NHS Northamptonshire CCG Primary Care Commissioning ...

NHS Northamptonshire CCG Primary Care Commissioning Committee in

Public

Tuesday 5 January 2021 14:30-15:30

Microsoft Teams

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A G E N D A Northamptonshire Primary Care Commissioning Committee Meeting

in Public

5 January 2021 14:30-15:30

Microsoft Teams

Time Agenda Item Action Presenter Reference 14:30 1. Welcome, Apologies and On Call

Director Note Andrew Hammond Verbal

14:30 2. Declarations of Interest relating to agenda items Members are reminded of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of NHS Northamptonshire Clinical Commissioning Group.

Note Andrew Hammond Verbal

14:30 3. Minutes of the previous meeting held on the 3 November 2020

Approve Andrew Hammond PCCC11-20/21

14:35 4. Action Log and Matters Arising Note Andrew Hammond PCCC12-20/21

14:40 5. Chair’s Update Note Andrew Hammond Verbal

14:45 6. COVID-19 Mass Vaccination Programme

Note Julie Lemmy Verbal

14:55 7. CCG Internal Audit on Delegated Commissioning

Note Julie Curtis PCCC13-20/21

15:00 7. Finance Update Note Stuart Rees PCCC14-20/21

15:05 8. GMAST Update Note Julie Lemmy PCCC15-20/21

15:10 9. General Practice Forward View Note Keiren Leigh Verbal 15:15 10. Primary Care Quality Report Note Sharon Wright PCCC16-

20/21

DATE OF NEXT MEETING The next Primary Care Commissioning Committee will take place on the 2 March 2021 at 14:30 via Microsoft Teams

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Minutes of NHS Northamptonshire CCG Primary Care

Commissioning Committee Meeting in Public

3 November 2020 - 2.30-3.00 Via MS Teams

Present Andrew Hammond Primary Care Lay Member, NHS Northamptonshire CCG (Chair) Julie Curtis Director of Primary & Community Integration, NHS Northamptonshire

CCG Dr Ammar Ghouri GP Governing Body Member, NHS Northamptonshire CCG Bev Messinger Patient & Public Involvement Lay Member, NHS Northamptonshire

CCG (Deputy Chair) Stuart Rees Chief Finance Officer, NHS Northamptonshire CCG In Attendance Dr Naomi Caldwell Clinical Executive Director, NHS Northamptonshire CCG Emma Follis Corporate Services and Governance Manager, NHS

Northamptonshire CCG Seema Gaj Commissioning Manager, General Medical Advice and Support

Team, NHS England and NHS Improvement - Midlands Dr Sanjay Gadhia Clinical Executive Director, NHS Northamptonshire CCG Dr Jonathan Ireland LMC Chair, Northamptonshire LMC Keiren Leigh

General Practice Forward View Programme Manager, NHS Northamptonshire CCG

Julie Lemmy Deputy Director of Primary Care, NHS Northamptonshire CCG Hayley Mann Primary Care Support Officer, NHS Northamptonshire CCG Sharon Wright Quality Improvement Manager, NHS Northamptonshire CCG Apologies Angela Dempsey Chief Nursing Officer, NHS Northamptonshire CCG Toby Sanders Chief Executive Officer, NHS Northamptonshire CCG Sam Turner Finance and Planning Lay Member Dr Jo Watt GP Chair, NHS Northamptonshire CCG

Minute No: Agenda Item PCCC20/2114 Welcome and Apologies The Chair welcomed members to the meeting and apologies for absence were noted as

above. There was no On Call Director attending the meeting. Due notice had been given in line with the Constitution and the meeting was quorate.

PCCC20/2115 Declarations of Interest Members noted the Standing Declarations of Interest. All members were asked to

declare any perceived conflicts of interests that related to items on the agenda.

PCCC20/2116 Minutes of Previous Meeting The minutes of the Primary Care Commissioning Committee held on 1 September 2020

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were Approved.

PCCC20/2117 Chairs Update Andrew Hammond made reference to the second lockdown as communicated by the

Government and asked for assurance that the CCG take into account all the lessons learnt from the first lockdown.

PCCC20/2118 Terms of Reference Emma Follis took the paper as read and stated that the Committee was asked to review

and approve the amended Terms of Reference. Emma stated that the Terms of Reference had been reviewed in line with the annual review and that a copy of the draft Terms of Reference had been shared with the Chair ahead of this meeting for comment. All suggested changes had been incorporated and amendments had been made in regards to accountability and reporting arrangements following the change to the CCGs delegation arrangements. It was noted that a further amendment will include the Governing Body Clinical Representative into the membership. Emma confirmed that if the Terms of Reference are approved they will be submitted to Governing Body and will be incorporated into the NHS Northamptonshire CCG Constitution. The Committee Approved the Terms of Reference.

PCCC20/2119 Finance Update Stuart Rees took the paper as read and confirmed that the report is up to and included

the Month 6 position which shows an £1.8m over spent. It was previously stated that the months 1-6 spend can be claimed back however there is a slight change to this in that the month 6 position will not get reimbursed until month 8 or 9. The overspend areas are COVID, prescribing and international recruitment. £500,000 is attributed to the delegated budget and the remaining on the other areas. However, as previously stated this overspend will be reclaimed; however we will not know the outcome of that claim until month 8 or 9. For month 7-12 the system has received an allocation for COVID so there will not be a reclaiming process. The CCG will set out the budget on historical data from months 1-6 and the CCG is being held to account to deliver within the budget. The budgets are currently sitting on one line on the ledger at present until the budgets have been agreed by NHS England and NHS Improvements (NHSE/I). The Committee noted the finance update.

PCCC20/2120 GMAST Update Julie Lemmy took the paper as read and highlighted a couple of points.

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It was confirmed that under the estates section to Committee were asked to note an increase in rent reimbursement for a practice due to a dispute over the number of parking spaces. It was confirmed that the District Valuer is in agreement with the amended number of parking spaces. . Julie confirmed that the procurement exercise for the new Data Protection Officer is complete and practices are being informed of the new provider. The Committee noted the GMAST update

PCCC20/2121 General Practice Forward View Keiren gave a verbal update on the General Practice Forward View in particular

focussing on GP Video Consultations. Keiren confirmed that there is a requirement for all CCGs to have 100% coverage for video consultation by the end of the financial year however this was reached a lot quicker and this was due to a system called AccRux. 100% of practices have this system and up until the 1st April 2021 it has been funded by NHSE/I. However, following that date it will no longer be centrally funded. The team have engaged with practices via the Locality Boards and confirmed they would like to continue with AccRux with a fairly unanimous agreement of the aspects of the system that General Practice would like to be included within the package. A proposal will be brought back to the Committee for approval. Keiren shared with the Committee the usage of video consultations since the COVID outbreak. He confirmed that year to date there have been over 37,000 video consultations taken place in General Practice and over 91,000 messages sent. Keiren also provided further figures to the Committee confirm that before the pandemic General Practice was completing approximately 40,000 video consultations per month and this has risen to approximately 150,000 since the start of the pandemic. This shows the enormity of the good work taking place in General Practice and also helps highlight the pressure that General Practice is still under. Dr Naomi Caldwell reinforced Kieran’s comments and noted that these figures should be shared with other not only other health providers but to General Practice to show that the CCG recognises the hard work that has been taking place. Keiren confirmed that Dr Jo Watt has put together some slides detailing this information and the Committee agreed that this should be put into a communications piece to be shared with stakeholders and member practices. Action – Keiren Leigh to work with Dr Jo Watt and the Comms team to share the good work taking place in General Practice. The Committee wanted to express their thanks to General Practice for their response during this pandemic.

Date of Next Meeting

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The next Primary Care Commissioning meeting in Public will be held on

Tuesday 3 November 2020 at 2.30pm via Microsoft Teams.

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A C T I O N L O G

NHS Northamptonshire CCG Primary Care Commissioning Committee Updated date 3 November 2020

Minute No: Agenda Item Action Lead Status/Update Timescale RAG

Meeting date 17 November 2020 PCCC20/2121 General Practice

Forward View Keiren Leigh to work with Dr Jo Watt and the Comms team to share the good work taking place in General Practice.

Keiren Leigh 05.01.2021

Completed On Track Overdue No further action

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Our Shared Values Our patients and our local population come first We work together in an open and accountable way We trust, challenge and support each other We do what we say we will do

NHS Northamptonshire CCG Report To

Primary Care Commissioning Committee in Public

Date of Meeting

5 January 2021

Title of the Report

CCG Internal Audit on Delegated Commissioning

Paper Reference

PCCC13-20/21

Presenter(s) of Report Julie Curtis, Director of Primary and Community Integration

Author(s) of Report

Hayley Mann, Primary Care Support Officer

Executive Director Sponsor

Julie Curtis, Director of Primary and Community Integration

Purpose of Report Please select:

☐ Ratification ☒ Approval ☐ Recommendation ☐ Assurance ☐ Note

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

Executive Summary During November 2020 Risk Assurance Services LLP (RSM) conducted an audit of the Primary Care Commissioning Committee. A draft of this audit has now been released and the CCG has received substantial assurance from RSM. There are two low priority management actions for the Committee to note:

Management Action 1 The CCG will ensure that Primary Care Commissioning Committee meeting minutes clearly distinguish between decisions made

Responsible Owner: Julie Lemmy - Deputy Director of Primary Care

Date: 31 January 2021

Priority: Low

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during meetings and actions to be taken.

Furthermore, actions will be assigned a due date and owner (with consideration being given to the use of an action log to track progress).

Management Action 2 The CCG will introduce a formal process for the review of rates and rental costs as part of primary care budget setting.

Responsible Owner:

Julie Lemmy - Deputy Director of Primary Care

Date:

31 January 2021

Priority:

Low

Strategic Objectives Please select: ☐ Incident Response & Operational Support ☐ Restarting Services & Processes Safely ☐ Reset & Transformation ☒ New CCG – Building a New Organisation ☐ CCG within the System – Roadmap to ICS Governing Body Assurance Framework Please select: ☐ GBAF 1.2 Unable to ensure there is a sustainable, affordable healthcare system in

Northamptonshire and the CCG hits 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 managed and delivered in line with CCG Policy and NHCP expectations.

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

☐ GBAF 4 The CCG cannot continue to operate in a BAU due to loss of key resources

☐ 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

Risk and assurance Does the content of the report identify any risks? ☐ Yes ☒ No If answered ‘Yes’ Please provide a summary of the risk/s and assurance of mitigation. Data Protection Impact Assessment - it is legal requirement to hold an approved DPIA for all processes and projects where the

Have the DPIA screening questions been completed? ☐ Yes ☒ No If any of the screening questions have been answered “YES”, then the full Data Protection Impact Assessment is required. If the screening questions

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transmission and/or storage of person identifiable data will be necessary.

indicate that a full assessment is not required, please note the reasons within your paper

Equality & Quality 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

Engagement Please select: Patient and Public ☐ Yes ☒ No Clinical ☐ Yes ☒ No Recommendations

The Committee is asked to: • Note the two low priority actions.

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Report To

NHS Northamptonshire Primary Care Commissioning Committee in Public

Date of Meeting

5 January 2021

Title of the Report

Finance Report 2020/21 – Month 8

Paper Reference

PCCC14-20/21

Presenter(s) of Report Stuart Rees – Chief Finance Officer

Author(s) of Report

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


Stuart Rees – Chief Finance Officer


☐ Ratification ☐ Approval ☐ Recommendation ☒ Assurance ☐ Note

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

Executive Summary 2020/21 Finance Report

This report provides an update on the financial position of the GP Services budgets for Northamptonshire CCG as at the end of November 2020. A summary of the financial position is attached at appendix 1.

Under the temporary finance regime introduced for the first six months of 20/21 Months the CCG received retrospective top payments in order to make the CCG breakeven. The finance regime for October 2020 to 31 March 2021, have seen allocations move to a more normal basis, with a total funding envelope agreed for the six month period. CCGs will not receive a ‘retrospective adjustment’ for any primary care expenditure from NHSEI for the remainder of the year, however additional funding for COVID related expenditure is available from the CCG’s COVID

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budget allocation in 20/21 but it should be noted that this is non recurrent funding that must be claimed by practices before 31st March 2021.

The CCG financial plan for months 7 -12 included significant levels of additional funding within primary care to help cover expected cost pressures on GP prescribing budgets and support required investment in primary care services.

The CCG is currently showing an underspend of £2.736m against the primary care budgets at the end of month 8 and if current expenditure levels continue this will increase to £5.474m by year end.

The main areas of underspend at month 8 are as follows:

• GP Prescribing - current expenditure forecasts for month 7 & 8 are below planned levels. • Locally Commissioned Services – Plans for spending additional investment funding for the second half of the

year still being finalised. • PCN DES Additional Roles Reimbursement – recruitment delayed due to Covid.

Commissioning colleagues are currently working on plans to ensure that the additional primary care investment funding is fully utilised by the end of the year.

It should also be noted that NHSEI have allocated an additional £1.867m funding for the GP COVID Capacity Expansion Plan. This will be fully distributed to GP Practices on a list size basis, during month 9 and is to aid their response to all aspects of the COVID response in the second half of the year. The expected cost pressures on delegated budgets previously notified to the CCG by NHSEI has been offset via the funding regime introduced during the pandemic. This is a non-recurrent solution to the cost pressures in 20/21but it is expected that with 2 years of growth funding and inflation it will be sufficient to offset these cost pressures recurrently moving into 2021/22, although this is still to be fully worked through by the CCG in the coming weeks and will need to be viewed alongside 2021/22 planning guidance that is issued. No impact of a no-deal Brexit has been included in Prescribing forecasts and this will require further consideration in future months.

Strategic Objectives Please select: ☐ Incident Response & Operational Support ☒ Restarting Services & Processes Safety ☒ Reset & Transformation ☐ New CCG – Building a New Organisation ☐ CCG within the System – Roadmap to ICS Governing Body Assurance Framework Please select: ☒ GBAF 1.2 Unable to ensure there is a sustainable, affordable healthcare system in

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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







Risk and assurance Does the content of the report identify any risks? ☒ Yes ☐ No If answered ‘Yes’ Please provide a summary of the risk/s and assurance of mitigation. Data Protection Impact Assessment - it is legal requirement to hold an approved DPIA for all processes and projects where the transmission and/or storage of person identifiable data will be necessary.

Have the DPIA screening questions been completed? ☐ Yes ☒ No If any of the screening questions have been answered “YES”, then the full Data Protection Impact Assessment is required. If the screening questions indicate that a full assessment is not required, please note the reasons within your paper


Engagement Please select: Patient and Public ☐ Yes ☒ No Clinical ☐ Yes ☒ No Recommendations The Committee is asked to:

• Note the financial position of the CCG reported at month 8.

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Primary GP Services for NHS Northamptonshire CCG 2020/21 – Month 8

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1.0 Introduction

In response to COVID-19, a temporary financial framework was put in the place to cover the period 1 April 2020 to 30 September 2020. The principle of the approach was that during this six month period, CCGs are expected to breakeven on an in-year basis.

Financial Allocations for the first six months of 2020/21 were calculated nationally based on expenditure levels at Month 11 in 2019/20 and CCGs were monitored against these adjusted allocations. Actual expenditure was reviewed on a monthly basis and a non-recurrent adjustment (‘retrospective adjustment’) actioned for reasonable variances between actual expenditure and the expected monthly expenditure.

Months 7 -12, i.e. 1 October 2020 to 31 March 2021, have seen allocations move to a more normal basis, with a six months allocation being made following a truncated planning round. CCGs will not receive a ‘retrospective adjustment’ for any primary care expenditure from NHSEI for the remainder of the year, however additional funding for COVID related expenditure is available from the CCG’s COVID budget allocation in 20/21 but it should be noted that this is non recurrent funding that must be claimed before 31st March 2021.

This report provides an update on the financial position of the GP Services budgets for Northamptonshire CCG as at the end of November 2020. A summary of the financial position is attached at appendix 1.

2.0 Overview

At the end of month 8 the CCG has spent £164.244m against an allocation of £166.980m. The CCG is currently showing an underspend of £2.736m against primary care budgets.

The main areas of underspend at month 8 are as follows:

• GP Prescribing - current expenditure forecasts for month 7 & 8 are below planned levels • Locally Commissioned Services – Plans for spending additional funding for the second half of

the year still being finalised. • PCN DES Additional Roles Reimbursement – recruitment delayed due to Covid.

These will be described in more detail in the sections that follow.

3.0 COVID Expenditure

At month 8 the CCG has incurred £2.172m of expenditure tackling COVID-19 within Primary Care services. The following table shows a breakdown of the areas that this funding has been spent on:

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The CCG has also incurred additional primary care expenditure on IT services in response to dealing with the COVID pandemic. This was funded through retrospective top ups to baseline budgets upto month 6 and is not specifically coded as COVID expenditure. This expenditure can be seen in the table below:

Any further practice claims for re-imbursement of Covid related expenditure must be submitted to the CCG prior to 31st March 2021.

4.0 Delegated Budgets

The allocation to fund GP Delegated Services for Northamptonshire CCG in 20-21 totals £108.945m, with £71.144m for the 8 months to November 2020. This includes retrospective allocations received for months 1 to 6 including £0.377m for business as usual and £2.058m for COVID related expenditure. CCG allocations of £0.034m year to date have been made from local discretionary funds to support the Home Vising Service, with a further £0.600m funding being made available to fund Hot Hubs for the remainder of the year. Based on the YTD position at month 8, the delegated Primary Care Medical budget is currently underspending by £0.696m. This is due mainly to an underspend on Locally Commissioned Services. The main points to note on these budgets are as follows:

• PCN DES Additional Role Reimbursement budgets underspending by £0.416m year to date, this is due to slippage in recruitment schemes in the first two quarters of 20/21. Commissioning colleagues are working with the PCNs to attempt to utilise as much of this budget as possible in order to support the Mass Vaccinations programmes, and recover the recruitment programme.

• Substantial underspends against Learning Disabilities DES and Minor Surgery DES comprise the majority of the remainder of the underspend. Patient behaviour in the first half of the

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year has reflected in lower uptake on these schemes than previous years. Although activity is now increasing as patients return to general practice, it is unlikely that the Minor Surgery DES will show substantial increases in activity. The Learning Disability DES is a national priority, and in order to achieve the 67% national target NHfT have been commissioned to provide additional capacity. The details are currently still being negotiated, but some activity has already successfully commenced.

• NHSEI have allocated an additional £1.867m funding for the GP COVID Capacity Expansion Plan. This will be fully distributed to GP Practices on a list size basis, during month 9 and is to aid their response to all aspects of the COVID response in the second half of the year.

• The expected cost pressure on delegated budgets previously notified to the CCG by NHSEI has been offset via the funding regime introduced during the pandemic. This is a non-recurrent solution to the cost pressures in 20/21but it is expected that 2 years of growth funding and inflation will be sufficient to offset these cost pressures recurrently moving into 2021/22, although this is still to be fully worked through by the CCG in the coming weeks as more guidance is issued.

5.0 Additional CCG commissioned expenditure

The CCG GP related budgets for the 8 months to November 2020 are £95.837m based on the notified budgets for the period. This includes retrospective allocations of £4.095m received in respect for overspends up to Month 6. At Month 8, the reported forecast is £93.796m resulting in a forecast underspend of £2.040m relating mainly to Prescribing (-£1.177m) and Primary Care Enhanced Services (-£0.849m). The main points to note on these budget areas are as follows:

• Prescribing expenditure in 2020/21 for the 1st half of the year was well above nationally expected values. Northamptonshire CCG has received retrospective top ups at month 6 amounting to £3.726m to cover these overspends in the first half of the year. The CCG planned for prescribing levels to increase over the winter months and therefore additional resource was added to the prescribing budgets for months 7 -12. However current forecasts are that expenditure will to be maintained at the same levels as the first 6 months although these budgets are extremely volatile and could change over coming months. This combined with list size growth and additional funding for Flash Glucose Monitoring within budgets has improved the overall position. These budgets are currently underspent by £1.177m.

• Other pressures within prescribing budgets relate to Government guidance to move Anticoagulation patients from warfarin to DOAC/NOACs which are considerably more expensive.

• SMS Text messaging continues to be an area of increased activity in the GP IT budgets

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• Additional non recurrent development funding of £1.2m was included within the financial plans for the second half of the year. Plans are still being finalised for how this funding will be deployed and as a result it is currently underspent by £0.849m. It is expected that this funding will be spent in full by year end and the underspend will not exist.

6.0 Issues not yet reflected in the forecast

• Commissioning colleagues are currently working on plans to fully utilise the budget

envelopes by the end of the year; this report will be updated appropriately as plans are developed.

• An additional allocation of £185k to support the 3 main priorities of the Ageing Well Programme has been received in month 8 and plans are currently being developed to how this will be spent in Q4.

• Premises Rent reviews are currently not included in the forecasting. We are working with GMAST to understand what those pressures may be as we move through the year.

• Increases in activity in the Vaccination programme are likely to increase expenditure against the GP Personally Administrated Drugs costs (also known as GP professional fees). We are currently awaiting further guidance from DoH via NHSEI.

• National planning assumptions and/or prior year outturn has been used to inform the 2020/21 budget requirements for the items listed below, however, actual costs will be monitored monthly during the year and any emerging issues reported to the Committee:

GP Locum Cover GP Retainer scheme GP Dispensing /Professional Fees

• No impact of a no-deal Brexit, or the second wave of CV-19 have been included in Prescribing forecasts.

7.0 Recommendation

The Committee is asked to:

• NOTE the financial position at month 8; • NOTE that plans are being developed to utilise existing budgets by the end of the financial

year.

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Appendix A

Annual

Month 8 Total Budget YTD Budget YTD ExpenditureVariance

(under)/overMonth 8 FOT

YTD Variance

(under)/over

Variance

(under)/over %

£ £ £ £ £ £

Prescribing

GP Practice Prescribing 105,700,500 69,985,891 68,880,724 -1,105,167 103,072,553 -2,627,947 -2.49 Central Charges 2,888,488 1,955,603 1,975,688 20,085 2,963,532 75,044 2.60CCG LCS Schemes 3,330,735 2,110,911 2,019,271 -91,640 2,913,058 -417,677 -12.54

Total Prescribing 111,919,723 74,052,405 72,875,684 -1,176,722 108,949,143 -2,970,580 -2.65

Primary Care LCS Core Allocation

PMS Reinvestment 4,153,128 2,768,752 2,768,748 -4 4,153,125 -3 -0.00 PCN Support 36,540 24,360 23,257 -1,103 36,540 0 0.00All Other LCS Schemes 12,184,528 7,692,508 6,844,412 -848,095 10,428,723 -1,755,805 -14.41

Total Primary Care LCS Core Allocation 16,374,196 10,485,620 9,636,417 -849,202 14,618,388 -1,755,808 -10.72

Out Of Hours

Out of Hours Contracrt 5,679,861 3,786,574 3,786,574 -0 5,679,861 -0 -0.00 Total Out of Hours 5,679,861 3,786,574 3,786,574 -0 5,679,861 -0 -0.00

Home Oxygen

Home Oxygen Charges 826,044 578,693 609,618 30,925 891,151 65,107 7.88Total Home Oxygen 826,044 578,693 609,618 30,925 891,151 65,107 7.88

Primary Care GPIT

Core Contract & Data Backup services 1,838,596 1,225,380 1,225,381 1 1,838,596 0 0.00RA Services 83,136 55,424 55,424 0 83,136 0 0.00SMS Text Messaging & Sunquest 222,420 154,066 154,453 387 222,420 0 0.00HSCN & KCOM 183,719 127,455 126,113 -1,342 183,719 0 0.00Busines as Usual 235,192 166,985 157,503 -9,482 96,812 -138,380 -58.84 Licences Sunquest, MIG & EMIS 109,464 73,950 73,950 0 109,464 0 0.00IT Support 0 0 0 0 128,898 128,898 0.00GP IT Covid - 19 394,650 394,650 404,133 9,482 404,131 9,481 2.40GP IT Capital 0 0 0 0 0 0 0.00

Primary Care GPIT 3,067,177 2,197,910 2,196,956 -954 3,067,176 -1 -0.00

Primary Care GP Forward View

GP Extended Access 4,474,042 2,934,480 2,890,300 -44,180 4,342,664 -131,378 -2.94 Care Navigation 129,000 85,866 85,866 0 129,000 0 0.00Online Consultation 193,000 132,806 132,806 0 193,000 0 0.00Primary Care Networks 563,000 563,000 562,149 0 562,149 -851 -0.15 Training Hubs 155,000 146,600 146,600 0 155,000 0 0.00GPFV Practice Nurse Measures 0 0 0 0 0 0 0.00GPFV Aspiring Leaders 16,000 5,312 5,312 0 16,000 0 0.00International Recruitment 746,000 617,022 617,022 -1 746,000 0 0.00Digital First 0 0 0 0 0 0 0.00Practice Resilience 103,000 70,624 70,624 0 103,000 0 0.00PCST Leadership & Learning 0 0 0 0 0 0 0.00GPFV Fellowships Core Offer 0 0 0 0 0 0 0.00Drs Retainer Scheme 150,000 104,420 104,420 0 150,000 0 0.00GPFV Infrastructure & Resilience 129,000 75,191 75,191 0 129,000 0 0.00Budget adjustments 0 0 0 0 0 0 0.00

Total Primary Care GP Forward View 6,658,042 4,735,321 4,690,289 -45,032 6,525,813 -132,229 -1.99

Primary Care Co Commissioning

Contract 69,547,612 46,358,408 46,332,290 -26,118 69,553,872 6,260 0.01DES Services 10,930,244 5,764,174 5,052,581 -711,593 10,207,310 -722,934 -6.61 Locally Commissioned Services 427,144 -36,888 0 36,888 0 -427,144 -100.00 QoF 9,958,632 6,639,088 6,674,658 35,570 10,011,987 53,355 0.54Premises 11,087,288 7,381,526 7,482,394 100,868 11,707,224 619,936 5.59GP COVID Support 2,691,750 2,171,750 2,171,748 -2 2,681,750 -10,000 -0.37 PCO 120,000 80,000 79,998 -2 120,000 0 0.00Prescribing Fees 3,176,098 2,115,351 1,983,990 -131,361 2,975,985 -200,113 -6.30 Central Contracts 1,005,900 670,600 670,600 0 1,005,824 -76 -0.01 Other 0 0 0 0 0 0 0.00

Total Primary Care Co Commissioning 108,944,668 71,144,009 70,448,259 -695,749 108,263,952 -680,715 -0.62

Total Primary Care 253,469,711 166,980,532 164,243,798 -2,736,735 247,995,484 -5,474,227 -2.16

Primary Care Summary Report 2020-21

Year to Date Year End Outturn

Primary Care FinancePrinted: 14:32 18/12/2020

File: N:\Northants\Finance\20-21 Finance\Northamptonshire CCG's\Reporting\Month 8\Finance Report\M8 PCCC Appendix A19 of 35

Report To

Primary Care Commissioning Committee (Public)

Date of Meeting

5 January 2021

Paper Title Monthly Delegated Contracts Update Paper Reference No:

PCCC15-20/21

Presenter of Report Julie Lemmy – Deputy Director of Primary Care

Author(s) of Report

Amanda Swingler - Primary Care Development Manager


Julie Curtis – Director of Primary Care & Community Integration

Purpose of Report

Please select:

☒ Approval ☐ Assurance

☐ Ratification ☒ Note

☒ Recommendation ☐ Information

Executive summary This report will be presented at every Primary Care Commissioning Committee (PCCC) to provide committee members with an overview on the delegated commissioning work that the primary care team has been undertaken alongside NHSE/I General Medical Advice Support Team (GMAST). 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 provide assurances on risks? N

Legal implications/ regulatory requirements

Are there any significant issues with legal compliance? N

Data Protection Impact Assessment - it is legal requirement to hold an approved DPIA where the transmission and/or storage of person

Have the DPIA screening questions been completed? N If any of the screening questions have been answered “YES”, then the full Data Protection Impact Assessment is required

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identifiable data will be necessary. If the screening questions indicate that a full assessment is not required, please note the reasons within your paper

Governing Body Assurance Framework

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


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




☒ GBAF 4 The CCG cannot continue to operate in a BAU due to loss of key resources

☒ GBAF 5 Failure to achieve full planning guidance delivery for 20/21 Plan




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: N Clinical: N

Recommendations The Primary Care Commissioning Committee is asked to:

• Note the contents of this report. • A separate paper has been produced for the committee in regard to the Castlefields and Abbey

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Medical Practice merger.

1. Introduction

This paper provides an update to the Primary Care Commissioning Committee (PCCC) about the contractual work the primary care team has been undertaking during the last month with member practices and NHSE/I. This will be presented to the committee on a monthly basis allowing members to understand key changes and updates at a practice level.

Where committee members feel more information is required, this can be provided verbally or via a detailed paper at the next scheduled PCCC meeting.

2. PRACTICE CONTRACTUAL ISSUES / CHANGES

2.1 CQC Update

Practice Detail Action required by the committee

No update this month.

2.2 Contract Variations update


Lakeside (K83002)

Withdrawal of Dr Anne Trigell from partnership with effect from 31 Dec 2020.

To Note

Lakeside (K83002)

Withdrawal of Dr Camilla Tilbury from partnership with effect from 31 Dec 2020.

To Note

Lakeside (K83002)

Withdrawal of Dr Katherine Scoffings from partnership with effect from 31 Dec 2020.

To Note

Eskdaill Medical (K83013)

Withdrawal of Dr Bryant partnership with effect from 31 Dec 2020.

To Note

Crick Medical Practice (K83053)

Withdrawal of Dr A Twigg from partnership with effect from 4 Jan 2021.

To Note

2.3 Merger Application

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Abbey Medical Practice (K83047) and Castefields (Y01139)

Castlefields to merge with Abbey Medical Practice with affect from 1st April 2021. All contracts will be transferred to Abbey Medical Practice and Castlefields will cease on 31st March 2020.

A separate paper has been brought to the committee for approval.

3. DIRECTED ENHANCED SERVICES

No update this month

4. LOCALLY COMMISSIONED SERVICES

No update this month

5. WORKFORCE AND CAPACITY


Flexible Pools of Employed GPs In addition to the £150 million nationally available, further financial support (up to £120k) is available to each STP/ICS to support the process of recruiting and deploying employed GPs (including returners) and other staff to share across local communities on the basis above. A further update will be provided at the next committee.

To Note

6. ESTATES, PREMISES AND INFORMATICS



7. OTHER

Service Detail Action required by the committee


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NHS Northamptonshire CCG Report To

Primary Care Commissioning Committee in Public

Date of Meeting

5 January 2021

Title of the Report

Northamptonshire CCG Primary Care Quality Report November 2020

Paper Reference

PCCC16-20/21

Presenter(s) of Report Sharon Wright, Quality Improvement Manager,

Northamptonshire CCG Author(s) of Report

Sharon Wright, Quality Improvement Manager, Northamptonshire CCG


Naomi Caldwell, Clinical Executive Director of Primary Care and Localities


☐ Ratification ☒ Approval ☐ Recommendation ☐ Assurance ☐ Note

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

Executive Summary This paper is presented to the committee to provide an overview of the key matters of quality and safeguarding in primary care.

Strategic Objectives Please select: ☒ Incident Response & Operational Support ☒ Restarting Services & Processes Safely ☐ Reset & Transformation ☐ New CCG – Building a New Organisation ☐ CCG within the System – Roadmap to ICS Governing Body Assurance Framework

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


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



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



☒ 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

Risk and assurance Does the content of the report identify any risks? ☐ Yes ☒ No If answered ‘Yes’ Please provide a summary of the risk/s and assurance of mitigation. Data Protection Impact Assessment - it is legal requirement to hold an approved DPIA for all processes and projects where the transmission and/or storage of person identifiable data will be necessary.

Have the DPIA screening questions been completed? ☐ Yes ☒ No If any of the screening questions have been answered “YES”, then the full Data Protection Impact Assessment is required. If the screening questions indicate that a full assessment is not required, please note the reasons within your paper


Engagement Please select: Patient and Public ☐ Yes ☒ No Clinical ☒ Yes ☐ No Recommendations

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The Committee is asked to: • Continue to monitor indicators through the dashboard; • Identify good practice and share across the county; • Outline any additional actions; • Share data with commissioning team to influence new models of care and enhanced services.

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Primary Care Quality Information and Risk Sharing Group

Northamptonshire CCG Primary Care Quality Report November 2020 1. Introduction The purpose of this report is to give an overview of quality of primary care within NHS Northamptonshire 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 CQC activity Quarter 2 2020/21: Emergency support framework calls have been undertaken to all at risk practices at the time of writing this report. Number of practices rated Outstanding 2 Number of practices rated Good 60 Number of practices rated Requires Improvement 4 Number of practices rated Inadequate 3

3. Risk log (data from dashboard) Number of practices on Formal Action 0 Number of practices on enhanced monitoring 5 Number of practices on routine monitoring 64

4. Overview of indicators for Practices flagging on dashboard: 5 practices flagging this quarter. 5. Safety

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Quality

measure and CQC domain

June

RAG

Nov

RAG

Position statement Mitigating actions

5.1 Incidents Q2 2020/21

1 incident reported that is being jointly investigated with local acute trust across a complete patient pathway.

Incident under investigation and lessons learnt to be shared at next meeting

5.2 Countywide Safeguarding update November 2020

Safeguarding continues to be an area of concern for primary care and as such a variety of changes have been implemented.

Communication

The move to virtual working has assisted with attendance of health visitors, midwives and district nurses at multi-disciplinary meetings to discuss vulnerable patients.

Maternity services used lockdown to positively move towards the “better birth” process of delivering care. This led to an expression of concern by several members of Primary care. A forum was held with safeguarding leads for maternity services; both north and south, explaining the better births care paper. To allay safeguarding communication concerns a process has been developed: all surgeries have an appointed midwife, details are logged in a directory which was shared on the portal and with practices, as well as a process developed for sharing of pregnancy knowledge and safeguarding worries.

Training & Forums

Safeguarding CCG face to face training provision remains on hold, the GP lead forums have moved online and the team are developing the portal with a wealth of resources, training and presentations, with the aim to have webinars, podcasts and voice overs completed in 2021. Holding virtual fora have also assisted in attendance and engagement of practices who previously did not attend in person. We have discussed continuing with the virtual world in shared with face to face when restrictions are lifted.

Safeguarding Assurance

.

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6. Responsiveness

Quality


Feb

RAG June

RAG

Position statement Mitigating actions,

assurance

The lead nurse has made contact with all surgeries and assisted with the Assurance framework to ensure safeguarding is embedded in practice, in a number of surgeries that expressed interest. Three practices had inadequate CQC ratings prior to lockdown and a fourth was discovered as needing intervention during the assistance in completion of a review.

Information Sharing Agreements

Dr Findlay continues to lead on information sharing agreements with the local board and education with a pilot that was due to start prior to the second Covid lockdown and is now delayed until April. Another safeguarding project to enhance sharing of safeguarding information in the East Northamptonshire area, involving schools, police and health is in the development stage.

5.3 Infection, Prevention and Control

Infection control and use of PPE updates have been provided to primary care both through daily communication briefings but also through the CCG primary care portal. Antigen testing is offered at a regional testing site, locally at a walk through or mobile testing unit. Swabs have been made available at practices to support testing of both staff and patients. Rapid testing through Lateral Flow Devices (LVD) will be rolled out through December. This will enable staff to be tested twice weekly and results be known within 30 minutes. 4 practices developed an outbreak between July and November 2020. This led to mutual aid and buddying systems described in business continuity plans to be operationalised. Local track and trace systems are in place to support practices in instances where staff members test positive. Advice on social distancing and infection control measures continue to be given and practices supported with walk arounds using video technology.

COVID-19 updates via the portal

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and timeframe

6.1

NHSE Complaints Q2

Complaints processes were paused through March –July 2020. No complaints data received from NHSE&I complaints team

6.2 Friends and Family test

Patient feedback processes were paused through March – December 2020

7. Effectiveness

Quality


July RAG

Nov RAG

Position statement Mitigating actions,

assurance and

timeframe

7.1 Primary Care webtool

All data entries for QoF were paused through March – December 2020

7.3 GP forward view update November 2020

Care Navigation Care Navigation is still moving forward with the creation of a bitesize intermediate training, which is aimed at being delivered at Practice or PCN level, for those who are experienced Care Navigators however, would like to improve on their current practice. We are currently in the process of setting up and arranging the first of the virtual Phase 2 training sessions, which was delivered on the 25th November 2020, with further training opportunities to be set from January 2021.

The soft skills training will commence once it is safe to do so; on a face to face basis and, will consist of a wide range of topics such as communication, resilience and conflict resolution skills, as outlined before. We will link in more closely with our Care Navigation training provider, so that we can learn from other areas across the country to consider and review not only our Care Navigation practice but, take best practice from other parts of the country to improve our own county wide offer. Productive General Practice

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Within the county we are currently half way through Wave 11 of Productive General Practice where 7 Practices are participating on the programme. The 11th November saw the engagement session for Wave 12, where another 7 practices have expressed a desire to be part of the quality improvement programme which will commence in January 2021. The total number of individual practices, who have participated and benefitted from the programme in the county since 2016, are thirty-seven. Productive General Practice focusses on improving patient outcomes, whilst linking in with the ten high impact actions, by considering how a practice can improve the patient experience, maximising staff wellbeing, increase value and efficiency. The programme aims to release time and create headspace, whilst building capacity to address current and future pressures, with tools and techniques that are delivered that can be applied and utilised again and again. The programme is delivered by selecting 2 modules from 8, with the current practices who are participating on Wave 11, choosing to look at clear job standards, well organised practice and efficient processes leaving an opportunity for them to cover, appropriate appointments, frequent attenders, common approach, time planning, emails, meetings and interruptions. The programme is determined to work with practices to support them in their participation during these challenging times and will be flexible wherever possible. Online Consultations Online and video consultations are still providing a safe opportunity for patients and primary care to provide a good quality service to our patients. Recent upgrades to GP Connect to enable patients to have primary care access via CCAS and 111 have meant a short but important change to appointment configuration, which will be rolled out across the county over the next few weeks. New Ways of Working New ways of working due to COVID-19 mean many interactions with patients are taking place through alternative routes to traditional face to face consultations. As an example, pre COVID in Northamptonshire, approximately 60,000 consultations

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generally took place each month over the phone. That figure has in some cases now tripled with over 150,000 telephone consultations taking place in June and July 2020 and 140,000 for August. Video consultations are now common place within Northamptonshire with all practices offering video consultations. Over 37,000 video consultations have taken place this year, which has increased from a base of zero pre COVID. Another significant development has been the use of messages to and from patients (links via SMS). These are response links sent by SMS to enable patients to answer questions from a clinician, complete questionnaires with the response going direct into the patient record. This function also enables patients to send images back to aid online diagnosis. This function also allows practices to send sick/fit notes, referrals letters, blood forms and support leaflets. Over 96,000 response links have been sent which again is starting from a zero base pre-COVID. Hot Hubs The CCG is support practices by allocating funding for the development of hot hubs to run throughout winter. This is to increase capacity over the winter period in primary care to support winter surges and the second COVID-19 peak whilst providing some resilience for primary care and the system over this crucial time Crucially, an appointment to see a suspected COVID-19 patient can take up to three times longer than a normal general practice 10 minute appointment as they may need a telephone call, video and then still a face to face with all the infection control measures that entails. All presentations of COVID-19 symptoms in primary care will need to go through the ‘hot’ process and this will include the normal winter presentations of coughs and colds and other seasonal flu that can account for approximately 15 - 20% of presentations this time of the year but as the 2nd wave rises, this could easily increase. These profound operation changes therefore mean that winter activity this year could take up to three times more time out of primary care capacity compared to ‘normal’ winter activity. This has the potential to incapacitate primary care at this crucial time of the year, in doing so, taking capacity away from the management of long term conditions, other emergency presentations and the ability to step up services in line with the Phase 3 letter. By directing a large proportion of these presentations away from main practice, it is estimated that the ‘hot 32 of 35

hub’ proposal should lead to a reduction in emergency presentations within the cohort that attend. The ‘hot hub’ however will also free up the additional capacity within primary care which should therefore lead to further reductions. The time released back to general practice will allow increased proactive management of long term conditions and early management of certain presentations that if allowed to progress unchecked could lead to emergency presentations. The additional time will mean general practice will be in a stronger position to carry out more comprehensive and robust patient assessments for presentations such as chest pain, TIA and complex housebound patients ensuring patients are on the correct pathways. Workforce The general practice workforce has grown by 50 FTE (2.6%) over the last 12 months. This has been in part due to our International GP Programme and Social Prescribing Link Worker Recruitment. Social prescribing link workers help to reduce health inequalities by supporting people to unpick complex issues affecting their wellbeing. They enable people to have more control over their lives, develop skills and give their time to others, through involvement in community groups. Additional Roles The workforce will grow considerably more over the coming years through the Additional Roles Reimbursement Scheme. The intention of the scheme is to grow additional capacity through new roles, and by doing so, help to solve the workforce shortage in general practice. The roles include First Contact Physiotherapists, Paramedics, Social Prescribing Link Workers, Health and Wellbeing coaches and other Direct Patient Care Staff. Early analysis shows the intention to recruit 148.32 FTE into the system by the end of the financial year, with a further 228 FTE by the end of March 2024. Training Hub The training hub now has full coverage across Northamptonshire, and will continue to build on its strong relationships with the LMC, CCG, Federations and Super Practice. Using funding from Health Education England the Training Hub Board is currently working on developing the infrastructure to support the training hubs core functions. The training hub will focus on;

- The development and expansion of clinical placements and learning opportunities in primary care

- Supporting recruitment into the primary care 33 of 35

workforce - Enable, support and embed the “new roles”

within primary care - Supporting the retention of the primary care

workforce - A single point of access for primary care

education and development opportunities (including PLT).

Flu Programme In light of the COVID-19 pandemic, the flu programme for this year will be more challenging than ever before. The operating model of delivery of immunisations in General Practice will require careful consideration and planning in order to ensure clinics can operate safely. Featured within the planning for each of the 69 Practices within the CCG footprint will be the safe administration of immunisations for:-

• Patients can attend General Practice to be immunised

• Housebound patients • Patients residing in a care setting.

To support practices to provide immunisations to the above cohorts, the CCG undertook a piece of work in conjunction with the LMC in order to identify specific challenges and potential solutions faced by each practice. One of the areas practices felt support would be beneficial was with the vaccination of residents living in a care home setting. A successful pilot was undertaken using an independent ambulance service to support practices to vaccinate residents in a care home, This has been received well by residents, care home teams and practices leading to the expansion of the service to undertake Covid vaccinations to care home residents in addition to those who are housebound. Estates The Primary Care Team continues to work with practices and Local Authority to ensure s106 monies are secured for the future and develop plans to ensure s106 monies being held by NHSE&I are utilised. Two practices have plans to improve their premises by reconfiguring existing space using s106 which has reached trigger point as in now available. The Brackley development went live week commencing 16th November. The extension at The Cottons in Raunds completed in September as did the extension at Woodsend (Corby). These two extensions funded centrally will provide additional space and a much improved building for patients to attend, whilst offering

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the Practices the opportunity to look at how they provide services in the future. Four further business cases for funding have been signed off by the CCG and NHSE&I and will proceed over the coming months.

7.4 CQC overview November 2020

During the pandemic it has been important to ensure that all practices continue to deliver safe and quality assured care, especially for those who are currently in special measures. In normal times practices that are in special measures are required to submit an improvement plan that is reviewed and discussed at a monthly assurance meeting. During the pandemic these moved to virtual meetings and have been in place and will continue monthly. Whilst more difficult to properly assess systems as not physically in the practice itself to observe, these have proved successful in continuing to engage with the practices and gaining assurance.

Recommendations:

• Continue to monitor indicators through the dashboard; • Identify good practice and share across the county; • Cleaning standards for primary care shared with practices; • 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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