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South Eastern Hampshire CCG and Fareham & Gosport CCGPrimary Care Commissioning Committee

Primary Care CommitteeBoardroom, CommCen Building, Fort Southwick, James Callaghan Drive, Fareham PO17 6AR

01 March 2017 14:00 - 01 March 2017 16:00

Overall of 73

AGENDA

# Description Owner Time

1 Chair's Welcome Chair 2.00

2 Register and Declarations of Interest

Item 2 - Register of Interests.xlsx 4

Chair 2.02

3 Minutes of the Previous Meeting

Item 3 - 161207 PUBLIC PCCC minutes.docx 5

Chair 2.05

4 Matters Arising Chair 2.10

5 Quality Report

Item 5 - Cover Sheet Quality report March 17.docx 14

Item 5 - Primary Care Quality Report 21.02.17.docx 17

Chief Quality Officer

2.15

6 Communication and Engagement ReportItem 6 - Cover Sheet Engagement report (March 2017).docx 36

Item 6 - Engagement Report (March 2017).docx 38

Chief Development

Officer

2.30

7 Finance Report

Item 7 - Finance Report Cover Sheet.docx 43

Item 7 - Finance Report.xlsx 45

Chief FinanceOfficer

2.40

8 Primary Care Estates UpdateItem 8 - Primary Care Estates Update Cover sheet.docx 47

Item 8 - Primary Care Estate Update V2.docx 49

Head of Primary Care

2.55

9 Primary Care Profile Thematic Analysis

Item 9 - Cover sheet Performance Profile.docx 54

Item 9 - Primary Care Performance Profile Feb 17 U... 56

Clinical Lead for Primary

Care

3.25

10 PMS Partnership ChangesItem 10 - Cover Sheet PMS Partnership Changes.docx 59

Item 10 - PMS Partnership Changes v2.docx 61


3.45

Overall of 73

# Description Owner Time

11 Decision Log

Item 11 - Cover Sheet Decision Log.docx 63

Item 11 - Decision Log.pdf 65


3.50

12 Minutes of Other Meetings

Item 12 - Cover sheet Minutes.docx 66

Item 12 - Primary Care Operational Group Minutes -... 68

Item 12 - LIS Chairs Action.docx 72

Chair 3.55

13 Any other business Chair 3.58

Overall of 73

Name Role CCG Current Position Declared Interest

Sarah Anderson Lay Member Governance& Audit Fareham & Gosport CCG Governing Body

• Joined the register of associates able to undertake workthrough Clarity Consulting Associates Limited. All work will beundertaken through my own limited company. There is noguarantee of work and only projects for organisations notassociated with the CCG.• Trustee, No Limits• Trustee and Company Secretary, Moving on Project• Director and owner of Hollybrook Associates Limited• Working on a contract to provide support on specificgovernance projects to the Corporate Governance Team until theend of May 2017

Molly Bailey Primary Care Engagementand Contracts Officer Both Employee • No interests to be declared

Julia Barton Registered Nurse/ChiefQuality Officer Both Employee

• Friends with the family of contractor, Marcus Pullen, director ofBlue Donut Studios• Governor, Portsmouth Hospitals NHS Trust

Alex Berry Acting Chief Officer Both Employee • No interests to be declared

Dr David Chilvers Clinical Chair Fareham & Gosport CCG Governing Body, MemberPractice

• GP Partner - Waterside Medical Centre, Mumby Road, Gosportwhich is involved in the Vanguard MCP process• Undertakes section 12(2) Mental Health Act assessments forSocial Services

Lucy Docherty Lay Member IntegratedCare Fareham & Gosport CCG Other

• Spouse works for HCC Childrens services in a senior position• Chair of Fareham Good Neighbours• Chair of Portsmouth Diocese Council for Social Responsibility• Close relative is an employee of Portsmouth Hospitals NHSTrust

Keeley Ellis Head of Primary Care Both Employee • No interests to be declared

SusanneHasslemann

Lay Member (Joint Chairof Audit Committee)(Co-Chair: QAC)

South Eastern Hants CCG Employee, GoverningBody

• Husband is trustee of Valley Leisure• Husband is Director, System Delivery, Southampton City CCG• Director & Owner of Scirum Ltd• Board Member, NHS Clinical Commissioners• Chair of Wessex PDLP (Performers List Decision Panel) and LayRepresentative on Wessex PAG (Performance Advisory Group)• Princes Trust volunteer

Dr Andrew Holden Clinical Lead -Membership Engagement South Eastern Hants CCG Governing Body, Member

Practice

• Wenham Holt (Chase Hospital) Beds - medical cover providedby Swan Surgery• Swan Surgery is a member practice of South Eastern Hampshire• Alliance Limited• Supporter - Friends of Petersfield Hospital• Rowan and Cedar Ward (Petersfield Hospital) -medical coverprovided by Swan Surgery• Partner Swan Surgery Petersfield• Wife is Partner at Liss and Liphook Surgery• Local Medical Committee - Representative for Hampshire &IOW LMC

Dr Paul Howden Chair - Clinical CabinetClinical Lead - Elective Fareham & Gosport CCG Governing Body, Member

Practice

• GP Partner, The Whiteley Surgery• Financial partnership interest in Yew Tree Clinic - Suite ofconsulting rooms attached to The Whiteley Surgery available forprivate hire for medical purposes• Wife qualified as Foot Health Professional and offering self-funded services to client within the Meon Valley area (notimpacting upon patients from F&G or SEH CCGs)

Kate McCandlish Head of Quality (Primaryand Community Care) Both Employee • No interests to be declared

Dr Barbara RushtonChair - Clinical Lead -Integrated out of HospitalCare

South Eastern Hants CCG Governing Body, MemberPractice

• GP Principal at Liphook and Liss Surgery which holds contract formicrosuction and audiology• Deputy Chair Health and Wellbeing Board• Cover Rowan and Cedarwood wards at Petersfield Hospital• Member of Alliance

Richard Samuel Accountable Officer Both Employee, GoverningBody

• Wife works as an accountant for the Royal Bournemouth andChristchurch Hospitals NHS trust• Step Father is elected as Hampshire County Councillor for SouthWaterside ward, Eastleigh• Elected as Board Member of NHS Clinical Commissioning• Member of Hampshire Carers Together• Board Member of the NHS England New Models of Care Board

Margaret Scott Lay Member (IntegratedCare) South Eastern Hants CCG Governing Body

• Works as a Public Appointments Assessor and occasionallyinvolved in selection panels for chairs of NHS trusts• Governor of University of Portsmouth which provides healtheducation

Pat Shirley Lay Member Patient andPublic Involvement Fareham & Gosport CCG Other • Chair of the Portsmouth and South Eastern/Fareham & Gosport

Crisis Care Strategic planning group

Sara Tiller Chief DevelopmentOfficer Both Employee, Governing

Body • No interests to be declared

Nick Wilson

Lay Member Public andPatient InvolvementChair of CommunityEngagement Committee

South Eastern Hants CCG Other

• Owner, Carne Wilson Consultancy• Trustee and Governor, Treloar School and College• Close working relationship with Community First HEH• Member of South East England Forum on Ageing (SEEFA)Executive Group• Director, Open Agenda Consultancy

Andrew Wood Chief Finance Officer Both Employee, GoverningBody • No interests to be declared

Page 1 of 1Item 2 - Register of Interests.xlsxOverall of 73

Minutes of the meeting of the Fareham & Gosport CCG and South Eastern Hampshire CCG Primary Care Commissioning Committees

Held at 2.00pm on Wednesday 7 December 2016 in the Newlease & Tournebury Meeting Room, Havant Borough Council, Civic Centre Road, PO9 2AX

Meeting in PublicPresentMargaret Scott (Chair) Lay Member for Procurement

and Commissioning South Eastern Hampshire CCG

Sarah Anderson Lay Member for Governance and Audit

Fareham & Gosport CCG

Julia Barton Chief Quality Officer Fareham & Gosport and South Eastern Hampshire CCG

Pat Shirley Lay Member for Patient and Public Involvement


Lucy Docherty Lay Member for Procurement and Commissioning


Susanne Hasselmann Lay Member and Joint Chair of Audit Committee

South Eastern Hampshire CCG

Sara Tiller Chief Development Officer Fareham & Gosport and South Eastern Hampshire CCG

Nick Wilson Lay Member for Public and Patient Involvement

South Eastern Hampshire CCG

Andrew Wood Chief Finance Officer Fareham & Gosport and South Eastern Hampshire CCG

Dr David Chilvers Clinical Chair Fareham & Gosport CCG

In Attendance

Dr Andrew Holden GP Representative South Eastern Hampshire CCG

Keeley Ellis Head of Primary Care Fareham and Gosport and South East Hants CCG

Kate McCandlish Head of Quality Primary and Community Care

Fareham and Gosport and South East Hants CCG

Molly Bailey Primary Care Engagement and Contracts Officer

Fareham and Gosport and South East Hants CCG

Page 1 of 9Item 3 - 161207 PUBLIC PCCC minutes.docxOverall of 73

Summary of Actions

Meeting Date

Agenda Item Action Who Deadline Date

Completed07/12/2016 3 Update on rent reimbursement

and NHS property services.The Chief Finance Officer

01/03/2017

07/12/2016 5 Discuss nurse accountability and supervision.

The Chief Quality Officer /Head of Quality Primary and Community Care/Fareham and Gosport’s Lay Member for Patient and Public Involvement

01/03/2017 16/02/2017

07/12/2016 6 Update on Learning Disability Health Checks and taking checks to the patient.

The Head of Primary Care

01/03/2017 22/02/2017

07/12/2016 10 Check with the LMC what ‘Full Time’ GPs equates to in sessions.

The Head of Primary Care

01/03/2017 22/02/2017

1 Chair’s Welcome

The Chair welcomed members and attendees to the meeting, including Kate McCandlish who had joined Fareham and Gosport and South Eastern Hampshire CCG’s as Head of Quality Primary and Community Care.

Apologies were received from South Eastern Hampshire CCG’s Clinical Chair and Chief Officer.

2 Register and Declarations of Interest

The register of interests was presented and members were advised that they should also raise any interests relating to agenda items being considered at the meeting.

The Primary Care Commissioning Committee noted the declarations of interest.

3 Minutes of the Previous Meeting

The minutes of the Public Joint Primary Care Commissioning Committee from September 2016 were presented to the committee. There were no amendments.

The Primary Care Commissioning Committee confirmed the accuracy of the minutes of the previous meeting.

4 Matters Arising

The Chair informed the committee that South Eastern Hampshire CCG’s GP Representative would be voting today as Clinical Lead for Primary Care, and had been formally appointed this role, due to the absence of the Clinical Chair.


The Primary Care Commissioning Committee noted the voting members for the meeting.

5 Quality Report

The Chief Quality Officer presented the Quality Report to the committee and explained that it provided a summary of the quality indicators which are used for primary care across both CCGs’ member practices.

NHS England Data SetThe report included details of the NHS England data sharing data set. The report was scored and prioritised using the red amber and green categories, but it was noted that this was an indicative rating only. The report also included the CQC outcomes for the practice and immunisation rates. The Chief Quality Officer advised the committee that even though three practices within Fareham and Gosport CCG were rated red and South Eastern Hampshire CCG had one practice rated red, this did not necessarily indicate poor quality but should rather be seen as an indicator that there are concerns about a number of the metrics in the practice, which may prompt a practice visit from NHS England (which would now be the CCG as delegated commissioners). As explained within the report, the NHS England data set report does not always directly triangulate with the CQC outcomes for the practice and could include some historical data.

Quality Surveillance and Reporting (QUASAR)The Chief Quality Officer provided an update on the QUASAR system which GP practices use to report concerns, and confirmed that high usage was being maintained. It was also confirmed that there had been several examples where the feedback from GP practices had led to the improvement of clinical services.

The Chief Quality Officer informed the committee that as part of this year’s local contract the quality team had developed “QUASAR Primary” which was a practice based complaints, incidents and feedback version of CCG’s system. It was going to be piloted in three practices from the 12th December 2016 with the aim to roll it out across all practices by the end of quarter 4 once the pilot was over.

Care Quality Commission (CQC)The report detailed the most recent CQC visits and the Chief Quality Officer confirmed that there were no practices in special measures for either CCG.

National Reporting and Learning System (NRLS)GP practices were also able to report concerns and incidents through the NRLS. It was reported that some CCG practices were using this as well as QUASAR which was mirroring the reporting fields.

Family and Friends Test (FFT)The quality team were continuing to work with practices on the FFT. The Chief Quality Officer explained that methodology was an issue but there was no longer a national programme to support this as it was now a requirement within the core contract. It was reported that the Head of Quality Primary and Community Care would be working on FFT and asking practices how it was working. The quality team would keep reporting and providing updates on practice patient feedback to the Primary Care Commissioning Committee.

Infection Prevention and ControlThe Chief Quality Officer confirmed that infection prevention and control metric was on the trajectory to be achieved in South Eastern Hampshire CCG but it would be challenging to meet the target in Fareham and Gosport CCG. Fareham and Gosport CCG’s Lay Member for Patient and Public Involvement requested assurance that nurses that were taking on new extended roles would be mentored. The Chief Quality Officer confirmed that the Head of Workforce and Education, was supporting with practices that employ paramedics and clinical


pharmacists to ensure they have adequate competency frameworks. It was reported that the approach for accountability and holding practices to account in relation to infection prevention and control was a high priority for the CCGs’ therefore support to practices was key. Further to this, the Chief Quality Officer advised that the quality team had created a leadership programme with the Thames Valley and Wessex Leadership Academy to support senior practice nurse leadership development. The CCGs would be able to offer advice on the supervision structures within practices.

The Primary Care Commissioning Committee noted the Quality Report.

6 Communication and Engagement Report

The Chief Development Officer presented the Communications and Engagement Report, and stated that the report detailed the activity since the committee last met. The following key points were highlighted:

1. Patient Participation Groups (PPG) – The Community Engagement Committee had discussed the activeness and effectiveness of PPGs following concerns that some were struggling to recruit members. The CCGs had worked with Committee members to develop guidance for GP practices which was subsequently discussed at the Practice Managers Forum.

2. Annual Health Checks for Learning Disabilities – Following concerns that those with learning disabilities were not being offered their annual NHS health check the CCGs invited HealthWatch Hampshire to share the findings of their work in this area with local practice managers. The CCGs had an action plan in place to increase the number of patients receiving health checks and were expecting the rate to increase in Q3/4.

3. GP Estates – PPG’s had reported concerns regarding how NHS Property Services worked with local practices on issues including service charges and redevelopments. The CCGs were aware of these issues and are discussions were being facilitated between GP practices and NHS Property Services where appropriate. The Head of Primary Care was now conducting work on GP Practice premises with the Chief Finance Officer.

The Chief Development Officer also informed the committee that there was an ongoing engagement programme around MCP development. There had been considerable debate and dialogue between Patient Participation Groups and Locality Patient Groups regarding the MCP Contract, in particular what it might be/look like and what it needed to deliver. It was noted that patient input into the outcomes would be a key driver for the contract to ensure it mattered to people. The CCG has had some fantastic input from patients already.

Fareham and Gosport CCG’s Lay Member for Procurement and Commissioning questioned whether GPs kept a list which would identify patients with learning disabilities who required a health check, and if so, what work was being conducted regarding patients who were missed off the list. The Head of Primary Care confirmed that practices are obliged to keep a register, which is reviewed and updated every year to ensure that the CCGs prevalence is accurate. The GP Representative for South Eastern Hampshire CCG reassured members of the public that the Primary Care Team within the CCG had looked at this issue in considerable detail and it had been identified that the issues were around coding and process rather than missed patients. The challenge would be to ensure these issues could be addressed which would mean that the way it was coded would be much improved next year. The Chief Quality Officer asked whether the CCG had considered engaging nurse practitioners to conduct health checks for patients with learning disabilities. Also, other CCGs were taking health checks to the patients rather than waiting for a patient to come to them. It was agreed that the Head of Primary Care would consider this.

South Eastern Hampshire CCG’s Lay Member for Public and Patient Involvement informed the committee that he had received concerns from the Chair of Butser Locality Patient Group


regarding patient representatives who were involved in MCP groups. It had been reported that they felt they weren’t having an impact. South Eastern Hampshire CCG’s Lay Member for Public and Patient Involvement questioned whether there were other work streams which patients could be involved with. The committee agreed that the issue should be brought to the wider Governing Body for consideration.

The Primary Care Commissioning Committee noted the information in the Communications and Engagement report.

7 Finance Report

The Chief Finance Officer presented the finance report, reporting that the budget for primary care showed a significant underspend; however the Locally Commissioned Services which showed a corresponding overspend, were not included. The Chief Finance Officer reassured the committee that spend had increased in comparison to last year but unfortunately this was not clear in the figures that were presented.

The Chief Finance Officer further explained that the CCG budgeted for Directly Enhanced Services (DES) which were not recommissioned and which added to the underspend, such as dementia. The Head of Primary Care assured the public that dementia was an existing DES but this year had been included as part of the core contract. The CCG estimates of growth in core GMS and PMS contracts were also higher than actuals.

South Eastern Hampshire CCG’s Lay Member for Public and Patient Involvement questioned whether there was any money left from the underspend for primary care. The Chief Finance Officer clarified that the overall financial position for the CCGs was poor and if the budgets were allocated differently an underspend would not be shown in the figures. South Eastern Hampshire CCG’s Lay Member for Public and Patient Involvement further questioned whether the CCG could reallocate the money within primary care to save pressures on secondary care. The Chief Finance Officer confirmed that the CCG was already doing this as part of the QIPP savings programmes.

The Lay Members asked whether there was more that the CCG could do to invest in the voluntary sector and to improve a patient’s experience following discharge from hospital. If funding had been reallocated due to financial challenges then this was a concern. The Chief Development Officer reported that work was in hand and that this had been discussed earlier that day.

The Head of Primary Care requested that any opportunities that were not being articulated within QIPP needed to be fed in to the Primary Care Team. General practice was under strain and the CCG needed to be careful that any proposals would not generate more capacity issues for practices.

Committee members discussed why there was an overspend on premises and not on services. The Chief Finance Officer explained that NHS England (NHSE) had a backlog in rent reviews so they had to make a provision to cover this. The CCG would be required to put more money aside each year. This was a new process since CCGs undertook delegated commissioning of GP Primary Care services. NHS England accrued the provision from 2015 for rent reviews that happened before that date. The CCG would be meeting with NHS England bi-monthly to obtain a clearer picture on the actual backlog. NHSE are working hard to identify the backlog and the CCG had been safe and cautious with the amount they had accrued.

The Primary Care Commissioning Committee noted the information within the Finance report.

8 Local Commissioned Services (LCS) and Local Incentive Scheme (LIS) for 2017/18


The Chair requested declarations of interests from members of the committee for this item of the agenda. The GP Representative for South Eastern Hampshire CCG and the Clinical Chair for Fareham and Gosport declared their interests as local GPs, the Chair allowed the members to stay within the meeting.

The Head of Primary Care presented the LCS/ LIS paper in order to bring to the committee’s attention the analysis that had been completed in financial year 2016/17 and recommendations for furthering the specification in 2017/18.

It was reported that the LCS had been on a journey this year, moving away from little individual service specifications to a standardised specification. There were ten commissioned services within the LCS and the primary care team had a system in place to monitor these. The review had had clinical input from the Joint Clinical Cabinet in November 2016 and also the Primary Care Operational Group (PCOG) which included NHS England. The Practice Manager Commissioning Advisory Group (PMCAG), Practice Managers Forum and the commissioning team had also been involved.

The Head of Primary Care explained that as this had been the first year for the block contract it was important to provide assurance to the committee that it had been value for money.

The Head of Primary Care informed the committee that there was an extra reward that practices could obtain for working at scale for one of the ten services. However practices were limited in medical services they could provide for each other because indemnity arrangements to cover staff seeing other practices patients is yet to be resolved nationally. Also, some of the practices who were working at scale in compliance with the LCS were not matching the level of impact the MCP would have therefore it was advised that it would be more beneficial to focus on the MCP regarding working at scale.

The Head of Primary Care highlighted that Minor Injuries Suturing had not generated enough activity and it was therefore recommended that this be decommissioned next year. The other nine services were recommended to be recommissioned. It was proposed that the money from the Minor Injuries Suturing decommissioned service be reinvested into clinical services rather than for practices working at scale.

It was also proposed that the following services be added into the LCS by reinvesting the PMS money:

- Diabetes Prevention Plan- National Cancer Diagnosis Audit (this has been piloted across the country and has

seen positive impact on general practice and patients)- Screening Follow Up- Secondary Care Referrals (move from the LIS to the LCS)- Wound Management (Practices are already providing this and have a significant

amount of activity)

The Head of Primary Care reported that the LIS runs alongside the LCS in order to incorporate the engagement required from GP practices to support the CCGs member role. This contract framework provides the incentive to ensure practices remained engaged in appropriate fora to consult with practices regarding commissioning issues. The Head of Primary Care proposed retaining the previous year’s funding weighting.

Fareham and Gosport CCG’s Lay Member for Patient and Public Involvement asked how mental health and learning disabilities were incorporated into the LCS and LIS. The Head of Primary Care explained that learning disabilities had a specific DES which is commissioned directly from NHSE. As delegated commissioners the CCGs are responsible for assuring and being assured that learning disability checks are being done. Mental Health is part of the core General Medical Services (GMS) contract and Quality Outcomes Framework (QOF). The Head of Primary Care advised the committee and the public that the LCS/LIS is a scheme to commission any services that are over and above the core contract.


Fareham and Gosport CCG’s Lay Member for Procurement and Commissioning asked for further clarification regarding the reinvestment of PMS money. The Head of Primary Care explained that practices are either PMS or GMS and both attract different but additional resource. Practice funding nationally has been reduced for general practice with both contract holders (GMS and PMS) receiving a reduction in funding over a 5-7 year period. The money removed from GMS practices is going back into NHS England and the money from PMS practices is going back to the CCGs for reallocation. Next year the CCG will have a further amount of the PMS money to reinvest.

The Clinical Chair for Fareham and Gosport commented that this reduction of money was creating a massive strain on practices.

South Eastern Hampshire CCG’s Lay Member for Public and Patient Involvement questioned whether patients should be worried about the decommissioning of the minor injuries suturing service. The Head of Primary Care confirmed that the CCG had identified through an analysis that patients have choice on where to go for treatment which include Emergency Departments and Minor Injury Units. The CCGs had tried to increase marketing for the LCS but patients with a wound were choosing to go elsewhere.

The committee questioned whether the CCG could monitor whether practices were providing the activity through the block contract. The Head of Primary Care explained that the CCG purchased software known as EMIS Enterprise Search and Report which allowed the CCGs to pull reports on activity across all ten services to identify activity by practice. Any zeros that were shown on this year’s reporting have been queried and practices confirmed that these were coding issues and the activity is there, apart from minor injuries suturing.

The Chair asked the committee to consider the Head of Primary Care’s recommendations as set out in the paper.

The Primary Care Commissioning Committee agreed the following recommendations:

1. The re-commissioning of services for the 2017/18 LCS.2. The de-commissioning of a service from the 2016/17 LCS.3. The removal of the reward payment offered in 2016/17 which should be re-

invested in additional clinical services.4. The proposed LCS services to be commissioned in 2017/18.5. The proposal of the LIS and the proposed weighting of funding.6. To delegate the final sign off of the proposed costing model for the LIS to

chair’s action, on the receipt of detailed finances by practice to provide assurance regarding conflicts of interest.

The Committee noted the risks set out in the Local Commissioned Services (LCS) and Local Incentive Scheme (LIS) for 2017/18 paper.

9 Update on Transformational Funding

The Chief Development Officer presented the paper, explaining that the paper was for noting and that the committee may recall that earlier in the year the CCGs were asked to submit a bid for transformational funding. In July 2016 both CCGs were awarded £360,000 from NHS England in order to support change to transform primary medical care in Wessex. The Chief Development Officer reported that the CCGs were required to report to this committee every quarter with an update.

The Chief Development Officer confirmed that the CCGs were making good progress with this.

South Eastern Hampshire CCG’s Lay Member and Joint Chair of the Audit Committee raised


concerns regarding the absence of any outcome time frames and questioned whether the recruitment was ongoing even though this was only 16/17 money. The Chief Development Officer explained that senior members of staff were stretched for capacity so the CCG had brought in additional lower cost fixed term contract resource to support the work for this year. The Chief Development Officer clarified that where funding had not already been agreed that expenditure would not continue into next year.

Fareham and Gosport CCG’s Lay Member for Procurement and Commissioning told the committee she was pleased to see the work the CCG was doing and asked if the recruited individuals would be working within our CCGs and whether there was a return to service agreement in place. The Chief Development Officer responded that the CCG were investing in current employees in order to retain skills and experience and would attract new people by working with universities. Newly qualified nurses have been appointed into primary care however it was still a work in progress.

The Primary Care Commissioning noted the information set out in the update on transformational funding paper.

10 Paper for Approving

Revised Policy for Section 96

The Head of Primary Care presented the revised policy for Section 96 applications further to NHS England’s feedback at the previous meeting. The Clinical Chair for Fareham and Gosport queried what the CCG would define as being full time for GPs. The Head of Primary Care confirmed that the CCG defined full time as being nine sessions per week; however they would consider every case individually. The Clinical Chair for Fareham and Gosport debated whether nine sessions was realistic and asked for clarity to be sought from the LMC.

The Primary Care Commissioning approved the revised policy for Section 96 applications.

11 Paper for Noting

Quality Framework – For Practices in CQC Special Measures

The Head of Primary Care confirmed that there were currently no practices within the CCGs geographic areas in CQC special measures, however the framework presented articulated how the CCG would work with NHS England to support practices within special measures.

The Chief Quality Officer explained that the CCGs had previously had one practice in special measures and had informed some of the development of the guidance through joint working. There was nothing of concern within the framework; it was a useful document which sets out the process to be followed. The committee queried whether this had been tested with the LMC and practice managers. The Head of Primary Care confirmed that it has been and was to be tabled at the Practice Managers Commissioning Advisory Group.

The Primary Care Commissioning noted the information set out in the update on the quality framework – for practices in CQC special measures.

12 Minutes of Other Meetings

The minutes of the Primary Care Operational Group from September and November 2016 were presented to the PCCC.

The Primary Care Commissioning Committee noted the minutes of other meetings from the Primary Care Operational Group from September and November 2016.


12 Any Other Business

There was no further business. The meeting ended at 3.30pm.

Date of Next MeetingThe date of the next meeting is:

Date: Wednesday 1st March 2017Venue: Board Room, Fort Southwick, James Callaghan Drive, Fareham, PO17 6AR


1

Primary Care Commissioning Committee – Meeting in Public

Date of Meeting 1st March 2017

Title Primary Care Quality Report

Purpose of Paper The purpose of the paper is to inform PCCC of the progress of the Quality work streams in Primary Care.

Executive Summary of Paper

This paper outlines progress made in the monitoring of quality of services delivered by both CCGs’ GP practices. It includes intelligence from the quality data sharing tool from NHS England, data on infection control and improvement plan, the national learning and reporting system (NRLS), the Family and Friends Test, CQC compliance and Quasar returns.

NHS England data set The February 2017 NHS England dataset identifies that Fareham

and Gosport CCG have 3 practices which are flagging as red and 9 practices flagging as amber.

Amber has therefore increased by one since November 2016 showing deterioration.

SEH CCG has 1 practice flagging as red and 7 as amber.

Quasar HCP and Incident reporting There were 96 submissions from F&GCCG and 135 for SEHCCG in

Quarter 3. Top categories include were communication, clinical treatment and

medicines management. Quasar Primary (incidents) Roll Out plan has begun

Care Quality Commission (CQC) The CQC published 2 inspection reports for GP practices in the

CCG’s during December 2016 and January 2017; One practices received an overall rating of ‘good’.One practice received an overall rating of ‘requires improvement’.

Currently there are no CCG practices in special measures and there are no overall “inadequate” ratings.

National reporting and Learning System (NRLS) Medication incidents remain the most common incident type (across

Wessex), followed by documentation and clinical assessment.

Family and Friends Test

Page 1 of 3Item 5 - Cover Sheet Quality report March 17.docxOverall of 73

2

F&GCCG and SEHCCG remained above average July-October 2016.

Infection prevention and control Between April and December 2016 the CCG’s reported 62 cases,

37 by SEHCCG against a trajectory of 50 and 35 by F&GCCG against a trajectory of 30.

Zero new cases of MRSA bacteraemia were reported during December 2016 and January 2017.

Key Issues to consider

For noting: Work-stream progress and updates.

Recommendations/ Actions requested

PCCC is asked to: Note the report Note updated work streams Note new work stream (safeguarding adults in primary care)

Author Kate McCandlishHead of Quality (Primary Care and Community Services)

Sponsoring member Julia BartonChief Quality Officer

Date 21 February 2017

CORPORATE STRATEGIC LINKS

Strategic Objectives:This paper links to the following: 1. Work with local people and their communities to prevent the

causes of ill health, support healthy lifestyles, reduce health inequalities and to give children the best start in life

2. Integrate primary care, community care, social care and voluntary services to deliver a range of care, close to home that allow people with complex needs and the most vulnerable to stay healthy and feel in control of their health

3. Commission consistently high quality planned care services that work with patients to deliver the best outcomes possible

4. Patients using local health services will experience reduced variation in treatment and care standards; they will notice increasing consistency in the quality of services across all care providers

This is an issue of Corporate Governance

ENGAGEMENT ACTIVITY

Engagement Activity List engagement activity

EQUALITY AND DIVERSITY

Equality and Diversity List E&D assurance


3

Other committees/ groups where evidence supporting this paper has been considered

Primary Care internal governance group (PC/MCP)Joint Quality Operational Group (JQOG)Primary Care Operational Group

Supporting documents List supporting documents

Diabetic Eye-Screening incident outcome report


Quality update report I December Primary Care Committee I 1

Primary Care Quality Update Report - February 2017

1.0IntroductionThis report provides members of Primary Care Committee with details of quality performance and improvement for general practice across both Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups (F&G and SEH CCGs). It includes quality data collated locally, NHS England data and outcomes from CQC inspections.

2.0NHSE Primary Care Quality Intelligence Sharing ToolOn confirmation of delegated commissioning, the CCGs and NHS England agreed a range of indicators which were considered core to the provision of high quality general practice and were already collated. Since this time, NHS England (Wessex) developed a quality intelligence sharing tool. The latest tool was shared with the CCG in November 2016.

The tool includes a wide range of metrics which include:

GP Outcome Standards (GPOS) GP High Level Indicators (GPHLI) CQC Inspection Outcomes Friends and Family test GP Patient Survey Complaints, Incidents and Safeguarding Pending contractual action Immunisations and cervical screening uptake Practice level workforce data

NHS England score practices according to the following:

Green < 3 outlier indicators Amber 3-5 outlying indicators Red > 6 outlying indicators.

The February 2017 NHS England dataset identifies that Fareham and Gosport CCG have 3 practices which are flagging as red and 9 practices flagging as amber. Amber has therefore increased by one since November 2016 showing deterioration.SEH CCG has 1 practices flagging as red and 7 as amber. This has not changed from November 2016.

Areas that flag as red or amber continue to include GPOS indicators flagging, FFT results, cold chain and immunisation incidents and cervical screening.

The top themes causing red or amber indicator flags are:

GPOS indicators flagging FFT results Patient survey results July 2016 data (F&GCCG) Cold chain and immunisation incidents Complaints (F&GCCG) Cervical screening MMR uptake at 5 years (2014/15) (SEHCCG)

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It should be noted that a concern with the dashboard in its current form is the lack of correlation between the dashboard’s overall score and the results of CQC inspections: For instance two practices at either end of the dashboard’s scoring range, yet both were rated ‘good’ by the CQC. Furthermore, all three F&GCCG practices to receive a red rating for their dashboard score received ‘good’ CQC ratings, whereas one practice with a green dashboard rating was assessed by the CQC as requiring improvement. It is also noted that this data set does not include correct CQC reports.

3.0F&G SEH Primary Care Quality Intelligence Dashboard (Nov 2016)This is an internal dashboard collated and collected by the Primary Care team. It includes prescribing data, contract type, enhanced services performance, workforce data and QOF clinical domain performance.

Several areas of concern have been highlighted and discussed with primary care colleagues:QOF clinical exeption reporting: 20 practices have an overall exeption rate of over that is significantly higher than the NHS England average.From a quality perspective this data might suggest that large proportions of patients may be excluded from care for their clinical needs.Action taken:

This warrants further investigation. This is enabled by the dashboard and monitoring by the Primary Care team. The CCG medicines management team has been made aware and this may form part of further analysis linked to prescribing trends.

Practice: Number of patients per Whole Time Equivalent: 7 practices have a red rating and are showing that they have between 3000-4500 patients per GP.In 2014, on average across England, there were around 1,700 registered patients for every full-time equivalent (FTE) GP. The average number of patients per FTE GP varies from around 1,300 to around 2,500 across CCGs. Therefore this number in the CCGs is might suggest that local GPs are under particular strain in primary care. However, this does not take into account the new roles such as advanced nurse practitioners and paramedics.

Triangulation of NHS England and local Primary Care Quality Intelligence Dashboard data: Action:

KMcC to triangulate into top 10 practices using intelligence from both dashboards (above) and soft intelligence.

Share this with primary care team, PCOG and PCC by April 2017.

4.0General Practice Quality Improvement Plan- progress

4.1 Quality Improvement Work Plan: updated.The general practice quality improvement plan is progressing well and progress is reviewed at the CCGs’ primary care quality group meeting. Details on progress with the plan is included in Appendix 1.

4.2 Practice Patient Safety Development (LCS) The 2nd practice patient safety development programme commenced in November

2017. This focused on the deteriorating patient in primary care e.g. acute kidney injury, meningitis or acute exacerbation of asthma. The second session has been delivered with the final two before 31 MARCH 2017.The group has learned how to identify problems in primary care, tools for assessing contributing factors and had the opportunity to learn from one another.

Quasar Primary has been tested successfully by 3 practices and now moved into development and update by 13 Feb 2017.


ROLL OUT PLAN: first meeting at one group of practices which enabled us to learn about teaching style and begin a Frequently Asked Questions reference page.

1 practice in each CCG has been supported by the quality team and Wessex Patient Safety Collaborative to complete a newly devised model safe practice toolkit. This is now ready for roll out.

Safety Culture Questionnaire has been sent to all practice on 30.01.17 and report summaries are expected by 31.03.17.

4.3 Practice NursingUpdate from Penny Evison practice nurse facilitator, Quality team CCG:A number of development initiatives continue for practice nurses (and the non-medical workforce) including:

The second annual CCG nursing in general practice conference is booked for the 16th February 2017 and will have a leading change, adding value focus.

Quarterly TARGET sessions continue

GP Nurse Leadership Course completes on 9 Feb 2017.

Health Education Wessex has entered a bid for funding to continue two further programmes in 2017/18.

3 further Health care support workers have started the Havant diploma course to follow the 5 that commenced the course earlier this year. This is now a rolling programme so people are able to apply to join the course throughout the year.

Revalidation training sessions continue to run and will be provided quarterly during 2017

Mentorship update sessions are offered and running as part of the NMC requirement for annual update

Six student nurse placements are available across SEHCCG and F&GCCG. Currently 2 student nurses and 1 return to nursing student are on placement in primary care at the moment. In addition, 10 paramedic students have been placed into primary care for their alternate (out of ambulance service) placement in 2016 and this will continue for 2017.

Monthly practice nurse newsletter and quarterly medicines management newsletters continue.

Various forums are now established and run quarterly to provide networking, clinical update, best practice and CCG support including GPN Forum, Non- Medical Prescribers Forum, Advanced Nurse Practitioner/Nurse Practitioner Forum, Infection Control champion workshops, Practice Lead Nurse Meetings.

4.0 Quasar – HCP healthcare professional feedback

There were 96 submissions from F&GCCG and 135 for SEHCCG in Quarter 3. Area of concern: Practices not submitting HCP feedback in quarter 3: report received form Quasar and shared with Primary Care.8 practices have reported no HCP feedback in OCT/NOV/DEC1 has merged with SHFT and may use an alternative system.Action taken:

Primary care team investigating.


The top 2 categories for Quarter 3 were Communication which relates mainly to discharge summaries and Trust Administration issues which are mainly the PCSE transfer of records backlog.

Feedback Category FG SEH TotalAccess to treatment or drugs 8 12 20Appointments 8 10 18Clinical treatment 26 20 46Communications 20 36 56End of life care 1 1 2Integrated care (including delayed discharge) 1 1Meds Management 11 10 21Other 1 1Patient care 2 2Transport (ambulances) 1 1Values and behaviours (staff) 1 1Waiting times 2 2Trust admin 13 36 49Admissions and discharges 7 4 11Total 96 135 231

Primary Care themes have been raised in the provider CQRM such as access to phlebotomy service changes which has caused additional workload in primary care and poor patient experience.The main theme identified was “unable to get through on the telephone” access.

UPDATE: response from provider 8.02.17 Closer monitoring of demand continues. Hours of opening for the booking line have been extended to 8.30 am. Text or email service where patients have hearing difficulties Engagement with local area where there has been particular issues- a voluntary service will

support one practice to help patients book their appointments.

Patient Safety: Practices are starting to report significant events via HCP feedback which we are able to share back to the service provider such as hospital induced AKI and medication errors.


4.1 Diabetic Eye-Screening incident outcome reportThis is a high level outline of the review that was undertaken following the identification of issues with the diabetic eye-screening programme.

In late March 2016, the DES programme provider produced a routine performance report for commissioners. This showed that 1533 new patients had been referred to the programme since the service started on the 4th January 2016.

Following a review undertaken by Public Health England, 5 patients, 3 PCCG and 2 SEHCCG, required a further review of their GP records to confirm whether it was an error in primary care coding or from the DES programme.

The review identified that the main issues include:

Some practices are still not referring patients on diagnosis of diabetes to the DES programme.

Additionally programmes are also not referring known diabetic patients to the DES programme when they first register with their GP practice.

They are wrongly assuming that the DES programmes continue to keep patients on the screening when they change/ register with a new GP practice.

An action has been taken for Public Health England to draft some further guidance for GP practices and for this to be shared with them via the PHE newsletter and locally via Top Tips.

5.0 Care Quality Commission

5.1 Practices in special measures: Currently there are no CCG practices in special measures and there are no “inadequate” ratings arising from a practice CQC inspection.

F&GCCG: 22 GP practices inspected and reports publishedOne has changed their registration- due after April (legal entity change)2 not yet published.

SEHCCG: 22 GP practices inspected and reports publishedOne has changed their registration- due after April (legal entity change)1 not yet published

SUMMARY: 85% GOOD overall (see detail in graph)


GOOD RI not reported not inspected0

10

20

30

40

50

F&GSHETOTAL

Bar chart: CQC practice ratings, according to CCG.

6.0 Infection Prevention and Control

6.1 Fareham and Gosport CCGClostridium difficile infection (CDI) F&GCCG reported 5 cases of CDI during December. 35 CDI cases have been reported year to date (April - December) in comparison to 31 cases in the same period last year and against an annual trajectory of no more than 30 cases of CDI. The CCG has breached its annual trajectory.

MRSA Bacteraemia (MRSA)A zero tolerance remains on any reported cases of MRSA. Year to date the CCG has reported zero cases of MRSA.

6.2 South Eastern Hampshire CCGClostridium Difficile InfectionSEHCCG reported 6 case of CDI during December. 37 CDI cases have been reported year to date (April – December) in comparison to 32 cases in the same period last year and against an annual trajectory of no more than 50 cases.

MRSA BacteraemiaA zero tolerance remains on any reported cases of MRSA. 2 cases of MRSA have been reported (one in May and one in June) year to date. A post infection review took place for both cases. The May case was put to NHS England for arbitration and was allocated to third party and therefore won’t be included against the SEHCCG annual numbers. The June case has been allocated to the CCG.

The 2016/17 infection prevention and control improvement plan is included in Appendix 2.

7.0 Complaints, Concern and Enquiries regarding GP surgeries – December 2016

During October and Number the CCG have been contacted by 10 members of the public and they are broken down into the following categories.

All complaints raised about GP practice are categorised as a concern by the CCG and managed by NHS England


Type F&G CCG SEHCCGComplaints 0 2

(elements of GP)Concerns 0 0Enquiries 5 3

Breakdown of concerns and enquiries: A further breakdown of the top trends from concerns during October and November

1. Trust Admin policies and procedures Handling of requests for information (includes FOI) – 3 IG breaches, 1 in regards to

location of patient records and 1 regarding patient on violent register2. Commissioning

Commissioning service/Issue – 2 enquiries from GPs about enuresis service and 1 relating to capacity of GP practice due to new development

3. Clinical treatment Delay in treatment

4. Access to treatment Access to service – requested guideline for non-alcoholic fatty liver disease

Complaints and concerns relating to practices on the issue/risk registerNo further concerns and complaints have been received in relation to the Vine Practice during December 2016.

No concerns and complaints have been received in relation to the Same Day Access Clinic during December.

One enquiry has been received from a patient who now lives in Ireland and their new GP is having problems accessing previous GP records previously registered in SEHCCG area.

To note: NHS England pilot on complaints dashboard.The CCG is part of the pilot of sharing information of complaints raised about GP practice via NHS England. NHS England is currently developing a dashboard setting out key data on the complaints follow-up.

8.0 Incidents

8.1 National Reporting and Learning SystemThe National Reporting and Learning System (NRLS) is a patient safety surveillance database currently operated by NHS Improvement. A previous managing organisation, the National Patient Safety Agency (NPSA), described the system as follows:

8.2 NRLS reporting for SEH and F&GCCG23 incidents were submitted from F&G and SEH practices between April 2016 and October 2016. Medication incidents were by far the most common incident type, accounting for 16 of the 23 incidents reported (70%).Update: There was no data reported for January 2017.

The low numbers of reporting means it is difficult to identify solely from NRLS data whether an individual GP practice has a good safety culture. It also limits the usefulness of NRLS data for triangulation purposes. Quasar Primary implementation will address the current need the practices have for a local incident reporting system and enable more effective local learning.


8.3 Serious incidents reported by GP practicesYear to date (April 16– February 17) the CCG have been made aware of 2 SI’s that occurred in primary care.

The CCG has taken a pragmatic approach to a further 1 possible SI, but managing this as a significant event, supporting the surgery (see 10.3 for action taken).SHFT are investigating 1 Primary Care SI. This equals a total of 3 that we are aware of.NHS England has been made aware of all ongoing investigations.

8.4 New Concern investigation (not currently a serious incident)One F&G practice have undertaken an internal investigation of a medication error which was reported as a safeguarding adults alert initially.

A pragmatic approach was taken in discussion with Chief Nurse and deputy Chief Nurse.A meeting was completed on 01.01.17 with the practice, including 3 GPs, the practice pharmacist and the managerial team, with reference to a “just culture” appendix 3.

A facilitated significant event analysis meeting was held whereby contributory factors and learning points were identified. KMcC produced an action plan (currently with the provider for factual accuracy) and will be summarised in a report. The report will be shared with NHS England and the local authority safeguarding team.

9.0 Family and Friends Test The limitations of this method of gathering data was discussed at the December Primary Care Group. It was concluded that those practices using only kiosk or tablet methods of collecting friends and family scores may be disadvantaged.

Action taken: A survey monkey questionnaire was sent out to all practices to find out how they use FFT data to change services, how they would prefer to collect this in the future and how the CCG might help. Found here:https://www.surveymonkey.co.uk/r/8GBY5QK

This should give a broader picture of requirements to allow an options appraisal to take place, with recommendation for the April 2017 period onwards.

July-October 2016 neither CCG fell below average.


https://www.surveymonkey.co.uk/r/8GBY5QK

In addition, it is important to note how some GP practices gather patient feedback in alternative ways. For example, one group of 4 practices explained to me how they found the FFT data to be unrepresentative of the patient experience. They therefore commissioned their very active Patient Participation Group to undertake local surveys for each of their sites and built action plans based on this feedback.

10 Areas of concern/ clinical visit focus

10.1 Gosport Same Day Access ServiceFebruary 2017 Clinical Visit: areas of improvement remain such as infection control- sharp boxes.However, overall there is evidence of leadership and management implementing safe practices and patient experience is high.The Head of Quality for Primary Care Community Services is assured that with the added resource supplied by the CCG and the evidence gained from the clinical visit that patient safety is managed well.

11 New work plan area: Safeguarding adults in primary careA meeting took place to discuss concerns regarding the low numbers of safeguarding adults alerts coming from primary care.A plan was created to start work in this area with input from the Quality team.Objective: to scope the level of training and support for safeguarding adults in primary care, followed by an action plan.

Head of Quality (Primary Care & Community Services) role now embedded within the quality team: Clinical visits completed:

Winter warmer- G2 PHT GP practice F&G Bridgemary (Significant Event) GP practice F&G Stoke Road (pre-CQC) GP practice SEH Stakes Lodge (Vine) (review whistle-blowing policy) Queenswood SEH (post CQC action plan)

Planned: Hepatology 17 Feb 2017 GP practice Clanfield SEH (primary care contracting visit)

The report provides information from various data sets relating to general practice however at present.

From the data gathered, the primary care committee should note the generally positive quality outcomes being delivered across the CCGs’ practices. As areas of concern are identified, these are logged and reviewed by the Quality team.

Primary Care Committee is asked to note the content of the quality report for general practice (under delegated agreements) and advise of any areas which require further assurance.


Appendix 1: Quality Work streams- update

Work stream Improvement Actions Update – February 2017 Progress update

HCAI

1. Practice HCAI Champions updates x 2 in Q42. Continue C.DIFF RCA investigations and sharing of learning3. Continue C.DIFF training around antibiotics and PPIs. 4. Review community acquired cases of HCAI with the Medicines

Management team5. Collaborate with Solent, SHFT and PHT on a whole pathway approach6. Continue practice HCAI, environmental and sharps audit programme.

1. Not due2. Ongoing3. Ongoing4. Ongoing, meeting held Aug 165. Ongoing, meetings in place 6. Ongoing

In progress

Patient Safety

Champions/Safe Model

Practice

1. Provision of x 6 training sessions across Q3 and 4 (working with Nicola Davey and Tom Kenny) (LCS)

2. Each practice to complete SafeQuest safety culture audit (LCS)3. Model safe practice project in Emsworth and Stubbington practices

project in collaboration with Wessex AHSN PSC4. Refresh CCGs' Sign up to Safety

1. First 3 delivered. 1 further booked2. Sent 30.01.20173. complete4. next years plan to be drafted.

In progress

Significant Events and

Serious Incidents

1. In collaboration with NHSE and other Wessex CCGs, develop guidance for primary care for serious incident framework

2. Facilitate and where appropriate lead general practice serious incident investigations, ensuring high levels of staff support and shared learning.

3. Undertake further observations of practice significant event audits and meetings.

4. In conjunction with NHSE, incorporate primary care serious incidents into CCG Serious Incident closure panel

1. Draft framework seen by Wessex quality hub & supporting roll out of Quasar Primary.

2. Ongoing, 3 investigations completed and 1 supported meeting

3. Ongoing, supported upon request from practices

4. SIs reviewed as part of CCG panel

In progress

Primary Care Incident

Reporting & Feedback

1. Monitor practice feedback reporting to Quasar (LCS)2. Follow up relevant Quasar safety incidents with providers3. Pilot Quasar Primary end Q2 (LCS)4. Roll out Quasar Primary to all practices by end Q4 (LCS)5. Build automated link from Quasar to NRLS but continue to report practice

incidents to NRLS manually until link completed.6. Provide practices with a Quarterly Quasar newsletter7. Deliver Quasar Website and self service reports 8. Update practices on Quasar outputs at Target 9. Work with NHSE and Blue Donut to develop primary care intelligence

sharing module on Quasar

1. Ongoing on quarterly basis2. Ongoing for patient safety incidents3. complete4. Delivery started 5. In progress6. Ongoing 7. In progress8. In progress- update at PM Forum9. In progress

In progress

SAFE

TY

Safeguarding 1. Provision of levels 1, 2 and 3 training, advice and guidance 1. Ongoing, led by WHCCG In Page 10 of 19Item 5 - Primary Care Quality Report 21.02.17.docx

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Children 2. Support for SCRs and alerts3. Facilitation of Section 11 audits

2. Supported by designated nurse for safeguarding children

3. Completed

progress

Safeguarding Vulnerable

Adults: learning and development

1. Work with HCC and HSAB L&D facilitator to roll out of 4 LSAB safeguarding adults learning and development strategy and training across CCG practices.

2. Continue mental capacity and DOLS training once bid awarded3. Support for general practice SCR and section 42 investigations4. Signposting to/provision of Prevent and Domestic Abuse training

1. In progress2. Update awaited3. Update awaited4. Ongoing

In progress

Safeguarding Vulnerable adults in

Primary Care: Quality of

reporting and management.

1. Gap analysis2. AIMs

Link to objectives of the Quality strategy.Have an education/training part of the plan.Create/Update/Publicise/produce an overall policy to support practices to manage safeguarding adults. For local application.

1.in progress

Sepsis

1. Working with patient safety champions, lead practice nurse group and CCG primary care team ensure timely dissemination of educational resources, screening tools and national updates re sepsis.

2. Through data scanning ensure any incidents related to sepsis generate learning to take back into primary care.

1. Ongoing via CCG practice nurse lead group and PM weekly / top tips. Sepsis has been overtly included in the Primary Care Patient Safety programme.

2. Ongoing

In progress

Acute Kidney injury (AKI)

1. Bid for resource from Wessex Academic Health Science Network Patient Safety Collaborative to develop awareness of AKI in primary care

2. In collaboration with Wessex Kidney Centre ‘acute kidney injury nurse specialist’ develop an AKI awareness champion’s network in primary care.

3. Provision of AKI training, advice and guidance through lead practice nurse group, non-medical prescribers’ forum and TARGET events.

4. Through data scanning ensure any incidents related to AKI generate learning to take back into primary care.

1. Completed2. Ongoing3. Completed4. Ongoing

In progress

Effe

ctiv

e

Practice Nursing &

Safe Staffing

1. Continue support to practices for new NMC revalidation process for RNs2. Working with HEE Primary Care Learning Networks, continue to promote

student nurse/AHP placements in general practice and mentorship registers/updates

3. Continue to deliver the newly qualified nurses in general practice preceptorship programme

4. Target training programme for nurses and support workers

1. Ongoing, monthly revalidation workshops now reduced to quarterly.

2. Ongoing, student nurse placements in primary care increasing. Eight Sept 16 newly qualified nurses took first post-

In progress


5. Roll out of new essential skills requirements for non-medical practice staff.

6. Continue to facilitate the non-medical prescribers forum7. Continue to produce and circulate practice nurse newsletters8. Facilitate the practice nurse forum quarterly9. Provide a 2nd annual practice nurse conference and CCG PN award for

Safe Care initiatives (Alyson Stainer Award)10. Development of practice nurse leadership capability through delivery of a

senior practice nurse leadership course (20 places). 11. Assist in setting up the Wessex PN facilitators network

employment in primary care. 3. Ongoing4. Ongoing5. Completed6. Ongoing7. Ongoing on monthly basis8. Ongoing9. Scheduled to take place February 1710. Pilot commenced Monday 11

October. High level of interest in this programme across Wessex and Thames Valley

11. Wessex GPN Forum now established. Chairs changed and agreed at last meeting (Jan 2017) – Penny Evison (SEH / F&G CCG) now chairing and Pippa Stupple (HEE Wessex) deputy chair.

Primary Care Workforce

Medical Workforce1. Working with medical colleagues support national recruitment and

retention strategies:a. There has been an increase of GP training programme across

Wessex from 142 (July 15) to 1509August 16)b. Two of the national GP ambassadors (to increase recruitment) are

Wessex GPsc. GP deanery engagement events with medical students and

foundation year doctors to promote general practice as a career.Non-medical workforce

2. Support NHS England clinical pharmacists in primary care across SEH and F&G CCG primary care colleagues

3. In collaboration with Health Education England Wessex develop Primary Care Community Education Provider Networks (CEPNs) across SEH and F&GCCG primary care practices

a. Increase number of pre-registration health care student clinical placements in primary care

4. Increase number of newly qualified nurses employed into primary care 5. Take forward recommendations arising from the Primary Care Workforce

Commission report “The Future of Primary Care: Creating Teams for Tomorrow” to deliver a multi-disciplinary workforce for primary care and

1. Ongoing - HEE Wessex is on track to having increased GP training capacity from132 to 150 from Aug 2016 (fill rate 94%, up overall from last year) and is running an active programme to engage doctors in GP training. Also involved in the iRDS to be launched April 2017 RDS. The Wessex GP Dean is the HEE national lead for the I&R scheme.

2. Ongoing – 9 NHS Eng. phase 1 clinical pharmacists in post across SEH and F&G CCG. GP Supervisor Training Event for clinical pharmacists in primary care took place 24th January 2017 with useful and positive feedback. Application submitted to NHS England for a second phase of clinical pharmacists Feb 2017

3. Ongoing, Four CEPNs established in

In progress


promote innovative workforce models (e.g. mental health practitioners, physicians associate, AHPs, paramedics, nursing associate)

6. Work with Southern Health Foundation Trust to take forward development of workforce necessary to deliver new models of care.

footprints of HEE Wessex School of GP patch offices. Four multi-professional learning environment leads appointed.

4. Ongoing, 8 newly qualified nurses appointed to primary care from Sept 16 graduates. Expressions of interest from Sept 2017 graduates are currently being received.

5. Ongoing, active engagement with the HEE nursing associate (NA) training test site in Hampshire and will be providing NA placements in primary care.

6. Workforce development workshop (using Skills for Health 6 step framework) being delivered for 3 local MCPs on 07 March 2017 in collaboration with HEE Wessex.

Support Practice

Compliance with Reg 12 H&SC Act

1. Continue to deliver developmental mock CQC visits to practices2. Support for practices whose CQC inspections result in improvement or

enforcement actions3. Monitoring the delivery of compliance via post CQC inspection action

plans4. Report CQC compliance to the PCOG and PCCC

1. Upon request or based on soft intelligence (4 planned in Q4)

2. One this quarter- complete.3. Ongoing4. Ongoing as part of reporting

In progress

Information Governance

1. Liaise with CSU IG team on provision of practice advice and guidance for IG matters.

2. Monitor practice IG breach trends and share learning3. Provision of training on implications of Caldicott 3 to practices 4. Ensure IG compliant data sharing agreements are in place for new

models of care

1. As required2. PLAN: Analysis of 6 month data

and how learning was shared in Primary care.

3. As required4. Ongoing

In progress

Patie

nt C

entr

ed

Practice patient

surveys and Friends &

Family test

1. Working with the primary care team, continue to provide support, advice and guidance for FFT to practices.

2. Undertake triangulation and benchmarking of a variety of courses of patient feedback re: general practice experiences, providing support to any outlier practices.

3. Review and where requested, support practices to develop improvement actions arising from patient surveys.

4. Ensure sharing of learning and innovation from practice initiatives which enhance patient experiences

1. Ongoing, reporting of FFT to quality in primary care group and primary care operational group

2. Ongoing as part of regular reporting3. Survey sent to gain feedback from

practice managers re: tablets and alternatives

4. Option appraisal planned by end March 2017 based on above.

In progress


PPG Engagement with Quality

1. Act on feedback from practice patient participation groups and the CCGs' Community Engagement Committees

2. Support practices to involve PPGs more in quality and safety development initiatives

1. Feedback is received via CEC2. To commence

In progress

Support for PWLD

1. Undertake an equalities Act review of the requirements of PWLD in primary care

2. Develop plans to provide training on reasonable adjustments and potential for LD liaison services in primary care

3. Ensure strong GP links with LD mortality reviews under LeDeR programme

1. To commence2. In progress, primary care team

have identified action to be taken which was presented to PCOG

3. Programme managed by NHSE

In progress

Making Every Contact Count

(MECC)

1. With multi-system colleagues collaborate in pilot MECC network in Gosport

2. Provide MECC introduction workshop engagement event for primary care workforce

1. Completed, Gosport MECC network established; monthly MECC training sessions commence Jan 2017

2. Completed – 03 November 2016.

To close

Quality capacity for primary care

1. Bid for resources from NHSE to support primary care transformation programme

2. Appoint a Head of Quality for Primary and Community Care in Q3

1. Completed, resources allocated and supporting employment of Head of Quality in PC

2. Completed

To close

MCP Quality

1. Establish MCP quality group and ensure alignment with STP and other Vanguard quality groups

2. Make strong quality links to emerging MCP models of care, providing advice and guidance to service redesign and new ways of working

3. Inform the quality requirements for the MCP procurement and contracting process, including issuing of ITT

4. Develop a framework and toolkit for quality and clinical governance which will support new models of care and cross organisational service provision

1. Completed2. Completed and ongoing3. QIA meeting 31 January 20174. New model of CQRM monitoring

agreed but yet to start.

In progress

New models of Care Quality

1. Undertake quality reviews of new and emerging models of care and support actions to address any deficits.

2. Work with community providers to increase primary care capacity and capability in readiness for MCP procurement and in light of Gosport practice mergers

1 New model of CQRM monitoring agreed but yet to start.

2 In progress

In progress

Enab

lers

Primary Care Audit

Programme

Quality Exercises

Exercise 1 Practice has a lunchtime meeting, in which they role-play a mother presenting at the front desk holding a fitting infant.

Exercise 2 Anaphylaxis in child receiving childhood immunizations. Exercise 3 Home visit to elderly frail patient in nursing home, who has no

These remain discussion items for the Quality team.

In progress


capacity, and has developed pneumonia. What are the considerations? Exercise 4 Dealing with an aggressive patient at reception, complaining

that his repeat prescription has gone missing. Audit diabetic population:

1. Search for all HBA1c >48 with no diabetes diagnosis. 2. Search for diabetic patients who have not had blood tests done for >2 years. 3. Search for diabetic patients who have failed to have a BP checked in past 18 months 4. Search for diabetes resolved read codes. These should read “diabetes in remission”

Audit Drug Safety update

1. Search for patients on spironolactone and check they have had a potassium check in past 12 months. 2. Tibolone is now contra-indicated in women with a history of breast cancer, simple search.3. Tamoxifen action is inhibited by fluoxetine or paroxetine antidepressants. Search for these4. Frailty. Help reduce unplanned admissions. 5. Look at last 10 expected deaths in the community, excluding those in residential care homes. Had the patients been referred to the Intermediate care team?


Quality Outcomes Success Indicator Threshold Method of Measurement Frequency of Monitoring

Progress update – January 2017

1 A reduction in any preventable CCG/community rates/numbers of MRSA bacteraemia and Clostridium difficile for NHS South Eastern Hampshire CCG and Fareham and Gosport CCG residents

1. National yearly target reduction trajectories for C.Diff will be achieved

2. Zero-tolerance for MRSA BSI

3. Primary care will have access to an IPC nurse who can offer advice and guidance

As nationally determined

1. Monthly numbers of CCG

CDI

MRSA bacteraemia

2. Notification of all cases to GP surgeries incl advise

3. Notification of colonised MRSA cases to GP practices incl advice

4. Active contribution to the development and delivery of the CCG’s HCAI plan

5. Regular meetings with Medicines Management, Quality Team IPC lead and IPC specialist nurse to review/discuss CDI cases

1. ¼ IPC reports

2. 2 monthly meeting with CCG IPC lead

In progress however challenges identified to achieve annual CDI and MRSA trajectories

CDISEHCCG reported 32 cases of CDI year to date (April – November 2016) against an annual trajectory of 50

F&GCCG reported 30 cases of CDI year to date (April – November 2016) against an annual trajectory of 30. The risk of breaching the annual trajectory is included on the quality team risk register (12).

MRSASEHCCG have 2 reported MRSA case YTD, one was upheld at NHS England arbitration panel.

F&GCCG have no reported cases of MRSA year to date (April – November 2016)

2 GP practice based link advisors will be supported and developed to be able to undertake local IPC audits, update local policies and protocols and deliver basic training to practice staff, in conjunction with the IPC specialist nurse and CCG quality team.

1. Evidence of treatment room audits: - 1 per surgery per year

2. Primary care will have access to an IPC nurse who can offer advice and guidance

3. Practice Nurse Study Days programme will be held

4. Practice Nurse champions receive regular training

85% 1. The number of practices audited

2. Analysis of the learning and outcomes in each practice

3. Feedback via IPC champions and training/Target of key themes

1. ¼ reporting to the CCG via IPC report

In progress and delivering

Quarter 1 report received August 2016Annual report presented to JQOG August 2016Two PN study days held during Q1

Quarter 2 IPC report to JQOG November 2016.

PN IPC links continue undertaking


waiting room and communal area audits

3 Through the analysis of infection data and learning from root cause analysis the CCGs will be able to recognise areas in primary care that require further improvement in IPC, to improve the care and treatment of patients.

1. Systems and process for improvement will be identified by Root Cause Analysis of all CDI and MRSA cases

2. Learning will be identified and through a CCG plan will be implemented by the quality team with IPC specialist input

3. Health economy wide analysis and surveillance will reduce cases

95% 1. The CCG HCAI plan will be delivered in conjunction with the quality team IPC lead and Primary Care/Practice Nurse lead

2. Serious Incidents will be analysed and learning implemented with the quality team

3. Cases will be triangulated across the health economy population area in conjunction with providers

4. Appropriate investigations/reviews of infections including MSSA and Ecoli will be delivered as required

1. Contribution to annual CCG HCAI plan

2. ¼ analysis and reporting to both CCGs on cases

In progress and delivering.

Two MRSA PIR panels were held during quarter 1 and one was send to NHSE for arbitration, case assigned to third party.No cases were reported during quarter 2 and during October and November 2016.

Meetings with PHT/SHFT/Solent have been set up to discuss IPC and identify cross organisational learning. Two of these meetings took place during quarter 1 and have continued during quarter 2 and 3.

IPC meeting with Medicines Management took place August 2016

PHT IPC committee in Q1 and Q2 attended by CCG IPC reps

Deputy chief quality officer continuous to chair strategic/operational Wessex CIPG meetings

4 GP practices will be compliant with the Health and Social Care Act:Safe Care and TreatmentRegulation 12 (2) hAssess the risk of and preventing detecting and controlling the spread of infections, including those that are healthcare related.

1. GP practices will be able to evidence compliance

2. Practice Nurses will have annual IPC training

Fully compliant

1. CQC inspection outcomes

2. Practice visits and audits (IPC leads)

3. GP practices portfolio of compliance and self-assessments

4. Record of PN IPC training delivery

1. Annual review through primary care development team

2. Review of CCG PNF practice visits

In progress and on track to deliver,

Two annual update sessions were provided by IPC leads during quarter 1 to PNs.

No practice has been identified by CQC as inadequate on SAFE domain regulation 12 Health and Social care Act..


Monitored by CQC. 5. Sharing of (mock) CQC visit 2 mock CQC visits have been conducted year to date.No further CQC mock visit have been requested by the practices

5 Robust IPC primary care policy reflective of national guidance

1. Ratified and imbedded IPC policy

Fully imbedded

1. Reviewed IPC policy presented to JQAG for ratification

1. Annual In progress and on track to deliver,

Policy under review by IPC lead, due August 2016 – delayed to December 2016 due to unforeseen circumstances.

6 Enhanced understanding of CAUTI hotspots and improvements in practice

1. Reduced number of contaminated samples send from nursing homes

As locally determined

1. Support the Hampshire wide CAUTI work stream

2. Report on CAUTI work progressed by Solent to CCG for consideration/adaptation

3. Advice CCGs of nursing homes that regularly sent contaminated samples

1. Quarterly

2. As required

3. As required

In progress and on track to deliver,CAUTI meeting attended by IPC lead.

IPC leads making active contact with care homes on contaminated urine samples providing advice and education as required.


Appendix 3: Just Culture NHS England Sign Up to Safety


1



Title Transforming Primary Care – Engaging with our local communities

Purpose of Paper This report provides the Primary Care Commissioning Committee with information on engagement activities with the public and patients that have taken place since the previous meeting.


Fareham and Gosport (F&G) and South Eastern Hampshire (SEH) CCGs engages with local people to support the development of primary care through a number of routes and this report provides the key themes from the feedback received.


The Committee is asked to consider the three main issues raised during this period:

Dementia Friendly status in GP practices Consistency of treatment between different GP practices Multi-speciality Community Provider contract.

These, and what the CCGs are doing in response, are detailed in section three.


PCC is asked to:

Note the report and consider the issues in section three.

Author Elizabeth KerwoodHead of Communications and Engagement

Sponsoring member Sara Tiller Chief Development Officer

Date 15th February 2017

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Strategic Objectives:This paper links to the following: Engagement is a statutory requirement which supports the CCG to

deliver all of its strategic objectives.

ENGAGEMENT ACTIVITY

Engagement Activity This report details the engagement activities undertaken since the previous meeting.


Equality and Diversity N/A


N/A

Supporting documents N/A

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Transforming Primary CareEngaging with our local communities

1. PurposeThe purpose of this report is to provide members of the Primary Care Commissioning Committee with information on engagement activities with the public and patients that have taken place since the previous meeting.

2. Engaging with local peopleFareham and Gosport (F&G) and South Eastern Hampshire (SEH) CCGs engage with local people to support the development of primary care through the following routes:

Locality Patient Groups – ongoing engagement with Patient Participation Groups through the Locality Patient Groups including representatives being members of the CCGs’ Community Engagement Committees

Multi-specialty Community Provider (MCP) – ongoing engagement in localities about the transformation and development of local services. This includes having representation from Patient Participation Groups and the voluntary sector on established MCP Locality Boards

Changes to primary care services – engagement programmes to support GP practices which would like to make changes to their current services.

3. Feedback received and action takenIn addition the CCGs have received feedback through a number of other routes and these are detailed in Appendix one.

The issues raised and the action taken, or being taken, by the CCGs are set out in Appendix two. Issues to which we would particularly draw the Committee’s attention to are:

Dementia Friendly status – A number of GP practices across the CCGs have gained or are working towards Dementia Friendly status. This has been welcomed by the Patient Participation Groups who have supported practices to do this where possible

Consistency of treatment – Concerns have been expressed about consistency of treatment between different practices. This is in part due to historical variations in funding but the MCP could help to resolve this

Multi-speciality Community Provider contract – Concerns have been expressed about the possibility that the MCP procurement process might result in a private sector provider taking over. Whilst this concern and the issue of profit margins are recognised, private sector organisations, such as pharmacies and care providers, are already making a substantial contribution to health and many GP practices are small businesses.

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4. Transforming local NHS services in Fareham surveyIn the beginning of December 2016 we launched a six week online survey seeking the views of people living in Fareham on local GP services.

The survey was promoted through a range of ways including:

An article with a link to the survey on every GP practice website Press release issued to the local media Tweets through the CCG Twitter account Briefings for local groups including the Locality Patient Group Promotion by the Patient Participation Groups Promotion by the voluntary sector.

The survey was completed by 937 people registered with the 10 practices in the Fareham MCP Locality. Of these:

63% of respondents are female 2% of respondents are 24 years old or younger, 36% are 25 to 54 years old, 53%

are 55 to 74 years old and 9% are over 75 years old 41% have a long term condition 12% care for dependent children and 10% are responsible for caring for a

parent/friend/relative.

The overarching themes from the survey results are:

The vast majority of respondents are happy to see a GP other than their own or an experienced nurse for both same day and routine advice and care unless, for some respondents, their GP has specifically asked them to come back

Half of respondents are happy to see a pharmacist but there is a lack of understanding about the knowledge and skills held by these staff

A significant proportion are happy to be seen at a practice other than their own for both same day and routine advice and care

Respondents are happy to travel with the majority prepared to travel up to five miles and some over 10 miles

The vast majority are happy to speak to a health professional over the phone with half being happy to use alternative ways such as email and web-based consultations.

This valuable insight is being used by the MPC Locality to help shape plans to develop a same day access hub in the local area.

5. Voluntary sector themed TARGETsFollowing the success of voluntary sector themed TARGETS in 2015, the CCGs have been working with Community First, Gosport Voluntary Action and Community Action Fareham to run these events again. Representatives from a wide range of voluntary sector and community groups have been invited to have a stall in a market place which will be held during registration and breaks at the event. A small number of groups have also been asked to present to those attending about their service.


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The TARGET for South Eastern Hampshire CCG was held on January 26. It was attended by a range of GPs and practice staff. Both primary care staff and the voluntary sector have feedback how useful the event was, and that it provided them with an ideal opportunity to network with each other.

The TARGET for Fareham and Gosport CCG will be held on March 9.

6. RecommendationThe Primary Care Commissioning Committee is asked to note this report and consider the CCGs’ responses to the issues highlighted in section three.


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Appendix oneSince the last Committee meeting the CCGs have received feedback through the following routes:

Fareham and Gosport CCG Community Engagement Committee held on January 10

South of Butser Locality Patient Group held on January 12 South Eastern Hampshire CCG Community Engagement Committee held on

January 18 Gosport Locality Patient Group held on January 24 Fareham and Gosport Voluntary Sector Health Forum on February 7.


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Appendix twoThe table below details the themes from the feedback received by the CCGs and the actions that have or will be taken.

Theme Feedback received Actions planned or takenGP practices’ answerphone messages

The answerphone messages used by some GP practices when they are closed are confusing and don’t direct people to NHS 111

The Patient Participation Groups are going to listen to the messages and provide feedback to the practices as required

Services provided by individual practices

Some practices offer services that are not available to others which would be helpful

The Multi-speciality Provider Contract (MCP) and the way in which GP practices are working far more closely will give scope to expand these and potentially develop others were appropriate

GP estates Patient Participation Groups have reported concerns about how NHS Property Services work with local practices on issues including redevelopments

The CCGs are aware of these issues and are facilitating discussions between GP practices and NHS Property Services where appropriate

Dementia Friendly status

A number of GP practices across the CCGs have gained or are working towards Dementia Friendly status

This has been welcomed by the Patient Participation Groups who have supported practices to do this where possible

Consistency of treatment

Concerns have been expressed about consistency of treatment between different practices

This is in part due to historical variations in funding but the MCP could help to resolve this

MCP contract Concerns have been expressed about the possibility that the MCP procurement process might result in a private sector provider taking over

Whilst this concern and the issue of profit margins are recognised, private sector organisations (such as pharmacies and care providers) are already making a substantial contribution to health and many GP practices are small businesses

Mental health services Concerns have been expressed in a variety of patient forums about the quality and availability of mental health services

Community mental health services will be part of the integrated MCP model while a Mental Health Alliance has been formed under the Sustainability and Transformation Plan (STP) umbrella to develop enhanced specialist mental health and learning disability services


1


Date of Meeting 1 March 2017

Title Primary Care Finance report, Month 10 2016/17

Purpose of Paper This paper sets out spend against budget for primary care in 2016/17.


Primary care budgets are showing a significant underspend against budget in both CCGs. However, it should be noted that overall levels of investment into primary care are being maintained compared to previous years; underspends arising from PMS reviews are being reinvested into Local Commissioning Schemes. Also, budgets were set based on an estimated level of growth that is proving to be higher than the actuality.


The PCCC should note the maintenance of investment into primary care, at a time when both CCGs are facing increasing financial difficulty.


PCCC is asked to: Note the finance report and the reasons for the apparent underspending.

Author Andrew WoodChief Finance Officer

Sponsoring member Andrew WoodChief Finance Officer





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3. Ensure a range of easily accessed and responsive urgent and emergency care to support people in a crisis



ORThis is a statutory requirementThis is an issue of Corporate Governance

ENGAGEMENT ACTIVITY

Engagement Activity List engagement activity


Equality and Diversity List E&D assurance


List meetings that have considered evidence

Supporting documents List supporting documents

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F&G Co-commissioningDescription Budget 2016/17 FOT Variance

GMS Contract 13,486,323 13,224,427 (261,896)PMS Contract 2,491,411 2,446,299 (45,112)

QOF 2,717,478 2,697,631 (19,847)DES 1,353,512 1,122,475 (231,037)PCO 490,195 469,340 (20,855)

Collaborative 120,161 130,363 10,202Prescribing/Dispensing 177,860 179,100 1,241

Premises 3,096,059 3,262,917 166,859Total 23,933,000 23,532,554 (400,446)

F&G LCSDescription Budget 2016/17 FOT Variance

Commissioning LIS (inc Elective)

958,935

568,521 (390,414)Bundle LCS 304,809 304,809Phlebotomy 59,099 59,099

Pace of Change 2,138 2,138Glaucoma 8,780 8,780

Low Vision (Activity & Equipment) 18,067 18,067Computer Software/License (Harvey Walsh, FFT, Sitekit) 5,572 5,572

Sub Total of LCS Schemes 958,935 966,985 8,0501516 Y/E Accruals reconciliation 0 (59,432) (59,432)

GP Development Programme 18,000 18,000 0Winter Resilience 132,000 82,120 (49,880)Other expenditure 0 690 690

Subtotal of Other Expenditure 150,000 41,377 (108,623)Total 1,108,935 1,008,363 (100,572)

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SE Hampshire Co-commissioningDescription Budget 2016/17 FOT Variance

GMS Contract 8,403,058 8,515,242 112,184PMS Contract 9,573,107 8,981,313 (591,794)

QOF 2,972,112 3,041,983 69,872DES 1,335,365 1,296,844 (38,521)PCO 458,747 470,541 11,794

Collaborative 133,570 142,625 9,055Prescribing/Dispensing 342,671 319,000 (23,671)

Premises 2,358,371 2,431,725 73,354Total 25,577,000 25,199,273 (377,727)

SE Hampshire LCSDescription Budget 2016/17 FOT Variance

Commissioning LIS (inc Elective)

1,063,168

595,869 (467,299)Bundle LCS 318,835 318,835Phlebotomy 78,468 78,468

Pace of Change 14,279 14,279Glaucoma 16,220 16,220

Low Vision (Activity & Equipment) 10,739 10,739Computer Software/License (Harvey Walsh, FFT, Sitekit) 13,657 13,657

Sub Total of LCS Schemes 1,063,168 1,048,066 (15,102)1516 Y/E Accruals reconciliation 0 (145,718) (145,718)

GP Development Programme18,000 18,000 0

0 (20,000) (20,000)Winter Resilience 141,000 85,103 (55,897)

Subtotal of Other Expenditure 159,000 (62,615) (221,615)Total 1,222,168 985,451 (236,717)

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1



Title Primary Care Estates Update

Purpose of Paper This paper aims to provide an update on the CCGs’ ETTF schemes and the progress made on the development of the priorities for primary care estate following the agreement on the criteria.


In June 2016 the Primary Care Commissioning Committee reviewed and discussed a paper that set outthe results of the initial prioritisation of schemes for bidding against the Estates and TechnologyTransformation Fund (ETTF).

Previous discussions at the PCCC and elsewhere also identified the need for the development of criteria that can be used to approve and prioritise proposals relating to premises spend in primary care.

There have been successful award of three schemes: Emsworth Surgery Redevelopment in Cohort 2 Bordon Healthy New Town Health Campus in Cohort 3 Fareham Central Reprovision/Extended Primary Care in Cohort

3

The following priorities list was discussed and agreed by Primary Care Commissioning Committee in September 2016:

1) Adverse CQC report/ unsafe or unfit premises2) Sub optimal (over or under) utilisation3) Supports primary care at scale / primary care capacity,

and is in line with the Better Local Care Estate strategy4) Needed to meet significant population growth5) Supports 7 day working6) Supports GP training7) Is an IT enabler scheme


N/A

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PCCC is asked to: Note the progress with the Estates and Technology

Transformation Fund Note the agreed estates priorities principles Feedback on the draft scoring matrix in Appendix A so that the

CCG Primary Care Estates Group can work on a final document.

Author Keeley EllisHead of Primary Care

Sponsoring member Sara TillerChief Development Officer



Strategic Objectives:This paper links to the following: 1. Integrate primary care, community care, social care and voluntary

services to deliver a range of care, close to home that allow people with complex needs and the most vulnerable to stay healthy and feel in control of their health


ENGAGEMENT ACTIVITY

Engagement Activity N/A



Other committees/ groups where evidence supporting this paper has been consideredSupporting documents List supporting documents

Scoring matrix (Appendix A)

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Primary Care Estate UpdateAuthor: Keeley Ellis, Head of Primary CareDate: 15/02/2017

1. INTRODUCTION

In June 2016 the Primary Care Commissioning Committee reviewed and discussed a paper that set outthe results of the initial prioritisation of schemes for bidding against the Estates and TechnologyTransformation Fund (ETTF).

Previous discussions at the PCCC and elsewhere also identified the need for the development of criteria that can be used to approve and prioritise proposals relating to premises spend in primary care.

A long list of primary care areas for investment was identified within the CCGs’ Strategic Estates Plans (SEPs), which were agreed by the Governing Bodies earlier in 2016.

This paper aims to provide an update on the CCGs’ ETTF schemes and the progress made on the development of the priorities for primary care estate following the agreement on the criteria.

2. UPDATE ON ETTF

The ETTF is designed to accelerate investment in infrastructure to enable the improvement and expansion of joined-up out of hospital care for patients. Funds are to be specifically targeted at increasing capacity in out of acute hospital settings and to enable better access to general practice; widen the range of care and its associated community amenities; increase training capacity; implement new technologies and help to reduce unnecessary demand on urgent care services.

As agreed by Primary Care Commissioning Committee several applications within the ETTF were submitted. The CCG were informed on 1st November 2016 that there has been a successful award of three schemes:

Cohort What is cohort 2 and 3? Amount awardedCohort 1 None

Schemes which can be delivered and funded by 31 March 2017 and which are supported by CCGs and STP.

N/A

Cohort 2 Emsworth Surgery

Redevelopment

Schemes which are supported by CCGs and STPs which can be delivered by 31 March 2019.

£4.4m (£2.2 in 17/18 and £2.2 in 18/19)

Cohort 3 Bordon Healthy New Town -

Health Campus Fareham Central Reprovision/

Extended Primary Care

Schemes with a delivery estimate of 30 months or more. Award of pre-project costs.

£350,000

£500,000

Project Initiation Documents (PIDs) were expected to be submitted for each of these schemes by 31st January 2017 which has been achieved. A progress report will be brought to next PCCC which outlines how each of these schemes are progressing.

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3. ESTATES PRIORITISATION

The following priorities list was discussed and agreed by Primary Care Commissioning Committee in September 2016. Although initially this list was used to support decisions around capital funding, it was agreed that the same principles should apply with regards to revenue bids (such as increases in reimbursable rent) as well.

1) Adverse CQC report/ unsafe or unfit premises2) Sub optimal (over or under) utilisation3) Supports primary care at scale / primary care capacity, and is in line with the Better Local

Care Estate strategy4) Needed to meet significant population growth5) Supports 7 day working6) Supports GP training7) Is an IT enabler scheme

This eligibility scoring list has been applied to all of the current primary care estate that is currently within Fareham and Gosport and South East Hants CCGs’ footprint, this is provided in Appendix A.

The purpose of this is to provide Primary Care Commissioning Committee with an equitable scoring matrix which can be used when considering any business cases from primary care to invest in estate; either for capital funding or revenue.

This matrix document should also aim to identify the CCGs’ estates priorities for primary care.

4. RECOMMENDATION

Primary Care Commissioning Committee are asked to:

1) Note the progress with the Estates and Technology Transformation Fund2) Note the agreed estates priorities principles3) Feedback on the draft scoring matrix in Appendix A so that the CCG Primary Care

Estates Group can work on a final document.


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Havant Health Centre and Leigh Park NHSPS 4 4 4 3 5 5 3 3 31

Queenswood Surgery Third Party 4 4 5 4 4 5 4 1 31Merging; supported based on estate rationalisation

Gosport Hub SHFT 5 4 5 1 5 5 3 2 30 Petersfield Community Hospital Hub SHFT 5 4 5 1 5 4 3 2 29

Forest End SurgeryPartnership owned 4 5 3 4 5 5 1 3 30

Waterbrook Medical CentrePartnership owned 3 4 5 4 3 5 4 1 29

Lockswood Surgery Third Party 4 4 4 3 4 4 3 3 29

Stubbington Medical PracticePartnership owned 3 4 4 2 4 4 5 3 29

Bid supported based on merger or relocation

Bordon Healthy New Town N/A 5 5 5 2 5 2 1 3 28 Fareham Community Hospital Hub CHP 5 3 4 3 3 4 2 3 27 Waterlooville Health Centre NHSPS 3 4 5 4 3 3 4 1 27

The Homewell.Curlew Practice NHSPS 3 4 4 2 4 4 4 2 27Bid supported based on relocation (Oakpark?)

The Staunton Surgery NHSPS 3 4 4 2 4 4 4 2 27

Brune Medical Centre LIFT 3 4 4 3 4 4 1 4 27Bid would be supported based on increased utilisation

Gosport Medical Centre LIFT 3 4 4 3 4 4 1 4 27Bid would be supported based on increased utilisation

Lee-On-The-Solent Medical Centre NHSPS 3 4 4 2 4 4 3 3 27 Manor Way Surgery NHSPS 3 4 4 2 4 4 3 3 27 Rowner Health Centre LIFT 3 4 4 3 4 4 1 4 27

Stoke Road Medical CentrePartnership owned 3 4 4 2 4 4 3 3 27

Bid would be supported based on rationalisation

The Centre Practice NHSPS 3 4 4 2 4 4 3 3 27 Stakes Lodge Surgery Partnership 3 4 5 4 3 2 2 2 25


owned

The Riverside Partnership, LissPartnership owned 2 3 4 4 2 5 3 2 25

The Whiteley Surgery Third Party 3 5 4 3 3 2 2 3 25Estimated population growth, support of additional space

Liphook Village SurgeryPartnership owned 3 2 4 2 4 5 3 1 24

The Grange Surgery Third Party 3 4 3 2 3 4 3 2 24Bid would be supported based on rationalisation

Emsworth Community Hospital NHSPS 2 2 4 2 2 3 5 3 23

George and Dragon SurgeryPartnership owned 2 3 4 2 2 5 4 1 23

Liphook and Liss SurgeryPartnership owned 3 4 3 4 2 1 4 1 22

Liss SurgeryPartnership owned 2 3 4 2 2 5 3 1 22

Rowlands Castle SurgeryPartnership owned 3 3 3 2 4 4 2 1 22


Clanfield SurgeryPartnership owned 3 4 4 1 4 2 2 1 21

Working with another practice, site must remain as rural

Park Lane Medical Centre Third Party 3 3 4 3 3 1 2 2 21Redevelop, not move; must stay in Leigh Park

The Denmead Practice NHSPS 3 5 4 1 2 2 2 1 20 Portchester Health Centre NHSPS 1 1 2 2 1 2 5 5 19 The Bosmere Medical Practice Third Party 2 2 2 2 2 2 2 5 19 The Elms Practice NHSPS 2 3 2 3 3 2 3 1 19 Waterside Medical Practice NHSPS 2 3 2 3 3 2 3 1 19 Cowplain Family Practice Third Party 2 2 2 2 2 2 2 4 18 Hambledon Surgery Third Party 2 2 2 2 2 3 4 1 18 Chase Hospital CHP 2 2 3 2 2 3 1 2 17

Swan SurgeryPartnership owned 2 2 2 2 2 2 2 3 17

The Village SurgeryPartnership owned 2 2 2 2 2 2 2 3 17

Bridgemary Medical CentrePartnership owned 2 2 2 2 2 2 2 3 17


Brockhurst Medical Centre Third Party 2 2 2 2 2 2 2 3 17Bid would be supported based on rationalisation

Bury Road Surgery SHFT 2 2 2 2 2 2 2 3 17Bid supported based on merger or relocation

Forton Medical Centre Third Party 2 2 2 2 2 2 2 3 17


Waterside Medical Centre Third Party 2 2 2 2 2 2 2 3 17Bid would be supported based on increased utilisation

Brook Lane SurgeryPartnership owned 2 2 2 2 2 2 2 3 17

Gudgeheath Lane SurgeryPartnership owned 2 2 2 2 2 2 2 3 17

Highlands Medical CentrePartnership owned 2 2 2 2 2 2 2 3 17

Jubilee SurgeryPartnership owned 2 2 2 2 2 2 2 3 17

Site must remain as unique population

Westlands Medical CentrePartnership owned 2 2 2 2 2 2 2 3 17

Badgerswood SurgeryPartnership owned N/A 0

Forest SurgeryPartnership owned N/A 0

Emsworth SurgeryPartnership owned N/A 0

Horndean SurgeryPartnership owned N/A 0

Pinehill Surgery Third Party N/A 0

Considered for ETTF


1



Title Primary Care Performance Profile

Purpose of Paper This paper aims to provide the PCCC with themes identified to the Primary Care Operational Group (PCOG) with regards to the Monitoring of Primary Care Performance as delegated commissioners


This paper aims to provide the PCCC with themes identified to the Primary Care Operational Group (PCOG) with regards to the Monitoring of Primary Care Performance as delegated commissioners


N/A


PCCC is asked to: Note the information set out in the paper.

Author Lisa BakerPrimary Care Development Officer



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3. Ensure a range of easily accessed and responsive urgent and emergency care to support people in a crisis



ENGAGEMENT ACTIVITY

Engagement Activity Primary Care Operational Group – February 2017




JCC Meetings in October and NovemberLMC Meetings in October and NovemberPCOG in October and November

Supporting documents N/A

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Practice Performance Profile

Author: Lisa Baker

Feb 2017

Introduction

This profile has been developed as a means to monitor key metrics across both Fareham & Gosport and South Eastern Hampshire Clinical Commissioning Groups (CCGs). It will assist the CCG in identifying trends to establish areas in Primary Care where support may be required, as well as areas of best practice for sharing and learning. The Primary Care Operational Group (PCOG) review the performance profile on a regular basis and it has recently been shared with constituent practices to assist them with identifying gaps in their prevalence. Since releasing the profile it has created interest from surrounding CCGs and Commissioning Support Services (CSU) who are now developing something very similar.

The following caveats should be applied.

1. Public Health Data is over 3 years old, practices could have made a considerable improvement/decline over this time2. FFT data is not cumulative it is recorded monthly e.g. Practice (a) had 14 responses in April of which all 14 recommended the practice, therefore

recording 100%. However in May no one completed the survey recording 0%

Background

Fareham and Gosport CCG comprise of 21 GP practices with an overall population of 203,178 patients.

South Eastern Hampshire CCG comprise of 22 GP practices with an overall population of 212,376 patients

The profile consists of 58 measures in the following categories; Core Contract, Prevention and Clinical Management, Enhanced Services, Prescribing, Public Health, Mental Health & Quality.

Analysing the 58 measures areas can be identified where there is significant “low” performance across practices, or where individual practices have low performance in a number of areas. These are categorised using a traffic light system of red, amber & green.

As a result of this the CCG has identified 6 practices and is providing support where necessary. Research has shown that one of the major drivers to successful improvement in GP parameters is information sharing and peer pressure and the CCG would look to encourage this..The table below shows by practice the number of reds across the 58 measures

Total number of practices with 0-10 reds 17Total number of practices ranked 11-14 13Total number of practices ranked 15-25 13

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Examining the metrics in more detail –

The profile helped to identify the top 5 metrics where practices have a higher number of reds.

Of the 5 the CCG has identified that

1. FFT numbers are showing nationally a reduction in responses. The data is not counted as YTD so is a monthly picture only. Practices have experienced some time wasting and inappropriate responses which have influenced the % recommend in the survey.

2. Repeat dispensing overall is coming down, however it still remains in the top 5

3. With the publication of 15/16 QOF it has identified that we have an increasing number of practices recording high exception rates

4. We have only just secured regular data updates for this measure so based on the national picture we have a high number of practices not performing to the national measure. We have now added screening into the 17/18 Local Commissioned Service

5. We have only just secured regular data updates for this measure so based on the national picture we have a high number of practices not performing to the national measure. We have now added screening into the 17/18 Local Commissioned Service

Below is an example of measured metrics where the number of reds is low (i.e. good performance)

1. Overall QOF Public Health Additional Services Exception Rates

2. Flu Vaccine uptake this year

3. Diabetic Eye screening

Friends and Family Test % recommended

Repeat dressing Usage

Overall QOF Clinical Domain Exception Rates(per cent)

Cervical Screening Patients receiving Intervention (per cent)

Sum of 2.5 year coverage % Bowel Cancer Screening 60-74


CQC

The chart below details the CCGs current CQC status.


1



Title PMS Partnership Changes

Purpose of PaperThe purpose of this paper is to further clarify the process discussed at the last meeting of the committee.


Delegated co-commissioning provides CCGs with the responsibility of processing and approving applications for partnership changes within PMS practices. The Head of Primary Care for Fareham & Gosport and South Eastern Hampshire CCGs brought a paper to the December 2016 Primary Care Commissioning Committee (PCCC), in which the committee approved the proposal for managing PMS partnership changes in line with the scheme of delegation.

The Primary Care Team has received feedback from Practice Managers that the process is a lot more onerous for them since the CCGs took over this responsibility. They feel it takes longer for changes to be put in place and that their change going outside of the Primary Care Team for ‘approval’ gives the impression that they are not in control of their own business decisions.



PCCC is asked to: Approve the process outlined in Flowchart 1.

Author Sophie HolmesPrimary Care development Officer


Date 20/02/17


This paper links to the Strategic Objectives:

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2

following:This is a statutory requirement

ENGAGEMENT ACTIVITY





N/A

Supporting documents Decision log

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PMS Partnership Changes

1.0 Introduction

Delegated co-commissioning provides CCGs with the responsibility of processing and approving applications for partnership changes within PMS practices. The Head of Primary Care for Fareham & Gosport and South Eastern Hampshire CCGs brought a paper to the December 2016 Primary Care Commissioning Committee (PCCC), in which the committee approved the proposal for managing PMS partnership changes in line with the scheme of delegation.

The purpose of this paper is to further clarify the process discussed at the last meeting of the committee.

2.0 Proposed Process

The Primary Care Team have been following the process discussed at PCCC, giving opportunity to see how the process works. The majority of partnership changes have been going to the Chair of PCCC for approval. This has been evidenced in the scheme of delegations decision log which is also brought to the committee for assurance on various other elements of co-commissioning.

The Primary Care Team has received feedback from Practice Managers that the process is a lot more onerous for them since the CCGs took over this responsibility. They feel it takes longer for changes to be put in place and that their change going outside of the Primary Care Team for ‘approval’ gives the impression that they are not in control of their own business decisions.

The Primary Care Team and the Chair of the Primary Care Commissioning Committee are looking for approval of the below process

Flowchart 1

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Applications approved by the Head of Primary Care would be added to the scheme of delegations decision log and reported back to the Primary Care Commissioning Committee in the same way that chairs action currently is.

3.0 Recommendation

Based on the information set out in this paper, the Primary Care Commissioning Committee is asked to:

1. Approve the process outlined in Flowchart 1.

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Title Decision Log

Purpose of Paper To update the committee on decisions made in line with the scheme of delegation


N/A


N/A


PCCC is asked to:Note

Author Sophie HolmesPrimary Care development Officer




This paper links to the following:

Strategic Objectives:

This is a statutory requirement

ENGAGEMENT ACTIVITY



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2



N/A

Supporting documents

Page 2 of 2Item 11 - Cover Sheet Decision Log.docxOverall of 73

What Date of Application Outcome Who Date of Decision Rationale Method of Decision: How Noted at PCOG Noted at PCCC

is the detail around the request Approved or rejectedmade the decision

(Choose from drop down)decision was made for the decision e.g. via meeting or email decision is to be implemented

Brune Medical Centre Premises Improvement grantApproval for grants for practices to move from

single to double glazing. Approved NHS England

This grant does not apply to replace existing glazing on

like for like basis.

Moving from single glazing to double glazing can be

viewed as a security measure.

Email between Sophie Holmes

and Martin Jones on 04.10.16.

practice to obtain 3 quotes for

CCG to approve N/A PCOG on 30.11.2016

Vine Medical Group Breach notice

Phone lines being down at practice and

patients unable to access during core hours,

amounting to a breach of core contract

02/11/2016 Pending

Was the breach issued as soon as the practice were

mad aware?

Practice asked to conduct a

Significant Event Analysis to

submit to the CCG, this will

then be discussed with the

LMC

N/A PCOG on 30.11.2016

Park Lane Medical

CentreBreach notice

Phone lines being down at practice and

patients unable to access during core hours,

amounting to a breach of core contract

20/09/2016 Pending

Was the breach issued as soon as the practice were

mad aware?

Practice asked to conduct a

Significant Event Analysis to

submit to the CCG, this will

then be discussed with the

LMC

N/A

Riverside Partnership Boundary Changes

Following closure of their branch site in

Bordon, the practice wish to change their

boundary to remove Bordon and to widen

their boundary around Liss.

This was approved

06/06/2016 Approved Head of Primary Care 10/11/2016

◦ Engagement with patient population had been

undertaken

◦ Patient safety element due to patients who register

living In Bordon being far away for a home visit

◦ The purpose of the branch closure was for the

practice to become sustainable, continuing to see

patients from Bordon would not have helped achieve

the purpose.

◦ Meeting with neighbouring

practices

◦ Liaison with NHSE regarding

application

◦ Subject to a new

comprehensive map supplied

◦ Practice to update website,

patient info leaflet and NHS

Choices

◦ CCG to notify stakeholders

◦ NHSE to issue contract

variation and to notify PCSE

◦ yes - 13Q assessment

undertaken and a

comprehensive list of

stakeholders were engaged,

along with letters sent to all

head of household

PCOG on 30.11.2016

Bosmere Medical

PracticePartnership Changes requiring a procurement decision.

applied to remove Dr Victoria Holliday who

retired on 30th June 2016. replaced with a

salaried GP

Approved PCCC 07/12/2016

◦ Going from 8 partners to 7 partners, therefore there

Is no reason to doubt the remaining partners can

continue with the PMS contract

◦ All partners are on the registered performers list

◦ A salary GP has been recruited to replace the

sessions lost, therefore low risk of impact on patient

safety and patient experience

◦ Conversation with practice

about plans to recruit and

impact on practice

◦ Paper to PCC with

recommendation

◦ Partner to leave practice as

planned

◦ CCG to liaise with NHSE to

raise variation to contract

N/A PCOG on 30.11.2016

Grange Surgery Partnership Changes requiring a procurement decision.Dr Ben Arnold leaving the practice from the

28th October 2016 with no plans to recruitApproved PCCC 07/12/2016

◦ Going from 4 partners to 3 partners, therefore no

reason to doubt the remaining 3 partners can

continue with this PMS contract




impact on practice


recommendation


planned



N/A PCOG on 30.11.2016

Homewell & Curlew Partnership Changes requiring a procurement decision.Dr Ryan leaving the practice on the 1st Jan

2017 with no plans to recruitApproved PCCC 07/12/2016

◦ Going from 9 partners to 8 partners, therefore there

Is no reason to doubt the remaining partners can

continue with the PMS contract




impact on practice


recommendation


planned



N/A PCOG on 30.11.2016

Swan Surgery

Liphook Village Surgery

Forton Medical Centre

Stoke Road Medical

Centre

Waterside Medical

Centre

Brune Medical Centre

Queenswood Surgery

Cowplain Family

Practice

Denmead Practice Partnership Changes.Applied to add Dr Mark Saville to the

Partnership effective from 1st June 201729/12/2015 Approved PCCC - Chairs Action 31/01/2017

Partner joining is already on the local performers list

and it supports the sustainability of the practice.


◦ Details sent to Margaret

Scott (Chair) outlining the

change

◦ Partner to join practice



N/A

Denmead Practice Partnership Changes.

Senior partner retiring who CQC registered

member. The new senior partner will register,

however the decision will therefore ned to be

taken as a chairs action for PCCC

05/01/2016 Approved PCCC - Chairs Action 31/01/2017No change to number of partners, CQC membership is

being transferred so no risk




change


planned

◦ CQC membership to change



N/A

Denmead Practice Partnership Changes.

Partner left without notice, new partner

joining who is already a GP in South Eastern

Hampshire

11/01/2016 Approved PCCC - Chairs Action 01/02/2017

Partner is no longer working there, therefore should

not be an accountable partner, plans in place to

recruit


about plans to recruit



change


planned



Letter was sent to patients

notifying them due to the

immediate effect of this

Denmead Practice Partnership Changes.Applied to add Dr Ewan O'Farrell to the

Partnership effective from 1st March 201724/01/2017 Approved PCCC - Chairs Action 01/02/2017






change




N/A

Bosmere Medical

PracticePartnership Changes.

Applied to add Dr David Atchison to the

Partnership effective from 1st July 2017.08/02/2017 Approved PCCC - Chairs Action 16/02/2017






change




N/A

Vine Medical Group Partnership Changes.Informed us that Dr David Matthews left 1st

April 201613/02/2017 Approved PCCC - Chairs Action 22/02/2017

Partner had already left the practice 10 months ago.

The Chair requested assurance as to why the CCG

were only just being made aware. The practice

confirmed that it was an administrative error and

confusion with the scheme of delegation.


on why only just being

informed



change

◦ Partner has left the practice

and the practice are aware of

the partnership changes

process



N/A

Any consultation of

engagement required?Decision required

CO-COMMISSIONING DECISION LOG

Practice

Merge process being

undertaken with CCG leads

and Practices

Yes, as per merger

communications planPractice Mergers (with no service changes for patients)

To merge businesses but maintain two sites

and enhanced access for patientsChief Development Officer 17/11/2016 Supports CCG strategic aimsApproved 27/10/2016

Practice Mergers (with no service changes for patients)To merge businesses but maintain two sites

and enhanced access for patients

03/11/2016

10/04/2016

Chief Development Officer

approval

PCCC 07/12/2016

Supports CCG strategic aims, however some concerns

around Southern Health were raised This was

concluded that sustainability requires Southern Health

to be involved and the merge was approved

PCCCPractice Mergers (with no service changes for patients)

To merge businesses but maintain two sites

and enhanced access for patients.

Will also merge with Southern Health FT and

will result in circa 40,000 list size- therefore

novel and contentios and must go to PCCC

Chief Development Officer

approvalApproved Chief Development Officer 30/04/2016 Supports CCG strategic aims

Merge process being


and Practices as well as

Southern Health Project

manager

Yes, as per merger

communications plan

Yes, as per merger

communications plan

Merge process being


and Practices as well as

Approved

G:\Development Directorate\Primary Care - General Practice\CoCommissioning\Decision log\Decision Log v3Page 1 of 1Item 11 - Decision Log.pdf

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Title Minutes of Other Meetings

Purpose of Paper For information.


The following minutes are presented for information:

Primary Care Operational Group o 30th November 2016

Chairs Action – Local Incentive Scheme o 12th January 2017


Topics of discussion at the meeting


PCCC is asked to: Note the information set out in the paper.

Author Sophie HolmesPrimary Care Officer

Sponsoring member Margaret ScottChair, Primary Care Commissioning Committee



This is an issue of Corporate Governance

ENGAGEMENT ACTIVITY

Engagement Activity Not applicable


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Equality and Diversity Not applicable


Not applicable

Supporting documents Not applicable

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MinutesJoint Fareham & Gosport and South Eastern Hampshire Primary Care Operational Group (PCOG)

Held on Wednesday 30th November 2016 in the CommCentre Building

Attendees

Andrew Holden (AH) (Chair) GP Lead for Primary Care – South East Hampshire CCGAndy Wood (AW) Chief Finance OfficerJason Peett (JP) Head of Medicines Management Keeley Ellis (KE) Head of Primary Care Lucy Doherty (LD) Lay Member ChairMelanie Smoker (MSm) NHS England Natalie Barker (NB) (minutes) Primary Care Engagement OfficerPat Shirley (PS) Lay Member ChairPaul Howden (PH) GP Lead for Planned Care/Long Term Conditions – Fareham & GosportSally Ross (SR) GP and LMC Medical DirectorSara Tiller (ST) Chief Development Officer Sarah Malcolm (SM) Senior Commissioning Programme OfficerSophie Holmes (SH) Primary Care Development OfficerApologies

Barbara Rushton Clinical Chair – South Eastern HampshireDavid Bailey (DB) Deputy Chief Officer for FinanceDavid Chilvers (DC) Clinical Chair - Fareham and Gosport CCG Julia Barton (JB) Chief Quality OfficerLisa Harding (LH) Director, LMCLisa Medway (LM) Estates Project ManagerLyn Darby (LD) Deputy Chief Commissioning OfficerMargaret Scott (MSc) Lay Member Chair Sian Davies (SD) Consultant in Public HealthSuzanne Van Hoek (SVH) Deputy Chief Quality Officer

Action Log

No: Meeting: Owner: Action: Status:2 October Commissi

oningCommissioning to take forward the Mental Health GP Referral Activity. This was on the F&G TARGET on 29.11.16 and to be scheduled at SEH TARGET, and removed from actions when complete.

G

3 November SH For TARGET sponsorship, write to providers for 2017/18 to give equitable opportunities. Agenda for PCOG between January and March 2017 when EOI’s have been received.

A

4 November AH PCSE – AH to raise with JB for assurance that Quality have clinical issues arising with PCSE registered.

R

5 November NB To agenda PCSE at PM Forum. G

6 November MS Regarding the Vulnerable Practice and GP Resilience Scheme Progress MS was asked to go back to NHSE for an update on progress.

R

7 November JP LCS 2016/17 - JP to advise on ‘provision for adequate equipment’ in the LCS specification.

G

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8 November All PCOG members to feedback on the GPFV Implementation Plan.

G

0 November SH In future to bring a paper to PCOG after Action on Elective to include:- What is happening and what is being done- Outcomes from the meeting

To feed the data into the Primary Care Profile report.

R

1. Introductions:Welcome and apologies - AH welcomed the group to the meeting and informed the members of the apologies which are noted above.

2. Register and Declarations of Interest: The latest version of the Conflict of Interest Register was noted.

3. Minutes from Previous Meeting:The minutes from the previous meeting from 9th November 2016 were agreed as an accurate record and the action log was updated.

4. Matters Arising:Terms of Reference Please note these have been re-worded to state that deputies for attendance are to be sent where appropriate and these persons should be enabled to make decisions.

Capita Financial Audit Update / PCSE:AW stated the PCSE concerns have been raised nationally. GP’s are now encouraged to QUASAR any issues that impact patient care, e.g. patient notes not being available at a consultation. The Primary Care Team continue to maintain a log of QUASAR issues and raise this via NHSE Area Team, who then liaises with PCSE. These items are also raised via quality meetings and are on the CCG corporate risk register. There was a discussion around patients being consulted with no paper notes and the clinical risk around this. The latest notes would ordinarily also be available electronically, unless the electronic transfer from the previous practice is not possible. It should be noted that is is unlikely that a patient is seen at consultation without any notes at all. MSm stated that as an Area Team, they do not directly hold the PCSE contract, as it is held by central NHSE. They are therefore only able to escalate issues and rely on feedback from PCSE on progress updates. They have been told there is a ‘target team’ working on the issues with PCSEs. MS felt some parts of the contract are working well, but from a CCG perspective there is not confidence in the service. ST asked if the group has ideas for taking this forward, proactively, on a clinical basis within the influence of the CCG.

Action: AH to raise with JB for assurance that Quality have clinical issues arising with PCSE registered. To agenda PCSE at PM Forum.

Vulnerable Practice and GP Resilience Scheme Progress - PH declared a conflict of interest with this item. There are currently 6 practices on the vulnerable practice list. KE has visited 5 and has signed Memorandum of Understanding’s with them. Funding applications were submitted by 25th November and the funds allocated should be allocated for spending by 31st March 2017 and be sent directly to practices.

Action: MS was asked to go back to NHSE for an update on progress.


3

5. LCS (Locally Commissioned Service) Specification:

AH and PH declared a conflict of interest with this item.

The paper was discussed at JCC on 23rd November where amendments were suggested to the specification. This focused around the additions to the specification which are:3.1 – Diabetes prevention programme3.9 – Wound management3.10 – Follow up for breast, bowel and diabetic eye screening. KE clarified there is no duplication of work or payment with Public Health England. 3.11 – National Cancer Diagnosis Audit – Focusses on diagnoses made in 2014 and practices running their own audit. AH asked the group to clarify that this is a clinical audit, not financially based.3.12 – Secondary Care Referrals – This is a continuation of practices using Harvey Walsh to upload referral data.

The block contract is felt to have been a successful scheme in 16/17, and has created capacity both in the Primary Care Team and amongst practice managers through reduced reporting equirements. It will therefore continue. Practices will be paid for this activity based on their 01.04.17 list size. The per patient population payment is to be determined with Finance. KE provided assurance to the LMC that practices are not penalised if they have no patients requiring a particular service commissioned. Practices reporting a ‘0’ this year have been communicated with and this ultimately seems to be down to coding.

Action: JP to advise on ‘provision for adequate equipment’ in the LCS specification.

6. GPFV Planning Guidance:

This is a new requirement from NHS England that practices are required to write a operating plan. The 1st draft was submitted last week along with the 3 CCG Operational Plan. PS and SR felt the plan is quite aspirational and therefore needs close scrutiny.

Action: PCOG members to feedback on the GPFV Implementation Plan.

7. GP Referral Report:

SH discussed her paper on GP referral rates as well as a comparison verses provider referral data. For discrepancies of above average referral rates within primary care, the team have liaised with practices as to reasons why this could be, and responses have been such as patients private insurance has lapsed or practices have taken on complex patients from practices that have closed down. These actions and points are then fed to the Action on Elective meeting.

A comparison of provider and Primary Care reported data was made, and discrepancies are obvious across all 8 identified specialities (T&O, Urology, Gynae, Dermatology, Ophthalmology, Cardiology, Rheumatology and ENT). There were some discussions about the accuracy of the data which it was agreed would be picked up through the correct route at Action on Elective.

Actions: Through AoE share the data with CSU to ensure all data is aligned and similar. Through AoE investigate if follow up activity is being coded as 1st outpatient appointment. In future to bring a paper to PCOG after Action on Elective to include:

- What is happening and what is being done- Outcomes from the meeting

To feed the data into the Primary Care Profile report.


4

8. Decision Log:

The latest decision log was discussed and clarified the purpose of the log is to provide PCOG with oversight on decisions taken outside of this group as per the scheme of delegation. No members raised objectives to the decisions made.

9. Any Other Business:Partnership Changes – AH highlighted concerns that PCSE have not made contact about the changes, however KE gave assurance that this is being discussed at PCCC.

10. Date of Next Meeting:

25th January 2017


Local Incentive Scheme (LIS)Chairs Action for 17/18

1. Background

In December 2016 the recommendations paper for the CCG enhanced services for General Practice came for discussion and a decision.

2. Recommendations for next year’s LIS

The recommendations for next year’s Local Incentive Scheme made to Primary Care Commissioning Committee in December were as follows:

Components 1 – 3:1. Continue to support clinical commissioning through attendance at forums. 2. Continue to support prescribing improvement plans and reducing prescribing spend. 3. Continue a component that focusses on quality and safety in Primary Care

Component 4 will put a focus on:a. Improving data quality in general practiceb. Coding of veterans and veterans families to ensure the CCG has a robust recording of this

cohort of patients to continue to design servicesc. Support the CCGs critical work regarding elective activity and ask practices on an ad-hoc

basis to support data audit work

For component 5 the recommendation was to continue to incentivise collaborative working and further enhance that to include implementation of the GP Forward View which is a strategic must for the CCG.

4. Matching the LIS to the CCGs’ strategic objectives:

Component Strategic Objective MetContinuing to support clinical commissioning through attendance at forums.

Ensure that the CCGs is engaged with its key stakeholders

Continue to support prescribing improvement plans and reducing prescribing spend. Continuing a component that focusses on quality and safety in Primary Care

Patients using local health services will experience reduced variation in treatment and care standards; they will notice increasing consistency in the quality of services across all care providers

Incentivising practices to focus on data quality and audit of elective work

Commission consistently high quality planned care services that work with patients to deliver the best outcomes possible

Incentivise Primary Care at Scale and collaboration and implementation of the GP Forward View

Integrate primary care, community care, social care and voluntary services to deliver a range of care, close to home that allow people with complex needs and the most vulnerable to stay healthy and feel in control of their health

5. Funding weighting

Given the strategic importance of component five, but also the importance of component four to support the CCGs’ Financial Recovery Plan and component three to support quality improvement in general practice; the weighting of the funds available to practices was proposed to remain the same as 2016/17 which is as follows:

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Continuing to support clinical commissioning through attendance at forums.

10%

Continuing to support prescribing improvement plans and reducing prescribing spend.

15%

Continuing a component that focusses on quality and safety in Primary Care

10%

Incentivising practices to focus on data quality and audit of elective work

20%

Incentivise Primary Care at Scale and collaboration and implementation of the GP Forward View

45%

6. Chair’s Action

Primary Care Commissioning Committee approved the proposal of the LIS and the proposed weighting of funding. PCCC also delegate the final sign off of the proposed costing model for the LIS to chair’s action, on the receipt of detailed finances by practice to provide assurance regarding conflicts of interest.

The detailed finances were reviewed by the Chair of PCCC on 12th January 2017. It was noted that: There had been no reduction in the focus on quality and patient experience with the proposed

schemes. Payments were based on list sizes and therefore couldn’t materially benefit any of the GPs that

could be perceived to have a conflict of interest. There isn’t any funding that is practice specific and therefore there isn’t any benefit for any member

practices which have Governing Body GPs represented on the CCG Governing Body.

Chair’s action and approval was given to the funding model for the Local Incentive Scheme.

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