costs and

pay costs not in dispute. Nevertheless, debts in relation to the property continue to be a

significant challenge within Nottinghamshire and the CCG is being supported by NHSE/I with

this.

An interim Associate Director of Primary Care has been appointed, which will provide further

support for this agenda.

A national meeting is being scheduled with NHS Property Services and the GP Practice with

the highest levels of debt this month.

09/03/2020

RR032 Primary Care

Commissioning

Committee

Commissioning Jul-19 Reducing workforce capacity within General Practice may impact the sustainability of

some GP Practices. In responding to these challenges, Practices should consider

adapting their workforce models to enable the sustained delivery of core services,

whilst also ensuring sufficient capacity to deliver/contribute to system and

transformation requirements.

Lack of pace of change (e.g. adaption of workforce models) may present a risk that the

CCG's population access needs are not met, adversely impacting patient experience

and/or outcomes.

Workforce

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4 4 16 • Role and remit of the Primary Care Commissioning Committee (and

supporting governance structures - e.g. primary care quality /

contracting teams)

• PCCC assurance reporting requirements.

• Establishment of Primary Care Cell , as part of CCG's Covid-19

incident response

• Appointment of Associate Director of Primary Care

• Appointment of Associate Director of PCN Development

• Appointment of Locality Directors (and supporting teams)

• Establishment of Primary Care Networks (PCNs) (and/or other

collaboration/federation activities)

• Delivery of the Nottingham and Nottinghamshire ICS Workforce and

OD Plan

• Ensuring the best use of funding via the GP Forward View, targeting

resources to areas of need e.g. GP Resilience Funding, Practice

Manager training and development funding.

• CQC Inspection Rating(s) / Report(s).

Action: Implement and embed PCCC supporting

governance and reporting requirements to ensure

appropriate assurance is provided regarding primary

care services (e.g. quality of services, delivery of

contract requirements, patient experiences).

Action: To continue to deliver requirements of Primary

Care Workforce Strategy.

4 4 16 April 2020: GP workforce capacity is being monitored daily via the Primary Care Cell (which

has been established as part of the incident response structure).

A daily Primary Care OPEL report has been established to monitor primary care workforce

and service pressure. In addition, each Primary Care Network (PCN) has identified a business

continuity plan to respond to workforce pressures. Joint working through local 'hub'

arrangements are also taking place / being developed as part of the Covid-19 response. This

will build more capacity and resilience to delivering core General Practice services.

17/04/2020

RR089 Finance and Turnaround

Committee / Primary Care

Commissioning

Committee

Commissioning Jul-19 There is a risk associated with the loss of financial flexibility for the CCG as a result of:

• National funding adjustments, which reduced primary care allocations (£1.4 million

for Mid Notts); and

• Updated guidance on the cost of the new GP contract (£0.4 million cost increase for

Mid Notts).

The impact of the above is that the primary care financial position is more sensitive to

the impact of unforeseen pressures that could occur during 2019/20.

This presents a risk that there is an additional £1.8 million risk to delivery the CCG's

overall financial target.

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4 3 12 • Financial management arrangements (including Associate Director of

Primary Care as nominated Primary Care Budget Holder) to identify

opportunities within Primary Care budgets to match the pressure

where its arisen.

• Financial Recovery Plan (and associated action plan, SRO, Programme

Lead and supporting governance arrangements).

No further actions required as risk proposed for

archiving.

3 1 3 Risk score reduced and proposed for archiving at the April 2020 meeting. 17/04/2020

RR104 Primary Care

Commissioning

Committee

Commissioning Aug-19 Increasing pressure / demand on GP Practices, alongside capacity and access concerns,

presents a potential risk regarding the quality of primary care services being received.

This, in turn, may result in poor clinical outcomes and/or patient experience.

Quality

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4 3 12 • Quality reviews / Quality dashboards / Primary Care Quality

monitoring framework.

• Primary Care Network (PCN) collaborative arrangements / business

continuity arrangements.

• Increased clinical capacity at surrounding GP Practices (via transfer of

workforce from two closed Practices)

• Increased quality and contract review meetings with two remaining

GP Practices(weekly).

Action: To develop proactive business continuity and

collaborative arrangements across PCNs.

4 2 8 March 2020: The CCGs are continuing to utilise eHealth Scope to monitor quality indicators

across the CCGs' GP Practices. A Quality Update report was presented to the February PCCC

meeting which covered the four key areas:

• Primary Care Quality Dashboard - An overall summary of the quality dashboard ratings and

actions identified to be taken with either individual practices or where an issue has been

identified in relation to several practices or all practices.

• Primary Care Quality Groups / Primary Care Quality Team – An update on the activity of the

Primary Care Quality groups and Primary Care quality team.

• Care Quality Commission (CQC) - An overall summary of current CQC ratings and actions

being taken to support practices with either an overall rating of ‘Inadequate’ or ‘Requires

Improvement’.

• Practices Receiving Enhanced Support – An overview of any practices currently receiving an

enhanced level of support from the Primary Care quality team.

A quarterly meeting of a Primary Care Quality Group for each Integrated Care Partnership

(ICP), including standardised terms of reference, membership, work plan and governance and

reporting arrangements, is now established.

09/03/2020

Current Risk RatingInitial Risk Rating

NHS Nottingham and Nottinghamshire CCG Corporate Risk Register (April 2020)

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