Meeting of the Norfolk and Waveney CCG Primary Care ...

Agenda

Meeting of the Norfolk and Waveney CCG Primary Care Commissioning Committee

Tuesday 12th January 2021, 13:30 – 15:30 Part 1 Meeting to be held via video conferencing and You Tube

Item/PageNo

Time Agenda Item

Lead

1.

13:30 Chair’s introduction and report on any Chair’s action

Chair

2. Apologies for absence Chair

3.

Declarations of Interest To declare any interests specific to agenda items. Declarations made by members of the Primary Care Committee are listed in the CCG’s Register of Interests. For noting

Chair

4.

13:35 Review of Minutes and Action Log from the December 2020 meeting For approval

Chair

5.

13:40 Forward Planner For Noting

SP

Finance & Governance

6.

13:45 Risk Register For noting

SP/MB

7.

13:55 Finance Report For noting

JI/JH/JG

8. 14:05 Terms of Reference Review For Approval

SP/AB

Service Development

9. 14:20 PCN Development Review (presentation) For Approval

KL

10. 14:40 Prescribing Report For noting

MD

11. 14:50 Learning Disability and Austism Briefing For Noting

PM

Any Other Business

12. Questions from the Public Chair

Date, time and venue of next meeting Tuesday 9th February 2021 13:30 – 16:30

To be held by videoconference and You Tube Any queries or items for the next agenda please contact:

[email protected]

Questions are welcomed from the public. Please send by email: [email protected]

N&W Primary Care Commissioning Committee 12 January 2021 - Part One-12/01/21 1 of 60

Tab 3 Declarations of Interest

FIRST NAME LAST NAME JOB TITLE / ROLE

PR

IMA

RY

CA

RE

CO

MM

ISS

ION

ING

CO

MM

ITT

EE

Re

gis

tere

d w

ith

a N

&W

GP

Pra

cti

ce

NAME OF PRACTICE

(To remain confidential)

DECLARED INTEREST

(name of organisation nature of business

or nil return)

TYPE OF INTERESTDIRECT /

INDIRECTNATURE OF INTEREST DATE FROM DATE TO ACTION TAKEN TO MITIGATE RISK

Kathy Branson Consulting Ltd Financial D I am Director of Kathy Branson Consulting Ltd, which

provides consultancy and coaching services in the field of

health and care 2014 Present I do not take contracts that

are specific to the Norfolk & Waveney area.

2014 Present I do not take contracts that are specific to the Norfolk & Waveney

area. In the unlikely event that I am party to

discussions/decisions which relate to the nature of my declared

conflict, I am prepared to leave/not be part of the discussion.

East of England Leadership Network Non-Financial D I am a coach in the EoE leadership network and provide

pro-bono coaching to up to 4 people per annum.

2019 Present These sessions are bound by confidentiality agreements

Blend Coaching and Leadership Development faculty Financial D I am a member of Blend Coaching and Leadership

Development Faculty who have contracts with STPs to

provide coaching in the pandemic. This includes Norfolk

and Waveney staff

2020 Present These sessions are bound by confidentiality agreements

Norfolk and Norwich University Hospitals NHS FT (NNUHFT) Financial D I joined the Nurse Reservist scheme to carry out

Coronavirus vaccinations during the crisis. This means I

have a reservist bank contract, held by NNUHFT but

working across the STP and paid at Band 5

2020 Present I will leave the meeting / find an alternative chair for the item if

the vaccination programme is discussed.

Norfolk and Norwich University Hospitals NHS FT (NNUHFT) N/A I Son is Nurse at NNUHFT 2019 Present I do not discuss commissioning decisions with my son

Emma Bugg Associate Director of PCN Development Norwich Y Y Old Catton Medical Practice Nothing to declare N/A N/A N/A

Cath Byford Chief Nurse Y N/A East Suffolk Nurses League Non-Financial D Chair of the East Suffolk Nurses League 2010 Present In the unlikely event that a matter relating to East Suffolk Nurse

League arises I shall not be part of any discussion or decision.

PrescQipp Non-Financial D PrescQipp Member of the council of members 2015 Present

PrescQipp Financial D Voiceover work including paid voiceover for PrescQipp e-

learning

2018 Present

Benjamin Hogston Associate Director of PCN Develop. Great Yarmouth &

Waveney

Y Y Humbleyard Practice Nothing to declare N/A N/A N/A

Jason Hollidge Director of Commissioning Finance Y Y Attleborough Surgeries Grant Thornton LLP N/A I Close friend of Darren Bear a Board member of Grant

Thornton LLP, a national Accountancy, Audit and

Consultancy firm, that would be likely to tender for the

provision of these services to the CCG

2020 Present Removal from involvement in any tenders where Grant Thornton

have submitted an application.

John Ingham Chief Finance Officer Y Y Humbleyard Practice Norfolk and Suffolk NHS FT (NSFT) I Close friend of NSFT Trust Secretary 2019 Present

Flagship Housing Group Limited Financial D Non-Executive Director Flagship Housing Group Limited 2019 Present To be raised at all relevant meetings where

discussions/decisions relate to the conflict declared

Hopestead Financial D Trustee of Hopestead - charitable arm of Flahship Housing

Group Limited

2020 Present To be raised at all relevant meetings where


Swanton & Co Limited Financial D Director of Swanton & Co Limited 2013 Present To be raised at all relevant meetings where


Princes Trust Non-Financial Personal D Volunteer Mentor at Princes Trust 2007 Present To be raised at all relevant meetings where


Emma Kriehn-Morris Associate Director of Financial Management Y Y Mattishall Surgery Nothing to declare N/A N/A N/A

Parveen Mercer Head of Delegated Commissioning Y Y Rosedale Surgery Nothing to declare N/A N/A N/A

Rebekah Mercer Associate Director of PCN Development Y Y Grimston Medical Practice NHS Norfolk and Waveney CCG Non-Financial Personal I Partner works for N&W CCG as Associate Director - Urgent

and Emergency Care

2019 Present Will not take part in any discussion or decisions relating to the

declared interests.

Fran O'Driscoll Associate Director of PCN Development South Norfolk Y Y Bridge Road Surgery Nothing to declare N/A N/A N/A

Sadie Parker Associate Director of Primary Care Y N/A Active Norfolk Non-Financial D Represent N&WCCG as a member of the Active Norfolk

Board

2019 Present Low risk. If there is an issue it will be raised at the time

Sally Ross-Benham Associate Director of PCN Development North Norfolk Y Y Stalham Green & Ludham Surgery NHS Non-Financial Personal I Spouse is a NHS Volunteer delivering medication or

shopping to frail and vulnerable. Also delivers PPE or other

items to practices in North Norfolk - only claims for cost of

fuel

2020 Spouse's role to be declared should any item on the agenda look

relevant to the conflict

Norfolk and Waveney MIND Non-Financial Personal D Volunteer for Norfolk and Waveney MIND (outside of core

CCG hours)

2020 Present

Norfolk and Waveney MIND Non-Financial Personal D Ambassador for Norfolk and Waveney MIND (outside of

core CCG hours)

2020 Present

John Webster Director of Strategic Commissioning Y N/A Nothing to declare N/A N/A N/A

Castle Partnership GP Surgery Financial D Employed as an Advanced Nurse Practitioner and Castle

Partnership Norwich

2014 Present

OneNorwich Financial D Employed one day a week by OneNorwich as a clinical

advisor in the Inclusion Hub for vulnerable adults.

2020 Present

Queens Nursing Institute Non-Financial Personal D Member of the Queens Nursing Institute, Member of the

Faculty of Homeless and Health Inclusion

2020 Present

Norfolk and Norwich Univercity Hospitals NHSFT N/A I Sister employed registered nurse at NNUH 2020 Present

Norfolk and Norwich Univercity Hospitals NHSFT Non-Financial D NNUH Stakeholder trust governor on behalf of N&W CCG 2020 Present

Hein van den

Wildenberg

Lay Member - Governing Body Y Y Lakenham Surgery Finance Director Eaton Golf Club (Norwich) Ltd, a voluntary role Non-Financial Personal D Finance Director Eaton Golf Club (Norwich) Ltd, a voluntary

role

2019 Present Low risk. If there is an issue it will be raised at the time.

Thomas Araya NHS England & Improvement Primary Care Contracts Y N/A Nothing to declare N/A N/A N/A

Dr Tim Barger Norfolk & Waveney Local Medical Committee Medical Y Y Hingham Surgery Nothing to declare N/A N/A N/A

NHS Norfolk and Waveney CCG N/A I Personal friend of an employee of the CCG 2015 Present

Norwich Practices Limited (NPL) N/A I Personal friend of an employee of NPL 2015 Present

Norfolk County Council Financial D Elected Member of Norfolk County Council, Elmham

and Mattishall Division

Norfolk County Council Financial D Cabinet Member for Adult Social Care and Public

Health

Norfolk County Council Financial D Chair of Norfolk Health and Wellbeing Board

Breckland District Council Financial D Elected Member of Breckland District Council, Upper

Wensum Ward

Norfolk County Council Financial D Chair of Governance and Audit Committee

Manor Farm Financial D Farmer within Dereham patch Low risk. If there is an issue it will be raised at the time.

St. Stephens Gate Medical Practice Financial D Partner at St. Stephens Gate Medical Practice 2019 Present

One Norwich Financial D Director, One Norwich Practices Ltd (GPPO/PCN) 2019 Present

N2S Financial D Director, N2S, Provider of day surgery in a primary care

setting

2014 Present

Joni Graham Executive Officer Norfolk and Waveney LMC Y Y Orchard Surgery Nothing to declare N/A N/A N/A

Tony Goldson Suffolk Health & Wellbeing Board Chair Y Y Cutlers Hill Surgery Nothing to declare N/A N/A N/A

HealthWatch Norfolk Financial D Trustee and board member HeathWatch Norfolk 2020 Present

East Harling Parish Council Non-Financial Personal D Member, East Harling Parish Council 2020 Present

NHS England Non-Financial D GP appraiser, NHSE 2015 Present

Gill Jones HealthWatch Suffolk, Community Development Manager Y N/A Nothing to declare N/A N/A N/A

Humbleyard Practice Financial D Employee of Humbleyard Practice 2020 Present

Norfolk and Norwich University Hospitals NHS FT (NNUHFT) Non-Financial Personal D Chair of NNUHFT Patient Panel 2018 Present

Fiona Theadom NHS England & Improvement Senior Contracts

Manager

Y N/A Nothing to declare N/A N/A N/A

Naomi Woodhouse Norfolk & Waveney Local Medical Committee Director of Y Y Long Stratton Medical Partnership Nothing to declare N/A N/A N/A

Will not take part in any discussion or decisions relating to the

declared interests.

Will not take part in any discussion or decisions relating to the

declared interests.

TBC

Y East Harling GP PracticeAndrew Hayward HealthWatch Norfolk Trustee Y

TBC Will not take part in any discussion or decisions relating to the

declared interests.

Low risk. In attendance as a representative of the Local

Authority. Chair will have overall responsibility for deciding

whether I be excluded from any particular decision or discussion.

James Foster Member Practice Representative Y

Y North Elmham Surgery Ongoing

Ongoing

Ongoing

Ongoing

Ongoing

Ongoing

Norfolk Health & Wellbeing Board ChairBorrett Y

N/A Will not take part in any discussion or decisions relating to the

declared interests.

YMel Benfell Norfolk & Waveney Local Medical Committee Executive

Officer

Bill

Rosemary Moore Member Practice Representative Y

I exclude myself from any decisions relating to funding of

PrescQipp

Sarah Webb Administrator Y

Y Y Theatre Royal SurgeryDennis Head of Medicines ManagementMichael

Bacon Road Medical Practice

STAFF INFORMATION

Y

Y

Y

GP PRACTICE INFO

Y

INTERESTS

East Norwich Medical Practice

North ElmhamDoris Jamieson Lay Member

Tracy Williams Governing Body Y All potential conflicts are declared at each meeting. For any

related items, individual would not participate in discussions,

voting, procurements etc.

Y Magdalen Medical Practice In a non decision making role. In the event that a matter arises

during the course of the meeting the chair shall decide whether

its appropriate that my involvement continues or tif I should not

be a part of the discussions.

Kathryn Branson Registered Nurse - Governing Body

Y

2 of 60 N&W Primary Care Commissioning Committee 12 January 2021 - Part One-12/01/21

Tab 4.1 Minutes

Norfolk and Waveney CCG Primary Care Commissioning Committee

Part One

Minutes of the Meeting held on

8th December 2020 13:30 via video conferencing & You Tube

Present: Doris Jamieson (DJ) – Primary Care Committee Chair, Norfolk & Waveney CCG John Ingham (JI) – Chief Finance Officer, Norfolk & Waveney CCG Hein Van Den Wildenberg (HW) - Lay Member for Financial Performance In attendance: Michael Dennis (MD) - Head of Medicines Optimisation, Norfolk & Waveney CCG James Foster (PF) - Practice Manager Committee Member Cllr Tony Goldson (TG) - Chair Health & Wellbeing Board at Suffolk County Council Andrew Hayward (AH) – Trustee of Healthwatch Norfolk Jason Hollidge (JH) – Director of Commissioning, Finance, Norfolk & Waveney CCG Parveen Mercer (PM) – Associate Director of Delegated Commissioning, Norfolk & Waveney CCG Rosemary Moore (RM) – Practice Manager Committee Member Sadie Parker (SP) – Associate Director of Primary Care, Norfolk & Waveney CCG Karen Watts (KW) - Associate Director of Nursing and Quality, Norfolk and Waveney CCG Tracy Williams (TW) – Health Care Professional Attending to support meeting Thomas Araya (TA) Contract Manager, NHSE&I Claire Dyke (CD) Training Hub Manager, Norfolk & Waveney CCG Rebekah Mercer (RM) Associate Director of PCN Development (West Norfolk), Norfolk & Waveney CCG

Jayde Robinson (JR) Senior Primary Care Network Development Manager – Norwich Norfolk & Waveney CCG Sarah Webb (SW) – Primary Care Administrator (Minute taker), Norfolk & Waveney CCG

1. Chair’s Introduction Action

DJ welcomed everyone to the Norfolk and Waveney CCG Primary Care Committee Meeting and due to the unprecedented times the meeting was being held virtually via Webex and broadcast live on You Tube. The meeting was due to be held in public but due to the current restrictions this had not been possible. Chair welcomed Andrew Hayward (AH) to the Committee. AH represented Healthwatch Norfolk as a Trustee. Chair reported that she had taken a Chair’s Action to approve the Supporting General Practice in Norfolk and Waveney investment as part of the NHSE/I programme and the detail about the funding available to


Tab 4.1 Minutes

Primary Care was included in the pack.

2. Apologies for Absence

Mel Benfell (MeB) - Director of General Practice Contracting & Liaison, Norfolk & Waveney Local Medical Committee (LMC) Kathy Branson (KB) – Registered Nurse Cllr Bill Borrett (BB) – Chair Health and Wellbeing Board at Norfolk County Council Mark Burgis (MB) - Locality Director for North Norfolk, Norwich & South Norfolk, Norfolk & Waveney CCG Cath Byford, (CB) Chief Nurse, Norfolk & Waveney CCG Kerry Overton (KO) – Community Development Officer, Healthwatch Suffolk Fiona Theodom (FT) - Senior Contract Manager, Primary Care, NHS England and NHS Improvement – East of England John Webster (JW) – Director of Strategic Commissioning, Norfolk & Waveney CCG Naomi Woodhouse (NW) - Director of General Practice Contracting & Liaison Norfolk & Waveney Local Medical Committee

3. Declarations of Interest

Chair reported that the Declarations of Interest register would be updated for the January 2021 and encouraged Committee members to provide any updates. Item 8 KW – Member of Colitsihall Practice Item 9 JF and TW - TW is also registered at Bacon Road Conflicted attendee will not participate in discussion of the relevant item

4. Review of Minutes and Action Log from the November 2020 meeting

It was noted that the Minutes of the November 2020 meeting had one minor typo. Page 7 first paragraph Silicone should be Silicon. The minutes were then agreed to be a true and accurate record. ACTION: SW to send Minutes to DJ for signature. It should be noted that there were no matters arising. Chair reviewed the action log and it was noted that the Training Hub and Risk Register items were on the agenda. Learning Disability Health checks - PM provided an update. NHSE/I colleagues confirmed that apart from the core CQRS data no other data was available. An internal process had been set up and practices had been asked to report on a monthly template as part of the supporting primary care investment. The Business Intelligence Team would analyse this monthly data and the action was therefore closed.

SW

5. Forward Planner SP

Items highlighted in red were items not being brought on their due date and an explanation was provided. Red items for December 2020 were the Estates Quarterly Report and Phase 3 Primary Care Plan. It was noted that staff were focused on preparing the COVID vaccination programme. These items will be reported on at a later date.


Tab 4.1 Minutes

6. Risk Register SP

Three risks have reduced. PC4 – Improved Access – the final locality agreed their plan. This risk has now met its target. It was agreed to close this risk. PC10 – Prescribing gabapentanoids – MD would update later on the agenda. PC12 – Finance Risk – finance confirmed the CCG received the expected funding. It was agreed to close this risk. HW wanted to highlight the RAG rating on PC13 – should this be 3x4 or 4x3. PC9 was also queried. SP would review these outside of the meeting PC6 LD Health Checks – JI referred to additional funding outlined in Chair’s Actions. JI asked if regular updates would be provided given the amount of work needed to improve uptake. SP confirmed that from the 40 practices reviewed so far 39 planned to complete health checks. SP confirmed the BI report could be brought to Committee on a regular basis. PC2 Estates – DJ asked JH when the estates work would restart. JH confirmed that work was underway. A facet survey was being carried out by an external body. An estates strategy was to be undertaken for each PCN locality, planned to complete by the end of March 2021 and this formed part of the wider Estates Strategy for Primary Care. PC3 Locally Commissioned Services – DJ asked if there would be an increase to this risk given the pressures on the team, SP would review with PM outside of the meeting PC5 – Flu vaccine – DJ asked if an additional risk would be raised in respect of the COVID vaccination programme, or could these be linked. SP agreed that this would be helpful and confirmed she would liaise with KW outside of the meeting to ensure it was reported to the correct committee. PC11 Phase 3 Recovery – DJ asked if there would be some slippage in recovery targets. SP confirmed that the £150m allocation was designed to help practices find the additional capacity to managed business as usual, the recovery Phase 3 plan and step up the vaccination programme. SP acknowledged this risk needed to be worked through in more detail. JF outlined how he envisaged using some of the additional funding to assist his practice.

7. Finance Report JH

JH confirmed that month 6 top up allocations had been received. It should be noted that the comparatives in this report were based on an


Tab 4.1 Minutes

interim submission of the full year plan and subsequent to month 7 closing, a final submission was made. The month 8 report would reflect this final submission as comparatives. Month 7 Primary Care showed a £90k overspend against the interim plan to date, with a £370k forcecast overspend – both items have now been mitigated in the final plan submission. The key drivers were increased rental costs and the migration costs of the NHS111/ GP out of hours contracts. COVID Costs From month 7 onwards the allocation for COVID related costs is fixed. NHSE/I have outlined the categories in which valid claims would be made, these related mainly to staff costs and shielding backfill. It was therefore expected that a significant reduction would be seen compared to the first 6 months of the year. N&W CCG received £2.94M funding to support the primary care response as part of the national funding recently announced. DJ noted that there was a favourable variance forecast in respect of prescribing for year end and asked if this was realistic. JH responded that this was a product of the interim position referred to earlier and the final plan submission had brought this in line with plan. JI commented that prescribing was one of the biggest financial risks for this year and there were a number of significant factors which would have a bearing on financial costs. Chair thanked JH for the update.

8. Care Quality Commission report for Coltishall Medical Practice PM

PM provided an update based on information already available in the public domain. The CQC report had now been published and the practice had been rated inadequate with special conditions attached. The CCG support team had worked with the practice and CQC. The CQC seemed pleased with the progress made and the weekly assurance meetings had now been stepped down to once a fortnight as a result. DJ asked if the CQC had imposed a timeline as to when they would expect to see improvements. PM responded by saying ordinarily this would be 6 months after the first inspection. JI noted that safety had been rated inadequate and asked if assurance would be provided to the Committee that key safety themes would be addressed. PM responded that tight timelines had been implemented around safety and these had been met. If the CQC still had concerns then it was unlikely they would have stepped down the assurance meetings. TG asked if the prescribing practices had been addressed and PM confirmed that a prescribing plan was in place and delivering to plan.


Tab 4.1 Minutes

JI commented that there were a number of areas of learning and asked if there was a plan in place to share this with other practices. PM confirmed that this is being planned post COVID response. MD confirmed that prescribing leads meetings had been taking place and these will be reinstated again in February 2021. The first item to be addressed will be drugs safety alerts in order to try and prepare for what the CQC may inspect in future. JH asked if the CQC had targeted this practice for an inspection and PM confirmed she believed it was targeted as there had been a number of prescribing errors identified. There being no further questions Chair thanked PM for the update.

9. Norwich PMS Business Case

Opioid Reduction Service

Asthma checks and inhaler adherence in schools

JR

Asthma Piiot Project

JR highlighted key points. JR requested funding for a 12-month project pilot for Nurse Prescriber – total cost of project £76,566. The pilot would provide ongoing assessment for a permanent solution and the paper referred to the aims of the pilot. This pilot was worked through with a number of system partners. In summary, in Norwich it was approximated 3000 children aged 5-16 had a diagnosis of asthma and Appendix 4 A&E admissions were highlighted. Work would be ongoing with schools to identify further children. JR offered to take questions: HW asked if the selection criteria was just for Norwich schools and what happened if the pilot was a success after 12 months in terms of funding. JR responded that this was a test pilot model and if proven successful there was the opportunity to be wider scale. There could be some children registered outside of Norwich from the schools that have been identified. Initially it will be trialled in Norwich for Norwich registered patients. KW asked how the experience of benefits and outcomes received during the pilot will be captured. JR said that this would be built in as part of the evaluation process. DJ asked how the particular school was selected and JR responded the school approached Norwich PCN as part of ongoing work engaging with the community.


Tab 4.1 Minutes

JI commented that he was supportive of the pilot particularly in terms of addressing equalities. JI wanted to build on HW’s comments around the ongoing potential, and as a non clinician wanted to understand that after the child had been supported whether there would be a larger uptake of asthma reviews at the end of the pilot. JR responded that the impact investment funding stream could be utilised to fund this long term and there was a need to ensure that this was financially sustainable. There were different funding pots to fund this longer term dependent on the outcomes. JH asked if it was anticipated that posts would be recruited to fixed term and was this practical. The proposal was for 12 months and the posts recruited to would be based on that concept and there was a pool of interested candidates that had expressed an interest. DJ asked how children had been prescribed inhalers without a proper diagnosis and if there would be a one off inhaler prescription. AH confirmed that it was difficult to make a clear diagnosis of asthma in children particularly in toddler age and that children tended to get a number of viral infections across the year. MD agreed that this pilot was a good idea and commented that inhaler technique is poor therefore supported this proposal. Committee agreed to support the proposal. It should be noted that the LMC have made some comments and EB would respond to these. ACTION: EB to respond to LMC comments offline. Opioid Reduction Service JR requested funding for a 12 month fixed term Nurse Prescriber with the provision for work with the opioid reduction service, work with the Drug and Alcohol Liaison Team (DAT) and the Norfolk and Norwich University Hospital (NNUH) which would ensure sustainable pathways. Work had been done with stakeholders to understand what was available across the patch. The aim was to deliver an integrated care holistic approach and work was already being done with system partners. Areas had been identified where improvements could be made as Norwich had the highest death rate associated with opioid in Norfolk and Waveney and it was felt it was important to address the inequalities. JI asked MD for comments and wanted to understand the role of the nurse, asking if the model was sustainable. MD has set up a Dependence Forming Medicines Group including various partners. This model was not

EB


Tab 4.1 Minutes

used in Great Yarmouth and Waveney and he was interested to see how this worked, especially with potentially moving into West Norfolk. JR commented that it was going to be a practice based initiative with secondary care providers working in a PCN intercollective response and learning would be shared with practices. The model was slightly different from the model across the system and looked to address health inequalities as part of the role. SP commented one of the things that worked well across GYW was where groups of practices developed a joint policy and approach was undertaken around drug seeking behaviour and asked if Norwich PCN would develop something similar. JR responded the model was based on an all parties group which had addressed the risk of opioid dependency through early intervention and prevention and the collaborative working approach would be embedded. KW asked about the governance around the progress of the Pilot as it rolled out, as well as adverse incident reporting. JR said that there would be a clinical lead on this project and progress reports would be reviewed monthly. JR said she would obtain written confirmation around incident reporting from the clinical lead. ACTION: JR to link in with the clinical lead around incident reporting. JI asked about the expectations set around the pilot and how these would be continued. JR said that this would form part of the evaluation process. If it was sustainable longer term with the impact funding could be from the investment fund or through PMS for the longer term. HW referred to page 57 of the pack and asked about the potential for overlap of risks. JR said there was a link with prescribing as part of the development and there would be continual engagement, to avoid duplication and learning will be shared. MD agreed that this will be joined up and would explore what has worked well historically. Early review should give an opportunity to tweak the model. Committee agreed to support this proposal.

JR

10. Workforce and Training Hub CD

CD introduced herself and provided Committee with an overview of the Training Hub portfolio. CD highlighted that there was a need to ensure targets were met for training in respect of funding streams received. Programmes of work were on track and within budget and KPI’s were being met. CD reported there had been challenges delivering the COVID specific training given that this was at such a large scale. There was a need to ensure workforce resilience, competency and their overall health and


Tab 4.1 Minutes

wellbeing. HW asked about the maturity matrix in Appendix 1 and where the Training Hub scored itself. HW said it would be good to get some idea of training uptake across all areas at a future Committee. CD confirmed the maturity matrix takes us to March 2021. Work had been undertaken with Health Education England and with Primary Care Strategic Commissioning on infrastructure to support the maturity of the Training Hub and the programmes expected from this, and this was still under development. CD was required to report to various forums that ensured that requirements were met and ensure the workforce was trained. AH asked if there was any public involvement with training, particularly around patient experience influencing training. CD said that a Training Hub Fellow had been recruited to engage from the community to understand what the public want from their practices and community and this pilot. Discussions were still taking place. DJ highlighted the importance of involving Healthwatch. DJ thanked CD for the update.

11. Primary Care Resilience Programme PM

PM provided an update. PM confirmed that the CCG had been awarded the sum of £154k by NHSE to invest in improving resilience in General Practice. There are a number of practices that are experiencing resilience issues and the CCG was inviting GP practices to submit an application for funding by 4 January 2021. In order to assess these applications, the CCG had adopted the NHSE criteria and funding allocated where it was felt there would be the most impact – this was likely to be practices rated ‘requires improvement’ or in special conditions. This could result in fewer practices receiving funding than in previous years. DJ asked why outcome wasn’t weighted according to measure. PM said she would obtain consensus with LMC colleagues to draw out the practices that were struggling the most. Chair thanked PM for the update.

12. PCN Development and Locality Update – West Norfolk RM

RM provided an update. The current priority for West Norfolk was delivering the COVID vaccination programme. There is a site going live the following week and another is due to go live on 21st December 2020 with the final 2 PCNs after Christmas. RM described PCN development in West Norfolk. The practices were previously working in an isolated way and had come together to plan this programme. RM said it should be noted PCN developments were formed around the delivery of service to meet specifications. PCN development had been


Tab 4.1 Minutes

enhanced during the COVID outbreak. JI asked about prescribing as it did not appear obvious from the report. RM said that this had been reflected in the ARRS recruitment and the recruitment of clinical pharmacists. Some practices had issues and there had been more focus placed on these as well as some successful recruitment. MD attended the Local Delivery Groups previously and engaged with the Clinical Pharmacists and will engage with the Clinical Directors going forward. MD said that he was happy to attend meetings as required. DJ thanked RM for her update.

13. Prescribing Report MD

MD commented that focus in January will be on electronic prescribing. The report this month was light touch but had an extra focus on broad-spectrum antibiotics. Dr Mark Abrahams, Pain Consultant from Addenbrookes held a 1-hour presentation and Q&A on chronic pain and critiqued NICE guidance and MD offered to share the presentation. Dr Mark Abrahams’ focussed messaging was for patients not to use high dose opiates for chronic pain. Cost Pressures Sertraline shortage had created a cost pressure of £1.7m DOACs were increasing. Free Style Libre had become a significant cost pressure. Dependence Forming Medicines – the oral morphine equivalent indicator had been updated and awaited and this will be recalculated. Gabapentinoids had improved. Hypnotics hadn’t yet improved and would remain on the Risk Register. Antibiotics – percentage of broad-spectrum antibiotics went above national target. No more than 10% antibiotics should be broad spectrum as this may result in increased resistance to treatment. It also indicated that our antibiotics formulary was not being adhered to. Three of the five highest prescribers were dispensing practices and were not signed up to the prescribing quality scheme - these had been encouraged to sign up. The most concern was in Swaffham and Downham PCN therefore there was a need to engage further with their Local Delivery Group. TG asked when a comparison with Warfarin and a new drug was undertaken if the number of blood tests were taken into account and the cost involved. MD confirmed it was. There was draft guidance from NICE which suggested DOACs were more cost effective however the cost had not been taken into account properly. MD reported this was a complex area. HW referred back to PC9. HW felt that it would be useful to report back to this Committee and MD agreed he would report on Dependence Forming


Tab 4.1 Minutes

Medicine regularly and outline practices of concern. TW asked about DFM – TW noted we should also consider the combination of drugs. In regard to hypnotics given the increase in prescribing during the pandemic, there is a need to explore previous trends. TW agreed that gabapentinoids should remain on the Risk Register. MD stated Sertraline was no longer cost effective and use of alternative SSRI’s would be considered for new patients with anxiety and/or depression JI recognised that there were areas of concern for patient safety and public health and asked if the Committee could provide any further support. MD agreed that there were some drivers in the system and that engagement with practices was key. JI was conscious of the pressures and wide variation in primary care and asked if a letter from Chair of Primary Care Commissioning Committee could be issued to highlight issues. SP added that Primary Care Commissioning Committee papers are published on the website, this is highlighted in the practice newsletters to ensure practices are aware of what is reported in public. DJ confirmed she would be happy to sign a letter. DJ felt it important to ensure practices were aware where information on them may appear in public. DJ felt that it would be useful to share the chronic pain training with Committee members. ACTION: MD to share slides with Committee Members and draft a letter from DJ. DJ thanked MD for his report.

MD

14. Any Other Business There being no other business the Committee Chair then closed the meeting at 15:05. Chair confirmed one question had been received from a member of the public, however as it does not relate to the Agenda, the relevant CCG staff member would respond offline.

Date, time and venue of next meeting Tuesday 12th January 2021, 13:30

Via WEBEX & You Tube

Any queries or items for the next agenda please contact: Sarah Webb – [email protected]

Minutes agreed as accurate record of meeting: Signed: ……………………………………………………… Date: ……………………... Chair


Tab 4.2 Action Log

Code

RED Overdue

AMBER Update due for next Committee

GREEN Update given

BLUE Action Closed

No Meeting date added Agenda Item Owner Action Required Action Undertaken / Progress Due date Status Date Closed

0026 8th December 20204 SW

SW to send DJ signed minutes from November 2020 Committee SW completed 12th January 2021 9th December 2020

0027 8th December 2020 9 EB Norwich PMS Business Case

• Asthma checks and inhaler adherence in schools

LMC sent apologies and submitted comments to Committee

Members.

EB to progress comments received offline from

LMC

EB has written to the LMC with the appropriate

responses for the queries raised on each

business paper.

12th January 2021 5th January 2021

0028 8th December 2020 9 JR Norwich PMS Business Case

• Asthma checks and inhaler adherence in schools

Query regarding incident reporting

JR checked with Sarah Ambrose - this being

picked up as part of the pilot model. In addition,

feedback from students as part of the

engagement work will also be factored in for the

evaluation.

12th January 2021 5th January 2021

0029 8th December 2020 13 MD Prescribing Report

Dr Mark Abrahams, Pain Consultant from Addenbrookes held a 1-

hour presentation and Q&A on chronic pain

Pressures and wide variation in primary care Chair to write a letter

to highlight issues

SW circulated Chronic Pain document

MD to draft a letter for DJ

12th January 2021

0030 8th December 2020 14 SW Question from the public SW to progress this to resolution with

Complaints and Enquiries Manager 12th January 2021 22nd December 2020

NHS Norfolk & Waveney CCG Primary Care Commissioning Committee - Part One

Action Log 12th January 2021


Tab 5 Forward Planner

Norfolk and Waveney CCG – Primary Care Committee – 2020/21 PART ONE

Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-20 Feb-20 Mar-20

Proposed date: 14th 11th 8th 13th 10th 8th 12th 9th 9th

Standing items:

Risk Register y Y y Y y Y y y

PCN Development and Locality Update

Y GYW

Y North

Y Norwich

Y South

Y West

Y GYW

Y North

Y Norwich

Monthly Finance Report Y Y Y Y Y Y Y Y Y

Estates Quarterly y Y Y

Digital Quarterly Y y Y

Prescribing Report Y Y Y Y Y Y Y Y

Workforce and Training Y Y Y Y

CQC Inspections Report Y Y

Phase 3 Primary Care Plan Y Y

Spotlight items:

Annual or Bi Annual Report on Delegation

y

Spotlight items: Items noted without a date:

Local Commissioned Services Y

Terms of Reference Review Y

Committee training Y

Learning Disability /Autism Health check 6 monthly

Y

Severe Mental Illness Health checks

Y

Improved Access Y Y

Items noted without a date:

CQC new reports by exception

Bowthorpe Care Village Locally Commissioned Service

Audit Report

Items highlighted in red have not been included in the agenda at the nominated dates. Details as follows:

This month we have paused the locality update in PCN Development due to focus on the vaccination programme

CQC inspections report – inspection programme has been suspended during phases one and two of the pandemic, only urgent focused

inspections taking place. Coltishall inspection report published in November is on the agenda this month

Annual or bi-annual report on delegation – the report is yet to be produced due to Covid response priorities

Severe mental illness health checks – this work has been impacted by the Covid response, high risk patients are being prioritised by

practices as part of phase 3 recovery work

Estates quarterly report – the estates team is currently focused on preparing for the Covid vaccination programme, as such there will be

no estates update this quarter

Phase three primary care plans – monitoring has been paused to focus on the Covid vaccination programme this month


Tab 6 Risk Register

2020/21 – Primary Care Commissioning CommitteeRisk RegisterDecember 2020

PCCC Committee – 12/01/2021


Tab 6 Risk Register

1.0 PCCC risk dashboard

2

This risk dashboard categorises the key financial strategic risks by their impact and likelihood to help the strategic focus to be on those that will cause the

CCG the greatest issues. Key: = Worsening Risk = Stable risk = Improving risk Bold outline indicates a change from the previous month

New risks: There have been no new financial risks identified in month. Risk increases in month: There have been no increases in risk in

month.

Risk decreases in month: There have been no decreases in risk this

month.

Rare Possible Almost certain

Likelihood

Cat

astr

op

hic

Co

nse

qu

en

ce

Mo

der

ate

Neg

ligib

le

1 23 510

7 8 96 11

13

Ref. DetailsRisk

appetiteDec-20

PC1 Lack of GP workforce 12 12

PC2 No priori tised PC s trategic estates plan 9 12

PC3Fai lure to del iver Loca l ly Commiss ioned

Services project6 9

PC5 Increased demand for Flu vaccination 6 12

PC6Fai lure to del iver Learning Disabi l i ty

Annual Phys ica l Health Checks6 16

PC7Inabi l i ty for GPs to del iver ful l services

during Coronvirus pandemic.6 12

PC8Cost pressures due to medicine supply

i ssues9 12

PC9High prescribing of hypnotics and

anxiolytics in Primary Care12 16

PC10High prescribing of gabapentinoids in

Primary Care12 9

PC11Knock on effect of other providers not

reinstating face to face services12 12

PC13 Res i l ience of genera l practice workforce 6 12


Tab 6 Risk Register

Appendix A – Full PCCC Risk Register (1 of 4)

3

Refe

ren

ce

(refe

ren

ce n

um

bers

are

tem

po

rary

)

Date

Ad

ded

to

Reg

iste

r

Risk Description

(and implication)

Un

mit

igate

d R

isk

Rati

ng

(L

xC

)

Existing Mitigating Controls Assurances on Control

Cu

rren

t/ M

itig

ate

d

Ris

k R

ati

ng

(L

xC

)

Date Risk

ReviewedGap in Controls/Assurance Actions and Progress

Date to

Complete

Action(s)

Tolerated Risk

Rating (LxC)

Lead

CC

G a

nd

Ow

ner

PC1 1.6.20

STRATEGIC RISK:

Lack of general practice (GP) workforce due to

vacancies and impending staff retirements.

IMPLICATION:

The impact on the service delivery to patients.

4x4 = 16

Workforce plans in place at system level

Workforce team recruited in CCG structure

Training hub created with clinical leadership

recruited

PCNs supported to develop and implement

workforce trajectories in support of the additional

roles recruitment scheme

PCN Workforce Templates, being gathered for

submission to NHSE in order to infom Training Hub

spending.

National workforce reporting service - Practices

report monthly, PCNs report quarterly, contractual

requirement as part of GMS and PCN DES

Internal: Reporting to Primary

Care Commissioning Committee

(PCCC)

Training Hub and Workforce

Advisory Group meets two-

monthly

External: NHSE returns monthly

as part of the General Practice

Forward View implementation and

quarterly assurance meetings

4x3=12

significant risk

25.11.20

→

Recruitment of community pharmacists and

technicians is challenging

Lack of agreed system approach for rotational roles,

eg community paramedic

GPIT is holding up some recruitment

July 2020: Workforce & Training programmes are

returing to normal after COVID. Refocus on TNA and

delivery, Changes need to be made in line with new

ways of working. PCN Workforce Planning template to

be submitted by 31st August 2020, provideing details of

recruiting plans for 2020/21. recruitment to the ARRS is

a priority, especially Clinical Pharmacists and

Community Paramedics. Currently working with

EEAST on a rotaional programme with primary care.

August 2020; PCN Workforce Templates being

submitted to Workforce Team, ready to be submitted to

NHSE by 31st August

October 2020: ARRS templates submitted to NHSE and

approved. PCNs reviewing figures before final

submission. Good progress being made with EEAST in

progressing rotational roles

November 2020: PCN ARRS returns have been

resubmitted 31.10.20 as per national timetable, pharm

tech training programme with HEE - 10 places secured,

continue to progress with EEAST. Working with AHP

leads to discuss possibilities for rotational/ portfolio roles

December 2020: ARRS underspend comms sent to

practices inviting bids according to national criteria.

Focus on planning to support Covid vaccination

programme. National funding to support resilience of

general practice released.

31.3.21

TARGET Risk

Score (4x3=12,

SIGNIFICANT

PCCC

(Senior

workforce

and training

manager)

PC2 1.6.20

STRATEGIC RISK:

There is a lack of a prioritised primary care estates

stratetgic plan and a lack of evidence based decision

making for premises development – i.e. that the

appropriate buildings to deliver services and new service

models are not in place.

IMPLICATION:

Operational risk relating to the ability of practices and

PCNs to deliver services within capacity of existing

primary care estate. 4x4 = 16

1. New primary care estates team in place.

2. Sustainability and Transformation Partnership

(STP) estates work stream as enabler in situ

3. Estates and Technology Transformation Fund

(ETTF) successful bids in progress. Improvement

grants for primary care in progress

4. Sustainability and Transformation Partnership

(STP) estates plan in place.

5. Primary Care Data Gathering under way as part

of national pilot.

6. CCG commissioned Primary Care Demand and

Capacity Review due to be completed by Jan '21 -

ajead of schedule due in December 2020

7. CCG to work with PCNs to develop PCN level

estate strategies with all strategies completed by

Mar '21

Internal:

Local Primary Care Estates

Group established

Exec lead now in place for STP

estates workstream

External:

Primary care estates team

beginning to gain regular

exposure to wider stakeholders

4x3=12

significant risk

25.11.20

→

Demand and capacity review underway, but not yet

complete

Incomplete picture of primary care estate and its

condition

July 2020: Current focus is on demand and capacity

review, starting in Kings Lynn. Estates update will be

brought to September committee meeting and will

enable us to further update on actions being taken.

September 2020: NorLife making progress with

Demand and Capacity analysis with work starting on the

west norfolk locality. Primary care estates team are

drafting a proforma document to assist with development

of estate strategies and working with CCG PCN teams

to establish best approach of engagement with each

PCN.

October 2020: West Norfolk presentation to Fairstead

engagement group, no further update as work has been

paused during pandemic, hence increase in risk.

November 2020: PCN meetings taking place, 4/5

completed. Strategies due to be compelted by end of

March 2021. Framework developed to support strategy

development and CCG is supporting PCNs to do the

work.

December 2020: Final PCN meeting has taken place.

Focus this month has been on supporting identification

of sites for Covid vaccination programme.

30.06.2022

TARGET Risk

Score (3x3 = 9,

SIGNIFICANT

PCCC

(Associate

director of

estates)

- decreased

Updated: 22/12/2020 - Concise v1.3

Status Change

- same

- increased


Tab 6 Risk Register


4

Refe

ren

ce

(refe

ren

ce n

um

bers

are

tem

po

rary

)

Date

Ad

ded

to

Reg

iste

r

Risk Description

(and implication)

Un

mit

igate

d R

isk

Rati

ng

(L

xC

)


Cu

rren

t/ M

itig

ate

d

Ris

k R

ati

ng

(L

xC

)

Date Risk


Date to

Complete

Action(s)

Tolerated Risk

Rating (LxC)

Lead

CC

G a

nd

Ow

ner

PC3 1.6.20

STRATEGIC RISK:

Risk of failure to deliver the Locally Commissioned

Services project in line with published timeframes.

IMPLICATION:

This risk could impact/affect the successful

commissioning of locally commissioned services in

primary care.

Any deviation from the CCG's plans could attract legal

challenge.

Patients would be affected by a change in service

provision.

Inequity of current arrangements would continue

Phlebotomy services in Cromer and south Waveney

affected by short term changes in provision

4x3=12

1. Project being led by the delegated

commissioning team to ensure a consistent,

system-wide approach

2. Discussions had been taking place with the

LMC, LMC will represent general practice during the

process

3. Scoping of updated project in process

4. Discussions ongoing with NNUH regarding

Cromer Hospital service, some interim

arrangements in place

5. Discussions ongoing with ECCH regarding south

Waveney with services currently provided

Internal: Reporting to Primary

Care Commissioning Committee

(PCCC) and Executive

Management Team

External: None

3x3=9

significant risk

25.11.20

→

Completion of scoping and development of proposal

for EMT to consider before recommending to PCCC

July 2020: Paper being presented to EMT on 3.8.20 with

proposed short term approach to phlebotomy issues.

Plan to bring LCS paper to September PCCC once

further scoping has been completed.

Aug 2020: Extensive database created to capture all of

the primary care commissioned services across Norfolk

& Waveney including service specs, costs, and funding

source. Presentation made to Chief officers and

approach discussed with slide deck being presented to

September PCCC.

October 2020: Further work to refine costs for LCS

across the 5 localities. Discussion with finance team

around resource to support. Capacity within delegated

team is being monitored due to competing priorities and

risk may be raised if pressures continue

November 2020: Capacity issue in delegated team and

competing priorities has meant little progress has been

made

December 2020: Capacity within the delegated team is

now more significant as a vacancy has arisen and no

additional staff with appropriate skills have been

identified that could support the project. we review early

January 20201 on what other steps can be taken to bring

this project back on track

31.3.21

TARGET Risk

Score (3x2=6,

MODERATE

PCCC

(Associate

Director of

delegated

commission

ing)

PC5 1.6.20

STRATEGIC RISK:

Risk of increased demand for Flu vaccination among the

local population, delivered as per the National Directed

Enhanced Service (DES), to include expanded

programme as part of Covid phase 3 response

IMPLICATION:

Demand outweighs supply and results in an inability to

vaccinate population which could lead to increased

hospital admissions and strain on primary and

community care at a time of potential second Covid wave

Key Challenges:

- Late delivery of Flu vaccine stock.

- Delay in delivery of childhood Flu immunisation

programme, delivered through Public Health Norfolk.

- Reduced staff capacity due to social distancing, staff

risk assessments, donning and doffing PPE

- Reduced physical capacity to manage the programme

due to social distancing within general practice

- Risk to practice income due to increased staffing and

physical capacity required

4x4=16

1. CCG Flu plan in draft

2. Flu lead identified and CCG Flu cell established

3. Practices and PCNs have begun their planning

supported by locality teams

4. System discussions ongoing to agree

responsibilities and ensure that we make every

contact with a health professional count

5. Protect NOW risk stratification programme for flu

under development

6. Demand and capacity analysis understanding

eligible population vs forecast planning

7. Last year's uptake by practice for each at risk

group under review to determine where support is

likely to be needed

Internal: Flu plan monitored by

flu cell which reports to strategic

command. PC Flu Delivery Group

meets weekly to review progress

and troubleshoot issues. Primary

Care and Strategic Flu Cell sitrep

submitted to Strategic Command.

External: NHSE Regional

Immunisation & Vaccination

Team, PHE Health Protection

Team, NHSE Assurance sitreps

at PCN level

4x3=12

significant risk

25.11.20

→

Uncertain as to how much further national vaccine

supply will be released to support mop-up of under

65 cohort. Currently understand that GPs can

access 10% of their list size, however still waiting

on guidance on how much and how trusts and

community pharmacies can access.

July 2020: Flu cell first meeting, comms being

developed for practices, working with STP partners to

ensure every contact counts, confirmation PPE will be

provided by CCG

August 2020:

- Governance: Established Primary Care Flu Delivery

Group which feeds into Strategic Flu Cell. PC Flu

Delivery Group focuses on supporting practices with

local delivery.

- Comms and engagement: PC Team now sending out

weekly Flu FAQs to practices providing practical advice

and updates to support delivery of flu programme.

- Finance: Developing business case to address flu

associated costs; centralised budget e.g. for social

media campaign; supporting collaboration between

practiecs to deliver flu at scale.

- Community pharmacy: Working closely with

Pharmacy Lead (LT) to join up conversations with LPCs

(Suffolk and Norfolk) to support dialogue between

pharmacies and practices. Pharmacies will prioritise

clinically at risk and vulnerable pts. Continuing to work

through improving relationships and notifications of pts

vaccinated.

October 2020: business case submitted to executive

team. National funding expected shortly. National stock

expected in November with guidance published shortly.

Some practices have epxerienced power cuts and one

has lost stock.

November 2020: We have escalated concerns about

vaccine supply and limitations to achieving uptake in the

under 65 category to the Strategic Flu Cell and NHS E

regional team.

31.12.20

TARGET Risk

Score (3x2=6,

MODERATE

PCCC

practice flu

programme

only

(head of

primary

care

strategic

planning)


Tab 6 Risk Register


5

Refe

ren

ce

(refe

ren

ce n

um

bers

are

tem

po

rary

)

Date

Ad

ded

to

Reg

iste

r

Risk Description

(and implication)

Un

mit

igate

d R

isk

Rati

ng

(L

xC

)


Cu

rren

t/ M

itig

ate

d

Ris

k R

ati

ng

(L

xC

)

Date Risk


Date to

Complete

Action(s)

Tolerated Risk

Rating (LxC)

Lead

CC

G a

nd

Ow

ner

PC6 1.6.20

STRATEGIC RISK:

Failure to deliver Learning Disability Annual Physical

Health Checks to eligible people with LD as per the

National Directed Enhanced Service (DES).

IMPLICATION:

There is a risk that people living with learning disability

will experience significant health inequalities. Access to

an annual physical health check is intended to help

reduce this risk, however, there are variable rates of

uptake across Norfolk & Waveney GP practices.

4x4=16

1. STP plan in place to increase uptake of LD

health checks across practices

2. All practices signed up to the LD DES

3. Regular monitoring by Norfolk Health Overview

and Scrutiny Committee

4. CQC inspections usually include review of LD

health checks performance

5. Application to be regional exemplar in progress

Internal: Primary Care

Commissioning Committee,

External: NHSE Checkpoint and

Assurance Framework, Health

Overview and Scrutiny Committee

4x4=16

high risk

21.10.2020

→

Programme paused during response to Covid

Health checks cannot be completed fully via video

consultation

Some people with LD may find it challenging to

undertake consultation by video

July 2020: STP programme group established, led by

Amanda Dunn at NCC. Exemplar bid being drafted.

August 2020: NHS regional Exemplar bid for £35k

submitted with a focus on increasing uptake of AHCs in

the BAME/transient/traveller communities. CCG teams

took part in a live Q&A session with people with lived

experience. Delegated team have been contacting GP

practices to move to resume delivery of AHCs. CCG

working with LA and community providers to share

register details for reconciliation purposes. NHSE/I

restoration letters have all emphasised LD&A health

checks as a priority with an achievement target of 67%.

October 2020: Likely to be challenging for practices to

achieve new target. Capacity within primary care team

focused on immediate response. Lack of data means

we do not fully understand our current position, hence

increased risk rating.

November 2020: Most recent data shows low uptake to

date, practices with little or no claims will be contacted,

information being prepared for locality teams

December 2020: new national funding for resilience in

general practice includes requirement to increase LD

health checks. As part of distribution of funding, CCG

has asked for monthly returns from practices.

Exemplar bid funding has now been awarded and a post

recruited due to start 11 Jan 2021.

Ethnicity profiling fro practice data has been completed

for all 105 practices which will be used to target LD HCs

uptake within BAME communities.

Associate Director of Delegated Commissioning has met

with Norfolk County Council lead and agreed a process

on how data can be shared to support up take.

31.03.2021

TARGET RISK:

Moderate Risk

2x3=6

PCCC

(Head of

delegated

commission

ing)

PC7 1.6.20

STRATEGIC RISK:

The inability for general practice to deliver full services

during the Coronavirus pandemic due to the impact from

staff shielding, staff risk assessments, PPE, Test and

Trace and social distancing

IMPLICATION:

The impact on the service delivery to patients and

Primary Care staff from reduced capacity and increased

demand (from sick patients, backlog of paused services

and increasing waiting lists in secondary care).

3x4=12

1. National guidance and support from NHSE,

updated regularly

2. Local guidance and support provided through

business continuity toolkit and infection prevention

and control training

3. CCG has PPE Cell procuring and delivering PPE

to all practices

4. Online staff occupational health risk assessment

tool being procured for 6 months, supported by local

risk mitigation training

5. Practice reimbursement process in place for

Covid costs, including backfill

6. Practice income protected nationally, along with

local protection arrangements

Internal: primary care cell

established and team meetings

twice a week, PPE cell

established with team meetings

twice a week. Weekly sit reps to

Strategic Command

External: Regular sit reps to

NHSE, regular discussion with

LMC

3x4=12

significant risk

25.11.20

→

National guidance takes time to be published which

can lead to uncertainty locally.

Continuous updates to government advice and

restrictions during pandemic.

July 2020: Current focus is on rolling out staff risk

assessments support, restoration planning and flu

planning.

Aug 2020: CCG has procured an online OH staff

assessment called Rainbird to support practices with

staff risk assessments

October 2020: increased focus on supporting and

reminding practices about safe use of PPE, cleaning and

Covid secure workplaces. Encouraging business

continuity planning in the event of outbreaks

November 2020:

- Providing an upate and reminder on how practices can

access the online Risk Assessment tool Rainbird.

- Sign off of new escalation process for practice issues -

which intends to support a quicker and more streamlined

response from across CCG teams to primary care. As

well as provide clarity on the expected level of support

and interaction from the CCG to practices during an

'issue' or 'event'.

- Continuing to share latest information and guidance via

the Covid FAQs and support via the PCIR.

December 2020: National practice resilience funding

received to support capacity for recovery. New Covid

vaccination programme will have a further call on general

practice

31.3.21

TARGET Risk

Score (3x2=6,

MODERATE

PCCC

(Associate

director of

primary

care)

PC8 28.7.20

STRATEGIC RISK:

Cost pressures relating to ongoing medicines supply

issues

IMPLICATION:

NCSO price concessions conitnue to have a significant

impact on prescribing spend.

3x4=12

Practices are provided with information relating to

supply issues where possible including alternatives

however in many cases it is not apporpriate to keep

switching the patient and thus the usual medicine is

prescirbed at a higher cost. CCGs are not given

prior warning of medicines moving into NCSO.

Internal: Details of the cost

implications of NCSO are

reported to PCCC and finance

each month

External: none

3x4=12

significant risk

25.11.20

→

Prescribing work through the prescribing quality

scheme has been paused during the initial Covid

response

July 2020: Continue to report on a monthly basis the

implications and report into PCCC and finance. Where

possible advise switching to an alternative medicine, add

switch onto OptimiseRx software.

August 2020: 65 practices currently live with

OptimiseRx, activation is also an indication in the PQS

which shoudl be finalised by mid September 2020.

October 2020: Cost pressures are detailed in

prescribing report

November 2020: Cost pressures are detailed in

prescribing report

December 2020: Sertraline remains an issue following

the pandemic, new guidelines to practices about

Sertraline as first line in new patients. No change in

overall position.

30.09.21

TARGET RISK

SCORE:

Significant risk,

3x3=9

PCCC

(head of

medicines

optimisation

)


Tab 6 Risk Register


6

Refe

ren

ce

(refe

ren

ce n

um

bers

are

tem

po

rary

)

Date

Ad

ded

to

Reg

iste

r

Risk Description

(and implication)

Un

mit

igate

d R

isk

Rati

ng

(L

xC

)


Cu

rren

t/ M

itig

ate

d

Ris

k R

ati

ng

(L

xC

)

Date Risk


Date to

Complete

Action(s)

Tolerated Risk

Rating (LxC)

Lead

CC

G a

nd

Ow

ner

PC9 28.7.20

STRATEGIC RISK:

High prescribing rate of hypnotics and anxiolytics in

primary care - 3rd nationally on volume per 1,000

patients.

IMPLICATION:

These medications have negative side effects on patients

and should not routinely be used long term.

4x4+16

Practices have been encouraged to review their use

of hypnotics/anxiolytics however not all practices

have taken decisive action to reduce this.

Internal : Review Open

Prescribing data each month,

report progress to PCCC. Identify

pracitces with the highest

prescribing rates. External:

NHS England

4x4+16

high risk

25.11.20

→



response

July 2020: 1) Continue to report on a monthly basis the

implications and report into PCCC and quality. 2) Work

with quality leads in each locality to prioritise pracitces

to target re support and the development of action plans.

3) Include the development of an action plan in the PQS

for the remainder of the year. 4) Make this topic a

priority in the prescribing leads meetings as they start

up again. 5) Ask GP Prescribing Lead to support in

discussions with practices who are not engaging with

the CCG on this.

August 2020: Focus on this issue in September PCCC

paper with proposed actions.

October 2020: no further update

November 2020: update in prescribing report

December 2020: DFM group established and meeting

as a system. Overall improving national position but still

a national outlier

31.3.21

TARGET RISK

SCORE:

Significant risk

3X4 = 12

PCCC

(head of

medicines

optimilsatio

n)

PC10 28.7.20

STRATEGIC RISK:

High prescribing of gabapentinoids in primary care -

14th nationally on volume per 1,000 patients.

IMPLICATION:

These medications have negative side effects on

patients, their use should be regularly reviewed and they

should be used in caution with opioids/hypnotics. 3x4=12

Practices have been encouraged to review their use

of gabapentinoids however not all practices have

taken decisive action to reduce this.

Internal : Review Open

Prescribing data each month,

report progress to PCCC. Identify

pracitces with the highest

prescribing rates. External:

NHS England

3x3=9

significant risk

25.11.20

↘



response

July 2020: 1) Continue to report on a monthly basis the

implications and report into PCCC and quality. 2) Work

with quality leads in each locality to prioritise pracitces

to target re support and the development of action plans.

3) Include the development of an action plan in the PQS

for the remainder of the year. 4) Make this topic a

priority in the prescribing leads meetings as they start

up again. 5) Ask GP Prescribing Lead to support in

discussions with pracitces who are not engaging with

the CCG on this.

October 2020: No further update

November 2020: update in prescribing report

December 2020: now 28th nationally so improving

position. DFM group established and meeting as a

system

31.3.21

TARGET RISK

SCORE:

Significant risk

3X4 = 12

PCCC

(head of

medicines

optimilsatio

n)

PC11 26.8.20

STRATEGIC RISK:

Primary care/ other providers interface in relation to

reinstating routine care and stepping back up services

as part of Phase 3, other providers do not appear to be

reinstating face to face across services and the knock-

on-effect of such is pushing further workload back on to

primary care.

IMPLICATION:

Routine monitoring is being pushed back to primary care

to carry out, with the patients being put in the middle. In

addition, due to the restricted clinical capacity due to

limiting face to face appointments that secondary care

providers have put in place, patients being referred now

are being put on huge waiting lists (which I am sure you

will already be aware of). This in turn generates more

administration work for practices and further down line

the potential for increased appointments in primary care

as patients need reviewing

4x4=16

The risk has been flagged via the PC sitreps to

strategic command and highlighted as a challenge

in the General Practice Phase 3 plan presented to

EMT. The Director of Strategic Commissioning is

aware of the risk and is looking into how to

approach with AD of Planned Care either through

the newly emerging Clinical Executive Committee or

Clinical Reference Group.

EMT sighted and noted in sitrep

reports

4x3=12

significant risk

25.11.20

→

National guidance issued around phase 3 and NHS

priorities, this will support BAU amongst our acute

providers.

Aug 2020: Met with Norfolk and Suffolk local authorities

public health departments and agreed restart principles

and their providers will not be referring activity into

primary care. Further system discussions to be had on

diverting activity from secondary care into primary care.

PCCC will receive a progress update at the October

committee.

October 2020: discussions underway with acutes and

with planned care team. Rapid review of initial priority

specialties. discussions on data gathering from general

practice commenced with LMC

November 2020: Discussions ongoing

December 2020: Discussions focusing on secondary

care phlebotomy, little progress made to address short

term issues but general support to redesign of

phlebotomy pathway

31.12.20

TARGET Risk

Score (4x3=12,

SIGNIFICANT

PCCC

(Associate

director of

primary

care

working

with AD for

planned

care)

PC13 2.11.20 STRATEGIC RISK:

The resilience of general practice is at risk due to a

number of factors including workforce and workload

IMPLICATION:

Individual practices could see their ability to delivery care

to patients impacted through lack of capacity or the

quality of care provided. This will have a wider impact as

neighbouring practices pick up additional workload which

in turn affects their resilience

4x3=12

1. locality teams support for practices in their areas

2. PCN development support

3. workforce support through ARRS and training

4. CCG working with NHSE to develop supportive

framework for improving primary care quality

INTERNAL: PCCC, locality

teams, development of primary

care quality supportive framework

EXTERNAL: complaints, CQC4x3=12

significant risk

25.11.20

→

Process for quality framework not yet fully

developed

December 2020: practice resilience support funding

received and process established to distribute to

practices. Potential for the need to establish a Covid

vaccination programme in primary care to impact on the

resilience of practices

31.3.22

TARGET risk

score (3x2=6,

MODERATE)

PCCC (AD

Delegated

Commissio

ning )


Tab 7 Finance Report

Subject:

Primary Care Commissioning Committee (PCCC) 2020/21 Financial Report – Month 08

Presented by:

Jason Hollidge, Director of Commissioning Finance

Prepared by:

James Grainger – Senior Finance Manager Primary Care

Submitted to:

Primary Care Commissioning Committee

Date: 12th January 2021

Purpose of paper:

To present the month 8 (November 2020) Primary Care financial position for the Norfolk and Waveney CCG to the Primary Care Commissioning Committee for information.

Executive Summary:

Full Year budgets are based on NHSE/I November 2020 advised allocations; which were calculated from the CCGs full year forecast plan submission to NHSE/I on the 18th November 2020. Month 8 year to date there is a marginal £0.1m overspend, however, the Full Year budget of £410.6m is expected to underspend by £1.4m at £409.1m. This is predominately due to the release of prior year benefits in Delegated Primary Care (£0.7m) and reduction in Forecast Outturn due to the reversal in month of duplicated treatment room costs in Local Commissioned Services (LCS) for the period April to October 2020 (charges for approx. £63k per month, giving a total full year benefit of £0.76m). Delegated Primary Care is forecast to be underspent by £0.7m due to prior year benefit, released in M08, of which £0.4m is due to higher estimation of Quality and Outcomes Framework (QOF) charges made in 2019/20, the actuals were lower due to the impact of Covid. The balance was a result of prior year benefit in translation fees (£0.1m), prescribing fees (£0.1m) and locum sickness (£0.1m).

Report

Attached Recommendation to Primary Care Commissioning Committee:

This report is presented for information only.

Agenda Item: 07 Finance Report M08 NHS N&W Primary Care Commissioning Committee Part One



Key Risks

Clinical and Quality:

None

Finance and Performance:

Achievement of Financial plan

Impact Assessment (environmental and equalities):

None

Reputation: The achievement of the plan impacts the CCGs reputation with NHSE/I.

Legal: None

Information Governance: None

Resource Required:

None

Reference document(s):

NHSE/I guidance and communications

NHS Constitution:

None

Conflicts of Interest:

None

Reference to relevant risk on the Governing Body Assurance Framework

Delivering Financial plan

GOVERNANCE

Process/Committee approval with date(s) (as appropriate)

As part of Finance Committee reporting on 15th December 2020.



2020/21 – Primary Care Commissioning Committee Finance ReportNovember 2020 (M08 reporting period)

Primary Care Commissioning Committee– 12/01/2021



Contents

2

Ref Description Page

1.0 Executive Summary 3

2.0 Overall Position 4

3.0 Detailed Analysis of Major Variances 5

4.0 COVID-19 Costs 6

5.0 Financial Risks 7



1.0 Executive Summary

3

• Full Year budgets are based on NHSE/I November advised allocations; which were calculated from the CCGs full

year forecast plan submission to NHSE/I on the 18th November .

• Month 8 Year to date shows a marginal overspend of £0.1m against a budget of £271.4m.

• The Full Year budget of £410.6m is expected to underspend by £1.4m at £409.1m. This is predominately due to the

release of prior year benefits in Delegated Primary Care (£0.7m) and reduction in Forecast Outturn due to the reversal in

month of duplicated treatment room costs in Local Commissioned Services (LCS) for the period April to October 2020

(charges for approx. £63k per month, giving a total full year benefit of £0.76m).

• Delegated Primary Care is forecast to be underspent by £0.7m due to prior year benefit, released in M08, of which

£0.4m is due to higher estimation of Quality and Outcomes Framework (QOF) charges made in 2019/20, the actuals

were lower due to the impact of Covid. The balance was a result of prior year benefit in translation fees (£0.1m),

prescribing fees (£0.1m) and locum sickness (£0.1m).

• Financial Risk remains against GP Prescribing; Forecast outturn ( FOT) for GP Prescribing is currently an overspend

of £0.1m. GP Prescribing is volatile for both item demand and price and could be further impacted by tariff changes as a

result of EU Exit.

• The CCG continues to investigate further mitigations to the specific financial risks and will monitor and report specific

actions required as necessary.



2.0 Overall Position

4

Key HeadlinesPrimary care overall shows a forecast full year underspend of £1.4m and this is made up of underspends in Delegated Co Commissioning due to the release of prior year benefits of £0.4m in QOF, £0.1m in translation services, £0.1m in prescribing fees and £0.1m in locum sickness. In addition, £0.76m was reduced in FOT for LCS due to duplication of treatment room costs earlier in the year.

Key Financial risks

The Key financial risks are discussed in detail in slide 7.

Budgets and AllocationFollowing the receipt of the full year allocations as part of the planning submission in November all comparatives now reflect this planning submission. This has lead to a significant change in variances, as previously reported budgets were based on notional estimated allocations.

The budgets shown are the allocation given to the CCG for all 12 months of the financial year, inclusive of a top up allocation given in months 4, 5 and 6 and a final top up at M07 which was received on 1st

December.

Total Primary Care

Annual

Budget (£m)

YTD Budget

(£m)

YTD Actual

(£ m)

YTD Variance

(£m)

(Fav)/Adv

Forecast

Actual

(£ m)

Forecast

Variance (£m)

(Fav)/Adv

Total Prescribing 186.8 124.9 125.0 0.1 186.9 0.1

Primary Care

Gp Forward View 7.1 4.7 4.7 0.0 7.1 (0.0)

GP Out Of Hours 8.6 5.6 5.6 (0.0) 8.6 (0.0)

Local Enhanced Services 16.1 10.7 10.2 (0.5) 15.4 (0.8)

Other Primary Care 7.4 3.2 3.2 0.0 7.4 0.0

PMS to GMS Transition 4.2 2.8 2.8 0.0 4.2 0.0

Primary Care Delegated Co-Commissioning 168.8 112.1 112.6 0.5 168.1 (0.7)

Primary Care IT 4.2 2.7 2.7 (0.0) 4.2 0.0

Total Primary Care 216.4 141.8 141.8 (0.0) 214.9 (1.5)

Other Primary Care

NHS 111 7.3 4.7 4.7 (0.0) 7.3 0.0

Total Directorate 410.6 271.4 271.4 0.1 409.1 (1.4)



3.0 Detailed analysis of major variances

5

Budget

£m

Actual

£ m

Variance

(Fav)/Adv

£m

Budget

£m

Actual

£ m

Variance

(Fav)/Adv

£m

Local Commissioned Services(LCS) 10.7 10.2 (0.5) 16.1 15.4 (0.8)

Primary Care Delegated Co-

Commissioning112.1 112.6 0.5 168.8 168.1 (0.7)

Category

Reduction in Local Commissioned

Services (LCS) costs for Treatment

Rooms due to double counting of costs

of approx £63k per month resulting in

full year costs of £0.8m

Full Year Favourable variance is due to

release of prior year benefit of £0.7m of

which £0.4m is due to higher

estimation of Quality And Outcomes

Framework (QOF)charges for 2019/20 ,

the actuals were lower due to Covid

impact. The balance was prior year

benefit in Translation Fees for £0.1m ,

Prescribing Fees £0.1m and locum

sickness for £0.1m

Year To Date (YTD) Full Year

Narrative



4.0 COVID-19 Costs

6

As part of the CCG’s response to the Covid-19 pandemic, the CCG have been facilitating payments to Primary Care to compensate them for additional costs incurred. These costs have been reimbursed by NHSE/I in month 1-6 and a fixed budget based on these claims has been set for the remainder of the year.Above is a summary of these costs by major cost category. The details of these costs are:Clean: Associated costs with deep cleaning practices when there have been outbreaks.IT & Comms: Investment in laptops, web cams and other remote management equipment, so practices can continue to provide care to patients remotely.PPE: Some of the PPE has been provided centrally but many practices have had to source masks, scrubs etc from local suppliers. In addition the CCG has managed to procure bulk quantities of PPE to distribute to practices.Prescribing: As previously mentioned this has been specifically disallowed from our COVID recharge, the costs to the CCG are from NCSO and respiratory drugs.

Staff: These are costs for practices who have required to provide additional locum cover for doctors who are ill or are shielding. Also the practices have sent us costs for opening on bank holidays.

From month 7 onwards the financial guidance changed with CCG allocations for COVID costs being fixed (based on expenditure levels in the earlier part of the year).

As per the guidance from NHSE/I the categories of spend that can be reclaimed by practices has been reduced significantly, as a result, for the remainder of the year the CCG is only expecting to record staff costs for practice members of staff who are shielding (due to being high risk or those shielding due to COVID related sickness) on an exceptional basis. Cleaning, IT & Comms, and PPE can no longer be claimed or funded for by the CCG.

An additional one-off payment of £2.9m for Norfolk and Waveney practices will also be made available. This has been funded from the £150m nationally for Primary Care response to the pandemic, and to fund Covid vaccination efforts, along with other nationally prescribed requirements.

Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20Annual Forecast

Outturn

£m £m £m £m £m £m £m £m £m

PPE 0.9 0.8 0.4 0.1 (0.1) 0.2 0.0 (0.0) 2.3

Clean 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1

IT& Comms 0.1 0.0 0.0 0.0 0.0 0.2 0.0 0.0 0.3

Prescribing 0.0 0.8 (0.8) 0.0 0.0 0.0 0.0 0.0 0.0

Beds 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1

Staff 1.0 0.7 0.8 0.6 0.0 0.8 0.0 0.0 3.9

Total Spend 2.0 2.3 0.3 0.7 (0.1) 1.2 0.1 0.0 6.6



5.0 Financial risks

7

This section sets out the financial risks facing the CCG to help the strategic focus to be on those that will cause the greatest issues.

Fig.7 - Growth in spend by category - £m

Risk Mitigation

2020/21 outturn position deteriorates from current forecast There is robust management and oversight arrangements, detailed review of underlying position, via monthly review of actual expenditure compared to plan and specific mitigations agreed with budget managers.

Financially unstable practices 3 Practices have been brought to the attention of the CCG. The mitigating of this potential risk is by supporting practice incomes with average payments. We are also in receipt of a provision from NHSE which can be allocated to practices “at risk”.

Financial Gap 20/21 due to lack of external funding Final allocations for the remainder of the year have been given and the CCG will need to manage budgets within these allocations.

Volatile prescribing costs, that can fluctuate and are exacerbated by COVID-19. CAT M and NCSO costs

Robust management and oversight.Through collaborative working between finance and medicines management to understand trends, variances and cost pressures.

Additional costs due to existing estates costs, e.g. rent rate reviews, and new estates costs as a result of practice premises and expansion.

The CCG cannot mitigate existing establishment rate changes, but can look to be assured by close liaison with the District Valuer.

Continued oversight so that estates growth is matched by annual increases in delegated budgetsImpact of COVID-19 NHSE/I Financial Trajectories are adjusted to take into account the impact of the COVID-19 crisis.

Delegated financial position and the inability to control the spend within the CCG due to nationally mandated expenditure.

Negotiation with NHS England and Improvement and involvement in national allocation working groups.

Look to cease or defer non mandated expenditure where possible.


Tab 8 Terms Of Reference

Subject:

Primary Care Commissioning Committee Terms of Reference

Presented by:

Amanda Brown, Head of Corporate Governance

Prepared by:

Amanda Brown, Head of Corporate Governance

Submitted to:


Date: 12 January 2021

Purpose of paper:

To present the Terms of Reference to the Primary Care Commissioning Committee.

Executive Summary:

Attached are the terms of reference for the Primary Care Commissioning Committee (PCCC). The PCCC is a decision making committee with terms of reference based on the model version produced by NHS England. The terms of reference are set out in the CCG’s Constitution which was approved by the governing body at its meeting on 1 April 2020. The terms of reference is a key document that sets out the membership, remit, responsibilities and reporting arrangements of the PCCC. The membership of the PCCC is constituted to have a lay and executive majority as follows:

Lay Member who leads on primary care

Lay Member who leads on financial performance

Chief Finance Officer or the Deputy Chief Finance Officer

Registered Nurse A number of key stakeholders and CCG representatives are also invited to attend committee meetings but are not voting members of the committee. The Chair of the Committee is the Lay Member who leads on primary care and the Vice Chair is the Lay Member who leads on finance.

Agenda Item: 08 Terms of Reference NHS N&W Primary Care Commissioning Committee Part One



The Committee’s quorum is three voting members to include the Chief Finance Officer or nominated deputy. The functions delegated by NHS England in accordance with its statutory powers are set out in the terms of reference (section 14) and include, but are not limited to, the approval of practice mergers, decisions relating to the commissioning, procurement and management of primary medical services contracts, undertaking reviews of primary medical services and management of delegated funds. No recommendations to amend the terms of reference are made at the current time. If changes to the terms of reference are proposed, the committee will need to agree the amendments for submission to the governing body. The governing body will review and agree the changes before an application is made to NHS England to amend the CCG’s constitution. Only once the changes are approved by NHS England will they come in to effect.

Recommendation to Primary Care Commissioning Committee:

No recommendations to amend the terms of reference are made at the current time.

Key Risks


Not applicable


As required by the Terms of Reference


Not applicable

Reputation: Providing assurance to the Governing Body on delegated functions supports the CCG in maintaining its reputation

Legal:

Information Governance: Not applicable

Resource Required:

Not applicable


CCG Constitution

NHS Constitution:

Not applicable


Not applicable


Not applicable

GOVERNANCE




Terms of Reference approved by the Governing Body approval 01.04.2020 PCCC review 12.01.2021



Governing Body’s


Revision History

Approvals This document has been approved by:

Revision Date

Summary of changes Author(s)

Version Number

Approval Date

Approval Body Version Number

01.04.2020 Governing Body 1




Introduction

1. Simon Stevens, the Chief Executive of NHS England, announced on 1

May 2014 that NHS England was inviting CCGs to expand their role in

primary care commissioning and to submit expressions of interest setting

out the CCG’s preference for how it would like to exercise expanded

primary medical care commissioning functions. One option available was

that NHS England would delegate the exercise of certain specified

primary care commissioning functions to a CCG.

2. In accordance with its statutory powers under section 13Z of the National

Health Service Act 2006 (as amended), NHS England has delegated the

exercise of the functions specified in Schedule 2 to these Terms of

Reference to NHS Norfolk & Waveney CCG. The delegation is set out in

Schedule 1.

3. The CCG has established the Norfolk & Waveney CCG Primary Care

Commissioning Committee (“Committee”). The Committee will function as

a corporate decision-making body for the management of the delegated

functions and the exercise of the delegated powers.

Statutory Framework

4. NHS England has delegated to the CCG authority to exercise the primary

care commissioning functions set out in Schedule 2 in accordance with

section 13Z of the NHS Act.

5. Arrangements made under section 13Z may be on such terms and

conditions (including terms as to payment) as may be agreed between the

Board and the CCG.

6. Arrangements made under section 13Z do not affect the liability of NHS

England for the exercise of any of its functions. However, the CCG

acknowledges that in exercising its functions (including those delegated to

it), it must comply with the statutory duties set out in Chapter A2 of the

NHS Act and including:

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

c) Duty to exercise its functions effectively, efficiently and economically

(section 14Q);



d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

7. The CCG does also need to specifically, in respect of the delegated

functions from NHS England, exercise those in accordance with the

relevant provisions of section 13 of the NHS Act.

8. The Committee is established as a committee of the NHS Norfolk &

Waveney CCG Governing Body in accordance with Schedule 1A of the

“NHS Act”.

9. The members acknowledge that the Committee is subject to any

directions made by NHS England or by the Secretary of State.

Role of the Committee

10. The Committee has been established in accordance with the above

statutory provisions to enable the members to make collective decisions

on the review, planning and procurement of primary care services in

Norfolk & Waveney, under delegated authority from NHS England.

11. In performing its role the Committee will exercise its management of the

functions in accordance with the agreement entered into between NHS

England and the CCG, which will sit alongside the delegation and terms of

reference.

12. The functions of the Committee are undertaken in the context of a desire

to promote increased co-commissioning to increase quality, efficiency,

productivity and value for money and to remove administrative barriers.



13. The role of the Committee shall be to carry out the functions relating to the

commissioning of primary medical services under section 83 of the NHS

Act.

14. This includes the following:

a. decisions in relation to the commissioning, procurement and

management of Primary Medical Services Contracts, including but not

limited to the following activities:

i) decisions in relation to Enhanced Services;

ii) decisions in relation to Local Incentive Schemes (including the

design of such schemes);

iii) decisions in relation to the establishment of new GP practices

(including branch surgeries) and closure of GP practices;

i. decisions about ‘discretionary’ payments;

ii. decisions about commissioning urgent care (including home

visits as required) for out of area registered patients;

b. the approval of practice mergers;

c. planning primary medical care services in the Area, including carrying

out needs assessments;

d. undertaking reviews of primary medical care services in the Area;

e. decisions in relation to the management of poorly performing GP

practices and including, without limitation, decisions and liaison with

the CQC where the CQC has reported non-compliance with standards

(but excluding any decisions in relation to the performers list);

f. management of the Delegated Funds in the Area;

g. Premises Costs Directions functions;

h. co-ordinating a common approach to the commissioning of primary

care services with other commissioners in the Area where appropriate;

and

i. such other ancillary activities as are necessary in order to exercise the

Delegated Functions;



j. approval of the process for submitting and approving business cases

for PMS Monies and the approval of the business cases for PMS

Monies.

k. review, redesign and decommissioning of existing Local Enhanced

Services; and

l. review and design of primary care dashboard.

15. In performing its role, and in particular when exercising its commissioning

responsibilities, the committee shall take account of:

a) The recommendations of the clinical executive and other Governing Body

committees;

b) The needs assessment and plan for primary medical care services in the

areas covered by NHS Norfolk & Waveney CCG including the resilience

of general practice providers;

c) Reviews of primary medical care services in the area covered by the

CCG;

d) The co-ordination of a common strategic and operational approach to the

commissioning of primary care services generally including supporting

developments in respect of integration with providers and local authority

services including co-location of services;

e) The management of the budget for commissioning of primary medical

care services in the area covered by the CCG;

Geographical Coverage

16. The geographical coverage will comprise the area covered by NHS

Norfolk & Waveney CCG.



Membership

17. The Committee shall consist of:

Members Part 1 and Part 2

Lay Member who leads on primary care

Lay Member who leads on financial performance

Chief Finance Officer or the Deputy Chief Finance Officer

Registered Nurse

18. The Chair of the Committee shall be the Lay Member who leads on

primary care.

19. The Vice Chair of the Committee shall be the Lay Member who leads on

finance.

In attendance Part 1 and Part 2

Chief Nurse or Associate Director of Nursing and Quality

Director of Strategic Commissioning

representative from the Norfolk & Waveney Local Medical Committee

A representative from East local team of NHS England or their deputies

Associate Director of Primary Care or an Associate Director for PCN

Development.

Head of Medicines Optimisation

A Healthcare Professional Governing Body member drawn from Member

Practices.

Two Practice Managers drawn from Member Practices.

In attendance Part 1 invitation only

Norfolk Healthwatch representative

Suffolk Healthwatch representative

Norfolk Health and Wellbeing Board representative

Suffolk Health and Wellbeing Board representative

Meetings and Voting

20. The Committee will operate in accordance with the CCG’s Standing

Orders. The Secretary to the Committee will be responsible (or delegate

where appropriate) for giving notice of meetings. This will be accompanied

by an agenda and supporting papers and sent to each member



representative no later than 5 days before the date of the meeting. When

the Chair of the Committee deems it necessary in light of the urgent

circumstances to call a meeting at short notice, the notice period shall be

such as s/he/they shall specify.

21. An urgent decision is defined as a decision that must be taken by the

Committee before the next scheduled meeting of the Committee.

i) If there is an urgent decision to be made, then in the first instance an

emergency meeting of the Committee should be called following the

procedure set out below.

ii) If an urgent decision needs to be made before an emergency meeting can

be arranged then the Chair has the mandate to make that decision

provided he/she has consulted with as many Committee members as

possible but in any event at least 1 Executive member.

iii) Urgent decisions made will be put on the agenda of the next ordinary

Committee meeting and will be formally noted in the minutes.

iv) The Committee or any three members of the Committee can call an

emergency meeting of the Committee by giving all members at least

seven (7) days’ notice.

v) Committee members may participate in emergency meetings by the use

of telephone, video conferencing facilities and/or webcam where such

facilities are available (subject to the approval of the Chair). Participation

in a meeting in any of these manners shall be deemed as presence in

person at the meeting.

vi) The accidental omission to give notice of a meeting to or the non-receipt

of notice of a meeting by any person entitled to receive notice shall not

invalidate proceedings at that meeting.

22. Each member of the Committee shall have one vote. The Committee

shall reach decisions by a simple majority of members present, but with

the Chair having a second and deciding vote, if necessary. However, the

aim of the Committee will be to achieve consensus decision-making

wherever possible.

Quorum

23. The quorum will comprise three voting members of the Committee one of

which to be the Chief Finance Officer or their nominated deputy.



Frequency of meetings

24. The Committee shall meet according to business requirements, but is

expected to meet a minimum of four times per year. For the avoidance of

doubt, the Committee can meet more than this.

25. Meetings of the Committee shall:

a) be held in public, subject to the application of 25(b) below;

b) the Committee may resolve to exclude the public from a meeting that is

open to the public (whether during the whole or part of the proceedings)

whenever publicity would be prejudicial to the public interest by reason of

the confidential nature of the business to be transacted or for other special

reasons stated in the resolution and arising from the nature of that

business or of the proceedings or for any other reason permitted by the

Public Bodies (Admission to Meetings) Act 1960 as amended or

succeeded from time to time.

26. Members of the Committee have a collective responsibility for the

operation of the Committee. They will participate in discussion, review

evidence and provide objective expert input to the best of their knowledge

and ability, and endeavour to reach a collective view.

27. The Committee may delegate tasks to such individuals, sub-committees

or individual members as it shall see fit, provided that any such

delegations are consistent with the parties’ relevant governance

arrangements, are recorded in a scheme of delegation, are governed by

terms of reference as appropriate and reflect appropriate arrangements

for the management of conflicts of interest. Where a sub-committee is

established the Chair of the sub-committee will be a Lay Member of the

CCG.

28. The Committee may call additional experts to attend meetings on an ad

hoc basis to inform discussions.

29. Members of the Committee shall respect confidentiality requirements as

set out in the CCG’s Standards of Business Conduct.



30. The Committee will present its minutes to East local team of NHS England

and the Part 1 minutes to the Governing Body of the CCG for information,

including the minutes of any sub-committees to which responsibilities are

delegated under paragraph 27 above.

31. The CCG will also comply with any reporting requirements set out in its

constitution.

32. It is envisaged that these Terms of Reference will be reviewed annually,

reflecting experience of the Committee in fulfilling its functions. NHS

England may also issue revised model terms of reference from time to

time.

Accountability of the Committee

33. This Committee is accountable to the Governing Body and NHS England.

34. Budget and resource accountability arrangements and the decision-

making scope of the Committee will be in line with those detailed in these

Terms of Reference and in the delegation agreement.

35. For the avoidance of doubt, in the event of any conflict between the terms

of the Delegation and Terms of Reference and the Standing Orders or SFI

of any of the members, the Delegation will prevail.

36. Any proposed changes must be approved by the Governing Body before

they take effect. These terms of reference will be reviewed at least once

per annum. The review date will be included in the CCG’s Governance

Handbook which can be found at www.norfolkandwaveneyccg.nhs.uk

Procurement of Agreed Services

37. Procurement of agreed services will take place in line with the

arrangements set out in the delegation agreement and other associated

guidance.

Decisions

38. The Committee will make decisions within the bounds of its remit.

39. The decisions of the Committee shall be binding on NHS England and the

CCG.



Schedule 1 – Delegation by NHS England

a) Decisions in relation to the commissioning, procurement and management of

Primary Medical Services Contracts, including but not limited to the following

activities:

i) decisions in relation to Enhanced Services; ii) decisions in relation to Local Incentive Schemes (including the design

of such schemes);

iii) decisions in relation to the establishment of new GP practices

(including branch surgeries) and closure of GP practices;

iv) decisions about ‘discretionary’ payments;

v) decisions about commissioning urgent care (including home visits as

required) for out of area registered patients;

b) the approval of practice mergers;

c) planning primary medical care services in the Area, including carrying out

needs assessments;

d) undertaking reviews of primary medical care services in the Area;

e) decisions in relation to the management of poorly performing GP practices

and including, without limitation, decisions and liaison with the CQC where

the CQC has reported non-compliance with standards (but excluding any

decisions in relation to the performers list);

f) management of the Delegated Funds in the Area;

g) Premises Costs Directions functions;

h) co-ordinating a common approach to the commissioning of primary care

services with other commissioners in the Area where appropriate; and

i) such other ancillary activities as are necessary in order to exercise the

Delegated Functions.

Schedule 2- Reserved Functions

a) management of the national performers list;

b) management of the revalidation and appraisal process;

c) administration of payments in circumstances where a performer is

suspended and related performers list management activities;

d) Capital Expenditure functions;

e) section 7A functions under the NHS Act;



f) functions in relation to complaints management;

g) decisions in relation to the GP Access Fund; and

h) such other ancillary activities that are necessary in order to exercise the

Reserved Functions;



Publications Gateway Reference 000449

Delegation by NHS England

1 April 202019

Delegation by NHS England to ……

Delegation

1. In accordance with its statutory powers under section 13Z of the National Health Service

Act 2006 (as amended) (“NHS Act”), NHS England has delegated the exercise of the

functions specified in this Delegation to NHS … CCG to empower NHS …. CCG to

commission primary medical services for the people of …. .

2. NHS England and the CCG have entered into the Delegation Agreement that sets out

the detailed arrangements for how the CCG will exercise its delegated authority.

3. Even though the exercise of the functions passes to the CCG the liability for the

exercise of any of its functions remains with NHS England.

4. In exercising its functions (including those delegated to it) the CCG must comply with

the statutory duties set out in the NHS Act and/or any directions made by NHS England

or by the Secretary of State and must enable and assist NHS England to meet its

corresponding duties.

Commencement

5. This Delegation, and any terms and conditions associated with the Delegation, take

effect from 1 April 202019.

6. NHS England may by notice in writing delegate additional functions in respect of primary

medical services to the CCG. At midnight on such date as the notice will specify, such

functions will be Delegated Functions and will no longer be Reserved Functions.




Role of the CCG

7. The CCG will exercise the primary medical care commissioning functions of NHS

England as set out in Schedule 1 to this Delegation and on which further detail is

contained in the Delegation Agreement.

8. NHS England will exercise its functions relating to primary medical services other than

the Delegated Functions set out in Schedule 1 including but not limited to those set out

in Schedule 2 to this Delegation and as set out in the Delegation Agreement.

Exercise of delegated authority

9. The CCG must establish a committee to exercise its delegated functions in accordance

with the CCG’s constitution and the committee’s terms of reference. The structure and

operation of the committee must take into account guidance issued by NHS England.

This committee will make the decisions on the exercise of the delegated functions.

10. The CCG may otherwise determine the arrangements for the exercise of its delegated

functions, provided that they are in accordance with the statutory framework (including

Schedule 1A of the NHS Act) and with the CCG’s Constitution.

11. The decisions of the CCG Committee shall be binding on NHS England and NHS …

CCG.

Accountability

12. The CCG must comply with the financial provisions in the Delegation Agreement and

must comply with its statutory financial duties, including those under sections 223H and

223I of the NHS Act. It must also enable and assist NHS England to meet its duties

under sections 223C, 223D and 223E of the NHS Act.

13. The CCG will comply with the reporting and audit requirements set out in the Delegation

Agreement and the NHS Act.

14. NHS England may, at its discretion, waive non-compliance with the terms of the

Delegation and/or the Delegation Agreement.

15. NHS England may, at its discretion, ratify any decision made by the CCG Committee

that is outside the scope of this delegation and which it is not authorised to make. Such

ratification will take the form of NHS England considering the issue and decision made

by the CCG and then making its own decision. This ratification process will then make

the said decision one which NHS England has made. In any event ratification shall not




extend to those actions or decisions that are of themselves not capable of being

delegated by NHS England to the CCG.

Variation, Revocation and Termination

16. NHS England may vary this Delegation at any time, including by revoking the existing

Delegation and re-issuing by way of an amended Delegation.

17. This Delegation may be revoked at any time by NHS England. The details about

revocation are set out in the Delegation Agreement.

18. The parties may terminate the Delegation in accordance with the process set out in the

Delegation Agreement.

Signed by …………………………….Matthew Swindells

NHS England Regional Director Deputy Chief Executive

for and on behalf of NHS England

Schedule 1 –Delegated Functions

a) decisions in relation to the commissioning, procurement and management of Primary

Medical Services Contracts, including but not limited to the following activities: i)

decisions in relation to Enhanced Services;

ii) decisions in relation to Local Incentive Schemes (including the design of such

schemes);

iii) decisions in relation to the establishment of new GP practices (including branch

surgeries) and closure of GP practices;

iv) decisions about ‘discretionary’ payments;

v) decisions about commissioning urgent care (including home visits as required)

for out of area registered patients;

b) the approval of practice mergers;

c) planning primary medical care services in the Area, including carrying out needs

assessments;

d) undertaking reviews of primary medical care services in the Area;




e) decisions in relation to the management of poorly performing GP practices and

including, without limitation, decisions and liaison with the CQC where the CQC has

reported non-compliance with standards (but excluding any decisions in relation to

the performers list);

f) management of the Delegated Funds in the Area;

g) Premises Costs Directions functions;

h) co-ordinating a common approach to the commissioning of primary care services

with other commissioners in the Area where appropriate; and

i) such other ancillary activities as are necessary in order to exercise the Delegated

Functions.

Schedule 2- Reserved Functions

a) management of the national performers list;

b) management of the revalidation and appraisal process;

c) administration of payments in circumstances where a performer is suspended and

related performers list management activities;

d) Capital Expenditure functions;

e) section 7A functions under the NHS Act;

f) functions in relation to complaints management;

g) decisions in relation to the GP Access Fund; and

h) such other ancillary activities that are necessary in order to exercise the Reserved

Functions;


Tab 10 Prescribing Report

Subject:

Prescribing team report

Presented by:

Michael Dennis, Head of Medicines Optimisation

Prepared by:

Michael Dennis, Head of Medicines Optimisation

Submitted to:


Date: January 2021

Purpose of paper:

Information

Executive Summary:

Progress on quality and spend indicators are outlined and some of our current projects are highlighted.

1. Prescribing team focus areas

1.1 The prescribing team are working on a number of projects at present. These

include, support for care homes, roll out of electronic repeat dispensing, oral

nutritional supplement reviews by our dietetics team and our prescription

ordering direct service.

1.2 So far, 91 of our practices have signed up and the team continue to

encourage remaining practices to join.

2. CCG Prescribing Performance

2.1 It is still uncertain whether the effects of covid on prescriptions has been

explicitly credited into this allocation. NHS clinical commissioners are in

discussion with DHSC on possible credits for increased prescribing costs of

both sertraline and DOACs during covid.

2.2 Net ingredient cost (NIC) per AstroPU (an attempt to normalise practice demographics) below is a proxy measure of cost-effectiveness, it doesn’t however take account of deprivation which is a key driver of prescribing

Agenda Item: 10 Prescribing Update NHS N&W Primary Care Commissioning Committee Part One



spend. Norfolk and Waveney has the 3rd highest normalised spend of East of England CCGs (5th last month at 3.75).

South Norfolk, North Norfolk and West Norfolk are showing the biggest spend increases on the previous year.

Lo

ca

lity

Co

st

As

tro

PU

s Spend to Date

Th

is m

on

th

Sp

en

d t

o d

ate

Cu

m %

ch

an

ge

fro

m l

as

t y

ea

r

North Norfolk

822,558 £3,102,416 £19,727,027 11.7%

Norwich 825,821 £2,931,119 £18,776,068 9.3%

South Norfolk

968,262 £3,452,147 £22,156,752 13.4%

West Norfolk

765,866 £3,191,655 £20,177,464 10.2%

GY&W 1,006,488 £3,565,024 £23,144,279 8.5%



2.3 There are significant cost-pressures on commonly prescribed drugs.

In December the effect of historic and current cost concessions totaled £476k £454k last month and £4.5m to December (£4.0m prediction last month, this includes sertraline). The top drugs in terms of growth this April to October compared to last, were

Sertraline £1.9m (price concession and volume rise)

Edoxaban £885k (national move away from warfarin)

Freestyle libre £388k (time limited partial funding)

Paracetamol £272k

Influenza vaccine £259k (this is cross charged)

Apixaban £190k (as above with edoxaban)

YTD Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20

£2,685,800 £625,160 £570,078 £428,831 £312,902 £264,679 £236,441 £104,680 £77,359 £65,670

£9,340 £9,340

£1,793,216 £43,001 £39,418 £89,870 £197,527 £185,750 £191,323 £257,724 £391,139 £397,463

£9,340 £9,340

£31,525 £4,531 £3,860 £1,907 £2,835 £2,628 £2,077 £2,877 £5,082 £5,728

£9,340 £9,340

£27,759 £73 £278 £2,316 £2,528 £2,623 £2,922 £4,312 £5,664 £7,044

£9,340 £9,340

£4,538,300 £672,764 £613,635 £522,924 £515,792 £455,680 £432,764 £369,592 £479,244 £475,905

£37,613 £9,340

All

Concession & NCSO

Products off concession & NCSO but back

into DT at higher price

Cat-

M

Concession & NCSO

Products off concession & NCSO but back

into DT at higher price

Oth

er

TAG have agreed to advice adjustment on first-line SSRI’s in anxiety and depression. Prescribers are asked to use alternatives to sertraline. The CMA have agreed a price increase for Priadel and this started in December, it will lead to a full year effect of around £110k increased costs.

3 Dependence forming medicines (DFMs)

3.1 As previously reported the CCG is now improving from its position as a

national outlier on its use of high dose opiates in chronic pain. Our very high

use of hypnotics (and anxiolytics) remains a concern however.

3.2 The national indicators for DFMs for October 20 are below

High dose opiates – 100th (out of 134) on high dose opiate items

as percentage of regular opiates

Gabapentinoids - 27th nationally (28th last month) on defined daily

doses of gabapentin and pregabalin

Hypnotics and anxiolytics – 3rd nationally on (3rd last month)

volume per 1000 patients – the trend (below) is however an

improving one.



3.3 The oral morphine equivalent indicator is not currently being updated due to

changes in equivalances of opioids by the Royal College of Anaesthatists. So

in the meantime I have used the percentage of high dose opiate items

indicator as a proxy of performance. The latest data available is below but is a

few months old now.

High dose opiates – 33rd nationally on milligrammes of oral

morphine equivalent

3.4 Plans to address the above issues were presented in a previous months paper and our newly formed DFM steering group has now met for the first time with further meetings planned.

4 Antibiotic Prescribing 4.1 Antibiotic volumes, the bar chart on the right shows the volume of antibitoic

prescribing by PCN’s. Norfolk and Waveney is below the volume target in the 12 months to October 20. West Norfolk Coastal, Fens and Brecks and Swaffham and Downham are above the national target.

4.2 Percentage of broad spectrum antibiotics, the bar chart on the left shows the percentage by PCN. Norfolk and Waveney CCG is slightly above the national target of no more than 10% of all antibiotics at 10.57% (10.41% last month). Swaffham and Downham prescribing is the key driver of this variance.



4.3

4.4 Our outlier practices that are driving this increase are (12m to October)

Litcham Surgery 19.4% signed up to PQS

Burnham Surgery 18.7% not signed

Bridge Street Surgery 18.3% not signed

Mundesley Surgery 17.5% signed up

Howdale Surgery 17.4% not signed

Theatre Royal Surgery 16.2% signed up

Thorpewood Medical 15.3% not signed

Long Stratton 15.1% signed up

In the meantime we have asked practice and PCN pharmacists to encourage

their practices to sign up to our prescribing quality scheme (PQS) and they

will then be funded to perform antibiotic audits and action plans.

5 Electronic Prescription Service (EPS)

5.1 EPS and eRD (electronic repeat dispensing) enable patients to have

electronic and digitally signed prescriptions to be sent to pharmacies and

dispensing appliance contractors. It allows patients to choose where they pick

up their prescriptions rather than tieing them into the dispensary or pharmacy

next to their surgery.



5.2 Some practices had been very reluctant to enable EPS but where written to by

NHS England last year advising them that it is part of their contract. I am

trying to establish with the EPS team if all of our practices are now enabled.

5.3 A further benefit of the EPS service is eRD, this enables patients to pick up

their electronic repeat prescription on an automatic rolling basis once the

template has been set up.

5.4 Once the patient is on a stable prescription and their monitoring is up to date

patients can benefit from this form of prescribing. When a patient is informed

of the process they will understand that when they collect their next

prescription a clock starts that then allows their next prescription to drop into

their nominated pharmacy 7 days before it is due to be pick up.

5.5 Pharmacies are also contractually required to ensure that patients are not

given medicines that they don’t need. It is therefore important to advice

patients to ‘open the bag’ at the pharmacy and hand back any intems not

needed. Pharmacies may then feel that a medicines use review might be

necessary and the GP informed as appropriate.

5.6 eRD also makes it much harder for patients to run out of their prescriptions

and this should reduce demand for out of hours requests, A and E

attendances or request for emergency supplies from pharmacies.

5.7 During the first wave of covid the CSU medicines team were redeployed to set

up eRD templates. It was felt that this would help maintain the medicines

supply chain during the high demand.

5.8 Appendix 1 shows the CCG comparative performance which is on the low

side and appendix 2 shows the comparative performance of practices.



Recommendation to Governing Body/ Committee:

The committee is asked to note this report

Key Risks


Some key quality areas need focus and outlier performance needs addressing. Mitigated through the prescribing quality scheme


Risks highlighted in report


Not applicable

Reputation: CCG practices are outliers for hypnotics and anxiolytics as highlighted in the report

Legal: Not applicable

Information Governance: Not applicable

Resource Required:

Medicines management team support to practices


Not applicable

NHS Constitution:

N/A


GP practice members may be conflicted


Prescribing cost risk noted on register

GOVERNANCE


Monthly report to PCCC



Appendix 1 - %age of EPS items out of all items

CCG (GP Practices only)

EPS Items Items

% of EPS

Items

% of EPS Items

(England - CCGs only)

NORTH LINCOLNSHIRE CCG

201,061 418,154 48.08 84.91

KERNOW CCG 712,274 1,204,430 59.14 84.91

SHROPSHIRE CCG 346,559 566,695 61.15 84.91

LINCOLNSHIRE CCG 1,209,985 1,914,357 63.21 84.91

WEST SUFFOLK CCG 344,682 534,138 64.53 84.91

SOUTH WARWICKSHIRE CCG

321,100 495,011 64.87 84.91

EAST RIDING OF YORKSHIRE CCG

434,024 660,296 65.73 84.91

NORFOLK AND WAVENEY CCG

1,481,510 2,195,632 67.48 84.91

IPSWICH AND EAST SUFFOLK CCG

531,607 776,114 68.50 84.91

NORTH YORKSHIRE CCG

592,848 864,294 68.59 84.91

WEST ESSEX CCG 354,814 513,666 69.07 84.91

WARWICKSHIRE NORTH CCG

277,166 388,385 71.36 84.91

OXFORDSHIRE CCG 763,700 1,055,218 72.37 84.91

NORTH CUMBRIA CCG

485,597 669,649 72.52 84.91

HEREFORDSHIRE AND WORCESTERSHIRE CCG

991,018 1,366,053 72.55 84.91

BERKSHIRE WEST CCG

503,683 684,820 73.55 84.91

FYLDE & WYRE CCG 315,205 427,452 73.74 84.91

MID ESSEX CCG 519,062 697,180 74.45 84.91

VALE OF YORK CCG 431,744 577,757 74.73 84.91

EAST STAFFORDSHIRE CCG

185,370 247,112 75.01 84.91

EAST LEICESTERSHIRE AND RUTLAND CCG

415,612 553,600 75.07 84.91

TELFORD & WREKIN CCG

209,692 277,339 75.61 84.91

CAMBRIDGESHIRE AND PETERBOROUGH CCG

1,201,411 1,573,744 76.34 84.91



Appendix 2 - %age of EPSitems out of all items

GP Practice

GP Practice Code

EPS Items Items

% of EPS

Items

E HARLING & KENNINGHALL MEDICAL PRACTICE

D82042 0 17,294 0.00

FELTWELL SURGERY D82079 0 15,807 0.00

GRIMSTON MEDICAL CENTRE D82010 0 14,037 0.00

HARLESTON MEDICAL PRACTICE D82084 0 21,051 0.00

LITCHAM HEALTH CENTRE D82049 0 15,742 0.00

MATTISHALL SURGERY D82039 0 21,255 0.00

BOUGHTON SURGERY D82604 22 7,676 0.29

CHURCH HILL SURGERY D82046 455 13,503 3.37

WATLINGTON MEDICAL CENTRE D82043 605 17,855 3.39

ELMHAM SURGERY D82056 1,506 27,526 5.47

GREAT MASSINGHAM SURGERY D82070 888 15,611 5.69

BLOFIELD SURGERY D82080 1,841 17,625 10.45

BURNHAM SURGERY D82072 1,683 14,560 11.56

SHIPDHAM SURGERY D82100 1,427 11,546 12.36

PLOWRIGHT MEDICAL CENTRE D82621 4,381 19,092 22.95

LUDHAM AND STALHAM GREEN SURGERIES

D82028 4,030 16,595 24.28

ALDBOROUGH SURGERY D82628 1,681 6,620 25.39

HOLT MEDICAL PRACTICE D82001 9,317 36,509 25.52

FLEGGBURGH SURGERY D82600 1,089 4,031 27.02

ACLE MEDICAL PARTNERSHIP D82104 7,137 24,625 28.98

UPWELL HEALTH CENTRE D82035 11,126 31,106 35.77

OLD MILL AND MILLGATES MEDICAL PRACTICE

D82036 6,269 17,171 36.51

LONG STRATTON MEDICAL PARTNERSHIP

D82037 8,215 21,154 38.83

STALHAM STAITHE SURGERY D82009 8,257 20,823 39.65

HEATHGATE MEDICAL PRACTICE D82078 8,724 21,132 41.28

HOWDALE SURGERY D82068 7,901 18,845 41.93

MARKET SURGERY D82016 10,537 24,495 43.02

MANOR FARM MEDICAL CENTRE D82065 9,260 20,621 44.91

CAMPINGLAND SURGERY D82057 10,900 22,748 47.92

CHET VALLEY MEDICAL PRACTICE

D82006 8,991 18,411 48.83

BRUNDALL MEDICAL PARTNERSHIP

D82032 10,839 20,893 51.88

HINGHAM SURGERY D82085 7,554 14,280 52.90

COLTISHALL MEDICAL PRACTICE D82062 10,951 20,144 54.36

HOVETON & WROXHAM MEDICAL CENTRE

D82025 15,002 26,462 56.69

ST CLEMENTS SURGERY D82105 9,100 15,997 56.89



MUNDESLEY MEDICAL CENTRE D82053 9,986 17,420 57.32

BRIDGE STREET SURGERY D82015 13,963 24,057 58.04

REEPHAM & AYLSHAM MEDICAL PRACTICE

D82030 12,499 21,094 59.25

CUTLERS HILL SURGERY D83035 15,544 25,301 61.44

BIRCHWOOD MEDICAL PRACTICE

D82059 18,727 30,198 62.01

LAWNS PRACTICE D82022 9,655 15,431 62.57

WINDMILL SURGERY D82624 5,778 9,116 63.38

LONGSHORE SURGERIES D83010 12,354 18,930 65.26

WELLS HEALTH CENTRE D82038 4,999 7,591 65.85

CROMER GROUP PRACTICE D82004 23,667 35,664 66.36

PASTON SURGERY D82066 11,275 16,845 66.93

FAKENHAM MEDICAL PRACTICE D82054 22,029 32,594 67.59

SOLE BAY H/C D83022 7,743 11,354 68.20

ATTLEBOROUGH SURGERY D82034 24,045 34,466 69.76

BUNGAY MEDICAL CENTRE D83034 18,988 27,193 69.83

DRAYTON MEDICAL PRACTICE D82029 31,312 44,010 71.15

PARISH FIELDS PRACTICE D82031 13,770 19,273 71.45

HUMBLEYARD PRACTICE D82064 27,525 36,101 76.24

SHERINGHAM MEDICAL PRACTICE

D82005 20,285 25,838 78.51

SOUTHGATES SURGICAL & MEDICAL CENTRE

D82099 19,193 23,830 80.54

COASTAL VILLAGES PRACTICE D82058 32,798 39,975 82.05

THE WOOTTONS SURGERY D82618 6,965 8,349 83.42

WEST POTTERGATE MED PRAC D82106 5,863 6,739 87.00

VICTORIA ROAD SURGERY D83016 16,150 18,497 87.31

BEECHCROFT AND OLD PALACE Y03595 11,299 12,903 87.57

MAGDALEN MEDICAL PRACTICE D82012 18,066 20,564 87.85

WOODCOCK RD SURGERY D82096 10,336 11,708 88.28

LAKENHAM SURGERY D82026 15,339 17,328 88.52

WYMONDHAM MEDICAL PARTNERSHIP

D82045 29,628 33,422 88.65

ANDAMAN SURGERY D83608 11,776 13,269 88.75

BECCLES MEDICAL CENTRE D83009 28,910 32,503 88.95

HEACHAM GROUP PRACTICE D82027 21,714 24,263 89.49

THORPEWOOD MEDICAL GROUP D82048 19,525 21,581 90.47

VIDA HEALTHCARE D82044 74,188 81,880 90.61

UEA MEDICAL CENTRE D82088 5,002 5,514 90.71

BACON ROAD MEDICAL CENTRE D82060 9,387 10,329 90.88

PROSPECT MEDICAL PRACTICE D82087 10,665 11,730 90.92

EAST NORWICH MEDICAL PARTNERSHIP

D82071 26,663 29,317 90.95

LAWSON ROAD SURGERY D82076 14,660 16,117 90.96

ROUNDWELL MEDICAL CENTRE D82023 18,528 20,292 91.31

OAK STREET MEDICAL PRACT. D82047 11,461 12,528 91.48



OLD CATTON MEDICAL PRACTICE

D82013 8,842 9,637 91.75

TAVERHAM PARTNERSHIP D82024 11,495 12,489 92.04

ST STEPHENS GATE MEDICAL PARTNERSHIP

D82008 28,345 30,784 92.08

TOFTWOOD MEDICAL CENTRE Y05291 8,943 9,712 92.08

SCHOOL LANE SURGERY D82041 21,013 22,817 92.09

THEATRE ROYAL SURGERY D82050 16,811 18,252 92.10

ALEXANDRA & CRESTVIEW SURGERIES

D83002 23,513 25,513 92.16

HELLESDON MEDICAL PRACTICE D82018 13,021 14,128 92.16

ROSEDALE SURGERY D83047 23,511 25,468 92.32

NORWICH PRACTICES HEALTH CENTRE

Y02751 15,224 16,467 92.45

THE MILLWOOD PARTNERSHIP D82019 30,263 32,642 92.71

HIGH STREET SURGERY D83023 24,216 26,101 92.78

THE PARK SURGERY D82067 22,844 24,570 92.98

ORCHARD SURGERY D82020 19,914 21,401 93.05

WATTON MEDICAL PRACTICE D82063 26,385 28,304 93.22

ST JOHN'S SURGERY Y03222 13,499 14,425 93.58

ST JAMES MEDICAL PRACTICE D82051 35,011 37,406 93.60

CASTLE PARTNERSHIP D82011 24,566 26,225 93.67

WENSUM VALLEY MEDICAL PRACTICE

D82040 21,601 22,923 94.23

BEACHES MEDICAL CENTRE D82003 43,015 45,626 94.28

EAST NORFOLK MEDICAL PRACTICE

D82007 41,653 43,832 95.03

TRINITY & BOWTHORPE MEDICAL PRACTICE

D82017 16,116 16,931 95.19

NELSON MEDICAL CENTRE Y06275 8,602 9,018 95.39

GROVE SURGERY D82002 21,843 22,525 96.97

KIRKLEY MILL HEALTH CENTRE D83030 12,697 13,083 97.05

SCHOOL LANE PMS PRACTICE Y01690 4,246 4,375 97.05

THE HOLLIES SURGERY Y00297 9,425 9,661 97.56

BRIDGE ROAD SURGERY D83011 18,827 19,122 98.46

THE LIONWOOD MEDICAL PRACTICE

D82073 14,121 14,239 99.17

1.


Tab 11 Learning Disability and Autism Briefing

1

Agenda Item: 11 Learning Disability and Autism Briefing NHS N&W Primary Care Commissioning Committee Part One

1. Introduction This paper aims to provide an update on the learning disabilities / autism (LD/A) health check programme for patients aged 14 and over in Norfolk and Waveney. 2. Background COVID-19 continues to have a significant impact on all general practices across Norfolk and Waveney. Competing pressures and patients with LD/A both in lockdown 1 and 2, either shielding or worried about coming into general practices have impacted of health check delivery. Planned COVID Vaccine Programme will also potentially impact on practices ability to deliver LD/A health checks. November Primary Care Bulletin advised that where appropriate and clinically safe to do so, the face to face element of the current health check can be excluded. NHSE letter to practices November 2020, advising of funding for the purpose of support General Practice Covid capacity up until March 2021. A condition of this funding is that Practices report monthly current LD/A health check performance, commencing December 2020. NHSE/I can only provide quarterly data. Monthly reporting will give allow identification

Subject:

Physical health checks for people age 14 and over with learning disabilities/autism in Norfolk and Waveney.

Presented by:

Parveen Mercer – Associate Director of Delegated Commissioning.

Submitted To: Primary Care Commissioning Committee – 12th January 2021

Purpose of Paper: Information and discussion.

Summary: At the end of quarter two, Norfolk & Waveney CCG General Practices have delivered LD/A health checks to a combined total of 14.4% of patient’s, aged 14 and over who are on Practices learning disabilities/autism register. This is compared to 22.6% for the same period in 2019/20. Development projects aimed at boosting uptake of learning disabilities / autism health checks include:

Exemplar project focused on BAME and transient communities.

Peripatetic team Pilot.

LD/A Communication App

Recommendation: To note the report, discuss and provide any feedback


Tab 11 Learning Disability and Autism Briefing

Page 2 of 2

and early intervention where a Practice is struggling to meet this year’s 67% target. We have circulated a spread sheet to make reporting as easy as possible. 3. Performance: NHS England remain focused on achieving a target of 75%. However, General Practices have been asked to achieve an annual rate of seeing at least 67% of people on their learning disabilities register, aged 14 and over through an annual health check, by 31st March 2021.

Uptake of Learning Disability & Autism Annual Health Checks by locality Q1 & Q2 20/21 (cumulative total)

GY&W North Norfolk

Norwich South Norfolk

West Norfolk

N&W total

20/21 Q2 20.8% 19.7% 9.9% 9.9% 11.9% 14.4%

19/20 Q2 28.1% 25.5% 21.8% 21.6% 15.9% 22.6%

4. Development Projects: 4.1 Exemplar Project: As a result of our innovative bid, Norfolk &Waveney CCG has been selected to be the exemplar site for the eastern region by NHS England. We have recently recruited an Outreach LD&A Worker to promote the importance of a LD/A health check and provide appropriate support access particularly amongst BAME, transient, Asylum Seekers and Refugees community groups. Utilising National General Practice profile we have collated ethnicity data to target available resource. Contact has been made with local Hindu Community Group. Due to Covid restricts the Group are not holding face to face community meetings but are prepared to distribute LD/A health check information virtually. When Covid restrictions are lifted the Group are happy for the CCG to attend one of their meetings. Contact has also been made with the local Muslim community groups with information forwarded in relation to exemplar project. Unfortunately, due to Covid restrictions the group are only meeting in small numbers for prayer. We are continuing to establish contact with other BAME, Transient, Refugee and Asylum Seeker communities. 4.2 Peripatetic Team Pilot: Having secured Transformation funding, we are actively seeking to establish a new team to support the provision of LD/A health checks within Primary Care. Recruitment has taken place for Band 6 Learning Disabilities Nurse & Band 4 Health Improvement Support Workers for Learning Disabilities. An expression of interest has been circulated offering a fixed term Secondment for a qualified clinician to provided oversite and leadership within the Team. 4.3 LD/A Communication App: As part of the above Transformation funding award, we are exploring the potential launch of an LD/A app. Elsewhere an app has allowed both patients and health care professionals to communicate and support progress on health goals and also acting as a method of early intervention if a patient needs to be physically seen. 5. Conclusion: Competing priorities with Practices including planned COVID Vaccine Programme may impact on LD/A health check delivery. The CCG is actively working with PCN’s and Practices to explore opportunities to boost Health Check activity. Monthly reporting will allow identification and intervention where a Practice is struggling to achieve the 67% target.


Meeting of the Norfolk and Waveney CCG Primary Care ...

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