NHS Corby CCG · GP Governing Body member, NHS Corby CCG . Senior Contract Manager, NHS England...

Primary Care Commissioning Committee in Public

Tuesday 23 July 2019

2.00pm-3.00pm

Meeting Room 1, Corby Enterprise Centre, London Road, Corby, NN17 5EU

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A G E N D A

NHS Corby CCG Primary Care Commissioning Committee in Public

Tuesday 23 July 2019 2.00pm-3.15pm

Meeting Room 1, Corby Enterprise Centre, London Road, Corby NN17 5EU

Time Agenda Item Action Presented by Reference

INTRODUCTORY ITEMS 14.00 1. Introductions and Apologies:

Note Tansi Harper Verbal

14.00 2. Declarations of Interest Note Tansi Harper Verbal

14.00 3. Minutes of meeting held on 28 May 2019

Approve Tansi Harper PPCCC-19-22

14.05 4. Matters Arising and Action Log Assurance Tansi Harper PPCCC-19-23

STANDING ITEMS 14.10 5. Primary Care Networks Assurance Julie Curtis Verbal

14.15 6. Primary Care Strategy Assurance Julie Curtis Verbal

14.20 7. Finance Update

Assurance Stuart Rees PPCCC-19-24

14.30 8. NHS England Update Assurance Jane Green Verbal

14.35 9. General Practice Forward View Update

Assurance Keiren Leigh PPCCC-19-25

14.45 10. Primary Care Quality Report Assurance Sharon Wright PPCCC-19-26

14.50 11. Primary Care Risk Register Assurance Julie Lemmy PPCCC-19-27

14.55 12. Medicines Management Risk Register Assurance Giles Owen PPCCC-19-28

ITEMS FOR INFORMATION

15.00 13. Terms of Reference Information Tansi Harper PPCCC-19-29

DATE OF NEXT MEETING The next meeting will be held at 14.00 on Tuesday 24 September 2019 in Meeting Room 1, Corby Enterprise Centre.

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Minutes of the Primary Care Commissioning Committee Meeting in Public

Tuesday 28 May 2019 at 10.00am

Boardroom, Francis Crick House, Summerhouse Road, Moulton Park, Northampton, NN3 B6J

Present Tansi Harper Lay Member NHS Corby CCG (Chair) Julie Curtis Interim Director of Primary & Community Integration Stuart Rees Chief Finance Officer, NHS Corby and NHS Nene CCGs In Attendance Roman Babinskyj Joanne Brodrick Dr Sanjay Gadhia Jane Green

Vice Chair, LMC Independent Lay Member, NHS Corby CCG GP Governing Body member, NHS Corby CCG Senior Contract Manager, NHS England Central Midlands

Salim Issak Contract Manager, NHS England Central Midlands Julie Lemmy Deputy Director of Primary Care, NHS Corby and NHS Nene CCGs Keiren Leigh Dr Nathan Spencer

Programme Lead primary Care Transformation & GPFV, NHS Corby and NHS Nene CCGs GP Governing Body Member, NHS Corby CCG

Sharon Wright Quality Improvement Manager, NHS Corby and NHS Nene CCGs

Apologies Jonathan Ireland LMC Colin Thompson Andrew Hammond

Public Health Consultant, NCC Lay Member , NHS Corby CCG

Minute No. Agenda Item PCCC19/20 001 Welcome and Introductions The Chair welcomed members to the meeting and declared the meeting quorate.

Stuart Rees informed the committee that he is the Director On Call this week.

PCCC19/20 002 Apologies for Absence Apologies were notes as above.

PCCC19/20 003 Declarations of Interest None were no declarations of interest relating to items on the agenda made by those

present.

PCCC19/20 004 Previous Minutes and Matters Arising Dr Nathan Spencer noted that his name had been mis-spelt on both sets of minutes. This

was duly noted. The minutes of meetings held on: 15th January 2019-APPROVED 19th March 2019-APPROVED The Chair requested that both sets of minutes be uploaded onto the Corby CCG website once IT issues have been rectified. Action: Approved minutes to be uploaded to Corby CCG website.

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PCCC19/20 005 Action Log and Matters Arising The Committee reviewed the Action log and the matters arising:

Action No. PCCC18/19 063 Sharon Wright informed the Committee that the Learning Disability indicator is improving and this is included in a quarterly report from the Quality Team, which can be presented to future Committee meetings.

PCCC19/20 006 Finance Report Stuart Rees took the paper as read and confirmed the financial position of the GP Services’

budgets for Corby CCG at Month 12 of the 18/19 financial year. The Committee was asked to note that these are draft figures which will need to be verified by the auditors. The primary care budget for 18/19 is £23.873m. Cost pressures on GP practice prescribing budgets were higher than planned which contributed towards an overall overspend of £0.231m at Month 12. The implications of this for the financial year 19/20 will be presented at the next meeting. The Chair thanked Stuart Rees for a very comprehensive report. The Committee noted the budgetary position and forecast outturn of the GP services budgets as at the end of Month 12 for the 18/19 Financial Year.

PCCC19/20 007 NHS England Update Jane Green provided a verbal update to the Committee. The new structure for Primary

Care following the merging of NHS England and NHS Improvement in April has not been finalised yet. Events were held last week within NHS England when staff were informed that the new structure will be finalised by September. It is worth noting that Central Midlands is one of the largest regions within NHS England.

Jane Green will provide the Committee further updates when they become available.

PCCC19/20 008 General Practice Forward View Update Keiren Leigh presented the GPFV update in a different format which the Committee noted

and welcomed.

Primary Care Workforce- Keiren reported that two events had been held as the first wave for the GP International Recruitment campaign. This had resulted in ten new clinicians being recruited. The weekend event involved candidates visiting all the interested practices, each practice giving a short presentation on their practice and what they could offer the candidates and culminated in candidates having interviews with each of the practices. There was also a chance for both candidates and interested practices to spend time together. The candidates will now commence a very intensive three month residential course in Poland before they take up post in September. They must pass this course before they will be able to commence in post. Sanjay Gadhia expressed congratulations to both Jane Finch and the Primary Care Team at

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Corby and Nene CCGs, who had organised the event and drawn up the itinerary. He had received many positive comments from everyone involved and also wanted to highlight how significant a success this was in comparison to the NHSE programme which has only managed to recruit 50-60 GPs across the whole of the country. Enablers- Nathan Spencer expressed concern regarding the IT infrastructure and that practices have no faith in the current provider. He highlighted the problems being encountered with passwords to gain access to SystmOne, in particular access being removed with no notification and the long lead time of 14 days to provide locums access to IT – this is especially difficult when locums are booked at short notice. Nathan Spencer also highlighted problems with Smartcards logging out when someone momentarily goes away from their desk. This then means that information is lost such as prescription or patient details. Action: Julie Lemmy and Dr Nathan Spencer to meet up to discuss in detail. The Committee welcomed the new format of this report and noted its content.

PCCC19/20 009 Primary Care Quality Report Sharon Wright confirmed no quality concerns had been raised. She also asked the

Committee to note that as future meetings of this Committee will now be in synchronisation with the Risk Sharing Group, this is the report that will be shared at this Committee in future.

PCCC19/20 010

Primary Care Strategy

Julie Curtis informed the Committee that the Primary Care Strategy has a national submission deadline of 30th June. A plan-on -a –page had been submitted to NHSE in April, following the Governing Body meetings. A further template together with a letter, which was circulated at the meeting, had been received from NHS England at the end of last week. The strategy will need to reflect the new PCNs.

The template itself is very detailed and has been forwarded to other teams for them to complete their part. The timescales are again extremely short but it is a crucial document as this will lead to funding for the GPFV.

PCCC19/20 011

ITEMS FOR INFORMATION: Risk Register

Julie Lemmy informed the Committee that there were no changes to the one that had been circulated prior to this meeting.

With the establishment of PCNs jointly across both CCGs, there is a need for this current risk register to become a joint register in order to reflect this change.

The Chair raised her concern that although it had been raised in previous meetings and at Board and through Internal Audit’s opinion , the committee has still not seen sight of the

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Primary Care Strategy or even a draft.

The committee noted the national deadlines which all CCGs need to meet regarding the submission of the strategy , but the Chair was concerned about the governance around such a submission if it had not been discussed at the PCC .

PCCC19/20 012 AOB None

The meeting closed at 10.20am.

PCCC19/20 012 Date and Time of the next meeting The Chair noted that there was a discrepancy regarding future dates of meetings on both

CCGs’ websites. This will be checked. Action: Future dates to be confirmed. The Chair moved to request the Committee pass a resolution to move into private session to consider private items of business (in line with the Public Bodies (Admission to Meetings) Act 1960) and the Committee agreed.

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Completed On Track Overdue No further action

Action Log Primary Care Commissioning Committee (PCCC) Updated 28 May 2019

Action Number Subject Action Lead Status Timescale RAG 28 May 2019

PCCC19/20 004 Previous Minutes Previous minutes to be uploaded to the CCG website Hayley Mann Previous minutes uploaded to CCG website on 5 June 2019

Complete G

PCCC19/20 008 General Practice Forward View Update

Julie Lemmy and Dr Spencer to discuss issues with Smart Cards

Julie Lemmy/Dr Spencer

23.07.19

19 March 2019 PCCC18/19 063 Primary Care Quality

Report Further guidance to be provided to the Committee in regards to the Learning Disability indicator

Sharon Wright Update provided at meeting on 28.05.2019

28.03.19 G

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Report To

Corby CCG Primary Care Commissioning Committee Meeting in Public

Date of Meeting

28 May 2019

Title of the Report

Finance Report – Month 3

Agenda Paper Reference No:

PPCCC-19-24

Presenter of Report Stuart Rees – Chief Finance Officer

Author(s) of Report

Andrew Burwell – Deputy Chief Finance Officer Lesley Kennedy – Primary Care Finance Manager

Executive Director Sponsor

Stuart Rees – Chief Finance Officer

Purpose of Report

Please select:

☐ Approval ☐ Note

☐ Ratification ☒ Information

☐ Assurance ☐ Update

Executive summary This report provides an update on the financial position of the GP Services budgets at month 3 for Corby CCG. The total primary care budget for 2019/20 is £25.527m. The CCG is currently reporting a breakeven position on these budgets at month 3 and are forecasdting for this to continue until year end. However it should be noted that there is limited financial data available at this stage of the year and therefore it is difficult to forecast with any certainty. Related Corporate Objectives Please select:

☐ Quality ☒ Commission sustainable services

☐ Transformation ☐ Workforce and Culture

☐ Engagement ☐ Accountability

Related CCG Framework Domain

Please select:

☐ Better Health ☒ Sustainability ☐ Better Care ☐ Leadership

Risk and assurance Does the content of the report present any risks or consequently

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provide assurances on risks? N

Governing Body Assurance Framework

Please select: ☒ GBAF01 The CCGs fail to deliver their statutory duties ☐ GBAF02 The CCGs are not able to deliver against the

national mandate and Northamptonshire Health Care Partnership work stream for Strategic Commissioning

☐ GBAF03 The CCGs fail to commission appropriate safe, effective and quality services that are sustainable

Conflicts of Interest Please select: ☒ No conflict identified ☐ Conflict noted, conflicted party can participate in

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

participate ☐ Conflict noted, conflicted party leave for the discussion and

decision

Quality & Equality Impact Assessment

Please select: ☒ No adverse findings/not relevant: go ahead as planned ☐ Adjust: Specific impacts have been identified and can be

addressed ☐ Continue regardless: Benefits outweigh risks and continuing

would not constitute unlawful discrimination ☐ Stop: Risks outweigh the benefits, including being open to

legal challenge

Engagement • Patient and Public • Clinical

N

Legal implications / regulatory requirements

Are there any significant issues with legal compliance?N

Recommendations

The Committee is asked to:

1) Note the budgetary position and forecast outturn of GP Services budgets as at the end of Month 3.

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Primary GP Services for Corby CCG 2019/20 – Month 03

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Contents

1.0 Overview

2.0 GP Services Delegated Commissioning

2.1 Key Headlines

2.2 Allocation Adjustments to Month 3

3.0 Primary Care Locally Commissioned Services Financial Position

3.1 Key Headlines

4.0 Primary Care Prescribing Financial Position

4.1 Key Headlines

5.0 GP Forward View budgets

5.1 Key Headlines

6.0 GP IT

6.1 Key Headlines

7.0 Primary Care Other budgets

8.0 Actions and Recommendations

Appendix :

A Expenditure against Budget @ month 3

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1.0 Overview

This report provides an update on the financial position of the GP Services budgets for Corby CCG as at the end of June 2019. The GP Services budgets are in a break-even position at the end of month 3 and are forecast to remain so throughout the year. However it should be noted that there is limited financial data available at this stage of the year and therefore it is difficult to forecast with any certainty. The figures reported reflect only two months’ of activity expenditure and one month of prescribing spend information.

Due to the timing of when prescribing information is released to the CCG, the prescribing expenditure in 2019/20 has not been fully analysed at practice level at this point. This exercise is expected to be completed for month 4 reporting.

The summary analysis of the financial position at month 3 can be seen at Appendix A. The key headlines for each individual budget area are described in more detail below.

2.0 GP Services Delegated Commissioning At month 3 the GP Services budget is reported as break-even. 2018 19 year end payments for Quality outturn Framework (QoF) Achievement, Learning Disabilities and Dispensing Service Quality Scheme (DSQS) have now been transacted.

Primary Care Network Directed Enhanced Service (PCN DES) budgets have been created in readiness for the commencement of the DES from 1st July (backdated to 1st April 2019-20).

2.1 Key Headlines

• Global Sum increased from £88.96 per weighted patient to £89.88 on 1st April 2019-20 (an increase of 1%).

• The Global Sum increase took into account the projected savings to practices for the National Indemnity Scheme which was implemented on the same date.

• Introduction of the PCN DES is scheduled for 1st July (participation payment is backdated to 1st April)

• Areas of underspend:

o Early indications should be treated with caution, but Directed Enhanced Services budgets for Minor Surgery appear to be following the same pattern of underspend as last year, with a year to date underspend on Minor Surgery being almost cancelled out by small overspends in Learning Disabilities and In Hours Urgent Care.

o Seniority payments under spent by (£0.003m) year to date.

• Cost Pressures:

o Currently there are no cost pressures forecast for year end, although CQC costs appears to be an area of pressure currently it is simply a budget timing issue.

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2.2 Allocation Adjustments to Month 3

The initial allocation to delegated budgets was £11,030,000. In line with original agreements, PMS Reinvestment funding has been moved into CCG core enhanced services budgets to ensure no funding is lost from primary care. Historically in Corby CCG this budget has stayed within the delegated work stream and the associated expenditure has been moved in. However in order to align policy with Nene CCG budget expectations this year we have moved the budget out, and the increase can be seen in Primary Care Enhanced Services budgets. 3.0 Primary Care Locally Commissioned Services Financial Position

At month 3 the GP Locally Commissioned Services (LCS) budgets are currently break even.

3.1 Key Headlines

• ECG activity is currently running at less than plan by £0.002m year to date although it is too early in the year to be confident that this is trend and so break-even is forecast at year end.

• LUTS activity is up year to date with an over spend of £0.001m, although once again it is early in the year and so current assumptions are that activity will fall back to break-even levels.

4.0 Primary Care Prescribing Financial Position

We currently have one months’ cash charges for prescribing, and so it is extremely early in the year to make any variance against the plan, therefore breakeven has been forecast.

Recent intelligence received would suggest that there will continue to be pressure on the Prescribing budget as the effect of the No Cheaper Stock Obtainable (NCSO) drugs is likely to be felt in 19/20, this along with the full year effect of national increases to the Category M drugs implemented in August 2019 (felt in reporting from October 2019 onwards). Initial information suggest the pressure from NCSO is likely to be in line with 2018/19 which contributed a £404k pressure to the outturn position.

Central Charges, which cannot be influenced directly by the CCG is currently in line with plan.

Month 3 shows Locally Commissioned Schemes expenditure to be in line with budget overall with small overspends reported year to date due to budget phasing and delay in VAT being reclaimed.

4.1 Key Headlines

• NCSO drug spend is expected to be a feature once again this year. Already PresQIPP (a primary Care medicines management support facility) is suggesting NCSO drugs pressure will be increasing in the first quarter.

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5.0 GP Forward View

At Month 3 expenditure on GPFV projects is progressing in line with plan.

5.1 Key Headlines

• Additional Budget allocations in line with NHSE Guidance were received in Month 3 by Nene CCG. Nene CCG is the STP lead for GP Forward View.

• Expenditure under GP Forward View for Corby CCG will relate to GP Extended Access and Online Consultation.

• Funding for ETTF, which falls within the GP Forward View Projects, is allocated to Nene CCG as STP lead.

6.0 GP IT

Month 3 reporting for GPIT expenditure projects is progressing in line with budget.

6.1 Key Headlines

• There is a very slight year to date under spend on Health and Social Care Network (HSCN) as the CCG costs have very slightly reduced month on month; this is balanced out by a small overspend on Business as usual

• SMS Text messages expenditure has increased year on year, and although currently forecast to be in line with budget there is a strong possibility that this will be put under financial pressure later in the year as we approach the flu vaccination season.

7.0 Other Primary Care

Other primary care budgets are currently forecast as breakeven.

8.0 Actions and Recommendations

Committee members are asked to note the budgetary position and forecast outturn of GP Services budgets as at the end of June 2019/20.

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Primary Care FinancePrinted: 10:11 16/07/2019

File: K:\Admin\1. CCCG Meetings\1. Governing Body\5. Primary Care Commissioning Committee\2019\D 23 July\PUBLIC\Working\PPCCC-19-24 - Finance Report

Annual

Month 3 Total Budget YTD Budget YTD Expenditure Uariance (under)/oUer Month 2 FOT In Month

MoUement Month 3 FOTThis month

Uariance to plan (under)/oUer

Uariance (under)/oUer

%

£ £ £ £ £ £ £ £

PrescribingGP Practice Prescribing 10,810,521 2,662,302 2,662,302 0 10,810,521 0 10,810,521 0 0.00Central Charges 288,039 72,010 72,010 0 288,039 0 288,039 0 0.00CCG LCS Schemes 376,750 94,188 94,188 0 376,750 0 376,750 0 0.00

Total Prescribing 11,475,310 2,828,500 2,828,500 0 11,475,310 0 11,475,310 0 0.00

Primary Care LCS Core AllocationLong Term Conditions 336,392 84,099 84,096 -3 0 336,392 336,392 0 0.00Hypertension 64,073 16,017 16,020 3 0 64,073 64,073 0 0.00Organisational DeUelopment (£1.50) 0 0 0 0 0 0 0 0 0.00Sleep Apneoa 22,146 5,537 5,483 -54 0 22,146 22,146 0 0.00All Other LCS Schemes 872,541 185,188 185,242 54 1,026,704 -154,163 872,541 0 0.00

Total Primary Care LCS Core Allocation 1,295,152 290,841 290,841 -0 1,026,704 268,448 1,295,152 0 0.00

Primary Care GPITCore Contract & GP Practice Data backups 202,903 47,025 47,026 1 275,058 -72,155 202,903 0 0.00Business as usual 30,807 7,169 8,930 1,761 0 30,807 30,807 0 0.00HSCN 28,505 7,126 5,318 -1,808 0 28,505 28,505 0 0.00SMS Texts 12,843 3,211 3,258 47 0 12,843 12,843 0 0.00Programme Support Costs 0 0 -0 -0 0 0 0 0 0.00

Primary Care GPIT 275,058 64,531 64,531 0 275,058 0 275,058 0 0.00

Primary Care Other Projects / ReserUes 0 0 0 0 0 0 0 0 0

Primary Care GP Forward ViewGP Extended Access 494,000 123,500 123,500 0 0 494,000 494,000 0 0.00Care Navigation 0 0 0 0 0 0 0 0 0.00Online Consultation 322,291 80,573 90,973 10,400 322,291 0 322,291 0 0.00Online Consultation 0 0 -10,400 -10,400 0 0 0 0 0.00

Total Primary Care GP Forward View 816,291 204,073 204,073 0 322,291 494,000 816,291 0 0.00

OOH OOH Contract 629,134 157,284 157,284 0 749,269 -120,135 629,134 0 0.00

Total OOH Contract 629,134 157,284 157,284 0 749,269 -120,135 629,134 0 0.00

Home OxygenHome Oxyen Contract 153,946 38,487 38,487 0 153,946 0 153,946 0 0.00

Total Home Oxygen 153,946 38,487 38,487 0 153,946 0 153,946 0 0.00

Total Primary Care Core Commissioning 14,644,891 3,583,716 3,583,716 -0 14,002,578 642,313 14,644,891 0 0

Primary Care Delegated ServicesContract 7,065,699 1,766,424 1,766,293 -131 7,065,699 0 7,065,699 0 0.00DES 700,984 175,249 174,938 -311 700,984 0 700,984 0 0.00Locally Commissioned Services 140,965 35,242 35,242 0 140,965 0 140,965 0 0.00QoF 1,018,586 254,647 254,958 311 1,018,586 0 1,018,586 0 0.00Premises 838,260 209,561 211,149 1,588 799,528 38,732 838,260 0 0.00PCO 99,546 24,886 21,748 -3,138 99,546 0 99,546 0 0.00Prescribing Professional Fees 184,880 46,222 46,759 537 184,880 0 184,880 0 0.00Central Contracts 832,767 109,351 110,496 1,145 1,019,812 -187,045 832,767 0 0.00Other 0 0 0 0 0 0 0 0 0.00

Total Primary Care Delegated 10,881,687 2,621,582 2,621,582 0 11,030,000 -148,313 10,881,687 0 0.00

Total Primary Care CCG Commissioning 25,526,578 6,205,298 6,205,297.79 -0 25,032,578 494,000 25,526,578 0 0

Primary Care Summary Report

Year to Date Forecast Outturn

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Northamptonshire Clinical Commissioning Groups

Report To

Primary Care Commissioning Committee Meeting in Public

Date of Meeting

23 July 2019

Title of the Report

General Practice Forward View Update


PPCCC-19-25

Presenter of Report Keiren Leigh, Programme Lead GPFV

Author(s) of Report

Keiren Leigh, Programme Lead GPFV, Julie Lemmy, Deputy Director Primary Care, Catherine Wills, GPFV Programme Manager


Julie Curtis, Director Primary & Community Integration, Northamptonshire Clinical Commissioning Groups

Purpose of Report

Please select:

☐ Approval ☐ Assurance ☐ Ratification ☐ Note ☐ Recommendation ☒ Information

Executive summary The paper gives an update for the GP Forward View Programme. Related Corporate Objectives Please select:

☐ Quality ☒ Commission sustainable services ☒ Transformation ☒ Workforce and Culture ☒ Engagement ☐ Accountability


Please select:

☒ Better Health ☒ Sustainability ☒ Better Care ☒ Leadership

Risk and assurance

Does the content of the report present any risks or consequently provide assurances on risks? N

Legal implications/regulatory requirements

Are there any significant issues with legal compliance? N


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Please select: ☐ GBAF 1.2 Unable to ensure there is a sustainable, affordable healthcare system in Northamptonshire and

the CCGs hit financial duties

☐ GBAF 1.3 Commissioned providers do not deliver required standards of performance

☐ GBAF 1.4 Failure to ensure compliance with statutory engagement requirements

☐ GBAF 1.5 Failure to ensure procurement activities are compliant with statutory requirements

☐ GBAF 1.6 Failure to move from joint delegation to full delegation for NHS Nene CCG

☐ GBAF 1.7 Failure to ensure commissioning and monitoring of services which are compliant with the CCG safeguarding statutory requirement

☐ GBAF 4 The CCGs cannot continue to operate in a BAU due to loss of key resource

☒ GBAF 5 Failure to achieve for full planning guidance delivery for 19/20 Plan

☒ GBAF 6 Failure to achieve full planning guidance delivery for Long Term Plan that supports system development to time and intervention described in the guidance

☒ GBAF 7 Failure to deliver of the strategic vision for primary care commissioning

☐ GBAF 8 Failure of partner organisations to transform prevents the delivery of the Long Term Plan

☐ GBAF 9 Possibility of commissioning inadequate services

Conflicts of Interest Please select:

X No conflict identified ☐ Conflict noted, conflicted party can participate in discussion but

not in decision ☐ Conflict noted, conflicted party can remain but not participate ☐ Conflict noted, conflicted party leave for the discussion and

decision


Please select: x No adverse findings/not relevant: go ahead as planned ☐ Adjust: Specific impacts have been identified and can be


would not constitute unlawful discrimination ☐ Stop: Risks outweigh the benefits, including being open to legal

challenge

Engagement

Patient and Public: y Extensive engagement has taken place and is ongoing with practices through the LMC, locality boards and local events e.g. all county PLT and Roadshows. The CCG has a regular new care models services meeting with the GP Federations and NHFT as well as occasional briefings to locality boards. Practices have been involved in co-designing some of the responses to the 10 high impact changes and all projects are progressing with practices at the pace that they are ready to go. Clinical: N

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Recommendations

The Primary Care Committee is asked to:

• The committee are asked to note the contents of the update papers.

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General Practice Forward View Primary Care Workforce

For the month of: May 2019 Lead: Catherine Wills Overall Workstream Status:

x Monthly Executive Summary including rationale for overall project RAG status: Monthly Executive Summary including rationale for overall project RAG status: The overarching aim for the current workforce plan is to stabilise general practice and prepare the workforce for the future. This is in part measured by how we close the gap between our current wte of GPs (349) and wider clinical workforce (423)and our local allocation of the national NHS Eng target of wte for workforce by 2020. The action plan contains actions specifically around Retention and Attraction. Each action is RAG rated. Progress and risk is reported to NHS Eng, the LWAB and PCS board. The below have been key developments throughout May and June 2019: - Our International GP Recruitment campaign is running strong and offers to 10 applicants may now be increased with additonal

interviews taking place throughout July and intend to recruit at least 22 GPs through this programme by the end of the year. - On the 29th May, the Primary Care Workforce Group and LWAB hosted a workforce session for all new Clinical Directors to focus

specifically on ‘System Working’, ‘Leadership’, ‘Employment at Scale’ and ‘HR Support’. - One out put from the 29th is a 12 month CD Leadership Programme that has now been put in place for all CDs and their deputies that

has been co-developed by CDs, Dr Robert Varnam from NHSE/I and LWAB. The first session focusing on ‘Vision’ kicks of this programme on the 12th August.

- A further output from the session on 29th was agreement from the majority of PCNs to run a joint recruitment campaign for Social Prescribing Link Workers. This is being led by the CCG with support from the LWAB via Altadicta to promote these new roles. Recruitment events will be taking place on the 26th July and 2nd August. https://www.jobs.nhs.uk/xi/vacancy/?vac_ref=915635223

- Finally General Practice has secured over £60k from Health Education England to continue to implement a General Practice Learning and Talent Development Plan which we put forward to LWAB and the PCWG in June. This has secured investment for clinical training for non medical staff, investment for work experience and clinical apprenticeships.

Key risks and issues to be escalated to PCC : - GP Numbers against trajectory to deliver core GMS - Successful recruitment of new roles across PCNs - Ability to manage change and OD effectively for implementation and mobilisation of PCNs

Key actions programmed for next month: Three Recruitment events for Social Prescribing Link Workers to be hosted across county 26th July and 2nd August. 12th Aug launch of CD Leadership programme Nurse Cadet Apprenticeship pathway launched in general practice Further IGPR interviews Develop induction programme for SPLWs 19 of 66

https://www.jobs.nhs.uk/xi/vacancy/?vac_ref=915635223

Primary Care Workforce Project Commentary GO-Live RAG

Workforce/Retention Induction programmes for social prescribers, PCN clinical directors

Q1 G

Workforce/Retention

Set up forum for First5s – led by First5s clinical lead

Q1 G

Workforce/Retention

Implement L&D Plan Q2 G

Workforce/Retention

Job description templates developed and evaluated with recommended bandings

Q1 G

Workforce/Retention

Update material on NorthantsGP – use Best of Both Worlds for targeted campaigns

Q1 G

Workforce/Retention

OD programme for PCN development Q1 G

Workforce/Retention

Lead and facilitate recruitment campaign to attract social prescribers and clinical pharmacists

Q1 G

Workforce /Retention International Recruitment phase 2 Q3 G

RAG Status

RAG Rating Definition for reference only

Workstream/Project On track

Workstream /Project progressing but minor /moderate risk or issues identified and affecting delivery.

Workstream /Project off track with major risks/issues that require escalation to Primary Care Committee 20 of 66

General Practice Forward View 10 High Impact Actions For the month of: May 2019 Lead:Keiren Leigh

Overall Workstream Status: X

Monthly Executive Summary including rationale for overall project RAG status : • Online Consultations second wave rolling out. As part of this would have 378600 (48%) population covered. The remaining practices will be contacted this month to schedule in their

mobilisation using the CCG supported programme to meet requirements by April 2020 • PID being created to support development of video consultation • Care Navigation learning events held 30th April, 1st May (further learning event 23rd May). The Task and Finish Group has been set up to develop further. • From June 2019, development advisers from the Time for Care programme team can offer support to PCNs which will take them through a diagnostic process to assess their current state of

readiness and priorities for future development. This will support PCNs who are having difficulties building relationships, developing their shared vision and purpose and local action plans would most benefit. We also understand that this support may not be required for PCNs within Integrated Care Systems but would appreciate feedback from regional colleagues on this assumption. Development advisers will then use contact details provided and work with local PCN, federation and LMC leads to set up and facilitate diagnostic discussions which will include as appropriate to the PCN:

• Assessing local readiness, building on what’s in place and areas of concern • Discussing outcomes from the PCN self-assessment process against the PCN maturity matrix • Building PCN vision and purpose • Developing a narrative to engage different audiences including patient and community involvement • Building adaptive and emergent plans – 30/60/90-day planning • What it means to work collaboratively in a system context • Signposting PCNs to appropriate local, regional and national support to meet their development needs.

Key risks and issues to be escalated to PCC:

Key actions programmed for next month: • Launch Phase 2 Care Navigation through task and finish group • Launch HIA support framework through the Primary Care Portal • Embed Time For Care includes support for network development, leadership and collaboration training • Support delivery of the five year framework for GP contract reform. ongoing • Online Consultations, new requirement to have 100% by April 2020 (Five year framework for GP contract reform).

Actions in place to recover project (Red/Amber status only): 21 of 66

10 High Impact Actions Project Commentary Go live RAG

Online Consultations Implement third wave (need to achieve 75% coverage by April 2020)

Q2 G

Contract Review Same Day Access

Update on progress against 10 HIA and plans for 2019/2020 delivery

Q1 G

Care Navigation Need to confirm focus on next priority areas/services Q2 G

General Practice Resilience Programme

Implement the approved GPRP funding - 12 month programme but commence in Q4

Q4 G

10 HIA Portal Launch HIA portal to aid implementation in all practices towards 10 HIA

Q1 A

Time For Care Link Time for Care training and support to PCS priorities Q1 A

Five year framework for GP contact reform

Support implementation Ongoing A

Video Consultations Create PID for Video consultations – core requiremen to offer this by April 2021.

Q2 G

RAG Status





General Practice Forward View Primary Care Networks For the month of: May 2019 Lead:Keiren Leigh

Overall Workstream Status: x

Monthly Executive Summary including rationale for overall project RAG status : • Placed Based Models Working session held on 27th March, providers involved in all four models (located in Corby, Wellingborough,

Northampton and Daventry) came together for the first time, shared learning from what they are already doing, to learn from other areas and start to set out the vision and activities relating to the implementation of the proposals.

• The Network DES went live on 1st July covering 100% population. • All 16 Primary Care Networks commenced Extended Hours Access (EHA) services through the Network DES w/c 1st July 2019. The EHA

service replaces the Extended Hours DES which was commissioned previously at practice level through the GMS contract. The former service provider 87% coverage for Northamptonshire patients, the new service through PCNs offers EHA to 100% of the population. The approaches being delivered varies by PCN but several are delivering the EH through a collaborative approach. There were short timescales for PCNs to organise the EHA therefore many are delivering from their own practice but expect this to change as the PCNs develop.

• In addition to this the Northamptonshire Health and Care Partnerships Local Workforce Advisory Board (LWAB) held an event on 29th May 2019 for all of the newly appointed Clinical Directors of the 16 PCNs. The event focused on four key areas; support for Clinical Directors in navigating our local system, leadership development, employment at scale and human resources support and resourcing. The event was the first of its kind nationally and was supported and attended by Dr Robert Varnam, Head of General Practice Development at NHS England. As a direct response to the event on the 29th May, we have developed a 12 month leadership programme to support PCN development.

Key risks and issues to be escalated to PCC: Key actions programmed for next month:


Primary Care Networks Project Commentary GO-Live RAG

Network DES Network Contract goes live 1 July 19 G

Network DES Extended Hours Access Live 1 July 19 G PCN Meeting with Clinical Directors 11th july G PCN Workforce Support Session for Clinical Directors 14th August G

RAG Status





General Practice Forward View Resilience For the month of: May 2019 Lead: Julie Lemmy


Monthly Executive Summary including rationale for overall project RAG status : East Northants All Practices continuing to work together as a PCN. Clinical and managerial leadership initiated as part of the resilience programme has now become business as usual Kettering & Corby Majority of Practices have signed up to use the same templates which will support quality, time saving (clinical and admin) and will also support a more mobile workforce by providing clinical reporting continuity across all sites Clinical pharmacist employed by a Kettering Practice is supporting the CCG manager with the project Northampton Practice/PCN meetings arranged for CCG managers to attend to discuss/gain update on project

Key risks and issues to be escalated to PCC:

Key actions programmed for next month: Meetings scheduled for the coming months to progress the work on 3 schemes Kettering/Corby, East Northants and Northampton. Updates to be provided along with assurance to NHSE now agreed with the providers.


Resilience Project Commentary GO-Live RAG

Resilience Investment 2019/2020 Baseline benchmark reliance bids for PCN Q1 G

RAG Status





General Practice Forward View Enablers (Technology/Estates) For the month of: May 2019 Lead: Garry McGuinnes/Julie Lemmy


Monthly Executive Summary including rationale for overall project RAG status : Estates: Health planner appointed on a secondment basis, role commences 1 April for a 12 month period Mapping of significant housing developments along with estimations of population per dwelling has been completed Practices have been invited to submit bids for ETTF, the closing date for these bids is 15th March, local evaluation of the bids will take place between 18th and 31st March 2019 To support ETTF bid applications information regarding significant housing developments and population growth have been shared with Practices, in addition to this each Practices has been provided with the 3 facet survey information. NHSE assurance panel arranged for 21 May 2019 to review the prioritised CCG Bids i.e. Estate & IT funding under the ETTF programme. Technology: GP Practice Server Virtualisation - Started, will finish by July GP PC Refresh – Started, expected to be finished by July. 80% of PCs will be upgraded by then. GP Laptop Refresh. Upgrade of CCG funded laptops given to practices in 2015. Practices will get one new laptop per 10k patients. VPN Migration –Due to start in 2 weeks. Migration from hard tokens to soft solution – Pulse Swivel. Migration taking place alongside laptop refresh. GP Server Room Refurbishment and switch upgrades– Started, expected to finish by Christmas. Upgrading Practice server rooms. Works take place OOH, hence the long project period. HSCN - Ongoing, 8 practice sites migrated to HSCN, 7 scheduled, 83 to be scheduled. Expected finish date - August WiFi – Third party engaged to start remedial works for GP Practice WiFi. Scoping to start W/C 13.05.19. Pathfinder Replacement: Ongoing – completion expected imminently.

Key actions programmed for next month: Estates Population growth analysis to be completed to be included in the estate prioritisation for capital investment for the next 5 years. Panel assessment of CCG prioritised bids by NHSE on 21 May 2019 27 of 66

Enablers Project Commentary GO-Live RAG

ETTF Bid submission programme for 19/20 and 20/21

The CCG prioritised bids approval will be made by the Primary Care joint committee on 14 May 2019

TBC G

IT Infrastructure GP Practice Server Virtualisation - Started, will finish by July

Q2 G

IT Infrastructure

GP PC Refresh – Started, expected to be finished by July Q2 G

IT Infrastructure GP Laptop Refresh – Due to start in 2 weeks, expected to finish July.

Q2 G

IT Infrastructure GP Server Room Refurbishment and switch upgrades– Started, expected to finish by Christmas

Q3 G

IT Infrastructure HSCN - Expected finish date - August

Q2 G

RAG Status






Report To

Primary Care Commissioning Committee (Public)

Date of Meeting

23rd July 2019

Title of the Report

NHS Corby CCG Primary Care Quality Report June 2019


PPCCC-19-26

Presenter of Report SharonWright, Quality Improvement Manager, Northamptonshire CCG’s

Author(s) of Report

SharonWright, Quality Improvement Manager, Northamptonshire CCG’s


Dr Sanjay Gadhia, GP Governing Body Member, NHS Corby CCG

Purpose of Report

Please select:

☒ Approval ☒ Assurance ☐ Ratification ☐ Note ☐ Recommendation ☐ Information

Executive summary This paper is presented to the committee to provide an overview of the key matters of quality and safeguarding in primary care. The report has been discussed and approved by NHS Nene and Corby CCG’s Risk Sharing Group on 23rd May 2019. Related Corporate Objectives Please select:

☒ Quality ☒ Commission sustainable services ☐ Transformation ☒ Workforce and Culture ☐ Engagement ☐ Accountability


Please select:

☒ Better Health ☐ Sustainability ☒ Better Care ☒ Leadership

Risk and assurance





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☒ GBAF 1.3 Commissioned providers do not deliver required standards of performance

☒ GBAF 1.4 Failure to ensure compliance with statutory engagement requirements



☒ GBAF 1.7 Failure to ensure commissioning and monitoring of services which are compliant with the CCG safeguarding statutory requirement


☐ GBAF 5 Failure to achieve for full planning guidance delivery for 19/20 Plan

☐ GBAF 6 Failure to achieve full planning guidance delivery for Long Term Plan that supports system development to time and intervention described in the guidance



☒ GBAF 9 Possibility of commissioning inadequate services


x No conflict identified ☐ Conflict noted, conflicted party can participate in discussion but


decision


Please select: x No adverse findings/not relevant: go ahead as planned ☐ Adjust: Specific impacts have been identified and can be



challenge

Engagement

Patient and Public: N Clinical: Y This report has been amended following clinical engagement at Joint Primary Care Risk Sharing Group (RSG) on 23rd May 2019

Recommendations

The Committee is asked to agree with the following recommendation:: • Continue to monitor indicators through the dashboard; • Identify innovative ways to capture Friends and Family data; • Identify good practice and share across the county; • Risk Sharing Group to outline any additional actions;

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• Share data with commissioning team to influence new models of care and enhanced services. • Approve the report for submission to PCCC

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Joint Primary Care Quality Information and Risk Sharing Group NHS Corby CCG Primary Care Quality Report February 2019

1. Introduction The purpose of this report is to give an overview of quality of primary care within NHS Corby CCG. The data is extracted from the dashboard which collates information relating to compliance, safety, responsiveness and effectiveness. Scoring is applied to outliers from an England average. All scores are aggregated to give an overall score that is RAG rated. The RAG in the report relates to the risk score at the time of writing the report. An escalation process is in place to determine the level of monitoring required as set out below:

• Routine monitoring; • Enhanced surveillance; • Formal Action

2. Care Quality Commission All practices have received an inspection in the current inspection programme. Outstanding 0 Good 4 Requires Improvement 1 Inadequate 0 3. Risk log (data from dashboard) Number of practices on Formal Action 1 Number of practices on enhanced monitoring 1 Number of practices on routine monitoring 3

4. Overview of indicators for Practices flagging on dashboard: 1 practices flagging amber this quarter. 1 practices flagging red.

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5. Safety

Quality measure and CQC domain

Oct

RAG

Feb

RAG

Position statement Mitigating actions

5.1 Incidents Q4 2018/19

No incidents reported this quarter.

5.2 Countywide Safeguarding update May 2019

Multi Agency Risk Assessment Conference (MARAC)

A structured template has been developed for use at MARAC meetings

• The template will be completed when all cases are discussed

• The resulting report will be forwarded to the victims GP

• The report will provide information about

a) Nature of abuse (psychological, financial, sexual etc.)

b) Perpetrator - relationship and access to victim

c) Victim-related concerns (health, pregnancy, housing etc.)

d) Key outcomes of meeting

e) Notes to GP about use of information and coding.

Feedback from practices has been very positive.

Training

In 2019 the same format for ‘train the trainer’ will continue with a morning focusing on the main theme and in the afternoon there will be an update and then a question time.

Community – modern slavery, gangs and radicalisation (Prevent). This was held in March ’19 was attended by 28 GP Safeguarding Leads.

Upcoming

Children – recognising and responding to suspected child abuse

Families – domestic abuse, FGM & looked after children

Adults – recognising and responding to different types

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of abuse

Practice – information governance, practice MDT and safeguarding procedures.

There were 10 practices that did not attend any of the ‘Train the Trainer’ Safeguarding Training modules or attend any quarterly forum in 2018. 2 of which were Corby practices.

Information Sharing

As from April 1st emails sent from all the email addresses on the NCC domain, which include the following, will be encrypted;

@northamptonshire.gov.uk

@childrenfirstnorthamptonshire.co.uk

@firstforwellbeing.co.uk

@nass.uk.net

NEL has advised that it is not necessary to add the comment ‘sensitive’ to the email header. If NCC wish to send encrypted emails to third parties, outside of government, police and NHS, they will mark the email sensitivity as confidential which will encrypt that message. The recipient will then need to follow the instructions on screen to be able to view the content. NCC will therefore no longer be using Egress or gcsx email addresses.

Police subject data requests

Practices frequently receive requests for disclosure of medical records pursuant to an investigation. Not uncommonly the investigating officer fails to provide either written consent or sufficient information to allow a relevant and proportionate disclosure by the practice. To facilitate this process our team have developed a template letter which practices can customize with their header. The letter explains the practice’s responsibilities as data controller and asks the officer to provider a copy of the data subject’s written consent, or in the case of a child who lacks capacity (usually under 16 but judgement is required), a person with parental responsibility. If consent is not provided then the officer must state the reason. The

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template letter will be added to the Portal under Practice/Resources in May 2019.

Quarterly GP forum

Fora are held at four locations for practice leads. The forum discusses current issues and has an educational focus.

Past forums

Winter Elective Home Education (EHE)

Spring Adverse Childhood Experiences (ACE’s)

Both forums well attended and educational topics well received.

Planned

Summer Adults with Learning Disabilities

Autumn Challenging Behaviours in Childhood

Safeguarding website

The website can be found at the following: http://gp.neneccg.nhs.uk/safeguarding

The website contains the following materials

a) Training presentations and scenarios

b) Links to websites and video casts

Under My Safeguarding you can find

a) Contact list and links to referral forms

b) Details of GP forum meetings

c) Dates of training events

d) Safeguarding updates

Practice assurance framework

The team has developed an assurance framework to assist practices in developing their own policies and procedures which contains:

• A brief synopsis of all the main safeguarding topics divided into 10 sections

• A set of 7 standards for each standard

• The standards are role based and provide guidance

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http://gp.neneccg.nhs.uk/safeguarding

on appropriate staff training

• Practices are encouraged to assess themselves against each standard

• Practices can hyperlink their policies to the relevant standard

Feedback on the value of the framework is encouraged.

5.3

Learning Disability (LD) update Q4 2018/19

The final numbers of LD Annual Health Checks (AHC) completed by the surgeries in Q4 have not yet been received. A report with an action plan will be produced once these figures have been obtained. As previously identified, surgeries decide when to deliver the AHC’s so it isn’t possible to obtain an accurate picture until the surgeries make their final submissions at the end of Q4.

2 surgeries have already exceeded the number of AHCs they achieved by end of Q4 for 17/18. Both surgeries responded to the significant input from the LD Health.

There have continued to be problems with surgeries inputting the correct data into CQRS to claim for AHCs completed. In addition to the newsletter that was circulated via the GP Portal, during Q4 surgeries were contacted by the LD Health Facilitator where an anomaly was identified in their declarations. Advice was provided on how to make a correct declaration and amend errors. Visits were offered to the surgeries to assist them if required. However, there have still been surgeries requesting that their declaration is incorrect and requesting for it to be amended. All surgeries had been advised that this would not be actioned this year following all the support that has been offered to enable them to submit correctly.

The implications of the inaccurate declarations will impact on the overall view of LD lists sizes and number of AHCs completed. The NHSE target for 18/19 is 66% of all people with a learning disability to have received an AHC and 75% by March 2020.

LD Health Facilitator to re validate LD registers in surgeries where list size numbers of AHC’s appear inaccurate. These will be amended as required.

LD Health

Facilitator to

contact

surgeries who

have achieved

less than 50%

of LD AHC’s to

identify

potential

strategy for

improving

uptake

5.4 Infection, Prevention and Control

Q4 2018/19: 8 cases of C Difficile were attributed to primary care with 100% of SEAs completed.

Themes: All patients had a number of long term

Continue to request SEA completion

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6. Responsiveness

Quality

measure and CQC domain

Oct

RAG Feb

RAG

Position statement Mitigating actions,

assurance and timeframe

6.1 NHSE Complaints Q4 2018/19

There were 2 complaints made by Corby CCG patients in Q4 18/19. Both complaints are currently under investigation.

6.3 Friends and Family test = March 2019

March 2019

1 practice has not submitted data

1 practices submitted less than 5 responses so data suppressed

1 practice achieved over 90% recommendation rate

2 practices achieved between 89 & 90% recommendation rate.

Discuss with practices to ascertain issues that have affected non compliance

Support practices to implement SMS texting to improve Friends and Family response rates.

NHSE contract teams have made contact with practices not submitting.

Q4 2018/19 conditions needing antibiotic care.

100% GPs report that antibiotics prescribed were compliant with prescribing guidance.

Further work underway to develop national reporting tools for GPs.

Report to Infection, Prevention and Control Committee

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Engagement made with Local Engagement Groups to assist with promoting FFT

7. Effectiveness

Quality

measure and CQC domain

Oct RAG

Feb RAG

Position statement Mitigating actions,

assurance and timeframe

7.1 Primary Care webtool data February 2019 May 2019 No further update

The primary Care Web Tool is website of practice identifiable statistics on individual practices and CCG’s. It displays a wealth of data on demographics and performance indicators that range from QOF (Quality and Outcomes Framework) results, clinical outcomes and prescribing habits, to patient access and satisfaction ratings. The data on individual practices is compared to national and local averages. This data is used to identify outliers. These are practices that have triggers that fall at 1 (level1) or 2 (level 2) SEMs (standard error of the mean) outside the mean score. The definition of these triggers has changed recently and practices with 6 or more triggers are classed as outliers and will signal flags to the CCG. A practice with a total of 6 or more points more than 2 SEM below the mean is considered to represent underachievement by the practice. The CCG uses this data alongside other indicators to assess service provision and patient safety and consequently will work with the practice to demonstrate improvement. Number of high achieving practice: 1 Number of achieving practice : 4 Number of practices approaching review: 0 Number of practices with review identified : 0

Continue to monitor practice based indicators

7.2 My NHS Sentinel Indicators Refreshed May 2019

My NHS Sentinel Indicators were refreshed in April 2019

5 practices are outliers in 0-4/13 indicators

Screening and Immunisation

Cervical screening = 1 practices scored less than

Continue to be monitored through the dashboard.

Identify areas

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England average of 71%

Flu vaccine under 65 at risk = 4 practices scored less than England average of 50.3%

Flu vaccine over 65 = 2 practices scored less than England average of 72.7%

Managing long term conditions:

Hypertension management = 1 practice scored less than England average of 83.6%

Cancer Detection = 1 practice scored less than England average of 48.4%

Managing MH and Dementia

Dementia face to face review = 3 practices scored less than England average of 84%

Safe and effective prescribing

Antibiotic prescribing = 1 practices scored more than England average of 1.1 ( less is better)

This is an improved picture from last year

of good practice and share across the county.

GP forward view update May 2019

Workforce The overarching aim for the current workforce plan is to stabilise general practice and prepare the workforce for the future. This is in part measured by how we close the gap between our current whole time equivalents (wte) of GPs (349) and wider clinical workforce (423) and our local allocation of the national NHS England (NHSE) target of wte for workforce by 2020. The action plan contains actions specifically around Retention and Attraction. Each action is RAG rated. Progress and risk is reported to NHSE, the LWAB and PCS board. The below have been key developments throughout Feb and March 2019: Following on from the successful Nurse Training Post campaign which saw an additional 10 nurses brought into post in general practice, we have now commenced our International GP Recruitment campaign. We have made offers to 10 applicants and intend to recruit at least 22 GPs through this programme by the end of the year. On the 14th March the Primary Care Workforce Group held a workshop to revisit workforce priorities for 2019/20, and focused on additional support around Retention and Attraction. The outcomes include the creation of a ‘Learning and Talent Development Plan’ and ‘PCN Support’ for managing change. Under Learning and Talent Development, the plan includes training, GP Fellowships, Apprenticeships, Leadership and increasing placements for medical and non-clinical

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students across the county. Under PCN Support, we are looking at how we can support a change programme for PCNs, support recruiting to new roles and offer inductions and collaborative recruitment campaigns. On the 27th March, the PCS Planning day included spending time with each of the four sites to hold initial conversations about the impact the projects may have on workforce and support needed to mobilise their projects. The NHCP workforce planner has now made contact with each site to work on the baseline data of workforce and activity and create forward models based on the service outlines they are developing. This will also include some support for undertaking stakeholder engagement as part of the planning process. Key risks and issues:

• GP Numbers against trajectory to deliver core GMS

• Successful recruitment of new roles across PCNs

• Ability to manage change and OD effectively for implementation and mobilisation of PCNs

Key actions programmed for next month: • Residential to start for first cohort of 10

international GPs in Poland • Workforce trajectories, skill gap analysis and

implementation of workforce plans for the four PCS projects

• Training and future capacity plan for student nurse placements agreed at LWAB and nursing cabinet

• Nurse Cadet Apprenticeship pathway launched in general practice

• Plan for enabling support for PCN mobilisation including OD/Change and Workforce

• Training Programme for General Practice Staff (Including PLTs, clinical and non-clinical) developed for 2019/20

10 High Impact Actions • Online Consultations second wave rolling out.

As part of this would have 378600 (48%) population covered.

• Care Navigation learning events held 30th April, 1st May (further learning event 23rd May)

• Approval of further 9 sites for Productive General Practice Programme – positive support for practices to maximise efficiencies

Key actions programmed for next month: • Launch Phase 2 Care Navigation • Launch HIA support framework through the

Primary Care Portal

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• Embed Time For Care includes support for network development, leadership and collaboration training

• Support delivery of the five year framework for GP contract reform. ongoing

• Online Consultations, new requirement to have 100% by April 2020 (Five year framework for GP contract reform).

• Go live additional Productive General Practice Sites

Primary Care Networks Five year framework for GP contract – sets out new requirements and funding support for the development of Primary Care Networks over the next five years. Every practice must have offered the opportunity to participate in the Directed Enhanced Service by end of June 2019. Additional workforce e.g. Clinical Pharmacist, Social Prescribing Link Workers, FCP Physio, FCP Paramedic. Placed Based Models Working session held on 27th March, providers involved in all four models (located in Corby, Wellingborough, Northampton and Daventry) came together for the first time, shared learning from what they are already doing, to learn from other areas and start to set out the vision and activities relating to the implementation of the proposals. Key actions programmed for next month:

• Practice submission deadline 15th May 2019 • CCGs review submissions 16th May 2019 • Confirm submissions to NHSE 31st May 2019 • Network contract goes live 1st July 2019

General Practice Resilience All practices agreed consultancy to review policies in order to streamline and standardise across the area. The area of work agreed upon was GDPR, this will save time and in particular support the more challenged practices who do not have time or the expertise to develop. All practices have received training on how to access new templates which are being developed within the locality. The focus of these templates is to improve quality by aiding clinical decision making and also save time, more challenged practices who do not have time or the expertise to develop these templates will benefit from being able to access the templates, practices can also make a request to the GPs involved in developing the templates to focus on specific areas of need. All practices have agreed protocols and process for using the paediatric service at Harborough Fields and all Practices are referring patients to the service. A number of practices have expressed an interest in a

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clinical decision making tool. The tool will save time, for example it auto populates safety alerts as they are issued meaning the clinician is updated with any changes immediately, this saves the time of the clinician who currently emails all prescribers to inform of any changes, it also ensures the alerts are seen by clinicians in a more timely manner reducing the risk of prescribing errors. The tool also supports clinician development in new clinicians within the practices as the templates provide aide memoirs and guidance to help clinicians with decision making. Key actions programmed for next month: Meetings scheduled for the coming months to progress the work on 3 schemes Kettering/Corby, East Northants and Northampton. Updates to be provided along with assurance to NHSE now agreed with the providers. Enablers (Technology/Estates) Estates: Health planner was appointed on a secondment basis, role commences 1 April 2019 for a 12 month period Mapping of significant housing developments along with estimations of population per dwelling has been completed Practices have been invited to submit bids for ETTF, the closing date for these bids is 15th March, local evaluation of the bids will take place between 18th and 31st March 2019. To support ETTF bid applications information regarding significant housing developments and population growth have been shared with Practices, in addition to this each Practices has been provided with the 3 facet survey information. NHSE assurance panel arranged for 21 May 2019 to review the prioritised CCG Bids i.e. Estate & IT funding under the ETTF programme. Technology: GP Practice Server Virtualisation - Started, will finish by July GP PC Refresh – Started, expected to be finished by July. 80% of PCs will be upgraded by then. GP Laptop Refresh. Upgrade of CCG funded laptops given to practices in 2015. Practices will get one new laptop per 10k patients. VPN Migration –Due to start in 2 weeks. Migration from hard tokens to soft solution – Pulse Swivel. Migration taking place alongside laptop refresh. GP Server Room Refurbishment and switch upgrades– Started, expected to finish by December 2019. Upgrading Practice server rooms. Works take place OOH, hence the long project period. HSCN - Ongoing, 8 practice sites migrated to HSCN, 7

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scheduled, 83 to be scheduled. Expected finish date – August 2019 WiFi – Third party engaged to start remedial works for GP Practice WiFi. Scoping to start W/C 13.05.19. Pathfinder Replacement: Ongoing – completion expected imminently. Key actions programmed for next month: Population growth analysis to be completed to be included in the estate prioritisation for capital investment for the next 5 years. Panel assessment of CCG prioritised bids by NHSE on 21 May 2019

Recommendation:

• Continue to monitor indicators through the dashboard; • Identify good practice and share across the county; • Risk Sharing Group to outline any additional actions; • Share data with commissioning team to influence new models of care and enhanced

services. • Approve the report for submission to PCCC

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Report To


Date of Meeting

23 July 2019

Title of the Report

Primary Care Committee Risk Register


PPCCC-19-27

Presenter of Report Julie Lemmy – Deputy Director of Primary Care

Author(s) of Report

Julie Lemmy – Deputy Director of Primary Care


Julie Curtis – Director of Primary & Community Integration

Purpose of Report

Please select:

☐ Approval ☒ Assurance ☐ Ratification ☒ Note ☐ Recommendation ☒ Information

Executive summary The Committee is asked to review and note the updated risk register for primary care. A new risk has been added to the register, this being PCC4 ‘Vulnerable Practices’ – following recent CQC inpsections at member practices in both Corby and Nene CCGs , that have either been issued with warning notices/or put into special measures. The Primary Care, Quality teams along with NHSE are currently working with member practices and providing them with emergency support to ensure that they put in the place/set up processes outlined in their reports. We intend to carry a formal review to take the learning from these inspections and develop a programme of support/learning to share with other practices. An update on this review will be provided to the committee in the coming months. The Primary Care risk register will be cross-referenced with the CCGs corporate risk on an ongoing basis and risks escalated where necessary. Related Corporate Objectives Please select:

☒ Quality ☒ Commission sustainable services ☐ Transformation ☐ Workforce and Culture ☐ Engagement ☒ Accountability

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Please select:


Risk and assurance















☐ GBAF 7 Failure to deliver of the strategic vision for primary care commissioning




☐ No conflict identified ☐ Conflict noted, conflicted party can participate in discussion but


decision


Please select: ☐ No adverse findings/not relevant: go ahead as planned ☐ Adjust: Specific impacts have been identified and can be



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challenge

Engagement

Patient and Public: N Clinical: N

Recommendations

The Primary Care Committee is asked to: • Note the updates for the exisiting primary care risks; • Note a new risk has been added to the register; • Note that a review will be undertaken to develop a support programme for member practices; • Note the Primary Care team will continue reviewing and reporting Northamptonshire CCGs Primary

Care Risk Register for PCCC.

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Report Date 28 Jun 2019

Risk Status Open

Risk Area Primary Care Commissioning GPFV

CCG

Control Status Existing

Action Status Outstanding

Standard Risk Register Report

Page 1 of 3

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Primary Care Commissioning GPFV

Risk Ref

Corporate Objective

Risk Title Cause & Effect Inherent Score

Risk Control Control Assurance (1st Line)

Control Assurance (2nd Line)

Control Assurance (3rd Line)

Overall Assurance Assurance

Level

Residual Score

Action Required Progress Notes Target Score

PCC 1

1. Quality – We will improve quality within all providers to ensure services are safe, efficient and effective

Sustainable Urban Extensions in the county - in line with local authority housing plans within the county of Northamptonshire.Risk Owner: Julie LemmyRisk Lead: Julie LemmyLast Updated: 28 Jun 2019Latest Review Date: 28 Jun 2019Latest Review By: Julie LemmyLatest Review Comments:updated June 2019

Cause - Population expansion - no practices to register with for core GMS services,Effect - Financial consequence for the CCG (increase in GMS revenue rent costs).

I = 3 L = 39

Working with local authority planners to hold early discussions with the developers and agree the S106 contributions for the SUE and any other developments. Control Owner: Julie Lemmy

The Primary Care Team will provide assurance to the primary care committees on monthly basis.

The Primary Care Committee holds the statutory duty to report to the joint GB of the CCGs.

The CCGs Governing Bodies will ensure the Primary Care Committees delivers against their delegated responsibilities. Internal audit will provide external overview in line with the CCGs policies.

Adequate

Assurance Date: 28 Jun 2019

Assurance By: Julie Lemmy

Working with the Local Health & Planning Group to develop the evidence to support requests for S106 on all applications for the Corby and surrounding areas.The Estate Strategy being developed will include all major urban extensions and this will help inform the capital investment programme for the CCGs for the next 10-15 years. Control Owner: Julie Lemmy

the local primary care and NHS England teams will ensure

The Primary Care Committees will oversee and make decisions on all capital investments for the CCGs working with NHS England and local authorities in the county.

External auditors will review and ensure all capital investments made by the CCGs are in line with regulations/SFIs of both the CCG and NHSE.

Adequate



I = 2 L = 36

Work with LA areas to review and respond to any planning application to be heard by the local authority planning Committees.Person Responsible: JulieLemmyTo be implemented by: 31 Mar2020

24 Jun 2019Julie LemmyThis is on-going and will not change as it is dependent on LA planning applications/SUEs commencing/being approved so this is business as usual.20 May 2019Julie LemmyThis is on-going and will not change as it is dependent on LA planning applications/SUEs commencing/being approved so this is business as usual.

I = 1 L = 33

PCC 2


Changes to PMS Contract core payments could financially destabilise member practices as payment will be reduced by 20% each year for the next three yearsRisk Owner: Julie LemmyRisk Lead: Julie LemmyLast Updated: 26 Jun 2019Latest Review Date: 28 Jun 2019Latest Review By: Julie LemmyLatest Review Comments:Updated June 2019

Cause - Leading to reduced services to patientsEffect - Reduced patient experience, poor staff morale and potential GP retirements.

I = 3 L = 39

PMS review group meets to agree the investment for each year - Agree year 5 reinvestment options by 31/3/2020.Control Owner: Julie Curtis

The Primary Care Team will work with the PMS working group to provide assurance to the primary care committees.

The primary care committees for the CCGs will ensure the sub committee meets its delegated responsibilities from the committee..

NHSE or external auditors will ensure that funding is invested and monitored.

Adequate



Regular monitoring of contracts and contractual levers if required Control Owner: Julie Curtis

Assurance to be provided to the primary care committees. Regular update papers to be provided and discussed at the committees as applicable.



Adequate



I = 2 L = 36

Task and finish group meet to agree reinvestment options for each year and implement the investment.Person Responsible: Julie CurtisTo be implemented by: 31 Mar2021

26 Jun 2019Julie LemmyThe task and finish group will meet late summer 2019 to agree the final year funding commissioning intentions and report back to the committees in early Autumn for roll out in April 2020.23 Apr 2019Julie LemmyThe PMS working group to meet in August to agree year 5 (the final year) funding for the reinvestment programme. Regular updates will be provided to the primary care committees.

I = 1 L = 22


Page 2 of 3

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Primary Care Commissioning GPFV

Risk Ref

Corporate Objective






Level

Residual Score


PCC 4


There is a risk that, in increasingly challenging national and local circumstances, an increasing number of Northamptonshire GP practices become 'vulnerable' Risk Owner: Julie CurtisRisk Lead: Julie LemmyLast Updated: 28 Jun 2019Latest Review Date: 28 Jun 2019Latest Review By: Julie LemmyLatest Review Comments:updated June 2019

CauseIncreasingly challenging national and local circumstances.Practices failing and returning contracts back to the commissioners.EffectAccess to primary care services in the county.Increasing number of Northamptonshire GP practices becoming 'vulnerable' and begin failing.Increased risk of poor quality and serious incidents.Poor CQC outcomes and poor patient experience, and potentially closures or caretaking arrangements need to be put in place.

I = 4 L = 416

Support to individual practices through the primary care team, medicines management team, IT and others as part of business as usual, GPFV delivery and NHS Long Term Plan delivery.Quality monitoring and mechanisms for improving performance, e.g. deep dive and early warnings – via risk and share groupVulnerable practices resilience funding to be made available in 19/20 & 20/21Control Owner: Julie Lemmy

CCG Primary Care & Quality Teams + NHSE local teams - reporting into the quality risk share group

CCGs Primary Care Committees / NHS England Assurance Committees

External Auditors

Adequate



I = 3 L = 39

1. Review and take the learning from recent CQC visits and look to develop a programme of support from either internal teams or external providers/bodies i.e. RCGP/Change consultants/LMC/NHSE etc.2. Quality monitoring and mechanisms for improving performance, e.g. deep dive and early warnings, review Vulnerable practices resilience funding in 2016/17-2018/19 & 19/20. Person Responsible: JulieLemmyTo be implemented by: 31 Mar2020

28 Jun 2019Julie LemmyFollowing the recent CQC inspections - fortnightly monitoring is now taking place and the learning from these review will be compiled to inform the formal review to be completed by end of September 2019.

I = 2 L = 24


Page 3 of 3

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Report To


Date of Meeting

23 July 19

Title of the Report

Medicines Management Risk Register


PPCCC-19-28

Presenter of Report Giles Owen – Deputy Director of Prescribing and Medicines Management

Author(s) of Report

Giles Owen – Deputy Director of Prescribing and Medicines Management


Julie Curtis – Director of Primary Care & Community Integration.

Purpose of Report

Please select:

☐ Approval ☒ Assurance ☐ Ratification ☒ Note ☐ Recommendation ☒ Information

Executive summary The Committee is asked to review and note the updated risk register for medicines management. Related Corporate Objectives Please select:

☒ Quality ☒ Commission sustainable services ☐ Transformation ☐ Workforce and Culture ☐ Engagement ☒ Accountability


Please select:


Risk and assurance

Does the content of the report present any risks or consequently provide assurances on risks? Y




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☐ No conflict identified ☐ Conflict noted, conflicted party can participate in discussion but


decision


Please select: ☐ No adverse findings/not relevant: go ahead as planned ☐ Adjust: Specific impacts have been identified and can be



challenge

Engagement

Patient and Public: N Clinical: N

Recommendations

The Joint Primary Care Commissioning Committee is asked to: • Note the medicines management risks;

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Report Date 16 Jul 2019

Risk Status Open

Risk Area Medicines Management

Control Status Existing

Action Status Outstanding


Page 1 of 3

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Medicines Management

Risk Ref

Corporate Objective






Level

Residual Score


MM 1 1. Quality – We will improve quality within all providers to ensure services are safe, efficient and effective

Increases in Drug Tariff prices not accounted for in the primary care drug budget.Risk Owner: Kathryn MoodyRisk Lead: Giles OwenLast Updated: 29 Jan 2019Latest Review Date: 11 Jul 2019Latest Review By: Giles OwenLatest Review Comments: Riskreviewed. Position has notchanged.

Cause - Price concessions (NCSO) due to limited availability of Cat. M drugs. - Price increases in Cat. M drugs. NHSE advised CCGs finance dept. not to make any allowance for NCSO drugs when setting the 18/19 drug budget. Effect - Significant increase in expenditure within the primary care drug budget

I = 4 L = 520

Budget Holder Meetings with FinanceControl Owner: Giles Owen

CFO report to JEMT.

Assurance Reporting process to JFC and GB.

Regulatory oversight of financial position.

Adequate

Assurance Date: 11 Jul 2019

Assurance By: Giles Owen

CFO works with Finance Team on mitigations in placeControl Owner: Giles Owen

CFO report to JEMT.



Adequate



Financial performance meetings with NHSE.Control Owner: Giles Owen

CFO report to JEMT.



Adequate



Medicines Management Team continue to inform the Finance Team of the situation. Control Owner: Giles Owen

Primary Care Finance Manager has access to NCSO reports to inform finance.

Assurance Reporting process to JFC as required.

Adequate



I = 4 L = 520

The position continues to be a concern. Finance are aware of the situation. Person Responsible: Giles OwenTo be implemented by: 31 Oct2019

I = 4 L = 520


Prescribing expenditure of OTC drugs does not decrease despite NHSE guidance. Risk Owner: Kathryn MoodyRisk Lead:Last Updated: 11 Jul 2019Latest Review Date: 11 Jul 2019Latest Review By: Giles OwenLatest Review Comments: Riskreviewed. Target risk scoremaintained. Progress and actionrecorded.

Cause - Patients continue to make GP appointments for the 35 conditions listed within NHSE guidance and clinicians continue to prescribe OTC visit rimary care prescribers.EffectSavings on the prescribing of OTC does not occur.Encourages self care for patients

I = 4 L = 312

Monitor GP practice performance via ePACT.Control Owner: Giles Owen

Prescribing Team will monitor GP practice performance on OTC indicators in the 19/20 using ePACT.

PMO oversight of progress on QIPP savings.

Assurance reporting to JEMT.

NHSE regulatory oversight

Set suitable targets within PAF for the OTC Control Owner: Giles Owen





Use prescribing meetings to promote the NHSE OTC guidance and to explain rationale for inclusion within the 19/20 PAF. Control Owner: Giles Owen





I = 4 L = 28

Initial discussions have taken place at NPMG about including prescribing of OTC medicines in the 19/20 Prescribing Achievement Framework as this will enable the Prescribing Team to work with GP practices in reducing the amount of prescribing of OTC medicines. Opinion is currently being sought by the local prescribing groups and this will be considered when NPMG advise on which indicators should be included in the 19/20 PAF. The PAF scheme will then go to JEMT and NHSE meetings for sign off.

GP engagement in the implementation of NHSE guidance.Person Responsible: KathrynMoodyTo be implemented by: 31 Mar2020

11 Jul 2019Giles OwenAction was approved at JEMT. GP practices have started implementing. Initial prescribing data is positive i.e. showing a reduction in expenditure on OTC items.22 Jan 2019Giles OwenInclusion of OTC in 19/20 PAF has been agreed by NPMG. Due to go to JEMT for sign off on the 5th February.

I = 4 L = 28


Page 2 of 3

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Medicines Management

Risk Ref

Corporate Objective






Level

Residual Score



Reputational risk with patients from the CCGs implementing NHSE guidance of not routinely prescribing OTC medicines. Risk Owner: Kathryn MoodyRisk Lead:Last Updated: 11 Jul 2019Latest Review Date: 11 Jul 2019Latest Review By: Giles OwenLatest Review Comments: Riskreviewed and the likelihood scorehas been reduced.

Cause - Patients will not be routinely prescribed OTC medicines as per NHSE guidance. - A significant number of these patients will be being prescribed these drugs currently, or had them prescribed in the past. - The majority of patients are exempt from prescription charges or have a pre-payment certificate so they have not previously had to purchase OTC items. Effect - The CCGs will receive complaints and maybe adverse media coverage from implementing the guidance

I = 3 L = 412

The Prescribing Team continued work with GP practices to facilitate the implementation of NHSE guidance. Working with clinicians to decide on which cohorts of patients should/shouldn't be prescribed OTC medicines, patient searches undertaken to highlight these patients as well as using comms materials e.g. posters, letters, messages on prescriptions and GP clinical systems to explain any changes.Control Owner: Giles Owen

Complaints and communications departments monitor situation in relation to patient complaints

Assurance reporting to JEMT


I = 3 L = 39

The intention is that the Prescribing Team will work with GP practices to facilitate the implementation of NHSE guidance. This will involve working with clinicians to decide on which cohorts of patients should/shouldn't be prescribed OTC medicines, doing patient searches to highlight these patients as well as using comms materials e.g. posters, letters, messages on prescriptions and GP clinical systems to explain any changes.Person Responsible: KathrynMoodyTo be implemented by: 31 Mar2020

11 Jul 2019Giles OwenNHSE guidance being implemented and minimal patients complaints have been received.22 Jan 2019Giles OwenNPMG have agreed that this area of work should be included within the 19-20 PAF. Communication materials have been produced to support the implementation.

I = 2 L = 36

MM 5 3. Commission sustainable services – We will ensure the development of seamless transition between providers, where patients need the support or intervention of primary care, community care, secondary care, social services or the voluntary sector...

Drug shortages following a "No deal EU exit"Risk Owner: Giles OwenRisk Lead: Giles OwenLast Updated: 29 Jan 2019Latest Review Date: 11 Jul 2019Latest Review By: Giles OwenLatest Review Comments: Riskreviewed. Decision on EU exitpostponed until 31st October2019.

CauseNo deal EU exitEffectDrug shortages affecting patient care and experience.

I = 4 L = 312

DHSC have been preparing for the potential effects on drug supply of a no deal EU exit. Negotiations have occurred with pharmaceutical companies so that additional drug supplies are being stock-piled.Control Owner: Giles Owen

Communication have been sent to GP practices and pharmacies to make them aware of the DHSC contingency plans and to advice them not to stock-pile or over-prescribe.

EPRR aware of the plans and has system oversight.

I = 4 L = 312

Further guidance is awaited from DHSCPerson Responsible: Giles OwenTo be implemented by: 31 Oct2019

I = 4 L = 312


Page 3 of 3

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Report To

NHS Corby CCG Primary Care Commissioning Committee in Public

Date of Meeting

23 July 2019

Title of the Report

Terms of Reference


PPCCC-19-29

Presenter of Report Tansi Harper, Lay Member, NHS Corby CCG Author(s) of Report

Emma Follis Corporate Services & Governance Manager NHS Corby CCG and NHS Nene CCG


Stuart Rees Joint Chief Finance Officer NHS Corby CCG and NHS Nene CCG

Purpose of Report

Please select:

☐ Approval ☐ Assurance ☐ Ratification ☐ Note ☐ Recommendation ☒ Information

Executive summary A review has been undertaken of the Committees Terms of Reference (TOR) for NHS Corby CCG and NHS Nene CCG, this has been done to further align the documents and ensure consistency in membership across Committees. Specific changes have been made to reflect the new Lay Member roles and the new Corporate Management Team (CMT) roles. The draft TOR are being presented to the Extraordinary Governing Bodies in Common (GBIC) meeting on 16 July 2019 for approval, as part of the Constitutional amendments required, and are therefore presented to the Primary Care Commissioning Committee for information. Subject to approval the TOR will take effect from September 2019. A verbal update on the outcome of the GBIC will be provided to the Committees. A summary of amendments to the TOR are listed below: Membership The Primary Care Commissioning Commtitee membership has been aligned to the new CMT Structure and new Lay Member structure.

Related Corporate Objectives Please select:

☐ Quality ☐ Commission sustainable services ☐ Transformation ☐ Workforce and Culture ☐ Engagement ☒ Accountability

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Please select:

☐ Better Health ☐ Sustainability ☐ Better Care ☒ Leadership

Risk and assurance

Does the content of the report present any risks or consequently provide assurances on risks? No


Are there any significant issues with legal compliance? No


Please select: ☒ GBAF 1.2 Unable to ensure there is a sustainable, affordable healthcare system in Northamptonshire and


☐ GBAF 1.3 Commissioned providers do not deliver required standards of performance


☒ GBAF 1.5 Failure to ensure procurement activities are compliant with statutory requirements


☐ GBAF 1.7 Failure to ensure commissioning and monitoring of services which are compliant with the CCG safeguarding statutory requirement


☐ GBAF 5 Failure to achieve full planning guidance delivery for 19/20 Plan


☐ GBAF 7 Failure to deliver of the strategic vision for primary care commissioning


☒ GBAF 9 Possibility of commissioning inadequate services


☒ No conflict identified ☐ Conflict noted, conflicted party can participate in discussion but


decision


Please select: ☒ No adverse findings/not relevant: go ahead as planned ☐ Adjust: Specific impacts have been identified and can be



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challenge

Engagement

Patient and Public: No Clinical: No

Recommendations

The Committee is asked to: • Approve the amendments to the Terms of Reference, in readiness for ratification by the

Governing Bodies.

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NHS Corby Clinical Commissioning Group

Primary Care Commissioning Committee (PCCC)

Terms of Reference

Membership • Chair (Lay Member for Patient and Public Engagement )

• Lay Member Primary Care (Chair) • Independent Lay Member Lay Member Patient

and Public Involvement (Deputy Chair) • Joint Accountable Officer • Lay Member Finance and Planning • • Joint Chief Finance Officer/Deputy Chief

Finance Officer • Director of Primary Care and Community

Integration Transformation, NHS Nene and Corby CCGs

Quorum • 3 voting members, including the Chair or Deputy Chair, and two executives2 Executive Directors.

In Attendance • GP Governing Body Members (excluding the GP CCG Chair)

• Lay member for Audit and Governance • CCG Quality Team Representative • Local Authority Public Health representative • Deputy Director of Primary Care • HealthWatch representative • NHS England representative • LMC representative • External GP (external to the CCG but with the

required Governing Body level experience) • Governing Body Registered Nurse Chief Nurse

and Quality Officer • Primary Care Support Officer

Frequency of Meetings • Bi-Monthly

Accountability and Reporting • Accountable to Corby CCG Governing Body • Executive summary from the Chair of the

Committee to be presented to Governing Body meeting and NHS England

• Approved minutes presented to Governing Body meetings

Date of Approval by Committee • July 20182019

Date of Ratification by Governing Body

• August July20182019

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Effective Date • September 2019

Review Date • August July 2020 2019

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2 | Pa g e

1. Constitution 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.

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 Corby CCG. The delegation is set out in Schedule1.

The CCG has established the Corby 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.

2. Purpose 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.

Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Governing Body and the CCG.

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:

Management of conflicts of interest (section 14O); Duty to promote the NHS Constitution (section 14P); Duty to exercise its functions effectively, efficiently and economically (section14Q); Duty as to improvement in quality of services (section 14R); Duty in relation to quality of primary medical services (section 14S); Duties as to reducing inequalities (section 14T); Duty to promote the involvement of each patient (section 14U); Duty as to patient choice (section 14V); Duty as to promoting integration (section 14Z1); Public involvement and consultation (section 14Z2).

The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:

• Duty to have regard to impact on services in certain areas (section 13O) • Duty as respects variation in provision of health services (section 13P).

The Committee is established as a committee of the CCG in accordance with the CCG’s constitution. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.

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3 | Pa g e

3. Membership Members of the Primary Care Commissioning Committee shall be appointed by the CCG Governing Body and will include individuals who are not on the Governing Body.

• Lay Member Primary Care (Chair) • Lay Member Patient and Public Involvement (Deputy Chair) • Joint Accountable Officer • Lay Member Finance and Planning • Joint Chief Finance Officer/Deputy Chief Finance Officer • Director of Primary and Community Integration

Joint Chief Finance OfficerExecutive Director of Primary and Community Integration Chair and Deputy Chair:

The Chair of the Committee shall be the appointed Lay Member for Patient and Public Engagement

The Deputy Chair of the Committee shall be the appointed Lay Member The Chair of the committee shall preside. If the Chair is absent from the meeting, the Chair

will nominate the Deputy Chair to preside.

Voting is as follows: 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.

4. Quorum, Frequency of meetings and required frequency of attendance

Quorum In order for meetings of the Committee to be quorate, there must be present at least 3 voting members, including the Chair or Deputy Chair, and two executives. Where a management representative is unable to attend a meeting, a suitably qualified and duly nominated deputy may attend in their absence and form part of the quorum. This must be notified to the Chair of the Committee in advance of the meeting.

A decision put to a vote at a meeting of the Committee shall be determined by simple majority of the voting members present. In the case of no decision, the Chair (or Deputy Chair) of the Committee shall have a second and casting vote. Where a voting member has nominated a suitably qualified deputy, they will be entitled to vote.

Frequency of meetings and attendance

The frequency of the meetings will be bi-monthly. • Members are required to state for the record any interest relating to any matter to be

considered at each meeting, in accordance with the CCG’s Conflict of Interest policy. Recommendations relating to the management of all conflicts of interest will be received from the Conflicts of Interest Guardian at the start of each meeting. Such recommendations are to be approved by the Committee and such recommendations and approvals shall be recorded in the meeting minutes.

Meetings of the Committee shall: • Be held in public, subject to the application of 28(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

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4 | Pa g e

time to time. 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.

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5 | Pa g e

• 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.

Members and non-voting attendees of the Committee shall respect confidentiality requirements and principles as outlined in the Data Protection Act 1998.

The Committee will present its minutes to the Local Team of NHS England and the Governing Body of Corby CCG for information, including the minutes of any sub- committees to which responsibilities are delegated.

The CCG will also comply with any reporting requirements set out in its constitution. It is envisaged that these Terms of Reference will be reviewed from time to time, reflecting

experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.

Governance of meetings The Committee will operate in accordance with the CCG’s Standing Orders. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than 7 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 shall specify.

5. In attendance The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions.

• GP Governing Body Members (excluding the GP CCG Chair) • Lay member for Audit Governance • CCG Quality Team Representative • Public Health representative • Deputy Director of Primary Care • HealthWatch representative • NHS England representative • LMC representative • External GP (external to the CCG but with the required Governing Body level experience) • Chief Nurse and Quality Officer • Primary Care Support Officer Quality Assurance Manager Deputy Director of Primary Care Public Health representative HealthWatch representative NHS England representative LMC representative External GP (external to the CCG but with the required Governing Body level experience)

A standing invitation is made to the following organisations:

NHS England Local Authority HealthWatch LMC representing its members

6. Authority Primary Care Commissioning Committee is authorised by the CCG Governing Body to provide assurance on any activity within its terms of reference.

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6 | Pa g e

The work and effectiveness of the Committee shall be subject to regular monitoring by the Audit and Risk Committee, which shall undertake at least one formal review annually of the effectiveness of the Committee as part of its assurance function.

7. Duties 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 Corby CCG, under delegated authority from NHS England.

In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and Corby CCG, which will sit alongside the delegation and terms of reference.

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.

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7 | Pa g e

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. This includes the following:

GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing breach/remedial notices, and removing a contract);

• Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”);

Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

Decision making on whether to establish new GP practices in an area; Approving practice mergers; and • Making decisions on ‘discretionary’ payment

The CCG will also carry out the following activities:

To plan, including needs assessment, primary medical care services in Corby CCG; To undertake reviews of primary medical care services in Corby CCG; To co-ordinate a common approach to the commissioning of primary care services

generally; To manage the budget for commissioning of primary medical care services in Corby CCG.

8. Reporting Arrangements The Committee will make decisions within the bounds of its remit as per the CCGs Schedule of Reservation and Scheme of Delegation.

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

The Committee will produce an executive summary report which will be presented to the Local Team of NHS England and the Governing Body of Corby CCG bi-monthly for information.

9. Compliance and Effectiveness A key responsibility of the Governing Body is to ensure that the CCG complies with its legal and Constitutional obligation to manage conflicts of interest. These obligations are set out in section 14O (4) of the National Health Act 2006 and section 8 of the CCG’s Constitution and our Conflicts of Interest Policy. Conflicts of Interests arising during the course of this committee will be managed in accordance with the CCG’s Conflicts of Interest Policy, which shall be reviewed in line with guidance as required from NHS England.

Procurement of Agreed Services The CCG will make procurement decisions as relevant to the exercise of its delegated authority and in accordance with the detailed arrangements regarding procurement set out in the delegation agreement.

10. Administration The Committee shall be supported administratively by Executive AssistantPrimary Care Support Officer whose duties in this respect will include:

Review of the Terms of Reference Maintain agenda against cycle of business and agreement of the agenda with the Chair Collation and distribution of papers Taking and issuing the minutes and preparing an action log in a timely way; Record attendance

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8 | Pa g e

11. Requirement for review The Terms of Reference will be reviewed annually or sooner if required with recommendations made to the Governing Body for ratification.

12. FOI Reminder The minutes (or sub-sections) of the Committee, unless deemed exempt under the Freedom of Information Act 2000, shall be made available to the public, through the Governing Body meeting.

13. Equality Act Each decision made/approved by Primary Care Commissioning Committee should align to the CCGs commitment to equality and inclusion. And by doing so, the Joint Executive Management Team Committee must be satisfied that decisions made meet the requirements of equality law, including but not limited to the Equality Act 2010; s149 Public Sector Equality Duty (PSED).

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