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Meeting Title

Primary Care Commissioning Committee Date Tuesday 2 August 2016

Meeting No. 19. Time 2:00pm – 3:00pm

Chair Mr Clive Wood ELR CCG Deputy Chair and Chair of the Committee

Venue / Location

Gartree Committee Room, ELR CCG, Leicestershire County Council, County Hall, Glenfield, Leicester, LE3 8TB

ITEM AGENDA ITEM ACTION PRESENTER PAPER TIMING

PC/16/84 Welcome and Introductions Clive Wood

2:00pm PC/16/85 To receive questions from the Public

in relation to items on the agenda To receive Clive Wood

PC/16/86 Apologies for Absences:

• Dr Tabitha Randell • Mrs Carmel O’Brien

To receive Clive Wood

PC/16/87 Declarations of Interest on Agenda items To receive Clive Wood 2:05pm

PC/16/88

To Approve minutes of the previous meeting of the ELR CCG Primary Care Commissioning Committee held on 5 July 2016

To approve Clive Wood A

2:10pm

PC/16/89 To Receive Actions and Matters Arising following the meeting held on 5 July 2016

To receive Clive Wood B

PRIMARY CARE FINANCE REPORT

PC/16/90 Primary Care Co-Commissioning Finance Report 2016-17: Month 3 (June 2016)

To receive Donna Enoux C 2:15pm

OPERATIONAL ISSUES

PC/16/91 Narborough Health Centre: Application to Temporarily Close Patient List

To receive Khatija Hajat D 2:30pm

PC/16/92 Syrian Refugee Resettlement Programme To receive Jamie Barrett E 2:40pm

ITEM AGENDA ITEM ACTION PRESENTER PAPER TIMING SUB-GROUP REPORTING

PC/16/93 Primary Care Delivery Group: Theme - July 2016 To receive Jamie Barrett F 2:50pm

ANY OTHER BUSINESS

PC/16/94 To receive Clive Wood Verbal 2:55pm

DATE OF NEXT MEETING

PC/16/95

Date of next meeting: Tuesday 6 September 2016, 2:00pm – 5:00pm (Cancelled) Tuesday 4 October 2016 (time to be confirmed), Goscote Committee Room, ELR CCG, County Hall, Glenfield, Leicester, LE3 8TB.

Clive Wood

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Paper A ELR CCG Primary Care Commissioning Committee

2 August 2016

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EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

Minutes of the Primary Care Commissioning Committee held on Tuesday 5 July 2016 at 2:00pm, Guthlaxton Meeting Room, ELR CCG, ELR CCG, County Hall, Glenfield,

Leicester, LE3 8TB

Present: Mr Clive Wood Lay Member (Chair of the Committee) Dr Tabitha Randell Secondary Care Clinician Dr Vivek Varakantam GP, Oadby and Wigston Locality Lead Mr Tim Sacks Chief Operating Officer Mr Colin Groom Deputy Chief Finance Officer (on behalf of Chief Finance

Officer) Mrs Chris Bufton Head of Nursing (on behalf of Chief Nurse and Quality Officer) In attendance:

Mrs Daljit K. Bains Head of Corporate Governance and Legal Affairs, ELR CCG Ms Claire Deare Development Manager, Leicester, Leicestershire and Rutland

Local Medical Committee Mr Peter Forrester Business Manager, Empingham Practice (Practice Manager

Representative) Ms Jenifer Fenelon Healthwatch Rutland Mrs Amardip Lealh Corporate Governance Manager (minutes)

ITEM DISCUSSION LEAD RESPONSIBLE

PC/16/72 Welcome and Introductions Mr Wood welcomed all members to the Public meeting of the Primary Care Commissioning Committee (PCCC), in particular, Mr Forrester, Business Manager from the Empingham Medical Practice, who was attending as the representative from the Practice Manager’s Forum. This was followed by a series of introductions. Mrs Daljit Bains informed that the meeting was not quorate until Mrs Chris Bufton joins the meeting. Mr Wood therefore proposed that the review and approval of minutes be deferred until later in the meeting.

PC/16/73 To receive questions from the Public in relation to items on the agenda No questions received as there were no members of public present.

PC/16/74 Apologies for Absence: • Dr Andy Ker, Clinical Vice Chair • Mrs Carmel O’Brien Chief Nurse and Quality Officer • Mrs Donna Enoux, Chief Finance Officer


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• Dr Nick Glover GP, Blaby and Lutterworth Locality Lead

• Dr Girish Purohit, GP, Lead Melton, Rutland and Harborough

• Mr Jamie Barrett, Head of Primary Care • Mrs Caroline Goulding, Primary Care Assistance

Contract Manager • Ms Kiran Loi, Public Health Specialty Registrar • Ms Sue Staples, Healthwatch Leicestershire.

PC/16/75 Declarations of Interest All GPs present declared an interest in any items relating to commissioning of primary care where a potential conflict may arise, with particular reference to the following items:

• PC/16/81 – Primary Care Delivery Group (PCDG): Summary Report June 2016 Dr Varakantam declared a conflict of interest as his Practice, The Croft Medical Centre, has been selected as one of the three Practices for a random Pre-Payment Verification review.

• Ms Deare declared an interest in relation to all GP Practices as the Local Medical Committee (LMC) provides general support to all Practices.

PC/16/77 To Receive Matters Arising following the meeting held on 7 June 2016 (Paper B) The revised matters arising following the meeting held on Tuesday 7 June 2016 were received, with the following updates noted:

• PC/15/35 - 7 Day Services in Primary Care: Pilot Update (including AVS), April 2016 Mr Sacks confirmed data is in the process of being collated, following the completion of the pilot programme in June 2016, which could not be presented in July 2016 due to the timeliness of the papers being circulated. An update will be presented to the Committee in August 2016. Action ongoing.

• PC/16/47: Asylum Dispersal in South Wigston: Commissioning Options Mr Sacks confirmed information continues to be collated to monitor progress of the asylum service provider, Inclusion Healthcare, which will be presented to the Committee in August 2016. Action ongoing.


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• PC/16/64: Primary Care Commissioning Support

Process Action complete.

It was RESOLVED to:

• RECEIVE the matters arising and note the progress to date.

PC/16/78 Primary Care Co-Commissioning Finance Report 2016-17: Month 2, May 2016 (Paper C) Mr Groom presented this report, which provided a summary of the financial position for the primary care co-commissioning budget for Month 2 (May 2016). Appendix 1 of the report contains the year to date and forecast position for primary care co-commissioning expenditure areas. For month 2, these have all been reported as breakeven due to the availability of robust in year data. Detailed variance analysis will be included in the reports from month 3 onwards. It was noted that the report did not include the prescribing budget and the wider primary care budget as these fell in the remit of the CCG Governing Body. It was RESOLVED to:

• RECEIVE the report.

PC/16/79 Latham House Medical Practice: Proposed Service Changes - Update (Paper D) Mr Sacks presented this report, which provided an update on the actions taken with the Latham House Medical Practice (LHMP) following the decisions made by the Committee at its last meeting in June 2016. The following actions have been taken to date: 1. Complex wound dressing clinics are being commissioned

from the Leicestershire Partnership NHS Trust (LPT). These will be provided from the Melton Hospital; and the specification and costs to the CCG are being finalised. It was noted that patients will not be disadvantaged as there will be no gaps in service provision.


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2. Mr Sacks has met with the Business Manager at the Practice and a follow-up meeting has been arranged for 15 July 2016 to work through a five year plan for service delivery and the potential impacts. It was stated this meeting may also be attended by Mrs Karen English, Managing Director of ELR CCG. It was agreed for the plan for the Practice to be shared with the Committee, once agreed.

In addition, Mr Sacks confirmed the Practice has received correspondence from the Rt. Hon. Sir Alan Duncan (Member of Parliament) in relation to information on the referral scheme, which has been forwarded to Mr Sacks. A response to be sent from the CCG to Sir Alan; with agreement from the Practice. It was RESOLVED to:


Tim Sacks

Tim Sacks

PC/16/80 Care Quality Commission (CQC): Wycliffe Medical Practice (Paper E) Mr Sacks presented this report, which provided an update on progress the Wycliffe Medical Practice has made following the inspection by the Care Quality Commission (CQC) on 15 March 2016. The CQC report, which is available from their website, was published on 10 May 2016, and rated the Practice as ‘Requires Improvement.’ Appendix A sets out the CQC’s findings; improvements required; the relevant contractual clauses and the remedial actions required by the practice for assurance to the CCG. In light of the above, the CCG has met with the Practice and created a draft plan of action; and noted the Practice has made good progress since the publication of the CQC report. Mrs Deare informed the Committee that the Local Medical Committee (LMC) have not been in touch with the Practice and raised concern in relation to the inconsistency of CQC reports and ratings across the region. It was RESOLVED to:



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PC/16/81 Primary Care Delivery Group (PCDG): Summary Report June 2016 (Paper F) Mr Sacks presented this report, which provided an update on the key themes from the PCDG meeting held in June 2016:

1. Estates and Technology Transformation Fund (ETTF) – System migration was highlighted as the only Information Management and Technology (IM&T) bid that the CCG would be submitting on behalf of the 3 Leicester, Leicestershire and Rutland CCGs.

2. E-Referral Service – The CCG is currently performing at 67% against the NHS Quality Premium target of 80%. Meetings have taken place with the Health and Social Care Information Centre (HSCIC) in order to undertake a data cleansing exercise to reduce the gap.

3. PPV Selection 2015/16 – Following a random

selection of Practices for the annual Pre-Payment Verification (PPV) exercise in line with the Quality and Outcomes Framework (QOF), the following 3 GP Practices were selected: - The Masharani Practice (C82611) - The Glenfield Surgery (C82056) - The Croft Medical Centre (C82067) The PPV exercise will be undertaken by the CCG’s Internal Auditors. Dr Varakantam declared an interest in relation to the PPV section of this report, as his Practice, The Croft Medical Centre, had been selected as part of this review.

Mrs Fenelon requested all abbreviations to be documented in full, as it can be difficult to understand the report, in the absence of this. Mr Forrester informed that he was present at the sub-group meeting and added the following:

• ETTF – It was noted there was a conflict issue raised at the PCDG in relation to this item. Mrs Bains confirmed that it was not within the remit of the PCDG to rank the bids in order of priority due to conflicts of interest. She added that the bids had been reviewed and agreed at the last PCCC meeting.


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• E-Referral Service – It was reported that the CCG is

not on trajectory for meeting the national target; however, is having discussions with (and involving) the University Hospitals of Leicester (UHL) NHS Trust. From a Practice Manager’s point of view, Mr Forrester stated the target needs to be understood, as well as impact and likelihood of it be achieved, or not; as this is a vital part of the contract. Mr Sacks noted the comments made and noted the number of requests made to Practices from the CCG and NHS England; and confirmed the CCG is willing to work with Practices as much as possible.

It was noted that this was the current target; although noting it was not the most useful for CCGs. Dr Randell suggested reviewing the administration and any guidance to expand the service and the increase use of e-referrals; as this could not be providing value for money.

It was RESOLVED to:

• RECEIVE the report. [Mrs Bufton joined the meeting]. Mr Wood confirmed that the meeting was now quorate.

PC/16/76 To Approve minutes of the previous meeting of the ELR CCG Primary Care Commissioning Committee held on 7 June 2016 (Paper A) The minutes of the meeting held on Tuesday 7 June 2016 were approved as an accurate reflection of the meeting, subject to the following area for clarification:

• Consistency of member roles Mrs Bains confirmed minor errors in relation to how roles have been noted throughout the minutes were inconsistent / inaccurate. These have been reported to Mr Wood and will be amended accordingly, Mr Wood noted that the amendments did not affect the decisions made.

• Page 2, Questions from the Public in relation to items on the agenda


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Mr Wood noted the action for the email from the Latham House Medical Centre to be shared with members of the Committee had not been added to the action log. Mr Sacks apologised for the oversight as this action had not been completed. It was agreed that it would now be more timely for the action plan for the Practice to be shared with the Committee (see PC/16/79 - Latham House Medical Practice: Proposed Service Changes – Update above).

It was RESOLVED to:

• APPROVE the minutes of the last meeting as an accurate record, subject to the above amendments.

PC/16/82 Any other Business Mr Wood thanked Mr Forrester for his attendance and contributions. There was no other business to discuss.

PC/16/83 Date of next meeting: Tuesday 2 August 2016 at 2:00pm, Gartree meeting room, ELR CCG, County Hall, Glenfield, Leicester, LE3 8TB. Apologies received from Dr Randell.

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Paper B ELR CCG Primary Care Commissioning Committee Meeting

2 August 2016

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NHS EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTE MEETING

ACTION NOTES

Minute No.

Meeting Item Responsible Officer

Action Required To be completed

by

Progress as at 25 July 2016

Status

PC/16/35 5 April 2016 7 Day Services in Primary Care: Pilot Update (including AVS) – April 2016

Jamie Barrett To: • review and update the

information and data presented;

• develop a plan for the next steps of the scheme.

June 2016

August 2016

On agenda. Action complete.

GREEN

PC/16/47 3 May 2016 Asylum Dispersal in South Wigston: Commissioning Options

Jamie Barrett To continually review and monitor progress with the service provider (Inclusion Healthcare) and present an update to the Committee in 3 months’ time.

August – September

2016

Information continues to be collated and will be presented in September 2016. Action ongoing.

AMBER

PC/16/79 5 July 2016 Latham House Medical Practice: Proposed Service

Tim Sacks To ensure: • the 5 year plan for service

delivery is shared with the Committee, once approved;

July – September

2016

Work in progress. Action ongoing.

AMBER

No progress made On-Track Completed

Key

Paper B ELR CCG Primary Care Commissioning Committee Meeting

2 August 2016

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Minute No.

Meeting Item Responsible Officer

Action Required To be completed

by

Progress as at 25 July 2016

Status

Changes - Update

• a response to be sent from the CCG to Sir Alan in relation to correspondence received regarding the referral scheme; with agreement from the Practice.

July – August 2016

Work in progress. Action ongoing.

AMBER

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Paper C ELR CCG Primary Care Commissioning Committee Meeting

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EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Front Sheet

REPORT TITLE: Primary Care Finance Report Month 3 (June 2016)

MEETING DATE: 2 August 2016

REPORT BY: Sapna Patel, Senior Primary Care Accountant

SPONSORED BY: Donna Enoux, Chief Finance Officer

PRESENTER: Donna Enoux, Chief Finance Officer

PURPOSE OF THE REPORT: The purpose of this report is to provide a summary of the financial position to Month 3 (June) of the Primary Care budgets.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG PCCC is requested to:

• RECEIVE the reported variance position against the Primary Care budgets based on reporting information available. At this stage there are still many areas reporting a breakeven position due to the unavailability of in year reporting information. Detailed variance reporting for these areas will be available in Month 4.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2016 – 2017: (tick all that apply) Transform services and enhance quality of life for people with long-term conditions

Improve integration of local services between health and social care; and between acute and primary/community care.

Improve the quality of care – clinical effectiveness, safety and patient experience

Listening to our patients and public – acting on what patients and the public tell us.

Reduce inequalities in access to healthcare Living within our means using public money effectively

Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).

EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not required at this point.


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RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: • Report covers finances for (but not the operational delivery of) Primary Care

Budgets that support the delivery of Primary Care Strategy (BAF 6); • Report supports the appropriate management of Primary Care Budgets and the

achievement of financial targets (BAF 10).


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Primary Care Finance Report Month 3 (June 2016)

2 August 2016

1. Month 3 Year to date and Forecast Position

Appendix 1 contains the year to date and forecast position for the total primary care expenditure areas. Month 3 reporting shows a YTD overspend of £215k and an annual forecast overspend of £53k. Prescribing Prescribing has been reported as breakeven however the YTD overspend (£122k) reflects performance as at M1 based on the data received from the PPA. As this is a volatile area, the information from the PPA will be monitored on a monthly basis against QIPP targets to provide a robust positon in the future. Community Based Services All community based services have been reported as breakeven apart from travelling families which is reporting an overspend of £52k due to slippage in QIPP. The impact will be quantified in M4 based on period of notice served. Q1 CBS claims were due in July therefore a detailed variance analysis will be included in M4 reporting. GP Support framework, AVS, 7 Day working, GP IT These have all been reported as breakeven due to the availability of robust in year data but detailed variance analysis will be included in the reports from month 4 onwards. Co-commissioning Appendix 2 contains the reported positions for the primary care co-commissioning expenditure areas. As at month 3 this shows a YTD overspend of £156k and a forecast overspend of £302k. The main areas of forecasted overspends and underspends are highlighted below: Overspends: Uppingham surgery premises (£116k), Long Street caretaking (£126k), APMS Wigston Central contract (£237k), Extended Hours (£57k), Glenfield premises (£11k), and Kingsway long term management plan (£10k) Underspends: Long street PMS contract (£48k), transformation reserves (£165k), prescribing charge income (£10k), and MPIG (£9k).


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Expenditure against pharmacists in GP practices (£488k) and wound clinics (£325k) will be funded from the FDR (£165k) and PMS monies (£659k). Potential release of funding from Market Harborough premises and NHS England support have been noted and will be accounted for in next month’s position. As co-commissioning is forecasting an overspend PCCC will no longer be able to approve additional expenditure and can only make investment recommendations to the Governing Body (as agreed at the July Governing Body Committee). Primary Care Other For month 3 this area is reporting an underspend of £301k. The main areas of forecasted overspends and underspends are highlighted below: Overspends: South Wigston Support (£50k), vulnerable practices (£16k), asylum seekers service (£55k) Underspends: Excess wound clinics budget (£318k), excess medicines management hub budget (£93k) and additional flexibility from realigned GP SIP budgets based on actual list size adjustments (£9k). Other immaterial variances There is a £3k underspend reported against joint working relating to Long Street. Northern Doctors is reporting an overspend of £4k based on actual contract value.

2. Recommendation: The ELR CCG Primary Care Commissioning Committee is requested to:

• RECEIVE the reported variance position against the Primary Care budgets

based on reporting information available.


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Appendix 1

YTD Position Forecast Outturn Position

M3 Primary Care Commissioning Report YTD Budget

YTD Actuals

YTD Variance

Annual Budget

Annual Forecast

Annual Variance

Over/(Under)

Area (£'000s) (£'000s) (£'000s) (£'000s) (£'000s) (£'000s)

CCG Prescribing

Scriptswitch 30 30 0 121 121 0

Central Prescribing 327 316 (11) 1,306 1,306 0

High Cost Drugs 242 250 8 966 966 0

GP Prescribing 11,580 11,705 125 46,321 46,321 0

Total Practice Prescribing 12,179 12,301 122 48,715 48,715 0

Community Based Services

Community Based Services 659 669 11 2,635 2,687 52

Total Community Based Services 659 669 11 2,635 2,687 52

GP Support Framework

Care Homes 114 114 0 457 457 0

End of Life 81 81 0 325 325 0

Prescribing Incentive Scheme 160 160 0 641 641 0

Long Term Conditions 34 34 0 138 138 0

Joint Working 81 81 0 325 323 (3)

Planned Care 0 0 0 0 0 0

GP Federation 44 44 0 175 175 0

7 Day Working Better Care Fund 156 156 0 623 623 0

Dementia 163 163 0 651 651 0

Heart Failure 41 41 0 163 163 0

Total GP Support Framework 874 874 0 3,497 3,494 (3)

Other

GP Co-Commissioning 9,836 9,992 156 39,344 39,645 302

Urgent Care Centres 483 483 0 1,930 1,934 4

GP IT 175 175 0 700 700 0

Primary Care - Licenses & Other 133 60 (74) 534 233 (301)

Total Other 10,627 10,709 82 42,508 42,512 4

0 0 0 0 0 0

Total Primary Care 24,339 24,554 215 97,355 97,407 53


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Appendix 2

YTD Position Forecast Outturn Position

M3 Primary Care Co-commissioning Report

YTD Budget

YTD Actuals

YTD Variance

Annual Budget

Annual Forecast

Annual Variance

Over/(Under) Activity Type (£'000s) (£'000s) (£'000s) (£'000s) (£'000s) (£'000s)

GMS Global Sum 5,905 5,904 -0 23,620 23,618 -2 MPIG Correction Factor 550 548 -2 2,201 2,192 -9 PMS reinvestment 165 203 38 659 813 154 FDR Payment 41 0 -41 165 0 -165

Total General Practice - GMS 6,661 6,656 -5 26,644 26,622 -22 PMS 65 53 -12 260 212 -48

Total General Practice - PMS 65 53 -12 260 212 -48 APMS Baseline 0 46 46 0 237 237

Total General Practice - APMS 0 46 46 0 237 237 Occupational health 12 12 0 46 46 0 Travel 0 0 0 1 1 0 Locum Adoption/Paternity/Maternity 25 25 0 101 101 0 Locum Sickness 9 9 0 35 35 0 Locum suspended doctors 0 0 0 0 0 0 Seniority 131 131 0 525 525 0 Sterile Products 0 0 0 0 0 0 Statutory Levy 0 0 0 0 0 0 Voluntary Levy 0 0 0 0 0 0 GP Training 23 23 0 92 92 0 Wigston Central Care taking/Sanctions on LS 0 126 126 0 126 126

Total Other GP Services 200 326 126 800 926 126 QOF Achievement 273 273 0 1,090 1,090 0 QOF Aspiration 682 686 4 2,727 2,744 16

Total QOF 954 959 4 3,818 3,834 16 DES Extended Hours Access 102 117 14 410 466 57 DES Learning Disability 19 18 -1 75 71 -4 DES Minor Surgery 169 169 0 676 676 0 DES Unplanned Admissions 225 225 0 901 901 0 DES Violent Patients 11 11 0 46 46 0 DES Minor Surgery - PMS 0 0 0 0 0 0 LES Extended Hours Access - PMS 0 0 0 0 0 0 LES Translation Fees 8 8 0 30 30 0

Total Enhanced Services 534 547 13 2,138 2,190 52 Dispensing Quality Scheme 27 27 0 110 110 0 Prof Fees Dispensing 349 343 -6 1,394 1,372 -22 Prof Fees Prescribing 52 56 4 210 225 15

Total Dispensing/Prescribing Drs 428 427 -2 1,713 1,706 -7 Prescribing charge income -73 -76 -3 -292 -302 -10

-73 -76 -3 -292 -302 -10 Prem Actual Rent 370 372 3 1,478 1,489 11 Prem Clinical Waste 29 29 0 115 115 0 Prem Cost Rent 68 67 -1 270 268 -3 Prem Health centre Rates 4 4 0 16 15 -1 Prem Health centre Rent 18 18 0 71 71 0 Prem Notional Rent 321 350 29 1,285 1,401 116 Prem Rates 191 191 0 764 764 0 Prem Water Rates 15 15 0 61 61 0

Total Premises Cost Reimbursement 1,015 1,047 31 4,062 4,185 123 Rent 8 8 0 33 33 0 Other premises 1 1 0 3 3 0

Total Other premises 9 9 0 36 36 0 GP Pensions 0 0 0 0 0 0

Total Pensions 0 0 0 0 0 0 Transformation reserves 41 0 -41 165 0 -165

Grand Total 9,836 9,992 156 39,344 39,645 302

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Paper D Primary Care Commissioning Committee

2 August 2016

1


Front Sheet

REPORT TITLE: Narborough Health Centre: Application to Temporarily Close Patient List


REPORT BY: Khatija Hajat Primary Care Contracts Manager

SPONSORED BY: Jamie Barrett Head of Primary Care

PRESENTER: Khatija Hajat, Primary Care Contracts Manager

PURPOSE OF THE REPORT

1. Narborough Health Centre has submitted an application to temporarily close their practice list for 12 months (August 2016 to July 2017);

2. This report provides information on Narborough Health Centre to support decision-making by the Primary Care Commissioning Committee;

3. The purpose of this report is for the PCCC to make a decision on whether the practice should be allowed to close their practice list for 12 months (August 2016 to July 2017) temporarily.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Primary Care Commissioning Committee are asked to:

• RECEIVE contents of report; • SUPPORT practice application to temporarily close patient list for 12 months


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REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2015 – 2016: (tick all that apply) Transform services and enhance quality of life for people with long-term conditions



Listening to our patients and public – acting on what patients and the public tell us.

Reduce inequalities in access to healthcare

Living within our means using public money effectively


EQUALITY ANALYSIS (Respond by inserting /completing one of the three statements below, delete the ones that does not apply) An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as this is a contractual process that requires a response.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The report highlights the following risks:

• BAF 3 – Primary Care


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Narborough Health Centre: Application to Close Patient List

2 August 2016

Introduction & Purpose 1. Narborough Health Centre has submitted an application to temporarily close their

practice list for 12 months. A closed patient list means the practice will not register new patients – this can be for a minimum of 3 months or a maximum of 12 months. This is the first application that the practice has made to the CCG.

2. The purpose of this report is for the Primary Care Commissioning Committee to make a decision on whether the practice should be allowed to close their practice list for 12 months.

3. The report has been prepared taking into consideration guidance from the “Policy

Book for Primary Medical Services” published by NHS England. The guidance requires the CCG to acknowledge receipt of the application within 7 days and make a decision within 21 days.

Background & Current Position 4. Narborough Health Centre covers two sites. The main surgery is located at

Thornton Drive, Leicester and the branch surgery is located on Narborough Road Leicester which falls within NHS Leicester City CCG area. The practice has applied to both the CCGs to transfer membership to NHS Leicester City CCG. The practice list size is 2534 as at 1st July 2016.

5. Registration activity from 1st January 2015 to 31st June 2016 is given in the table overleaf:

Date Total Deductions Total Registrations Net Registrations 01/07/16 75 105 30 01/04/16 54 97 43 01/01/16 59 63 4 01/10/15 79 99 20 01/07/15 58 80 22

6. 28 Practices within a 1.5 mile radius of both the main and branch surgeries

across both NHS Leicester City CCG and East Leicestershire and Rutland CCG were consulted for consideration of potential impact of list closure. These are plotted on the local maps in Appendix A.

7. 4 local pharmacies and the LMC have also been consulted. A total of 11

responses were received (9 practices, 1 pharmacy and the LMC). The responses from nearby GP practices indicate impact of Narborough Health


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4

Centre closing their patient list would have minimal impact with neighbouring practices agreeable to accept new patients. Pharmacy Services group felt there would a significant impact on their service. Appendix B sets out the responses received.

8. The Primary Care Contracts Manager met with the practice on 4th July 2016 to seek clarification on some of the responses to questions on the application form completed by the practice and to gain additional information to support decision-making by the CCG. A summary of the key points of discussion were:

• The practice previously considered closing their list about 4-5 years ago but

following discussions with the PCT (predecessor organisation) and the potential to transfer membership over to NHS Leicester City CCG the practice did not progress to a formal application to close their patient list.

• The main reason for the practice applying to close their list is due to their inability to provide a high quality service to their registered population. Ideally they would want their list size to reduce to a manageable level of 2400 from their current 2534 which is above the national average for a single handed GP.

• Current practice resource includes 9 GP sessions (between Dr Kapur and Dr

Sharma (long-term locum GP), 1 part-time Practice Nurse, 1 locum Practice Nurse (part-time), 4 part-time reception staff, 2 part-time admin staff and 1 Health Care Assistant. Without additional funding the practice is unable to increase this resource.

• The practice has experienced a growing number of patients wishing to

register with the practice over the last 6 months (approximately 10 per week) and feels it has reached an unsustainable level. This is beginning to impact on the service they are able to offer their existing patients in terms of appointment waiting times and quality of care.

• The practice is continuing discussions with the CCG to move to NHS

Leicester City CCG as a way of overcoming some of their financial challenges.

• The practice has been unable to set up a meeting with the Patient

Participation Group to discuss their plans to close patient list due to low levels of attendance confirmation. However, the PPG Chair has provided the practice with a letter supporting their application to close the patient list due to impact on appointment waiting times and quality of service to current patient population

9. The practice carried out a patient survey of new patients requesting to join the practice between 3rd July and 19th July. The results are shown in the table below which seems to suggest that whilst there were people registering for the first time, 50% of the responses seem to indicate this is due to patient’s inability to register with other practices.


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5

No of Patients Reason for applying to join NHC

5 First-time GP

2 Refused by Practice A in the City CCG

3 Refused by Practice B in the City CCG

10. The risks of not supporting practice application to temporary close their patient

list include: • Quality of service provided to existing patients may deteriorate and have a

negative impact on patient experience;

• Patient access to service may be reduced leading to longer waiting times for a GP/nurse appointment;

• Increased pressure on current workforce to cope with increasing list size and

growing patient demand;

• Potential increase in patient dissatisfaction/complaints. 11. Temporarily closing the practice list for 12 months would reduce the current

pressure faced by the practice and enable them to continue to provide a high quality service in a timely and efficient manner. When the practice list size reduces to below 2400 the practice will be happy to reopen the list. In the meantime patients in the area have a choice of practices willing to register patients in the area.

Recommendations

The ELR CCG Primary Care Commissioning Committee are asked to: • RECEIVE contents of report;

• SUPPORT practice application to temporarily close patient list for 12 months.

Primary Care Commissioning Committee 07 June 2016

Appendix A Narborough Health Centre – Main and Branch Surgery Boundaries


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Narborough Health Centre – Registered Patients, Neighbouring Practices and Braunstone Firlands Care Home


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Key

Primary Care Commissioning Committee 07 June 2016

Appendix B STAKEHOLDER CONSULTATION

Stakeholder Responder Comments / Queries

1 Victoria Health Centre (City CCG)

Samantha Rogers Executive Manager

Is this a practice in the village of Narborough? Does their boundary overlap with any of ours? A response was emailed to practice. No further comments were received.

2 Limes (ELRCCG)

David Concar Practice Manager

We have no objection to this temporary closure of list at Narborough HC. We know that the CCG would support us should our numbers increase substantially as a result of either this or the Cosby/surrounding housing developments, or indeed should the situation at Narborough HC continue or indeed worsen significantly.

3 LMC Dr Anu Rao Medical Officer

Thank you for your email regarding request from the practice (Narborough Health Centre) about list closure application. The LMC has not been contacted by the practice for any consultation with regards their application. It would hence be difficult to add any comments. However if the CCG feel fit then kindly sign post the practice to the LMC, for any help that they may feel is required in the future.

4 Kingsway (ELRCCG)

Jessica Parsons Practice Manager

We have no issues with this. (Kingsway Surgery’s patient list is closed until December 2016)

5 Westcotes GP Surgeries, Briton St Surgery (City CCG)

Shaun Chadwick Executive Manager

In essence and in answer to your question, there're no immediate concerns with the revision of the concerned practice boundary

6 Northfields Medical Centre (ELRCCG)

Julie Parker Assistant Practice Manager

Hi – we note this intention for Narborough Health Centre to close their patient list. We have the capacity to register patients who reside in our practice area and are aware that with previous practice closures there has been a fee that practices can claim for patients registering from the intended closed list practice.


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Stakeholder Responder Comments / Queries

7 Dr S Mansingh (City CCG)

Kamlesh Parmar Group Practice Manager

As you may be aware that Dr Lenten’s surgery had not long closed which was few doors down the road from us. We had made provisions to accommodate patients coming from there. We are confident that closing the list at Narborough Health Centre will have no impact to us.

8 Enderby M/C (ELRCCG)

Julie Read Practice Manager

Morning Khatija, the above was discussed at a recent clinical meeting. The EMC Practice is currently accepting up to 10 new patients per month and our list size remains open. If you need any further clarification, please do not hesitate to contact. Regards Julie.

9 Hazelmere (ELRCCG)

Claire Boswell Practice Manager

Question: Do you know what Narborough practice list size increase was last year; this would give us a clearer idea as to what impact would be to our practice? CCG Response: Yes their list size increased by 96 since 1st January 2015. Practice Response: Thanks for this. It isn’t a large number at all. I think the majority of new patients will probably lean towards The Limes and those that do venture this way will not (if in these small numbers) cause any negative impact to our practice.

10 Fosse Medical Centre (City CCG)

Vicky Hill Practice requested copy of the practice area. This was emailed to practice on 15th July 2016.

11 Pharmacy Services Group

Nick Somani Director

You recently sent an email to our pharmacy in Narborough regarding an application from the Narborough Health Centre to close their patient list for 12 months. We only received a notification this week Tuesday to reply by Friday (today). Can you kindly send further information on this application? Are you able to give me a call on 07947255431 / 07958343901?


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Stakeholder Responder Comments / Queries This would have a major impact on our pharmacy considering 95% of prescriptions to our pharmacy come from the Narborough Health Centre. This would lead to an immediate closure of the community pharmacy resulting in a loss of service to local residents and jobs within the local community. Can you kindly contact me urgently to explain in more detail your email to the Narborough Pharmacy on Tuesday? CCG responded with a telephone call on Monday 18th July providing more information including current list size and the practice boundary. No further response was received.

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Paper E ELR CCG PCCC Meeting

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EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP PCCC MEETING

Front Sheet

REPORT TITLE: Syrian Refugee Resettlement Programme


REPORT BY: Jamie Barrett, Head of Primary Care

SPONSORED BY: Tim Sacks, Chief Operating Officer

PRESENTER: Jamie Barrett, Head of Primary Care

PURPOSE OF THE REPORT: This paper provides an update to the PCCC Committee with regard to:

• Providing a background to the Syrian Resettlement Programme • Providing a local update on proposals to house refugees in the CCG area,

including the work being undertaken in collaboration with Local Authorities and options to ensure healthcare provision for these patients.

• Consider identifying a clinical lead Board GP to pre assess potential families based on the UNHCR information provided.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG PCCC is requested to:

• RECEIVE for information; and • NOTE progress to date.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2016 – 2017: Transform services and enhance quality of life for people with long-term conditions


Y


Y Listening to our patients and public – acting on what patients and the public tell us.

Reduce inequalities in access to healthcare Y Living within our means using public money effectively

Y



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EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not required at this point.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: BAF 10 Capacity of Primary Care


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EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP PCCC MEETING

SYRIAN REFUGEE RESETTLEMENT SCHEME

2 August 2016

INTRODUCTION

1 This paper provides an update to the Committee with regard to proposals to

house a number of Syrian refugees in the CCG area, and the work being undertaken in collaboration with Local Authorities to ensure healthcare provision for these patients.

BACKGROUND 2 The UK is at the forefront of the response to the crisis in Syria. The UK

Government is therefore expanding the existing Syrian Vulnerable Person Resettlement (VPR) Scheme and intends to resettle up to 20,000 Syrians in need of protection. The government is working closely with all local government associations and partner organisations to enable local authorities to plan for this. The UK has been leading the international response to the humanitarian crisis in Syria. The UK is providing more than £1.12 billion in humanitarian aid - more than any other country in the world except the United States. The UK is the only major country in the world that has kept its promise of spending 0.7% of our national income on aid. The government is working with partners in the UN High Commissioner for Refugees (UNHCR), International Organisation for Migration (IOM) and local authorities to ensure that numbers can increase as quickly as possible. The Syrian scheme is split into two phases.

2.1 Phase one has the task of immediately scaling up the existing resettlement programme and phase two will work towards transforming our resettlement and protection offer including developing ideas for community sponsorship as per the Home Secretary’s commitment. How does the UK choose who comes to the UK?

2.2 The people coming to the UK under the Syrian VPR scheme are in desperate need of assistance and many have significant needs. It prioritises those who cannot be supported effectively in their region of origin: women and children at risk, people in severe need of medical care and survivors of torture and violence amongst others. The government is working closely with the UNHCR to identify cases that they deem in need of resettlement and we will continue this work to ensure we deliver our commitment to provided refuge to 20,000 Syrians over the course of this Parliament.


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How does the Syrian Vulnerable Persons Scheme work?

2.3 The UK sets the criteria and then UNHCR identifies and submits potential cases for our consideration. Cases are screened and considered by the UK and we retain the right to reject on security, war crimes or other grounds. Once the screening process has been completed a full medical assessment is conducted by the International Organisation for Migration (IOM) in the host country. Full details of the case and medical history are sent to the local authority for assessment of need, including whether suitable accommodation and care are available locally. The local authority then provides details of the estimated costs. The first 12 months of a refugee’s resettlement costs, excluding economic integration are fully funded by central government using the overseas aid budget, in accordance with international guidelines and practice. To ensure that local authorities can plan ahead and continue to respond the government will also provide additional funding to assist with costs incurred in future years (inc NHS Providers)

2.4 East Leicestershire and Rutland CCG (ELRCCG) and West Leicestershire

CCG (WL CCG) has been actively involved in stakeholder meetings that have taken place across the Leicester, Leicestershire and Rutland (LLR) health community in partnership with Leicestershire County Council and the local borough and district councils, to support the development of housing and healthcare provision for anticipated refugees through the Syrian Refugee Resettlement Programme.

2.5 In 2015, three Syrian families were relocated to Leicestershire, and

subsequently housed in the city. Their primary healthcare needs have been met by the Leicester ASSIST Asylum Seeker Service, also an active stakeholder in ongoing discussions with regard to future service provision for refugees through the Syrian Refugee Resettlement Programme.

2.6 Charnwood Borough Council (CBC) is now leading on the Leicestershire

County aspect of the programme and recently contacted both ELRCCG and WL CCG to discuss more recent developments and the impact of these upon healthcare provision locally.

UPDATE – JULY 2016 3 At a meeting convened between CBC, ELRCCG and WLCCG on the 13 July

2016, an update was provided as follows: 3.1 There will be a phased arrival of a small cohort of Syrian refugees into the

borough of Charnwood between August 2016 and March 2017. Table 1 below depicts the number of refugees expected and the areas of Leicestershire within which they will be housed; those in italics depict areas in ELR CCG;

3.2 Each family will be allocated a support package, funded by the Home Office,

which will include a designated support worker and interpreting services. Therefore for ELR CCG the impact locally will be realised from November 2016.


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Table 1 Date District/Borough Households Individuals August (31st) 2016 Charnwood 2 10 November 2016

NW Leicestershire 2 10 Melton 2 10 Rutland 1 5

March 2017

Blaby 2 10 Hinckley & Bosworth 2 10 Harborough 1 5

3.3 It is not yet confirmed in which areas of Local Authorities cohorts will be

housed. The Local Authorities are actively seeking accommodation and have advised the CCGs that they will confirm housing arrangements as soon as possible in order to aid the CCG’s planning in terms of necessary primary healthcare provision.

ASSESSMENT OF NEED 4 The CCG is expected to support CBC in allocating patients to a local practice

for their primary healthcare needs. As part of this work, CBC have requested that each CCG reviews the medical pre-assessment forms for each family member arriving in the areas (this is in accordance to the Home Office recommendations) in order to confirm whether the level of need can be accommodated. Leicestershire Local Authorities have agreed to accept families which have been rated as ‘low need’.

4.1 ELR CCG therefore will need to consider the above and if appropriate nominate a named clinical lead for the November 2016 cohort. Dr Chris Trzcinski, WL CCG Deputy Chair, has reviewed the pre-assessment forms in confidence, and confirmed that he is satisfied with the rating for the August intake.

FUNDING 5 The CCG will be expected to submit a return to NHS England which will generate

a level of reimbursement for the provision of healthcare to this cohort of patients. The reimbursement is structured as follows, and at this stage it is not anticipated that the CCG would need to commission any additional translation services as these will be covered within the support package and as per table 1 the numbers of families is relatively small compared to the previous numbers linked to the South Wigston Asylum Centre.

I. £600 for primary healthcare registration and provision

II. £2000 for secondary care activity This activity is to be claimed quarterly. Therefore, for ELR CCG, the impact will not be realised until Quarter 3.


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SERVICE PROVISION ACROSS ELR CCG and WL CCG. 6 ELR CCG, in collaboration with WL CCG, is currently exploring two options for

service provision: 6.1 Option 1 to identify a practice locally (once the relevant Local Authority has

determined the location of the housing) with whom this cohort of patients will be registered, and agree the appropriate financial reimbursement in accordance with the sums outlined in section 5.

This could include top-slicing the £600 per patient allocation to fund a retainer from the ASSIST Asylum Seeker Service for the provision of advice and guidance in relation to these patients and to provide some tailored training.

6.2 Option 2 to contract with the ASSIST Asylum Seeker Service for the provision

of primary medical care for this cohort of patients. Whilst this would guarantee a level of expertise in relation to service provision for asylum seeker and refugee patients, the service operates from Leicester City Centre (as per the South Wigston Service) and it would be unrealistic to expect patients to travel that distance particularly if they are housed in the Rutland and other districts. An outreach service could be considered, hosted by a practice in districts – this would need to be progressed for the November 2016 intake.

NEXT STEPS 7 The CCGs will continue to liaise closely with CBC in relation to the planned

arrival dates and location of the refugee patients. 7.1 To progress the options above it is suggested that the practice situated

closest to the address of each family is approached in the first instance and requested to register the patients with additional training and support.

Recommendation: The East Leicestershire and Rutland CCG PCCC is requested to:

• RECEIVE for information; and • NOTE progress to date.

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Paper xxx ELR CCG Primary Care Commissioning Committee meeting

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NHS EAST LEICESTERSHIRE AND RUTLAND CCG PRIMARY CARE COMMISSIONING COMMITTEE MEETING

Front Sheet

Title of the report: Primary Care Delivery Group July 2016 Themes

Report to: Primary Care Commissioning Committee

Date of the meeting:

2 August 2016

Report by:

Jamie Barrett, Head of Primary Care

Presented by:

Jamie Barrett, Head of Primary Care

PURPOSE OF THE REPORT: To update the Primary Care Commissioning Committee (PCCC) on the key themes from the newly constituted Primary Care Delivery Group (PCDG). The below highlights the themes from the July 2016 Meeting.

1. Estates and Technology Transformation Fund (ETTF) – Discussion around the bids submitted and the next stage including the due diligence processes taking into account any revenue implications.

2. E-Referral Service (ERS) – All three CCG’s are meeting with HSCIC and UHL to address issues with ASI’s (Appointment Slot Issues) and current management handling would appear to impact on ELRCCG’s target. It was proposed a survey to be undertaken with GP Practices to understand the issues and processes involved.

3. Minor Surgery Level 5-7 – The group discussed the update to this service and how changes to the commissioner will be implemented.

RECOMMENDATIONS: The East Leicestershire and Rutland Primary Care Commissioning Committee is requested to:

• NOTE the contents of the report.


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REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2015 – 2016: Transform services and enhance quality of life for people with long-term conditions

√ Improve integration of local services between health and social care; and between acute and primary/community care.


√ Listening to our patients and public – acting on what patients and the public tell us.

Reduce inequalities in access to healthcare

√ Living within our means using public money effectively

√


√

EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in respect of this report. The Primary Care Delivery Group will ensure due regard is considered in the consideration of its responsibilities.


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